Wright Barbara, Evanson Anna, Casey Cameron, Law Keyne C, Rogers Andrew H, Comtois Katherine Anne
Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, Seattle, United States.
Department of Clinical Psychology, School of Psychology, Family, and Community, Seattle Pacific University, Seattle, United States.
JMIR Res Protoc. 2025 Aug 13;14:e72140. doi: 10.2196/72140.
Suicide is a recognized global public health problem that continues to pose substantial challenges in the United States. Veterans and service members are particularly at risk. Caring Contacts is a simple, scalable intervention comprising brief, periodic messages sent over 1 to 2 years that express unconditional care and concern. It reduces suicide risk among individuals with recent suicidal ideation or attempts and has demonstrated acceptability in military and veteran samples, but little is known about the mechanisms of Caring Contacts or its applicability to populations who are not suicidal.
We aim to evaluate if receiving Caring Contacts reduces suicide risk among veterans and active service members recruited based on their stress or distress levels, using ecological momentary assessment (EMA) and survey measures of suicidal ideation and cognitions; to examine the experiences of diverse veterans and service members with Caring Contacts; to evaluate if receiving Caring Contacts reduces distress (depression, substance use consequences, hopelessness, defeat, and psychological pain); and to identify the potential mechanisms of action for Caring Contacts (mattering, connectedness, social responsibility, and entrapment). Using EMA, this study will be the first to investigate mechanisms of the Caring Contacts intervention both in real time, as the messages are received, and over the course of 1 year.
In this randomized controlled trial, veterans or service members (N=510) experiencing stress or distress recruited via social media advertisements will be offered best available resources and randomized into 1 of 3 study conditions: 12 months of Caring Contacts and monthly EMA, 12 months of Caring Contacts without monthly EMA, or 12 months of monthly EMA alone. The individuals in the Caring Contacts conditions will receive 13 messages. A subset of participants from each condition will be asked to complete a qualitative interview after the 12-month follow-up about their study experience.
This trial was funded in October 2023; recruitment started in April 2024 and will conclude in May 2025. As of December 2024, we have enrolled 321 participants. Final quantitative data collection will be completed by July 2026, 2 months after the final 12-month follow-up date. Data from the qualitative interviews will be collected until September 2026. Data analysis will occur following data collection, and the results are expected to be published in winter 2027.
This study will be the first randomized controlled trial evaluating the impact of Caring Contacts among service members and veterans who were not recruited based on suicidality. If effective, our findings will demonstrate that Caring Contacts is beneficial for reducing multiple forms of psychological distress and suicide risk. In addition, we will evaluate potential mechanisms explaining the effects of Caring Contacts and assess the utility of EMA as a primary measure of outcome in suicide research trials.
ClinicalTrials.gov NCT06136234; https://clinicaltrials.gov/study/NCT06136234.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/72140.
自杀是一个公认的全球性公共卫生问题，在美国仍构成重大挑战。退伍军人和现役军人尤其面临风险。关怀联络是一种简单且可扩展的干预措施，包括在1至2年内定期发送简短信息，表达无条件的关心和关注。它可降低近期有自杀意念或自杀未遂者的自杀风险，并已在军人和退伍军人样本中显示出可接受性，但对于关怀联络的作用机制或其对非自杀人群的适用性知之甚少。
我们旨在评估接受关怀联络是否能降低根据压力或苦恼水平招募的退伍军人和现役军人的自杀风险，采用生态瞬时评估（EMA）以及自杀意念和认知的调查措施；考察不同退伍军人和现役军人对关怀联络的体验；评估接受关怀联络是否能减轻苦恼（抑郁、物质使用后果、绝望、挫败和心理痛苦）；并确定关怀联络的潜在作用机制（重要性、联系感、社会责任和陷入困境）。通过EMA，本研究将首次实时调查关怀联络干预措施的作用机制，即在接收信息时以及在1年的过程中进行调查。
在这项随机对照试验中，通过社交媒体广告招募的经历压力或苦恼的退伍军人或现役军人（N = 510）将获得最佳可用资源，并随机分为3种研究条件之一：12个月的关怀联络和每月一次的EMA、12个月的关怀联络但无每月一次的EMA、或仅12个月每月一次的EMA。处于关怀联络条件下的个体将收到13条信息。每个条件下的一部分参与者将在12个月随访后被要求完成关于他们研究经历的定性访谈。
该试验于2023年10月获得资助；招募工作于2024年4月开始，并将于2025年5月结束。截至2024年12月，我们已招募321名参与者。最终定量数据收集将于2026年7月完成，即最后一次12个月随访日期后的2个月。定性访谈数据将收集至2026年9月。数据收集后将进行数据分析，结果预计于2027年冬季发表。
本研究将是第一项评估关怀联络对非基于自杀倾向招募的军人和退伍军人影响的随机对照试验。如果有效，我们的研究结果将表明关怀联络有助于减少多种形式的心理苦恼和自杀风险。此外，我们将评估解释关怀联络效果的潜在机制，并评估EMA作为自杀研究试验主要结局指标的效用。
ClinicalTrials.gov NCT06136234；https://clinicaltrials.gov/study/NCT06136234。
国际注册报告识别码（IRRID）：DERR1-10.2196/72140。
