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Community-based interventions in mental health represent a paradigm shift from institution-centered care to treatments embedded within the fabric of local communities. By prioritizing inclusion and leveraging existing societal structures, this approach fosters a supportive environment conducive to addressing mental health challenges while promoting individual dignity and agency.
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Text Messaging to Extend School-Based Suicide Prevention: Pilot Randomized Controlled Trial.

Anthony R Pisani1,2, Peter A Wyman1, Ian Cero1

  • 1Department of Psychiatry, University of Rochester Medical Center, University of Rochester, Rochester, NY, United States.

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Automated text messages did not significantly reduce suicidal behavior in adolescents. The Text4Strength program showed no impact on coping skills or help-seeking, even for isolated students.

Keywords:
Text4StrengthUnited Statesadolescentawarenesscopingdepressionhelp-seeking attitudemental healthmood disorderrandomized controlled trialschoolself-harmself-violencestudentsuicidal behaviorsuicide preventionteenagertext messaging

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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.