Project Summary

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

COVID-19-Related Project Enhancement

COVID-19 has led to an increase in mental health problems among the public and healthcare workers. Reasons for this increase include social isolation, anxiety, and stress related to COVID-19.

With this enhancement, the research team will see how many healthcare workers and patients have mental health concerns. Concerns include anxiety, loneliness, depression, stress, and suicidal thoughts. The team will look at a state that has been severely affected by COVID-19. The team will compare two versions of text message support for patients and healthcare workers with mental distress. Results will help health systems, crisis lines, and community organizations learn how to support people when mental health resources are limited.

What is the research about?

Half of people who die from suicide have contact with a hospital or health system within a month of their death. Having a safety plan and follow-up support may help prevent suicide after people leave the hospital or clinic. In safety planning, healthcare providers or trained specialists help people create action plans to use if they have suicidal thoughts. Patients and their healthcare providers work together to list warning signs of suicide. They work to identify:

  • People and social settings they can use for support and distraction
  • Coping strategies
  • Professional help
  • How to keep themselves safe at home, such as by safely storing firearms or medicines

The research team is comparing two kinds of follow-up support to help prevent suicide after people leave the hospital or clinic with a safety plan. The first is support via phone calls, called SPI+. The second is Caring Contacts, or CC. It involves one phone call followed by CC text messages or emails.

Who can this research help?

Results may help health systems, suicide prevention hotlines, and community organizations when considering approaches to prevent suicide.

What is the research team doing?

The research team is working with 9 emergency rooms, or ERs, and 23 primary care clinics. The EDs and clinics are part of a health system in Idaho. The team is recruiting 1,382 adults and teens who report having low, moderate, or high risk for suicide to take part in the study.

All people in the study receive safety planning. The research team is assigning people by chance to follow-up support with SPI+ or CC.

In SPI+, people receive at least one, and up to six, phone calls from a specialist at a suicide prevention hotline. In these calls, people review and revise their safety plan. They discuss ways to overcome barriers to attending mental health appointments. The specialist also connects people to resources to address risk factors for suicide.

In CC, people receive one phone call from a specialist at the suicide prevention hotline. People receive 25 supportive text messages or emails from the hotline over one year. People don’t have to respond. If they do, a follow-up specialist will reply to their message.

After 6 and 12 months, the research team is following up with people to see if they have suicidal thoughts or behaviors. The team is asking patients about loneliness and if they seek care to prevent suicide or go to mental health appointments.

The research team is comparing these outcomes for people who receive SPI+ and people who receive CC. The team is looking to see if outcomes differ for teens compared with adults. Finally, the team is asking people and health providers how well safety planning plus follow-up works for them.

People who have attempted suicide or who are close to someone who has died from suicide are giving input on the study. Healthcare providers, suicide prevention hotline specialists, and mental health providers are also helping to develop and carry out the study.

Research methods at a glance

Design Elements Description
Design Randomized controlled trial
Population 1,382 patients (790 adults and 592 teens) who screened positive for suicide risk in ERs and primary care clinics
Interventions/
Comparators
  • SPI+: Safety planning plus structured phone call follow-up support
  • CC: Safety planning plus caring text message or email follow-up support
Outcomes

Primary: suicidal ideation and behavior

Secondary: loneliness, return to care for suicidality, uptake of outpatient mental health services

Timeframe 12-month follow-up for primary outcomes

Project Information

Anna K. Radin, DrPH, MPH
St. Luke's Health System
$3,906,980
The SPARC Trial: Comparing Safety Planning Plus Structured Follow-Up from a Suicide Prevention Hotline to Safety Planning Alone for Suicide Prevention among Adult and Adolescent Recipients of Care in Emergency Departments and Primary Care Clinics

Key Dates

August 2019
April 2025
2019

Study Registration Information

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Last updated: January 16, 2022