Clinical Trial: Text Message Intervention to Reduce Repeat Self-harm

Study Status: Terminated
Recruit Status: Terminated
Study Type: Interventional

Official 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.

Detailed Summary:

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
Sponsor: University of Dublin, Trinity College

Current Primary Outcome:

• Repetition of self-harm [ Time Frame: Three months ]
  Proportion of patients repeating self-harm
• Change scores on the Suicide Behaviors Questionnaire from baseline [ Time Frame: Baseline and three months ]
  The change scores on the Suicide Behaviors Questionnaire from baseline

Original Primary Outcome: Same as current

Current Secondary Outcome:

• Repeat episodes of self-harm per person [ Time Frame: Three months ]
  Number of repeat episodes of self-harm per person
• Change scores in the Modified Scale for Suicide Ideation from baseline [ Time Frame: Baseline anf three months ]
  The change scores on the Modified Scale for Suicide Ideation from baseline
• Change scores on the Positive and Negative Suicide Ideation Inventory from baseline [ Time Frame: Baseline and three months ]
  The change scores on the Positive and Negative Suicide Ideation Inventory from baseline
• Change scores on the Beck Hopelessness Scale from baseline [ Time Frame: Baseline and three months ]
  The change scores on the Beck Hopelessness Scale from baseline
• Change scores on the Global Assessment of Functioning Scale from baseline [ Time Frame: Baseline and three months ]
  The change scores on the Global Assessment of Functioning Scale from baseline

Original Secondary Outcome: Same as current

Information By: University of Dublin, Trinity College

Dates:
Date Received: March 26, 2013
Date Started: March 2015
Date Completion: December 2015
Last Updated: September 9, 2014
Last Verified: September 2014