[Skip to Content]
[Skip to Content Landing]

Preliminary Research Priorities for Factors Influencing Individual Outcomes for Users of the US National Suicide Prevention Lifeline

To identify the key insights or developments described in this article
1 Credit CME
Abstract

Importance  Since July 2022, calling or texting 988 in the US connects callers to the National Suicide Prevention Lifeline following a law passed by Congress to simplify access to the mental health crisis line in the US. Compared with other areas of suicide research, knowledge regarding how and to what extent crisis lines prevent suicide crises and suicide deaths remains in its infancy. The state of this research is briefly reviewed and critical directions for future research on factors that may influence effectiveness are suggested.

Observations  The new 988 line stands to improve access to critical lifesaving measures in the moments of a suicidal crisis. However, urgent questions remain regarding how to improve effectiveness of crisis lines. Available evidence suggests that crisis lines are often effective at reducing immediate distress and reducing suicide risk, but substantial gaps remain in understanding how crisis lines work.

Conclusions and Relevance  Future research is recommended with suicide prevention crisis lines, such as 988, to identify and test factors influencing effectiveness, including conversation, consumer, dyadic, and structural-level characteristics. Existing research, while minimal, suggests that prescription of 988 to prevent suicide death is clinically warranted, but much more work is needed to optimize care.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: August 23, 2022.

Published Online: October 12, 2022. doi:10.1001/jamapsychiatry.2022.3270

Corresponding Author: Adam Bryant Miller, PhD, RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC 27709 (abmiller@rti.org).

Author Contributions: Dr Miller had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Miller, Oppenheimer, Glenn.

Obtained funding: Miller, Yaros.

Administrative, technical, or material support: All authors.

Supervision: Miller, Yaros.

Conflict of Interest Disclosures: None reported.

