Text Messaging to Extend School-Based Suicide Prevention: Pilot Randomized Controlled Trial

Area of Science:

• Adolescent mental health
• Public health interventions
• Digital health

Background:

• Suicide is a leading cause of death in US adolescents, with 10% attempting suicide annually.
• School-based programs aim to reduce youth suicidal behavior.
• Text4Strength, an automated text messaging program, was developed to promote healthy norms and coping skills.

Purpose of the Study:

• To pilot a randomized controlled trial of Text4Strength in a high school setting.
• To evaluate the program's impact on factors potentially reducing suicidal behavior.
• To test the intervention as an extension of the Sources of Strength program.

Main Methods:

• A pilot randomized controlled trial was conducted in one high school (N=223).
• Participants received 1-2 text messages weekly for 9 weeks, focusing on coping, emotion regulation, and help-seeking.
• Surveys assessed proximal targets, symptoms, and suicide ideation at baseline, post-intervention, and 3-month follow-up.

Main Results:

• No significant effects were observed for any outcome at follow-up.
• The intervention's effect, if any, was small and undetected.
• Students with fewer friend nominations did not engage differently with the messages.

Conclusions:

• Text4Strength is unlikely to have impacted the targeted outcomes.
• Moderate to large effects can be ruled out with high confidence.
• Alternative digital delivery systems, like chatbots or gaming platforms, warrant investigation.