A Brief Psychoeducational Intervention Aimed at Encouraging Suicide Prevention Hotlines

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Researchers investigated whether a brief psychoeducational behavioral intervention called Crisis Line Facilitation may help to prevent suicidal behaviors among Veterans.

A study found that a brief psychoeducational behavioral intervention called Crisis Line Facilitation (CLF) may help to prevent suicidal behaviors among Veterans. These findings were published in the Journal of Psychiatric Research.

Recruitment for this study occurred in 2 inpatient mental health units of Veterans Health Administration facilities between 2016 and 2018. Veterans (N=307) who had reported suicidal ideation in the week prior to hospitalization and had not contacted the Veteran Crisis Line (VCL) during the past year were randomized to receive CLF (n=157) or enhanced usual care (EUC; n=150).

CLF and EUC were delivered in a single session. CLF was a discussion focusing on previous suicidal crises and perceptions of the VCL, highlighting ways that contacting the VCL in a future crisis could lead to positive outcomes. The primary outcome for this study was self-reported utilization of the VCL at 12-months following discharge.

The CLF and EUC cohorts comprised 88% and 87% men, mean age of 47.2 (standard deviation [SD], 12.8) and 46.8 (SD, 13.5) years, respectively, 29% and 24% were non-White or mixed race, respectively, 53% and 49% had not been deployed in active combat, respectively, 51% and 48% had 2 or more previous suicide attempts, respectively, and 66% and 69% had never used the VCL, respectively.

During the follow-up, 52 participants contacted the VCL. Among VCL users, 65.4% contacted the VCL once. The average number of contacts was 1.6 (SD, 1.1). No group differences in VCL contact were observed between groups (hazard ratio [HR], 1.24; 95% CI, 0.80-1.93; P =.34).

A total of 47 participants had a total of 183 suicidal behaviors, including 84 attempts, 89 aborted attempts, and 10 interrupted attempts. Among those with behaviors, the average number of events was 3.9 (SD, 7.1). There was a total of 7 deaths, and all were assumed to be suicides.

After adjusting for site, the CLF participants were less likely to engage in any suicidal behavior (HR, 0.51; 95% CI, 0.37-0.68; P <.0001).

In a sensitivity analysis which removed individuals with 10 or more suicidal behaviors, no significant effect was observed (HR, 0.75; 95% CI, 0.53-1.5; P =.092).

These findings may not be generalizable to a non-Veteran population, given the gender skew and the access to VCL.

Study authors concluded, “The present study provides initial evidence for the impact of a brief intervention to increase use of crisis lines and prevent suicidal behaviors in suicidal Veterans treated in inpatient mental health programs, although supplementary analyses also indicate the results may be driven primarily by a few participants with multiple attempts during the follow-up interval. […] To be widely adopted, suicide prevention services for inpatient psychiatry settings need to be relatively short and deliverable by existing clinical staff.”


Ilgen MA, Price AM, Coughlin LN, et al. Encouraging the use of the Veterans Crisis Line among high-risk Veterans: a randomized trial of a Crisis Line Facilitation intervention. J Psychiatr Res. 2022;154:159-166. doi:10.1016/j.jpsychires.2022.07.047