In response to the COVID-19 public health crisis in 2020, PCORI launched an initiative to enhance existing research projects so that they could offer findings related to COVID-19. The initiative funded this study and others.
The COVID-19 pandemic increased mental health challenges among the public and also among healthcare workers. To support the mental health of patients, clinicians, and staff, health systems need interventions that are effective and feasible to implement. Previous studies have shown that caring text messages, such as “Hello [name], I hope you’re doing OK and wanted to remind you that I’m here for you,” can significantly reduce suicidal ideation and behavior.
To compare the effectiveness of receiving caring text messages alone versus receiving caring texts plus an introductory phone call in reducing loneliness, suicidal ideation, and other mental distress among patients, clinicians, and healthcare staff experiencing mental distress
|Randomized controlled trial
|331 patients ages 12 and older who were receiving primary care and 335 clinicians and healthcare staff ages 18 and older; eligible participants reported experiencing mental distress, defined as a moderate or high-risk score for loneliness, suicidal ideation, psychological stress, anxiety, or depression
Secondary: suicidal ideation and behavior; perceived burdensomeness; thwarted belongingness, which is a perceived lack of social connection; depression
|Data Collection Timeframe
|January 2021 - January 2022
This randomized controlled trial compared two versions of a text messaging intervention for patients, clinicians, and healthcare staff.
The study had two cohorts: patients ages 12 and older who were receiving primary care at a large regional health system in Idaho and clinicians and healthcare staff at the same health system. Researchers randomly assigned participants in each cohort to one of two interventions:
- Caring Contacts (CC). Participants received 11 standard texts with caring messages over six months, personalized with their name. They could reply to converse with the sender.
- CC plus phone call. Participants received the CC intervention plus an introductory phone call for the participant and sender to get to know one another.
In both cohorts, trained non-clinician specialists from the state crisis and suicide hotline sent caring text messages and monitored and responded to texts from participants. They also made introductory phone calls to participants if applicable.
At baseline and six months, participants completed an online survey to assess loneliness, suicidal ideation and behavior, perceived burdensomeness, thwarted belongingness, and depression.
The study included 331 patients and 335 clinicians and staff who were experiencing mental distress. Among participants in both cohorts, 93% were White, and 8% were Hispanic or Latino. The average age was 43, and 83% were female.
People who had lived experience with suicide provided input during the study.
After six months, in both cohorts, the two interventions did not differ significantly in:
- Perceived burdensomeness
- Thwarted belongingness
Patients receiving CC plus a phone call reported slightly higher suicidal ideation or behavior than those receiving CC alone (p=0.05), but the magnitude of this difference was small.
Most participants were White and female; few adolescents enrolled in the study. Researchers collected surveys during surges in local COVID-19 cases. Results may differ for people of other backgrounds or when no surges in COVID-19 cases are present.
Conclusions and Relevance
Delivering CC in partnership with a state crisis and suicide hotline is feasible, including in rural and low-resource settings. In this study, including an introductory phone call did not improve the effectiveness of a CC intervention among participants who were experiencing mental distress.