Funding/Support: Preparation of this manuscript was supported grants from the National Institute of Mental Health (grant K01MH116325 to Dr Miller) and the Centers for Disease Control and Prevention (grant R01CE003295 to Dr Yaros).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
National Institutes of Health. Notice of Special Interest (NOSI): Priority research opportunities in crisis response services. Accessed August 16, 2022. https://grants.nih.gov/grants/guide/notice-files/NOT-MH-22-110.html
2.
Joiner  TE  Jr , Rudd  MD .  Intensity and duration of suicidal crises vary as a function of previous suicide attempts and negative life events.   J Consult Clin Psychol. 2000;68(5):909-916. doi:10.1037/0022-006X.68.5.909PubMedGoogle ScholarCrossref
3.
Simon  OR , Swann  AC , Powell  KE , Potter  LB , Kresnow  MJ , O’Carroll  PW .  Characteristics of impulsive suicide attempts and attempters.   Suicide Life Threat Behav. 2001;32(1)(suppl):49-59. doi:10.1521/suli.32.1.5.49.24212PubMedGoogle ScholarCrossref
4.
Deisenhammer  EA , Ing  CM , Strauss  R , Kemmler  G , Hinterhuber  H , Weiss  EM .  The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt?   J Clin Psychiatry. 2008;69(1):5230. doi:10.4088/JCP.07m03904PubMedGoogle ScholarCrossref
5.
Gould  MS , Chowdhury  S , Lake  AM ,  et al.  National Suicide Prevention Lifeline crisis chat interventions: evaluation of chatters’ perceptions of effectiveness.   Suicide Life Threat Behav. 2021;51(6):1126-1137. doi:10.1111/sltb.12795PubMedGoogle ScholarCrossref
6.
Deuter  K , Procter  N , Rogers  J .  The emergency telephone conversation in the context of the older person in suicidal crisis: a qualitative study.   Crisis. 2013;34(4):262-272. doi:10.1027/0227-5910/a000189PubMedGoogle ScholarCrossref
7.
Kerner  B , Carlson  M , Eskin  CK ,  et al.  Trends in the utilization of a peer-supported youth hotline.   Child Adolesc Ment Health. 2021;26(1):65-72. doi:10.1111/camh.12394PubMedGoogle ScholarCrossref
8.
Britton  PC , Bossarte  RM , Thompson  C , Kemp  J , Conner  KR .  Influences on call outcomes among veteran callers to the National Veterans Crisis Line.   Suicide Life Threat Behav. 2013;43(5):494-502. doi:10.1111/sltb.12033PubMedGoogle ScholarCrossref
9.
Dichter  ME , Krishnamurti  LS , Chhatre  S ,  et al.  Gender differences in veterans’ use of the Veterans Crisis Line (VCL): findings from VCL call data.   Gen Hosp Psychiatry. 2022;74:65-70. doi:10.1016/j.genhosppsych.2021.12.006PubMedGoogle ScholarCrossref
10.
Hannemann  CM , Katz  IR , McCarthy  ME , Hughes  GJ , McKeon  R , McCarthy  JF .  Suicide mortality and related behavior following calls to the Veterans Crisis Line by Veterans Health Administration patients.   Suicide Life Threat Behav. 2021;51(3):596-605. doi:10.1111/sltb.12722PubMedGoogle ScholarCrossref
11.
Johnson  LL , Muehler  T , Stacy  MA .  Veterans’ satisfaction and perspectives on helpfulness of the Veterans Crisis Line.   Suicide Life Threat Behav. 2021;51(2):263-273. doi:10.1111/sltb.12702PubMedGoogle ScholarCrossref
12.
Williams  K , Fildes  D , Kobel  C , Grootemaat  P , Bradford  S , Gordon  R .  Evaluation of outcomes for help seekers accessing a pilot SMS-based crisis intervention service in Australia.   Crisis. 2021;42(1):32-39. doi:10.1027/0227-5910/a000681PubMedGoogle ScholarCrossref
13.
Chan  CH , Wong  HK , Yip  PSF .  Exploring the use of telephone helpline pertaining to older adult suicide prevention: a Hong Kong experience.   J Affect Disord. 2018;236:75-79. doi:10.1016/j.jad.2018.04.093PubMedGoogle ScholarCrossref
14.
Gould  MS , Lake  AM , Munfakh  JL ,  et al.  Helping callers to the national suicide prevention lifeline who are at imminent risk of suicide: evaluation of caller risk profiles and interventions implemented.   Suicide Life Threat Behav. 2016;46(2):172-190. doi:10.1111/sltb.12182PubMedGoogle ScholarCrossref
15.
Kalafat  J , Gould  MS , Munfakh  JLH , Kleinman  M .  An evaluation of crisis hotline outcomes: part 1: nonsuicidal crisis callers.   Suicide Life Threat Behav. 2007;37(3):322-337. doi:10.1521/suli.2007.37.3.322PubMedGoogle ScholarCrossref
16.
Mishara  BL , Daigle  MS .  Effects of different telephone intervention styles with suicidal callers at two suicide prevention centers: an empirical investigation.   Am J Community Psychol. 1997;25(6):861-885. doi:10.1023/A:1022269314076PubMedGoogle ScholarCrossref
17.
Coveney  CM , Pollock  K , Armstrong  S , Moore  J .  Callers’ experiences of contacting a national suicide prevention helpline: report of an online survey.   Crisis. 2012;33(6):313-324. doi:10.1027/0227-5910/a000151PubMedGoogle ScholarCrossref
18.
Shaw  FFT , Chiang  WH .  An evaluation of suicide prevention hotline results in Taiwan: caller profiles and the effect on emotional distress and suicide risk.   J Affect Disord. 2019;244:16-20. doi:10.1016/j.jad.2018.09.050PubMedGoogle ScholarCrossref
