Building toward a text-based intervention for parents of suicidal adolescents seeking emergency department care : A pilot randomized controlled trial.

Objective: The growing demand for emergency department (ED) care for suicidal ideation and attempts in adolescents calls for effective interventions preventing post-ED recurrence of suicidal crises. Parents are tasked with implementing postdischarge suicide prevention recommendations, often with little support. To address this need, this study examined a parent-facing texting intervention targeting parental engagement in suicide prevention activities to lower youth suicide risk after discharge.

Method: A pilot randomized controlled trial was conducted with 120 parents (83.3% mothers) and their adolescents (ages 13–17, 65.8% female, 75.0% White) presenting to an ED with suicide risk concerns. Parents were randomized to a control group or a 6-week intervention providing parents with daily adolescent-centered text messages encouraging post-ED parental engagement in recommended suicide prevention activities with or without added parent-centered texts intended to support parents’ own well-being. Proposed mechanisms (parental self-efficacy, engagement in suicide prevention activities) were assessed at 2, 6, and 12 weeks. This trial is registered with https://clinicaltrials.gov (NCT05058664).

Results: The text-based intervention was feasible and acceptable. In exploratory analyses, relative to control, the text-based intervention was associated with greater parental engagement in suicide prevention activities postintervention at 6 (d = 0.48, p = .027) and 12 weeks (d = 0.53, p = .019) and lower youth suicide attempts at 12 weeks (hazard ratio = 0.23, CI [0.06, 0.96], p = .044), regardless of whether parents received additional parent-centered texts.

Conclusions: Warranting further study in a fully powered trial, findings suggest this parent-facing texting intervention intended to promote youth safety was acceptable and may offer a promising strategy to lower post-ED youth suicide risk.