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Text Message Intervention to Reduce Repeat Self-harm

Primary Purpose

Self-Injurious Behavior

Status
Terminated
Phase
Not Applicable
Locations
Ireland
Study Type
Interventional
Intervention
Supportive and interactive text messages
Sponsored by
University of Dublin, Trinity College
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Self-Injurious Behavior focused on measuring Self harm, Emergency Department, Repetition, Supportive Text messages, Interactive

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

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.

Sites / Locations

  • Beaumont Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

No Intervention

Experimental

Arm Label

No text messages

Supportive and interactive text messages

Arm Description

Patients in the non-intervention group will not receive any text messages. However, they will also receive the routine outpatient follow-up arrangements associated with attendance at an ED with self-harm including the provision of a contact phone number for the Samaritans.

We will deliver daily supportive and informative text messages for one month followed by one supportive and informative text message every other day the second month and then one weekly text message the third month to patients in the intervention group after they have been discharged from the ED following an episode of self-harm. Supportive text messages will mainly target relieving the patients of mood symptoms and providing them with strategies for dealing with suicidal thoughts while the informative ones will provide patients with a dedicated mobile phone number through which they can receive interactive support from the Samaritans. The text messages will encourage participants to text the Samaritans in times of crisis. Please see appendix I for examples of the relevant text messages.

Outcomes

Primary Outcome Measures

Repetition of self-harm
Proportion of patients repeating self-harm
Change scores on the Suicide Behaviors Questionnaire from baseline
The change scores on the Suicide Behaviors Questionnaire from baseline

Secondary Outcome Measures

Repeat episodes of self-harm per person
Number of repeat episodes of self-harm per person
Change scores in the Modified Scale for Suicide Ideation from baseline
The change scores on the Modified Scale for Suicide Ideation from baseline
Change scores on the Positive and Negative Suicide Ideation Inventory from baseline
The change scores on the Positive and Negative Suicide Ideation Inventory from baseline
Change scores on the Beck Hopelessness Scale from baseline
The change scores on the Beck Hopelessness Scale from baseline
Change scores on the Global Assessment of Functioning Scale from baseline
The change scores on the Global Assessment of Functioning Scale from baseline

Full Information

First Posted
March 26, 2013
Last Updated
September 9, 2014
Sponsor
University of Dublin, Trinity College
Collaborators
Beaumont Hospital, Royal College of Surgeons, Ireland
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1. Study Identification

Unique Protocol Identification Number
NCT01823120
Brief Title
Text Message Intervention to Reduce Repeat Self-harm
Official Title
Text Message Intervention to Reduce Repeat Self-harm in Patients Presenting to the Emergency Department
Study Type
Interventional

2. Study Status

Record Verification Date
September 2014
Overall Recruitment Status
Terminated
Why Stopped
Resignation of critical volunteer staff and lack of funding
Study Start Date
March 2015 (undefined)
Primary Completion Date
December 2015 (Anticipated)
Study Completion Date
December 2015 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Dublin, Trinity College
Collaborators
Beaumont Hospital, Royal College of Surgeons, Ireland