19.
Ramchand  R , Jaycox  L , Ebener  P , Gilbert  ML , Barnes-Proby  D , Goutam  P .  Characteristics and proximal outcomes of calls made to suicide crisis hotlines in California.   Crisis. 2017;38(1):26-35. doi:10.1027/0227-5910/a000401PubMedGoogle ScholarCrossref
20.
Ben-Ari  A , Azaiza  F .  Effectiveness of help lines among sociopolitical minorities: a view from both sides of the line.   Fam Soc. 2003;84(3):417-422. doi:10.1606/1044-3894.108Google ScholarCrossref
21.
Mishara  BL , Chagnon  F , Daigle  M ,  et al.  Which helper behaviors and intervention styles are related to better short-term outcomes in telephone crisis intervention? results from a Silent Monitoring Study of Calls to the U.S. 1-800-SUICIDE Network.   Suicide Life Threat Behav. 2007;37(3):308-321. doi:10.1521/suli.2007.37.3.308PubMedGoogle ScholarCrossref
22.
Gould  MS , Lake  AM , Galfalvy  H ,  et al.  Follow-up with callers to the national suicide prevention lifeline: evaluation of callers’ perceptions of care.   Suicide Life Threat Behav. 2018;48(1):75-86. doi:10.1111/sltb.12339PubMedGoogle ScholarCrossref
23.
Ramsey  C , Ennis  E , O’Neill  S .  Characteristics of lifeline, crisis line, service users who have died by suicide.   Suicide Life Threat Behav. 2019;49(3):777-788. doi:10.1111/sltb.12476PubMedGoogle ScholarCrossref
24.
Gould  MS , Kalafat  J , Harrismunfakh  JL , Kleinman  M .  An evaluation of crisis hotline outcomes: part 2: suicidal callers.   Suicide Life Threat Behav. 2007;37(3):338-352. doi:10.1521/suli.2007.37.3.338PubMedGoogle ScholarCrossref
25.
Gould  MS , Cross  W , Pisani  AR , Munfakh  JL , Kleinman  M .  Impact of applied suicide intervention skills training on the national suicide prevention lifeline.   Suicide Life Threat Behav. 2013;43(6):676-691. doi:10.1111/sltb.12049PubMedGoogle ScholarCrossref
26.
Labouliere  CD , Stanley  B , Lake  AM , Gould  MS .  Safety planning on crisis lines: feasibility, acceptability, and perceived helpfulness of a brief intervention to mitigate future suicide risk.   Suicide Life Threat Behav. 2020;50(1):29-41. doi:10.1111/sltb.12554PubMedGoogle ScholarCrossref
27.
Gould  MS , Munfakh  JLH , Kleinman  M , Lake  AM .  National suicide prevention lifeline: enhancing mental health care for suicidal individuals and other people in crisis.   Suicide Life Threat Behav. 2012;42(1):22-35. doi:10.1111/j.1943-278X.2011.00068.xPubMedGoogle ScholarCrossref
28.
Hunt  T , Wilson  CJ , Caputi  P , Wilson  I , Woodward  A .  The impact of caller gender on telephone crisis-helpline workers’ interpretation of suicidality in caller vignettes.   Int J Environ Res Public Health. 2018;15(4):E831. doi:10.3390/ijerph15040831PubMedGoogle ScholarCrossref
29.
King  GD .  An evaluation of the effectiveness of a telephone counseling center.   Am J Community Psychol. 1977;5(1):75-83. doi:10.1007/BF00884786PubMedGoogle ScholarCrossref
30.
Cross  WF , Pisani  AR , Schmeelk-Cone  K ,  et al.  Measuring trainer fidelity in the transfer of suicide prevention training.   Crisis. 2014;35(3):202-212. doi:10.1027/0227-5910/a000253PubMedGoogle ScholarCrossref
31.
Cross  WF , Crean  HF , Gould  MS ,  et al.  Development and initial evaluation of a suicide prevention curriculum for domestic violence hotline workers.   J Fam Violence. 2017;32(8):775-785. doi:10.1007/s10896-017-9922-7Google ScholarCrossref
32.
Draper  J , Murphy  G , Vega  E , Covington  DW , McKeon  R .  Helping callers to the National Suicide Prevention Lifeline who are at imminent risk of suicide: the importance of active engagement, active rescue, and collaboration between crisis and emergency services.   Suicide Life Threat Behav. 2015;45(3):261-270. doi:10.1111/sltb.12128PubMedGoogle ScholarCrossref
33.
Joiner  T , Kalafat  J , Draper  J ,  et al.  Establishing standards for the assessment of suicide risk among callers to the national suicide prevention lifeline.   Suicide Life Threat Behav. 2007;37(3):353-365. doi:10.1521/suli.2007.37.3.353PubMedGoogle ScholarCrossref
34.
Jobes  DA .  The Collaborative Assessment and Management of Suicidality (CAMS): an evolving evidence-based clinical approach to suicidal risk.   Suicide Life Threat Behav. 2012;42(6):640-653. doi:10.1111/j.1943-278X.2012.00119.xPubMedGoogle ScholarCrossref
35.
Stanley  B , Brown  G , Brent  DA ,  et al.  Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability.   J Am Acad Child Adolesc Psychiatry. 2009;48(10):1005-1013. doi:10.1097/CHI.0b013e3181b5dbfePubMedGoogle ScholarCrossref
36.
Gould  MS , Lake  AM . Suicide prevention and 988: beyond beds before, during and after COVID-19. National Association of State Mental Health Program Directors. Published September 2021. Accessed September 8, 2022. https://www.nasmhpd.org/sites/default/files/3_SuicidePrevention-988_FinalRevised_UPDATED%209.21.21.pdf
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close