The effect of a web-based depression intervention on suicide ideation: secondary outcome from a randomised controlled trial in a helpline

Abstract

ObjectivesThe effect of web-based interventions for depression on suicide ideation in callers to helplines is not known. The aim of this study was to determine if web-based Cognitive Behaviour Therapy (CBT) with and without telephone support is effective in reducing suicide ideation in callers to a helpline compared with treatment as usual (TAU). A secondary aim was to examine the factors that predict change in suicide ideation. Putative predictors included level of baseline depression, suicide behaviour, baseline anxiety and type of intervention.DesignRandomised controlled trial.SettingLifeline, Australia's 24 h telephone counselling service participants: 155 callers to a national helpline service with moderate-to-high psychological distress.InterventionsParticipants were recruited and randomised to receive either 6 weeks of internet CBT plus weekly telephone follow-up; internet CBT only; weekly telephone follow-up only or a wait-list TAU control group.Primary and secondary outcome measuresSuicidal ideation was measured using four items from the 28-item General Health Questionnaire. Predictors of change in ideation were tested using logistic regression analysis.ResultsRegardless of the intervention condition, participants showed significant reductions in suicidal ideation over 12 months (p<0.001). Higher baseline suicidal behaviour decreased the odds of remission of suicidal ideation at postintervention (OR 0.409, p<0.001). However, change in depression over the course of the interventions was associated with improvement in suicide ideation (OR 1.165, p<0.001).ConclusionsSuicide ideation declines with and without proactive intervention. Improvements in depression are associated with the resolution of suicide ideation. Specific interventions focusing on suicide ideation should be further investigated.Trial registrationControlled-Trials.comISRCTN93903959.

Crisis interventions in online psychological counseling

“…Eleven models of online crisis intervention were found ( Table 2). These programs are still ongoing, since the websites were tested in randomized clinical trials and Bae et al 9 van Spijker et al 35 Hirai & Clum 46 van Spijker et al 32 Lange et al 38 van Spijker et al 43 Knaevelsrud & Maercker 47 Barak 34 Wagner et al 44 Gilat & Shahar 45 Litz et al 39 Christensen et al 42 Litz et al 11 Mouthaan et al 37 Mouthaan et al 40 Cox et al 41 Robinson et al Eight weeks of intervention comprising: 1) information, 2) relaxation training (including breathing techniques, PMR and IIR), 3) cognitive restructuring, and 4) exposure modules (written).…”

“…The most recent studies are from 2013 and 2014 and were conducted in the Netherlands 32,40 and Australia. 33,42 All interventions employed native languages, but in several studies the researchers declared an interest in expanding the intervention platforms to other languages, aiming to expand access to include users from other locations. …”

“…Christensen et al 42 The intervention consists of internet-based P (one week) delivered through BluePages (an educational website that provides information about evidence-based treatments for depression), combined with web-based CBT (two to four weeks) provided by MoodGym (a web application that delivers CBT in five modules). The main therapeutic approach in the studies was CBT, either as exclusive therapy or combined with other treatments (Table 4), which is in line with current recommendations in the literature regarding the applicability and efficacy of this approach.…”

Mixed-Initiative Real-Time Topic Modeling & Visualization for Crisis Counseling

“…Request permissions from permissions@acm.org. or the caller, is connected to a crisis counselor via telephone hotlines [12] and web-based chats [5] for crises ranging from suicide and self-harm to sexual assault. Yet there is evidence that for a distressed individual, communication via text can be preferable to voice phone calls.…”

Online self-help for suicidal thoughts: 3-month follow-up results and participant evaluation

“…As a substantial portion of people with suicidal thoughts does not receive treatment (Bruffaerts et al, 2011), it is a promising means to reach more people. Still, very few effectiveness studies have been conducted in online suicide prevention (Pietrzak and McLaughlin, 2009;Luxton et al, 2011;Christensen et al, 2013;Watts et al, 2012).…”