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

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.
Detailed Description
Repetition of self-harm is common, ranging from 6% to 30% in 12 months. Repetition is strongly associated with subsequent suicide and has important implications for healthcare resources. In every country including Ireland, fatal suicide attempts rank among the top ten causes of death for individual of all ages and one of the three leading causes of death in the 15 -35 years age group. Previous studies of interventions to reduce the repetition of self-harm in unselected patient groups have been unsuccessful in reducing the proportion of repeaters. These interventions have included the use of antidepressants, problem solving, intensive care with outreach, an emergency card, psychosocial crisis intervention, and guaranteed inpatient shelter in cases of emergency. In a study involving the use of low cost postcards after an episode of self-poisoning, although no significant difference in the proportion of individual patients who repeated self-harm were detected, there was a clinically and statistically significant reduction in the number of events per individual by about 50%. Only a few non-pharmacological interventions have been reported to be effective in reducing repetition in selected subsets of populations with self-harm including; partial hospitalization, dialectical behaviour therapy and psychodynamic interpersonal therapy. These interventions are all resource intensive and therefore may only be applicable to carefully selected patients. Given the recent global financial crisis with consequent diminution of health care resources, interventions are needed that could be delivered economically to entire populations of patients who self-harm. In light of the growing interest in using text messages as an intervention in healthcare, the investigators will focus in this study on exploring the potential for using text messages to reduce repeat self-harm in patients presenting to the Emergency Department (ED). There is established research evidence for using text messages to remind patients of scheduled medical appointments, to coordinate medical staff,to deliver medical test results and to monitor patient side effects following treatment. In a review of the literature on the use of text messaging for clinical and healthy behaviour interventions, Wei et al. (2011) found that among 16 randomized controlled trials, 10 reported significant improvement with interventions and six reported differences suggesting positive trends. In one meta-analysis of four randomised trials of mobile phone-based interventions for smoking cessation, it was reported that text message interventions resulted in a significant increase in short-term self-reported quitting (RR of 2.18, 95% CI 1.80 to 2.65). In the same review, when data from an internet and a mobile phone programme were pooled and meta-analysed, they found significant increases in both short-, and long-term, self-reported quitting (RR of 2.03, 95% Conficence Intervals (CI)= 1.40 to 2.94). In a study of text message services based on qualitative interviews with 12 young people, the aim of which was to provide young people with information on cannabis and help them to reduce their consumption of the drug, participants reported that they saw the messages as flexible and discrete, and as being personally meant for them. They paid more attention to the messages than they did to mass approaches such as public information broadcasts on TV. Along with other factors, the participants reported feeling motivated to decrease their level of cannabis abuse and to maintain a reduced level. . In another study, young adults in 3 urban EDs (n= 45; aged 18 to 24 years, 54% women) who were identified as hazardous drinkers by the Alcohol Use Disorders Identification Test-Consumption Score were randomly assigned by the researchers to weekly text message-based feedback with goal setting (Intervention), weekly text message-based drinking assessments without feedback (Assessment), or to a control who received no text messages. At 3 months, they found that participants who were exposed to the text message-based intervention had 3.4 (Standard Deviation (SD)= 5.4) fewer heavy drinking days in the last month and 2.1 (SD 1.5) fewer drinks per drinking day when compared to baseline. In a recent randomised trial in Ireland of supportive text messages for patients with depression and comorbid alcohol use disorder, there was a trend towards finding a greater cumulative abstinence duration in the group that received twice daily supportive text messages compared to the control group who only received fortnightly tank you text messages: 88.3 (SD=6.2) vs. 79.3 (SD=24.1), t=1.78, df=48, p=0.08. In this trial, after adjusting for baseline scores, patients in the supportive text message group also had significantly lower Beck's Depression Inventory Scores compared to the control groups; 8.5 (SD=8.0) vs. 16.7 (SD=10.3) respectively, F (1, 49) = 9.54, p=0.003, ƞp2=0.17. In a study by Owens et al. (2010) to engage a group of self-harmers in the development of a text-messaging intervention to reduce repetition of self-harm, three broad categories of message emerged, namely, those that affirmed or validated emotions (e.g. "it's ok to feel angry"), those that prescribed actions, distractions or cognitive strategies (e.g. "call Samaritans," "have a warm bath"," take it a minute at a time") and those that were interrogative or designed to initiate dialogue (e.g. "do you want to talk?"). They also found that the group were unable to reach an agreement on a set of messages that might work in all circumstances to reduce the urge to self-harm or to enable people to feel cared for, concluding instead that text messages may need to be individualised. A major limitation of this study was its small sample size of only 8 people. Furthermore, participants in this study only reported how they envisaged they would respond to text messages rather than how they actually responded to text messages which could vary significantly from what is reported. In the recent randomised trial in Ireland of generic supportive text messages for patients with depression and comorbid alcohol use disorder, 20 of the 24 patients (83%) reported that the intervention had played a useful role in helping to improve their mental health. Recently, the Samaritans in Ireland introduce a limited interactive text message programme for patients who experience suicidal ideation. This service allows clients to receive support when in crisis via an interactive text messaging programme from a trained volunteer. After an extensive review of the literature using Google Scholar, MEDLINE, Pub Med, ERIC, Web of Science, Science Direct and PsychINFO, no published randomised trial was found on the use of text messages delivered via mobile phone as an intervention to address suicidal ideation and repeat self-harm in patients presenting with self-harm to the ED. Thus, the investigators seek to determine if text messaging is a useful and effective strategy to help reduce the frequency and intensity of thoughts of self-harm and depressive symptoms after patients are discharged from an ED following a presentation 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.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Self-Injurious Behavior
Keywords
Self harm, Emergency Department, Repetition, Supportive Text messages, Interactive

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
10 (Actual)

