Engagement With Crisis Text Line Among Subgroups of Users Who Reported Suicidality

Abstract

Objective: Despite the interest in technology-enhanced preventive interventions for suicidality, there is minimal peer-reviewed research on conversations of text message hotlines. In this largescale study, the authors explored distinct classes of users of the Crisis Text Line who reported suicidality. Classes were based on texters' presenting psychosocial issues and were explored across frequency of hotline use and conversation number.Methods: Data included 153,514 conversations from 122,909 individuals collected by the Crisis Text Line (2013)(2014)(2015)(2016)(2017). Analyses were restricted to conversations from users who mentioned current or previous suicidality and excluded texters who discussed a third party. The authors used latent class analysis to identify distinct classes of texters on the basis of crisis counselor-assigned issue tags and across subgroups reflecting whether the conversation was the first or last contact with the hotline and frequency of use (one-time, twotime, or $3-time texters).Results: Three classes emerged in all subsamples. The largest class, "lower distress," had the lowest prevalence of all issues. The second largest class, "anxious distress," had the highest prevalence of anxiety or stress and elevated depression. The smallest class, "relational distress," had the highest prevalence of depression and self-harm and higher probability of endorsing relational indicators.Conclusions: Psychological and relational issues mostly distinguished the three classes. Despite differing frequency of hotline usage, most texters who reported suicidal ideation and behaviors endorsed similar issues, and these issues did not seem to vary across conversations. Yet there appeared to be distinct subgroups of texters with different presenting issues, which may inform how crisis counselors tailor strategies for both low-and high-volume texters.

Listening to Mental Health Crisis Needs at Scale: Using Natural Language Processing to Understand and Evaluate a Mental Health Crisis Text Messaging Service

“…Such a result supports the validity of the behavioural classifications developed using a qualitative inductive thematic analysis ( 32 , 33 ) and their distinctiveness, and shows they can be predicted from linguistic features. Our results complement a previous study examining behaviours of texters using data from the USA Crisis Text Line ( 51 ). Using machine-learning techniques the researchers queried message-level data to identify conversations that included phrases related to suicidality and revealed three distinct behaviours among texters expressing suicide risk.…”

mHealth Interventions for Self-Harm: Scoping Review (Preprint)

“…Intervention type [31,32,34,36,38,39,41,45,48,50,54,61,64,65] 15 (44) Apps [30,33,40,[42][43][44]47,49,52,53,57,66,67] 13 (38) Texting or calling services [55,56,58 [31] and Bush et al (2017) [32] relate to the same intervention; Grist et al (2018) [36] and Stallard et al (2018) [37] are separate papers from the same study.…”

“…Other well-being [29,48,[53][54][55]60,62] 7 (20) Other mental well-being [29,32,43,45,49,53,54] 7 (20) Interpersonal issues [44,45,49,50,58,62] 6 (17) Hopelessness [29,33,54] 3 ( 9) Sleep [43,53,54] 3 (9) Alcohol or substance use [29,58,62] 3 (9) Quality of life [54,55] 2 (6) Other self-destructive behaviors Intervention feasibility and acceptability [29][30][31][32][33][34]36,37,44,47,48,50,54,…”

Detecting premature departure in online text-based counseling using logic-based pattern matching

“…Synchronous text-based counseling sessions may not have a set end-time or duration; users may depart from it at any time without a clear indication of closure. User premature departure is common ( Szlyk et al, 2020 ) and has potentially important implications. An abrupt ending can signify heightened symptom severity and risk.…”

“…Premature departure is common in synchronous online text-based counseling. For example, the US Crisis Text Line classifies sessions prematurely ended as “dropped” or “incomplete conversations” ( Szlyk et al, 2020 ). However, to date, only one empirical study examined termination in this type of counseling.…”