Effect of Augmenting Standard Care for Military Personnel With Brief Caring Text Messages for Suicide Prevention A Randomized Clinical Trial
Effect of Augmenting Standard Care for Military Personnel With Brief Caring Text Messages for Suicide Prevention A Randomized Clinical Trial
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DOI：
10.1001/jamapsychiatry.2018.4530
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发表时间：
2019-05-01
期刊：
影响因子：
25.8
通讯作者：
Ries, Richard K.
中科院分区：
文献类型：
--
作者：
Comtois, Katherine Anne;Kerbrat, Amanda H.;Ries, Richard K.
重要的是，需要对自杀行为进行合理和具有成本效益的干预，以解决军人自杀行为的高发生率。关怀联系人是简短的定期消息，表达无条件的关怀和关注，并已被证明可以防止自杀死亡，企图，意念，和hospitalizations.ObjectiveTo测试的有效性，增强标准的军事医疗保健与关怀联系人通过短信传递，以减少自杀的想法和行为超过12个月。设置.这项随机临床试验在美国南部和西部的3个军事设施进行。2013年4月至2016年9月期间，被确定有自杀风险的士兵和海军陆战队员被招募。最后一次随访是在2017年9月。干预两组都接受了标准护理，关怀联系人组还在第1天、第1周、第1、2、3、4、6、8、10和12个月收到了11条短信，主要结果和指标主要结果是目前的自杀意念和自杀风险事件（住院或医疗后送）。次要结局是最坏点自杀意念、急诊室就诊和自杀企图。自杀意念通过自杀意念量表、自杀风险事件和急诊科就诊治疗史访谈进行测量;自杀未遂通过自杀未遂自伤计数进行测量。（每组329例随机分配），分析了657例个体的数据（平均[SD]年龄，25.2 [6]岁; 539例男性[82.0%]）。所有参与者在基线时都报告了自杀意念，291人（44.3%）以前曾试图自杀。在657名参与者中，461名（70.2%）在12个月时进行了评估。主要结局无显著性。对当前自杀意念的可能性或严重程度或自杀风险事件的可能性没有显著影响;对急诊室就诊也没有影响。然而，收到关爱联系人的参与者（216名参与者中的172名[79.6%]）的几率低于仅接受标准治疗的患者（204名参与者中的179名[87.7%]）在基线和随访期间发生任何自杀意念（比值比，0.56 [95% CI，0.33 - 0.95]; P = 0.03），自基线以来自杀未遂者较少（233名患者中有21人[9.0%]接受关怀接触，标准治疗组228名患者中有34人[14.9%]接受关怀接触;比值比为0.52 [95%CI，0.29 - 0.92]; P =.03）.结论和相关性本试验提供了不一致的结果之间的主要和次要结果的关怀短信的有效性，但这种廉价和可扩展的干预提供了承诺，防止自杀企图和意念在军事人员。需要进行更多的研究。
IMPORTANCE Accessible and cost-effective interventions for suicidality are needed to address high rates of suicidal behavior among military service members. Caring Contacts are brief periodic messages that express unconditional care and concern and have been previously shown to prevent suicide deaths, attempts, ideation, and hospitalizations.OBJECTIVE To test the effectiveness of augmenting standard military health care with Caring Contacts delivered via text message to reduce suicidal thoughts and behaviors over 12 months.DESIGN. SETTING. AND PARTICIPANTS This randomized clinical trial was conducted at 3 military installations in the southern and western United States. Soldiers and Marines identified as being at risk of suicide were recruited between April 2013 and September 2016. The final follow-up was in September 2017.INTERVENTIONS Both groups received standard care, and the Caring Contacts group also received consisted of 11 text messages delivered on day 1, at week 1, at months 1, 2, 3, 4, 6, 8, 10, and 12, and on participants' birthdays.MAIN OUTCOMES AND MEASURES Primary outcomes were current suicidal ideation and suicide risk incidents (hospitalization or medical evacuation). Secondary outcomes were worst-point suicidal ideation, emergency department visits, and suicide attempts. Suicidal ideation was measured by the Scale for Suicide Ideation, suicide risk incidents, and emergency department visits by the Treatment History Interview; attempted suicide was measured by the Suicide Attempt Self-Injury Count.RESULTS Among 658 randomized participants (329 randomizely assigned to each group), data were analyzed for 657 individuals (mean [SD] age, 25.2 [6]] years; 539 men [82.0%]). All participants reported suicidal ideation at baseline, and 291(44.3%) had previously attempted suicide. Of the 657 participants, 461(70.2%) were assessed at 12 months. Primary outcomes were nonsignificant. There was no significant effect on likelihood or severity of current suicidal ideation or likelihood of a suicide risk incident; there was also no effect on emergency department visits. However, participants who received Caring Contacts (172 of 216 participants [79.6%]) had lower odds than those receiving standard care alone (179 of 204 participants [87.7%]) of experiencing any suicidal ideation between baseline and follow-up (odds ratio, 0.56 [95% CI, 0.33-0.95]; P =.03) and fewer had attempted suicide since baseline (21 of 233 [9.0%] in the group receiving Caring Contacts vs 34 of 228 [14.9%] in the standard-care group; odds ratio, 0.52 [95% CI, 0.29-0.92]; P =.03).CONCLUSIONS AND RELEVANCE This trial provides inconsistent results on the effectiveness of caring text messages between primary and secondary outcomes, but this inexpensive and scalable intervention offers promise for preventing suicide attempts and ideation in military personnel. Additional research is needed.