Please select the eligibility criteria that correspond to the clinical trial below.
Title: Text Message Intervention to Reduce Repeat Self-harm in Patients Presenting to the Emergency Department
Brief Summary: Between 6% and 30% of people who harm themselves repeat this self-harm within the following 12 months. The investigators know that people who harm themselves are much more likely to commit suicide, but the investigators have no clear evidence about the best way to reduce the likelihood of someone harming themselves again.

Text messaging is now a common form of communication. Previous research has shown us that the investigators can use text messages for different types of health care interventions. Examples of this include reminding patients of medical appointments, delivering test results, to check patient side effects following treatment and to reduce depressive symptoms in patients with depression and alcohol problems. The Samaritans have introduced interactive text messages (where you can have a conversation by text with their service) and have noted an increasing use of this contact with their service.

This research study is taking place to find out if using supportive and interactive text messages can reduce further episodes of self-harm in patients who present to the Emergency Department (ED) with self-harm.

The investigators hypothesize that supportive, informative and interactive text messages delivered to patients discharged from an ED after an episode of self-harm will significantly reduce the frequency and intensity of thoughts of self-harm and self-harming behaviour in patients compared with those receiving only follow-up treatment as usual. A secondary hypothesis is that patients receiving the text messages will report a favourable experience and an overall satisfaction with the system.


Options:
A: Inclusion Criteria:

* At least 18 years old
* Engage in non-suicidal self-injury (NSSI) to reduce or lessen negative thoughts or feelings
* Not taking psychotropic medications, or meet criteria for stability on a particular dose and are willing to maintain a stable dosage throughout the study
* Meet the proposed Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for NSSI disorder, which includes:

  1. five or more days in which the individual has engaged in NSSI in the past year
  2. NSSI is associated with at least two two of the following: psychological precipitant (e.g., negative feelings or thoughts), urge prior to the act, preoccupation with NSSI, contingent response (e.g., expectation that the act will relieve a negative feeling state)
  3. clinically significant distress or interference caused by NSSI or its consequences
  4. NSSI does not occur exclusively during states of psychosis, delirium, or intoxication
  5. absence of suicidal intent

Exclusion Criteria:

* Current suicidal ideation and intent
* Currently receiving cognitive-behavioral therapy (CBT) or any psychotherapy to address NSSI, anxiety, depression, or other Axis I disorders (and are not willing to discontinue that treatment)
* Unwilling to refrain from initiating additional treatment during the course of the study
* Current or very recent symptoms that warrant immediate clinical attention, alternative treatment, and/or a higher level of care that cannot be provided through the study (e.g., florid delusions or hallucinations, rapid mood state, severe manic symptoms)
* Current or recent (within 3 months) history of substance use disorder (exception would be marijuana, caffeine, nicotine)
* Emotional symptomatology is due to a medical/physical condition
B: Inclusion Criteria:

* Meets criteria for diagnosis of borderline personality disorder
* History of at least one suicide attempt or self-mutilation episode 12 months prior to study entry
* Experiences continued urges to self-mutilate or attempt suicide
* Stable living situation
* Use of effective birth control if sexually active
* Clinically stable enough to tolerate placebo condition
* Not participating in other forms of treatment during the study

Exclusion Criteria:

* Any current organic mental syndromes, lifetime schizophrenic or bipolar disorders, psychotic disorders, or mental retardation
* Inability to complete psychiatric interview due to lack of cooperation or lack of comprehension
* Unable to tolerate fluoxetine or DBT
* Currently receiving treatment for an acute medical illness or other debilitating problem, including substance abuse or anorexia nervosa
* History of major depression lasting more than 3 months
* Current Hamilton depression score above 22 and not receiving treatment
* Pregnant or breastfeeding
C: Inclusion Criteria:

* All patients 18 years and over, presenting to the ED with self-harm.
* All patients should have a mobile phone, be familiar with text messaging technology and be willing to take part in the study.

Exclusion Criteria:

* Patients who do not consent to take part in the study.
* Patients who do not have a mobile phone or are unable to use the mobile text message technology.
* Patients who are admitted as a psychiatric inpatient following the assessment in the ED or those who require admission to a medical ward for longer than 48 hours.
* Patients who would be unavailable for follow-up during the study period.
D: Inclusion Criteria:

* Participant is male;
* Participant is 18 years of age or older;
* Participant has presented via Emergency Department to The Ottawa Hospital General and Civic Campuses with intentional self-harm;
* Participant is willing to return to the The Ottawa Hospital General Campus for follow-up appointments;
* Participant is willing to consent to participate in the study.

Exclusion Criteria:

* Participant is unable to read or understand English;
* Participant has cognitive impairments that render them incapable of using a smart phone;
* Participant does not have a smart phone and/or a smart phone with a data plan;
* Participants who in the opinion of the investigator will be unlikely to commit to a three month long study.

Answer: C