8. Arms, Groups, and Interventions

Arm Title
No text messages
Arm Type
No Intervention
Arm Description
Patients in the non-intervention group will not receive any text messages. However, they will also receive the routine outpatient follow-up arrangements associated with attendance at an ED with self-harm including the provision of a contact phone number for the Samaritans.
Arm Title
Supportive and interactive text messages
Arm Type
Experimental
Arm Description
We will deliver daily supportive and informative text messages for one month followed by one supportive and informative text message every other day the second month and then one weekly text message the third month to patients in the intervention group after they have been discharged from the ED following an episode of self-harm. Supportive text messages will mainly target relieving the patients of mood symptoms and providing them with strategies for dealing with suicidal thoughts while the informative ones will provide patients with a dedicated mobile phone number through which they can receive interactive support from the Samaritans. The text messages will encourage participants to text the Samaritans in times of crisis. Please see appendix I for examples of the relevant text messages.
Intervention Type
Other
Intervention Name(s)
Supportive and interactive text messages
Primary Outcome Measure Information:
Title
Repetition of self-harm
Description
Proportion of patients repeating self-harm
Time Frame
Three months
Title
Change scores on the Suicide Behaviors Questionnaire from baseline
Description
The change scores on the Suicide Behaviors Questionnaire from baseline
Time Frame
Baseline and three months
Secondary Outcome Measure Information:
Title
Repeat episodes of self-harm per person
Description
Number of repeat episodes of self-harm per person
Time Frame
Three months
Title
Change scores in the Modified Scale for Suicide Ideation from baseline
Description
The change scores on the Modified Scale for Suicide Ideation from baseline
Time Frame
Baseline anf three months
Title
Change scores on the Positive and Negative Suicide Ideation Inventory from baseline
Description
The change scores on the Positive and Negative Suicide Ideation Inventory from baseline
Time Frame
Baseline and three months
Title
Change scores on the Beck Hopelessness Scale from baseline
Description
The change scores on the Beck Hopelessness Scale from baseline
Time Frame
Baseline and three months
Title
Change scores on the Global Assessment of Functioning Scale from baseline
Description
The change scores on the Global Assessment of Functioning Scale from baseline
Time Frame
Baseline and three months
Other Pre-specified Outcome Measures:
Title
Utilisation of the services provided by the Samaritans Ireland
Description
The range and frequency of utilisation of the services provided by the Samaritans Ireland
Time Frame
Three months
Title
Patient satisfaction with treatment
Description
Patient satisfaction (for both groups) with their overall follow-up treatment at three months following discharge from the ED would be measured using a self-designed likert scale.
Time Frame
Three months
Title
Feedback about patients' experiences, expectations and satisfaction with the communication system
Description
Feedback about patients' experiences, expectations and satisfaction with the communication system and its perceived impact on their mood, suicidal thoughts and potential to repeat self-harm. These aspects would be measured using semi-structured questionnaires which include likert scales at 3 months
Time Frame
Three months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
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.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Vincent IO Agyapong, MRCPsych MD
Organizational Affiliation
University of Dublin, Trinity College Dublin
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Siobhan MacHale, FRCPsych
Organizational Affiliation
Beaumont Hospital Dublin
Official's Role
Study Chair
Facility Information:
Facility Name
Beaumont Hospital
City
Dublin
State/Province
Co Dublin
ZIP/Postal Code
Dublin 9
Country
Ireland

