None listed
Conditions
Brief summary
Suicide is the leading cause of death for young people in Australia and hospital treated self-harm is the strongest risk factor for subsequent suicide. Brief contact interventions (BCI) after patients have been discharged have been shown to reduce repeat self-harm. RAFT is an SMS-based BCI that links patients with self-guided therapeutic content. This study will recruit individuals who have recently attended a hospital or emergency department for self-harm. Participants will be assigned to an intervention arm or a treatment-as-usual (TAU) control group. Participants assigned to the intervention arm will receive supportive text messages over 12 months. Adopting a 2x2 factorial design, half the participants assigned to the intervention arm will receive access to the self-guided therapeutic content. Additionally, half the participants assigned to the intervention arm will have the option to nominate a support person to receive information about self-harm and suicide. RAFT is aimed at reducing suicidal ideation and self-harm. This trial will assess whether RAFT is effective compared to treatment as usual, with exploration of the most effective combination of RAFT features. It is hypothesised that participants in the intervention arm will demonstrate greater reductions in suicidal ideation and the event rate of repeat self-harm relative to the control group. Self-report data will be collected remotely via online questionnaires at baseline, 5 weeks, 6 months and 12 months.
Interventions
RAFT is a text-message based, brief contact intervention for individuals who have recently presented to hospital for self-harm or a suicide attempt. RAFT aims to reduce suicidal ideation and repeat self-harm. RAFT sends a series of automated ‘caring contact’ text messages with links to brief, self-guided, low-intensity therapeutic modules that target proximal risk factors for self-harm – distressing thoughts, safety planning, emotional regulation, suicidal thoughts, interpersonal relationships a
RAFT is a text-message based, brief contact intervention for individuals who have recently presented to hospital for self-harm or a suicide attempt. RAFT aims to reduce suicidal ideation and repeat self-harm. RAFT sends a series of automated ‘caring contact’ text messages with links to brief, self-guided, low-intensity therapeutic modules that target proximal risk factors for self-harm – distressing thoughts, safety planning, emotional regulation, suicidal thoughts, interpersonal relationships and alcohol. These modules are hosted on a dedicated RAFT website (not publicly available) and each module takes approximately 10 minutes to complete. The therapeutic content was co-developed by clinicians and lived experience representatives for the purposes of this intervention. It provides suggestions for distraction techniques, safety planning templates, mindfulness techniques, and basic cognitive-behavioural therapy around challenging unhelpful thoughts. Participants will be randomised between: (a) an intervention using a 2x2 factorial design or (b) a control group who will receive treatment as usual (TAU). Participants assigned to the intervention group will be randomised between two factors: (1) participant receiving text messages alone with no links to the online therapeutic modules Vs participants receiving text messages with links to the online therapeutic modules; and (2) participant having the option to nominate a support person to receive a one-off text message Vs participants not having this option. Participants who are assigned to groups which do not receive a link to the online modules text messages, which express the hope that the individual is doing well and provides contact details for crisis services. The text message for the nominated support person, send 1 day after the participant enrols in the trial, includes the first name of the participant who nominated them, a brief statement that supporting a friend or family member through a difficult time can be challenging, and a link to a dedicated section of the RAFT website (not accessible to the public) that contains information about self-harm and suicidal thinking, safety planning, and links to external resources for carers (e.g. Beyond Blue). The body of the text message takes approximately 1 minute to read, the information on the support-person website takes approximately 15 minutes to read, and the external links are able to be accessed at the persons discretion. The primary aim is to determine whether the RAFT text message intervention reduces suicidal ideation compared to the control group. It also aims to assess whether the inclusion of links to therapeutic content is beneficial compared to just sending text messages, and whether sending additional information to a nominated support person (e.g. a family member or friend) is beneficial compared to sending messages to the participant alone. Participants assigned to an intervention group will receive a text message on Days 1, 3, 8, 15, 22 and 29 and then monthly for 12 months. Self-report data on suicidal ideation, self-harm behaviour, psychological distress, functioning and recovery, quality of life and alcohol use will be captured at baseline, 5 weeks, 6 months and 12 months. A data linkage at 24 months will capture emergency department and hospital admissions data. Participants are able to engage with the therapeutic content as often or as little as desired. The RAFT website will automatically track how often an individual accesses the therapeutic content.
Sponsors
University of New South Wales
Study design
Allocation
Randomised controlled trial
Intervention model
Factorial
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
18-65 years old. Presented at a hospital within the last seven days for self-harm or a suicide attempt. Are English literate. Have a smartphone with an Australian phone number.
Exclusion criteria
Experienced psychotic symptoms in the past 7 days.
Outcome results
None listed