Unraveling Crisis Text Services: Perceptions and Experiences among Low-income Young Adults with Suicidal Ideation

摘要 自杀是2021年15 - 24岁年轻人的第三大死因。年轻人经历过 在COVID-19大流行期间自杀意念增加，自杀意念的风险升高， 自杀企图卫生系统一直在努力满足年轻人的心理健康需求。危机短信 服务是免费的，匿名的，可快速访问的资源，可以提供关键的心理健康 为低收入的年轻人提供资源。2020年，最大的危机短信服务机构从事 与84.4万发短信者的对话，30%的人年龄在18 - 24岁之间。2022年7月，联邦政府成立了988 国家自杀危机热线（将用户连接到国家自杀预防生命线）和数量上升 45%在服务的第一周，显示了对危机文本服务的高需求。危机文本服务可以 经济来源低的年轻人可以获得医疗服务，他们可能因为农村、费用、 或缺乏精神健康保险。危机短信服务可以链接到初级保健的人， 否则就无法获得卫生服务，并成为临床医生可以推荐的免费资源。 给病人。尽管危机短信服务被广泛使用，但人们对人们的看法和 在年轻人中使用危机短信服务的经验。更好地了解年轻人如何使用或 在心理健康危机期间选择不使用危机文本服务可以提高危机文本的有效性 服务该项目将使用顺序解释性混合方法来解决两个具体目标： 目标1描述低收入年轻人的求助行为、动机、使用障碍， 危机短信服务对自杀意念的影响，通过基于网络的调查，100 - 125低- 在过去六个月内经历过SI的年轻人。参与者将被招募使用 社交媒体定量的封闭式调查项目将进行连续分析，描述差异 参与危机短信服务的年轻人和没有参与危机短信服务的年轻人之间的差异。定性开放式 调查项目将使用主题分析进行分析，并用于指导目标2访谈的重点。 目的2探讨低收入年轻人对危机短信服务的看法和经验 通过对18 - 24岁成年人的深入访谈，调查有自杀意念的成年人。样本将包括 那些参与自杀意念危机短信服务的人（n = 20）和那些没有参与自杀意念危机短信服务的人（n = 20）。 当出现自杀意念时的危机短信服务（n = 20）。参与者将通过社交媒体招募， 医疗保健提供者和当地组织，并通过同步文本，电话或 视频会议。将使用扎根理论分析数据。 这项研究将支持改善AHRQ优先人群的卫生服务，包括青少年。 以及低收入和农村的人。这项研究的结果可以用来预防自杀 干预措施，危机文本服务细化，并作为未来危机文本服务研究的试点数据。

ABSTRACT Suicide was the third leading cause of death for young adults aged 15-24 in 2021. Young adults experienced increased suicidal ideation during the COVID-19 pandemic and are at an elevated risk for suicidal ideation and suicide attempts. Health systems have struggled to meet the mental health needs of young adults. Crisis text services are free, anonymous, and rapidly accessible resources that can provide critical mental health resources for low-income young adults. In 2020, the largest crisis text service organization engaged in conversations with 844,000 texters, 30% aged 18-24. In July 2022, the federal government established the 988 national suicide crisis line (which connects users to the National Suicide Prevention Lifeline) and volume rose 45% in the first week of service, demonstrating the high demand for crisis text service. Crisis text services can be accessed by young people with low financial resources who may not access care because of rurality, cost, or lack of insurance coverage for mental healthcare. Crisis text services can link to primary care for people who otherwise do not have access to health services and constitute a free resource that clinicians can recommend to patients. Despite the widespread use of crisis text services, little is known about perceptions and experiences using crisis text services among young adults. A better understanding of how young adults use or choose not to use crisis text services during a mental health crisis could improve the effectiveness of crisis text services. This project will use sequential explanatory mixed methods to address two specific aims: Aim 1 Describe low-income young adults' help-seeking behaviors, motivations, barriers to use, and impact of crisis text services for suicidal ideation through a web-based survey with 100-125 low- income young adults who have experienced SI in the past six months. Participants will be recruited using social media. Quantitative close-ended survey items will be analyzed descriptively, describing differences between young adults who engaged with crisis text services and those who did not. Qualitative open-ended survey items will be analyzed using thematic analysis and used to direct the focus of Aim 2 interviews. Aim 2 Explore perceptions of and experiences with crisis text services among low-income young adults with suicidal ideation via in-depth interviewing with adults aged 18-24. The sample will include those who engaged with a crisis text service for suicidal ideation (n=20) and those who did not engage with a crisis text service when experiencing suicidal ideation (n=20). Participants will be recruited via social media, healthcare providers, and local organizations and interviewed via synchronous text, phone, or videoconference. Data will be analyzed using grounded theory. This research will support health service improvements for AHRQ priority populations, including adolescents and those who are low-income and rural. Findings from this study can be used to inform suicide prevention interventions, crisis text service refinement, and as pilot data for future crisis text service research.