Conference Agenda

Overview and details of the sessions of this conference. Please select a date or room to show only sessions at that day or location. Please select a single session for detailed view. Sessions in lavender colour have simultaneous translation.

Session Overview
OP19-5B: Symposium: Post-Treatment Technology-Based Caring Contacts for Suicide Prevention [Suivi post-tentative et prévention des récidives par l'utilisation des nouvelles technologies d'intervention]
Friday, 19/Jun/2015:
2:30pm - 4:00pm

Location: Salle Marie-Gérin-Lajoie - J-M400 (with translation/avec traduction)


Post-Treatment Technology-Based Caring Contacts for Suicide Prevention / [Suivi post-tentative et prévention des récidives par l'utilisation des nouvelles technologies d'intervention]

Chair(s): David D. Luxton (Naval Health research center & U. of Wash. school of medicine)

The time period following discharge from inpatient psychiatry and emergency department treatment is one of heightened risk for repeat suicide attempts for patients. The majority of post-hospitalization re-attempts and suicides occur during the first month after discharge with most occurring within a week after discharge (Luxton, June & Comtois, 2013). The caring contact concept is a suicide prevention intervention that involves the sending of brief messages of care and concern to patients at high risk for suicide following discharge from treatment.

This international symposium brings together researchers to present the underlying theory of caring contacts and data regarding the effectiveness of brief contact interventions for reducing self-harm, suicide attempt and suicide. Findings from a study (Chalker, Kerbrat & Comtois, in press) that examined the association between technology use, perceived social connectedness, and severity of suicidal ideation and behavior are presented. Findings from a meta-analytic study (Milner, Carter, Pirkis, Robinson, Spittal, in press) that included 12 randomized controlled trials of brief contact interventions (telephone contacts; emergency or crisis cards; and postcard or letter contacts) are also discussed. The methodology and preliminary findings from two multi-site randomized controlled trials of technology-based (email and SMS texting) caring contact interventions that are being conducted at U.S. military and Veterans medical treatment facilities are also presented. One of the studies (Luxton et al) is based on the original Motto (1976) caring letters study but updates the intervention with emails. Primary outcomes of the trial are suicide mortality rates and re-hospitalization rates for suicide attempts (to be determined 24 months post-discharge from index hospital stay). Time to self-directed violent behavior is also measured, and additional data are being collected regarding psychosocial and other suicide risk variables. The second study (Comtois et al) consists of two United States Marine Corps and one United States Army installations. Usual care is compared to usual care plus caring text messages from a study clinician. The schedule of the text messages closely replicates trials from Australia and Iran with additional text messages sent 1 day and 1 week after baseline interview. Primary outcomes are at 12 months and include suicide attempts or interventions such as hospitalization or medical evaluation to prevent suicide as well as suicidal ideation. Additional data is being collected regarding thwarted belongingness, outpatient behavioral health service utilization, mental health symptoms, and resilience.

The panel will also present recommendations for implementing caring contact interventions in diverse treatment settings. These include clinical, safety, privacy, and legal issues associated with caring contacts interventions.

Presentations of the Symposium


Technology Use and Perceived Social Connectedness: Are We Really Connected, and Is There a Connection? / [Utilisation de la technologie et perception des liens sociaux : sommes-nous réellement branchés, et y a-t-il un une connexion?]

Samantha Chalker
Dept. Psychiatry, U. of Wash. School of medicine

In a growing age of technology, with suicide numbers remaining high, it’s possible that there may be a relation between the two. With each younger generation growing up with more ready access to technology, it seems imperative to understand their technology use and its impact. There is a dearth of research on personal technology use, and even less on suicidal behavior in association with that usage. Current research regarding technology and suicide, which is often with active duty military personnel and Veterans, is primarily limited to how to treat suicidal individuals with new technologies. With many moving full speed ahead with technological interventions to treat suicidality, we decided in the current study to take a step back and examine personal technology use and determine associations between technology use and perceived social connectedness.

Using a cohort of active duty Soldiers and Marines (N=253) with a personal cell phone who were enrolled in a study due to recent thoughts of suicide, we will also examine the relationships between technology usage, perceived social connectedness, and severity of suicidal ideation and behavior.