12. IPD Sharing Statement

Citations:
Citation
Agyapong, V., J. Milnes, M. McLoughlin and C. Farren (2012).
Results Reference
background
PubMed Identifier
22464008
Citation
Agyapong VI, Ahern S, McLoughlin DM, Farren CK. Supportive text messaging for depression and comorbid alcohol use disorder: single-blind randomised trial. J Affect Disord. 2012 Dec 10;141(2-3):168-76. doi: 10.1016/j.jad.2012.02.040. Epub 2012 Mar 29.
Results Reference
background
Citation
Australian Bureau of Statistics (2003). Household Use of Information Technology Canberra, Australia. B., P. (2003).
Results Reference
background
Citation
Bateman, A. and P. Fonagy (1999).
Results Reference
background
Citation
Brianna S., Fjeldsoe B.A. and Alison L. (2009).
Results Reference
background
Citation
Carter, G. L., K. Clover, I. M. Whyte, A. H. Dawson and C. D'Este (2005).
Results Reference
background
Citation
Cohen, J. (1988). Statistical power analysis for the behavioral sciences, Academic Press. New York. Downer, S., J. Meara and A. Da Costa (2005).
Results Reference
background
PubMed Identifier
11463679
Citation
Guthrie E, Kapur N, Mackway-Jones K, Chew-Graham C, Moorey J, Mendel E, Marino-Francis F, Sanderson S, Turpin C, Boddy G, Tomenson B. Randomised controlled trial of brief psychological intervention after deliberate self poisoning. BMJ. 2001 Jul 21;323(7305):135-8. doi: 10.1136/bmj.323.7305.135.
Results Reference
background
PubMed Identifier
9703526
Citation
Hawton K, Arensman E, Townsend E, Bremner S, Feldman E, Goldney R, Gunnell D, Hazell P, van Heeringen K, House A, Owens D, Sakinofsky I, Traskman-Bendz L. Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition. BMJ. 1998 Aug 15;317(7156):441-7. doi: 10.1136/bmj.317.7156.441.
Results Reference
background
Citation
Haynes RB., S. D., Guyatt G., Tugwell, P., (2005). Clinical Epidemiology: How to do Clinical Practice Research. Philadelphia PA, Lippincott, Williams, Wilkins.
Results Reference
background
Citation
House, A., D. Owens and L. Patchett (1998).
Results Reference
background
PubMed Identifier
10709944
Citation
Jeffery RW, Drewnowski A, Epstein LH, Stunkard AJ, Wilson GT, Wing RR, Hill DR. Long-term maintenance of weight loss: current status. Health Psychol. 2000 Jan;19(1S):5-16. doi: 10.1037/0278-6133.19.suppl1.5.
Results Reference
background
PubMed Identifier
16916871
Citation
Leong KC, Chen WS, Leong KW, Mastura I, Mimi O, Sheikh MA, Zailinawati AH, Ng CJ, Phua KL, Teng CL. The use of text messaging to improve attendance in primary care: a randomized controlled trial. Fam Pract. 2006 Dec;23(6):699-705. doi: 10.1093/fampra/cml044. Epub 2006 Aug 17.
Results Reference
background
PubMed Identifier
1845222
Citation
Linehan MM, Armstrong HE, Suarez A, Allmon D, Heard HL. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1991 Dec;48(12):1060-4. doi: 10.1001/archpsyc.1991.01810360024003.
Results Reference
background
Citation
Luborsky, L. (1962).
Results Reference
background
PubMed Identifier
16461603
Citation
Menon-Johansson AS, McNaught F, Mandalia S, Sullivan AK. Texting decreases the time to treatment for genital Chlamydia trachomatis infection. Sex Transm Infect. 2006 Feb;82(1):49-51. doi: 10.1136/sti.2004.014381.
Results Reference
background
Citation
Molenberghs G, K. M., Ed. (2007). Missing data in clinical studies. Chichester, John Wiley & Sons. Owens, C., P. Farrand, R. Darvill, T. Emmens, E. Hewis and P. Aitken (2011).
Results Reference
background
PubMed Identifier
19141433
Citation
Patrick K, Raab F, Adams MA, Dillon L, Zabinski M, Rock CL, Griswold WG, Norman GJ. A text message-based intervention for weight loss: randomized controlled trial. J Med Internet Res. 2009 Jan 13;11(1):e1. doi: 10.2196/jmir.1100.
Results Reference
background
Citation
Rice R. and K. J. (2003).
Results Reference
background
Citation
Rickards L., Fox K., Roberts C., Flectcher L. and G. E. (2004). Living in Britain-The 2002 General Household Survey. London: Office for National Statistics. London, Office for National Statistics.
Results Reference
background
Citation
Sherry E, C. B., Warnke P. (2002).
Results Reference
background
Citation
Stross, R. (2008). What carriers aren't eager to tell you about texting. New York Times. New York.
Results Reference
background
Citation
Tomnay JE, P. M., Fairley CK. (2005).
Results Reference
background
PubMed Identifier
9259223
Citation
van der Sande R, Buskens E, Allart E, van der Graaf Y, van Engeland H. Psychosocial intervention following suicide attempt: a systematic review of treatment interventions. Acta Psychiatr Scand. 1997 Jul;96(1):43-50. doi: 10.1111/j.1600-0447.1997.tb09903.x.
Results Reference
background
PubMed Identifier
17921245
Citation
Weaver A, Young AM, Rowntree J, Townsend N, Pearson S, Smith J, Gibson O, Cobern W, Larsen M, Tarassenko L. Application of mobile phone technology for managing chemotherapy-associated side-effects. Ann Oncol. 2007 Nov;18(11):1887-92. doi: 10.1093/annonc/mdm354. Epub 2007 Oct 5.
Results Reference
background
Citation
Wei, J., I. Hollin and S. Kachnowski (2011).
Results Reference
background
Citation
Whittaker, R., R. Borland, C. Bullen, R. Lin, H. McRobbie and A. Rodgers (2009).
Results Reference
background
Citation
Suffoletto , B., C. Callaway, J. Kristan, K. Kraemer and D. B. Clark (2011 Dec 14).
Results Reference
background
PubMed Identifier
33884617
Citation
Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev. 2021 Apr 22;4(4):CD013668. doi: 10.1002/14651858.CD013668.pub2.
Results Reference
derived
PubMed Identifier
32368793
Citation
Storebo OJ, Stoffers-Winterling JM, Vollm BA, Kongerslev MT, Mattivi JT, Jorgensen MS, Faltinsen E, Todorovac A, Sales CP, Callesen HE, Lieb K, Simonsen E. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 2020 May 4;5(5):CD012955. doi: 10.1002/14651858.CD012955.pub2.
Results Reference
derived

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Text Message Intervention to Reduce Repeat Self-harm

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