Mobile Phone Intervention to Reduce Youth Suicide in Rural Communities

Study Overview
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Brief Summary
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The goal of this research project is to conduct a pilot RCT of Text4Strength, an interactive automated text messaging extension of Sources of Strength (SoS), a universal school-based suicide prevention program that prepares diverse 'key opinion leaders' to conduct public health messaging and activities with peers to increase school-wide positive coping norms, communication with trusted adults, and seeking help for suicidal peers (Wyman et al., 2010). The investigators previously developed and field tested Text4Strength messages (RSRB#00047481 and 53924 closed) to demonstrate feasibility, safety, student engagement, and student-perceived relevance for a universal texting extension. The investigators will now conduct a pilot randomized controlled trial in one large school in Western New York that has implemented Sources of Strength for the past two years. The school will continue with Sources of Strength in the 2016-17 school, and add this school-wide texting component as part of this research study. Consistent with Leon's guidelines on pilot studies, the primary focus will be to identify areas of promise, success in reaching proximate targets, and the need for additional modifications (Leon, Davis, & Kraemer, 2011). Findings from this study will inform further refinement of the text messaging program and provide preliminary data for a larger efficacy trial.

Official Title
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Mobile Phone Intervention to Reduce Youth Suicide in Rural Communities

Conditions
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Emotions, Suicide, Help-Seeking Behavior, Trusted Adults, Positive Affect

Intervention / Treatment
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* Behavioral: Intervention
* Behavioral: Control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 9th-12th grade students in study school must have own cell phone Exclusion Criteria: no cell phone not sufficiently English-speaking to complete surveys

Ages Eligible for Study
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Minimum Age: 13 Years
Maximum Age: 19 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Intervention group (receives interactive text messages) and control group (receives informative text messages)
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>receive interactive text messages | Behavioral: Intervention<br>* The intervention group will receive 2-5 interactive text message sequences per week. These messages will invite students to reply using keywords and short free text replies. Messages come from a library of strength-based peer quotations (reviewed for safety), psychoeducational interactions, and games designed to promote emotional skills and use of resources.<br>|
| Active Comparator: Control<br>Receive informational text messages | Behavioral: Control<br>* The control group will receive 1-2 (non-interactive) text messages per week containing general SoS concepts (e.g., Remember: more strengths are better when times get tough).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Emotion self-regulation skills | Difficulties with Emotion Regulation Scales (DERS) (Gratz & Roemer, 2004) | change from baseline to three-month follow-up | 
| Resources for Coping | uptake of Sources of Strength concepts (Wyman et al., 2010) | change from baseline to three-month follow-up | 
| Help-Seeking norms | Help-seeking from adults at school (Schmeelk-Cone, et al, 2012) | change from baseline to three-month follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Depression | Mood and Feelings Questionnaire (MFQ: Angold, et al., 1996; Costello & Angold, 1988) | baseline, immediate follow-up, three-month follow-up | 
| Suicidal Ideation | one question from the MFQ about suicidal ideation in the past two weeks | baseline, immediate follow-up, three-month follow-up |