In our predominately male sample (82.6%), with almost three-quarters (74.7%) being 28 years old or younger, we sought to define the usage of various technology devices, particularly mobile phone use.  Almost all (94.5%) of this suicidal sample reported having a smart phone as their personal mobile phone, and two-thirds (63.9%) have had their personal mobile numbers for over a year. Over 80% have their personal mobile phones on or near them (close enough to know if they were receiving a call/text message) for 76% or more of an average day and 92.5% have an unlimited text message plan for their personal mobile phones. Using their personal mobile phones, 80.5% reported making a call at least once a day, and 71.5% sending and receiving email, though 60.7% did not use chat apps, e.g., Skype. 15.6% reported never using a social networking site on their personal mobile phones, but 78.1% used a social networking site on some device. For those that had been deployed to a war zone, almost three-quarters (73.8%) left their personal mobile phone at home and instead used the web or email to stay connected when deployed. Per day, on average, 19.5% service members received more texts than they sent, while 9.7% sent more texts than they received. For this presentation, we will present data on relationships between indices of social connectedness (e.g., Joiner’s Interpersonal Needs Questionnaire), social usage of technology, and variations in suicidal ideation and behavior. Personal use of technology could be telling of a how socially connected one is, and this social connectedness may be associated with suicidal behavior and we hope it could promote future advances in the technology based interventions for suicidal individuals.

A Systematic and Meta-Analytic Review of Brief Contact Interventions for Reducing Self-Harm, Suicide Attempts, and Suicide / [Méta-analyse et revue systématique des interventions brèves par contact pour réduire l’automutilation, les tentatives de suicide et le suicide]

Gregory Carter
U. of Newcastle

There is growing interest in brief contact interventions for self-harm and suicide attempt. Thus far, the evidence has been inconclusive about their effectiveness. The aim of this presentation is to present data regarding the evidence regarding the effectiveness of brief contact interventions for reducing self-harm, suicide attempt and suicide.  A systematic review and meta-analyses were conducted of randomised controlled trials using brief contact interventions (telephone contacts; emergency or crisis cards; and postcard or letter contacts). Random effects meta-analyses were conducted on eligible studies providing information on: (1) the number of individuals with and without any subsequent episodes of self-harm or suicide attempt; (2) the total number of repeated episodes of self-harm or suicide attempt; and (3) the number of individuals who subsequently died by suicide. Several sensitivity analyses were conducted to examine study quality and subgroup effects. The literature search yielded 14 eligible studies overall, of which 12 were used in meta-analyses. For any subsequent episode of self-harm or suicide attempt, there was a non-significant reduction in the overall pooled odds ratio of 0.87 (95% CI 0.74-1.04, p=0.119) for intervention compared to control. The number of repetitions per person was significantly reduced in intervention versus control (IRR 0.66, 95% CI 0.54-0.80, p<0.001). There was no significant reduction in the odds of suicide in intervention compared to control (OR 0.58, 95% CI 0.24-1.38). A non-significant positive effect on repeated self-harm or suicide attempt and a significant effect on the number of episodes of repeated self-harm or suicide per person (based on only three studies) means that brief contact interventions cannot yet be recommended for widespread clinical implementation. We recommend further assessment of possible benefits in well-designed trials in clinical populations.

Feasibility and Acceptability of Caring Contacts via Text: Increasing Connection with Marines and Soldiers to Prevent Suicide Attempts and Ideation / [Faisabilité et acceptabilité des contacts aidants par texto : Augmenter les liens avec les Marines et les soldats pour prévenir les tentatives de suicide et les idéations suicidaires]

Katherine Anne Comtois
University of Washington School of Medicine

Increased suicidal behaviors and death by suicide among active duty Service Members have gained considerable attention as active duty males now carry—for the first time in history—a risk of death by suicide that is greater than comparable men in the general population. Furthermore, Service Members are at increased risk for suicide due to their access to lethal means. In 2009, the majority (59%) of military suicides were by firearm.  While there is access to behavioral health services in the military, many Service Members choose not to use them or don’t find them helpful, suggesting the need for innovative interventions to prevent suicide.

