None listed
Conditions
Brief summary
The aim of this study is to determine whether an SMS-text message follow-up intervention for deliberate self-harm (DSH) is more effective in reducing DSH re-presentation to hospital, than treatment-as-usual hospital follow-up. Method This study will be conducted at Blacktown, Westmead and Nepean Hospitals as a Randomised Controlled Trial (RCT). Individuals will be eligible for study inclusion if they present with DSH to a hospital Emergency Department during the recruitment period, have access to a mobile phone for personal use and are aged 16 years and over. Eligible study participants will be randomly assigned to either hospital follow-up treatment as usual (TAU) or TAU plus SMS-text message follow-up. The study will have a two year recruitment phase with participants in the intervention condition receiving a supportive SMS text message at 1, 2, 3, 4, 5, 6, 8, 10 and 12 months after their index admission/randomisation. The outcomes of interest are i) the number of DSH re-presentations in each group, ii) median time to first re-presentation in each group and, iii) deaths within each group, within 12 months following recruitment. Benefits Repetition of self-harm within 12 months of an index episode occurs at a median rate of 15% (interquartile range 12-25%). This has a strong association with subsequent completed suicide and significant ongoing resource implications for the health care system. We have demonstrated in our previous ’Postcards from the EDge’ study (Carter et al, 2005, 2007, 2013, Milner and Carter, 2015) that, in individuals with a prior admission for deliberate self-poisoning (DSP), a simple postcard follow-up significantly reduces hospital re-presentation rates and associated costs. SMS text messaging has been demonstrated to be an effective method of communication with vulnerable people. Determining whether electronic communication is more effective than current practice in preventing DSH re-presentation is of the utmost importance, since DSH accounts for 5% of all general hospital admissions in Australia and mobile phone ownership is becoming almost universal, particularly among young people who are more at risk of self-harm. Should text messaging prove more effective, it allows for a vastly more flexible, direct and deliverable medical follow-up system than has ever existed under traditional models of care for DSH patients.
Interventions
This is a non-drug trial.
Individuals who present to hospital Emergency Departments with deliberate self-harm, and who meet eligibility criteria, will be randomly allocated to one of two follow up conditions:
1a. Control group: will receive hospital follow-up treatment-as-usual (TAU). This consists of hospital and/or community mental health contact with the presenting individual, typically within 24 hours of their presentation, and a follow-up program of care including clinical re-assessment and
This is a non-drug trial. Individuals who present to hospital Emergency Departments with deliberate self-harm, and who meet eligibility criteria, will be randomly allocated to one of two follow up conditions: 1a. Control group: will receive hospital follow-up treatment-as-usual (TAU). This consists of hospital and/or community mental health contact with the presenting individual, typically within 24 hours of their presentation, and a follow-up program of care including clinical re-assessment and individual or family-based psychological therapies, as indicated. 1b. Intervention group: will receive TAU plus supportive Short Message Service (SMS) text messages (TAU + SMS) scheduled at 1,2,3,4,5,6,8,10 and 12 months after their index presentation/randomisation. The content of the SMS message uses the following wording: TEXT MESSAGE 1: Dear NAME. We hope that things have been going well for you since we last had contact. Just a reminder that the 24-hour contact line 13 11 14 is there if you’d like to connect with someone and Helpline staff 1800 011 511 can put you in touch with your local health service if needed. Best wishes. [Return SMS messages are unavailable from this service.] TEXT MESSAGE 2: Dear NAME. Just checking in with you. A reminder that help is there if you need it. Just call 13 11 14 or 1800 011 511. Best wishes. TEXT MESSAGE 3: Hi NAME. We hope that you’ve been ok since our last contact. We’re just checking in with you. A 24-hour phone line is there for you in case you’d like to connect with someone 13 11 14 or to contact your local health service 1800 011 511. Best wishes. Mode of Delivery: The scheduled delivery of supportive SMS text messages will occur via an automated text messaging service, with this process being overseen by project research officers. Frequency and duration of intervention: Participants in the intervention condition will receive SMS text messages over 12 months on an identical time schedule; 1, 2, 3, 4, 5, 6, 8, 10 and 12 months after their index admission/randomisation. The message (detailed above) will be scheduled as Text Message 1, 2, 3, then 2 and 3 rotated. Due to any potential concerns regarding ongoing surveillance, there will be no direct monitoring of message receipt or opening.
Sponsors
Prof Alison Jones
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Individuals will be eligible for study inclusion if they present with DSH during the recruitment period, have access to a mobile phone for personal use and are aged 16 years and over. We will include individuals who present with either a first or subsequent episode of DSH.
Exclusion criteria
Patients who are incapable of or unwilling to give informed consent, those of no fixed address, those with insufficient English to read an SMS, and those without a mobile phone, will be excluded from the study.
Outcome results
None listed