Crisis Intervention, Suicide and Depression
Conditions
Keywords
suicide, mental health crisis, crisis referrals, help-seeking, risk assessment, treatment barrier
Brief summary
Objective: Mental illness is a leading cause of disease burden; however, many barriers prevent people from seeking mental health services. Technological innovations may improve the ability to reach under-served populations by overcoming many existing barriers. The investigators evaluated a brief, automated risk assessment and intervention platform designed to increase the use of crisis resources provided to individuals who were online and in crisis. Hypothesis: The investigators hypothesized that individuals assigned to the intervention condition would report using crisis resources at higher rates than individuals in the control condition. Method: Participants, users of the digital mental health app Koko, were randomly assigned to treatment or control conditions upon accessing the app and were included in the study after their posts were identified by machine learning classifiers as signaling a current mental health crisis. Participants in the treatment condition received a brief Barrier Reduction Intervention (BRI) designed to increase the use of crisis service referrals provided on the app. Participants were followed-up several hours later to assess the use of crisis services.
Interventions
BEHAVIORALBrief help-seeking barrier reduction intervention
The BRI was designed to overcome common concerns and misconceptions (i.e., barriers) related to using crisis services. It works by first asking the user about what potential barriers may keep them from using the crisis service referrals, and then, based on the user's response, by providing information intended to help the user overcome the potential barrier(s) they selected. By exploring the menu of barriers, users could read brief messages designed to dispel common misconceptions or concerns related to each barrier. For example, a common concern among Koko users was that calls to lifelines invariably result in visits by the police or other emergency services. Users who feared this possibility could tap on the associated button and learn that active rescues such as these are extremely rare, and occur in less than one percent of all cases. Whenever possible, we used language throughout the intervention to help validate the experiences of the users.
Sponsors
Harvard University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Participants identified as experiencing a mental health crisis by a hybrid human-machine computation system evaluating semantic content of posts made on digital platforms.
Exclusion criteria
* Participants who were not identified as experiencing a mental health crisis.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Reporting Use of Crisis-referrals | 5 hours post intervention | The number participants indicating at follow-up that they used the crisis resources provided to them (e.g., called the suicide crisis hotline) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants in the Treatment Versus Control Conditions Reporting Their Experience Using Koko Was Good | 5 hours post intervention | The number of participants in the treatment versus control conditions reporting that their experience on the Koko digital platform was good versus bad using a two-option response question. |
Countries
United States
Participant flow
Recruitment details
Participants were recruited from 39,450 Koko users who signed up for the service between August 10, 2017 and September 20, 2017. Koko (née Panoply) provides safety services for large online social networks.
Pre-assignment details
All potential participants (N=39,450) screened for eligibility were considered enrolled. Potential participants were randomized upon accessing the platform, not later when identified as being in-crisis, because we used the platform's extant, AB-testing randomization tool. No other AB-tests were on the platform during the study period.
Participants by arm
| Arm | Count |
|---|---|
| Control Control Condition: Users in the control condition experienced the Koko digital platform as usual. | 805 |
| Intervention Brief help-seeking barrier reduction intervention: The BRI was designed to overcome common concerns and misconceptions (i.e., barriers) related to using crisis services. It works by first asking the user about what potential barriers may keep them from using the crisis service referrals, and then, based on the user's response, by providing information intended overcome the potential barrier(s) they selected. By exploring various barriers, users could read brief messages designed to dispel common misconceptions/concerns related to each barrier. For example, a common concern among Koko users was that calls to lifelines invariably result in visits by the police. Users who feared this possibility could tap on the associated button and learn that active rescues such as these are extremely rare, and occur in less than one percent of all cases. Whenever possible, we used language throughout the intervention to help validate the experiences of the users. | 775 |
| Total | 1,580 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Enrollment | Did not post on network | 5,066 | 5,080 |
| Enrollment | Post not classified as crisis | 13,967 | 13,757 |
| Follow up | Lost to Follow-up | 478 | 450 |
Baseline characteristics
| Characteristic | — | Total | Intervention | Control |
|---|---|---|---|---|
| Age, Continuous | — years | — | — | — |
| Race and Ethnicity Not Collected | — | 0 Participants | — | — |
| Region of Enrollment United States | — participants | — | — | — |
| Sex: Female, Male Female | — | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Male | — | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 805 | 0 / 775 |
| other Total, other adverse events | 0 / 805 | 0 / 775 |
| serious Total, serious adverse events | 0 / 805 | 0 / 775 |
Outcome results
Primary
Number of Participants Reporting Use of Crisis-referrals
The number participants indicating at follow-up that they used the crisis resources provided to them (e.g., called the suicide crisis hotline)
Time frame: 5 hours post intervention
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Control | Number of Participants Reporting Use of Crisis-referrals | 130 Participants |
| Intervention | Number of Participants Reporting Use of Crisis-referrals | 159 Participants |
p-value: =0.0295% CI: [1.03, 1.46]Chi-squared
Secondary
Number of Participants in the Treatment Versus Control Conditions Reporting Their Experience Using Koko Was Good
The number of participants in the treatment versus control conditions reporting that their experience on the Koko digital platform was good versus bad using a two-option response question.
Time frame: 5 hours post intervention
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Control | Number of Participants in the Treatment Versus Control Conditions Reporting Their Experience Using Koko Was Good | 250 Participants |
| Intervention | Number of Participants in the Treatment Versus Control Conditions Reporting Their Experience Using Koko Was Good | 234 Participants |
p-value: =0.1995% CI: [0.91, 1.59]Chi-squared