This study reports evidence for the feasibility and acceptability of an intervention to prevent suicidal ideation and attempts in active duty Soldiers and Marines using caring contacts via text message (CCVT). “Caring contacts” (connecting via non-demanding expressions of caring and concern) by letters, postcards, phone, and (in person) visits have been shown to reduce suicide deaths, attempts, and/or ideation in previous clinical trials. This study extends this research to use the technology of text messaging to connect with a young and transitory active duty population. CCVT are sent over the course of one year to participants’ personal cell phones—following them to most deployments, transfers to other bases, as well as to civilian life if retired, separated, or otherwise discharged from the military.

At the time of this submission, 269 Soldiers and Marines have enrolled in this clinical trial with half randomized to receive CCVT for one year. As of March 2014, we had a total of 307 “texting months” (given the total number of months over which 74 CCVT participants received texts). During that time, we received 75 replies to our texts. Two-thirds (61%) have been positive (e.g., “feeling much better”), a quarter (23%) have been neutral (e.g., “Roger. Got it.”), and the remaining 16% have expressed distress of some sort (e.g., “not so great”). Only 2 texts indicated high risk, resulting in our team responding immediately to the participant to assure he or she was connected to care. Installation leadership and clinicians have been very positive about the study (with few exceptions, who are disinterested rather than negative) and feel that texting adds to what they are doing. Operations leadership has been particularly supportive in the face of an ongoing service-wide drawdown of military personnel, since the intervention stays connected with the Service Member after the end of a military career (and for many, the end of access to military health services). In this presentation, we will also update with new cases and add the results of our 12-month post-CCVT interviews with participants in which their satisfaction with and opinions about CCVT are assessed, demonstrating that caring contacts via text are an acceptable and feasible intervention and our study procedures are also feasible and acceptable.

Caring Emails for Military Suicide Prevention: Preliminary Results and Recommendations / [Courriels aidants pour la prévention du suicide chez les militaires : Résultats préliminaires et recommandations]

David D. Luxton
Naval Health Research Center & U. of Wash. School of medicine

The caring letters concept is a suicide prevention intervention whereby brief messages of caring concern are sent to patients following treatment discharge (Motto, 1976; Luxton, June & Comtois, 2013). Caring letters, or “caring contacts”, is the only intervention shown to reduce suicide mortality rates in a randomized controlled trial (Luxton, June & Comtois, 2013). In the original Motto trial (1976), psychiatric inpatients were mailed brief caring letters following treatment discharge for five years. Compared to a control group with no further contact, the “caring letters” group had a significantly lower suicide rate for the first two years of the trial (Motto & Bostrom, 2001).

Given the elevated risk for suicide among post hospitalized psychiatric patients, including military Service members and Veterans (Luxton, Trofimovich, Clark, 2013; Valenstein et al., 2009), it is vital to test interventions that can help prevent suicide among these high risk groups. We are therefore conducting a five year randomized controlled trial (RCT) that aims to test the benefits of caring contacts to help prevent suicide and self-directed violence among post-hospitalized U.S. military personnel and veterans. The trial includes six psychiatric inpatient units at four US Military hospitals and two Veteran’s hospitals. The trial is registered on the United States National Institutes of Health Clinical Trials Registry, ( Identifier # NCT01473771) available online at:

The methodology of the trial is similar to the original Motto caring letter study; however, it updates the intervention by using emailed letters. Participants randomized to the caring letters group are sent a total of 13 emails based on a pre-determined schedule that begins when the participant is discharged from the inpatient psychiatry unit. The schedule of email contacts replicates the first two years of the original Motto trial (monthly for four months, then every two months for eight months, and then every three months). One additional email contact was added during the first week after hospital discharge when suicide risk is expected to be the highest. Primary outcomes of the trial are suicide mortality rates and re-hospitalization rates for suicide attempts (to be determined 24 months post-discharge from index hospital stay). Time to self-directed violent behavior is also measured, and additional data are being collected regarding psychosocial and other suicide risk variables.

The aims of this presentation are to report preliminary results from the in-progress trial that demonstrate how a caring emails intervention is providing the benefit of reconnecting patients in potential crisis to care services. These findings, along with the methodology, safety protocol, and recommendations for implementing caring contact interventions will be presented.