Suicide and Self-Injury
Preliminary Analysis of a Randomized Control Trial of a Text-Based Intervention for Lethal Means Restriction Targeting Parents of Suicidal Youth
Rebecca J. Wildman, B.A.
Graduate Student Researcher
University of Texas Southwest Medical Center
Dallas, Texas
Ellen M. Andrews, B.A.
Graduate Student
University of Texas Southwest Medical Center
Dallas, Texas
Betsy D. Kennard, ABPP, Psy.D.
Program Director
Children’s Health – Children’s Medical Center/University of Texas Southwestern Medical Center
Dallas, Texas
Background:
Youth suicide is a leading cause of death for youth between 10 and 24 years old (CDC, 2021). While attempts differ in method, mortality may depend on the method’s lethality (Spicer & Miller, 2000). Lethal means restriction (LMR) is a suggested potent suicide prevention strategy, though it has been under-utilized and LMR behaviors are not widely researched (Miller et al., 2012). LMR is theorized to reduce the lethality of suicide attempts by modifying the environment around a suicidal individual (Barber & Miller, 2014).
Past research suggests targeting parents and families may reduce other risky behaviors (Fosco et al., 2016; Stormshak et al., 2011). Parents have been found to respond well to the LM counseling, remembering key messages and engaging in more LMR (Runyan et al., 2014). However, there is limited research regarding tracking LMR behaviors over time and little research on using technology to prompt parents to increase LMR to impact youth suicide prevention. The present project is a randomized control trial of a text based LMR intervention.
Method:
The current sample includes 28 guardian-child dyads (82.1% female adolescents; 67.9% history of suicide attempts; 89.3% biological parents; 92.9% female guardians) recruited from a suicide prevention intensive outpatient program (IOP). Dyads are stratified based on adolescent history of suicide attempts and sex and randomized to the intervention or TAU conditions. They are followed for six months following IOP discharge, with blinded follow-up calls completed at one-month. The intervention involves twice weekly text-messages, one a nudge message and the other a survey assessing LMR behaviors. Guardians complete a parental self-efficacy questionnaire, the General Functioning subscale of the Family Assessment Device (FAD-GF-12), and a client satisfaction questionnaire (CSQ-8). Youth complete the Columbia Suicide Severity Rating Scale (CSSRS), Acquired Capability for Suicide Scale-Fearlessness about Death (ACSS-FAD), FAD-GF-12, and a questionnaire regarding perceptions of access to LM. Data collection is ongoing.
Results:
Preliminary analyses indicate parents enrolled in the text protocol are satisfied with the intervention (N = 12, M = 28.25, SD = 3.49). There is a significant effect of the text intervention on parent perceptions of family functioning when controlling for sex and history of attempts (F(1,28) = 7.16, p = 0.014); however, this effect was not seen in either child scores (F(1,28) = 0.24, p = 0.629) or the difference score between parent and child scores (F(1, 28) = 1.36, p = 0.256). There is no significant effect of the intervention on teen-reported access to LM, with teens in both groups reporting decreased access at follow-up. There is no significant effect of the intervention on parental self-efficacy in the current sample. Further analyses with sample from ongoing data collection will be presented.
Discussion:
Preliminary analysis suggests guardians find this intervention minimally invasive and helpful in supporting their suicidal youth and perceive their family to function better with the LMR reminders. This project acts as an example of a technology-based intervention targeting the support system around a suicidal individual.
