SMS SOS: a randomized controlled trial to reduce self-harm and suicide attempts using SMS text messaging

Garry J Stevens,Gregory L Carter,Jagadeesh Andepalli,Suzanne Brownhill,Richard Baldacchino,Anabel De La Riva,Jean Hawkins,Manish Anand,Grahame Gould,Andrew Page,Jo-Anne Micallef,Naren Gunja,Christopher J Ryan,Tristan Chapman,Ian M Whyte,Alison Jones,Anita Kotak,Trent E Hammond

doi:10.1186/s12888-019-2104-9

Abstract

BackgroundHospital-treated deliberate self-harm (DSH) is common, costly and has high repetition rates. Since brief contact interventions (BCIs) may reduce the risk of DSH repetition, we aim to evaluate whether a SMS (Short Message Service) text message Intervention plus Treatment As Usual (TAU) compared to TAU alone will reduce hospital DSH re-presentation rates in Western Sydney public hospitals in Australia.Methods/designOur study is a 24-month randomized controlled trial (RCT). Adult patients who present with DSH to hospital emergency, psychiatric, and mental health triage and assessment departments will be randomly assigned to an Intervention condition plus TAU receiving nine SMS text messages at 1, 2, 3, 4, 5, 6, 8, 10 and 12-months post-discharge. Each message will contain telephone numbers for two mental health crises support tele-services. Primary outcomes will be the difference in the number of DSH re-presentations, and the time to first re-presentation, within 12-months of discharge.DiscussionThis study protocol describes the design and implementation of an RCT using SMS text messages, which aim to reduce hospital re-presentation rates for DSH. Positive study findings would support the translation of an SMS-aftercare protocol into mental health services at minimal expense.Trial registration and ethics approvalThis trial has been registered with the Australian and New Zealand Clinical Trials Registry (Trial registration: ACTRN12617000607370. Registered 28 April 2017) and has been approved by two Local Health Districts (LHDs). Western Sydney LHD Human Research Ethics Committee approved the study for Westmead Hospital and Blacktown Hospital (Protocol: HREC/16/WMEAD/336). Nepean Blue Mountains LHD Research Governance Office approved the study for Nepean Hospital (SSA/16/Nepean/170).

Highlights

Hospital-treated deliberate self-harm (DSH) is common, costly and has high repetition rates
Aims and hypotheses The aim of this study is to investigate whether Treatment As Usual (TAU) aftercare for DSH patients plus supportive Short Message Service (SMS) text messages delivered over 1 year reduce DSH re-presentations to hospital, compared to TAU alone
Differences in the incidence of subsequent DSH between the Intervention and TAU conditions at 6 and 12 months will be investigated using multi-level negative binomial regression models to estimate the incidence risk ratios (IRR) and absolute risk differences based on incidence proportions in an intention to treat analysis

Summary

Introduction

Hospital-treated deliberate self-harm (DSH) is common, costly and has high repetition rates. Hospital-treated DSH is common [1] and costly [2]. Repetition of DSH within 1 year of hospital admission occurs at a median proportion of 15% (interquartile range 12–25%) [1]. DSH is associated with a range of psychiatric issues [3], an increased risk of suicide attempts, and suicide [3, 4]. In Australia, DSH accounted for 6% of all hospitalised injury cases during 2012–2013 and four-billion dollars in healthcare expenditure annually, making prevention and early intervention an Australian national health priority [5]. Hospital-treated DSH is associated with an increased risk of suicide death, highlighting the importance of effective prevention and early intervention strategies

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