Hotline Use in the United States: Results from the Collaborative Psychiatric Epidemiology Surveys

Follow-Up Care Offers and Acceptance in Crisis Line Suicide Prevention Services

Background: Prior work has explored the impact of follow-up calls in a crisis line context, but no research has investigated the offer and acceptance of follow-up care. Aims: To identify caller/call characteristics associated with whether a caller is offered and accepts follow-up services. Methods: This cross-sectional study included data from 55,594 callers to a member center of the 988 Suicide & Crisis Lifeline (988) between 2017 and 2019. Logistic regression analyses were conducted to examine associations between caller/call characteristics and two follow-up outcomes. Results: Black callers and those with higher suicide capability and intent had greater odds of being offered and accepting follow-up. Longer call duration was also associated with higher odds of being offered and accepting follow-up. Higher suicidal desire uniquely increased the odds of offers, whereas a higher level of buffers uniquely decreased the odds of offers. Limitations: Data were collected from a single 988-member center and cannot be generalized. Conclusions: That one-third of callers do not accept follow-up highlights the need to understand reasons for not accepting follow-up. That callers with higher risk profiles are offered and accept follow-up at higher rates is reassuring and underscores the benefit of tailoring follow-up interventions for higher-risk callers.

Advanced child tax credit payments and national child abuse hotline contacts, 2019-2022

BACKGROUND

Children in households experiencing poverty are disproportionately exposed to maltreatment. Income support policies have been associated with reductions in child abuse and neglect. The advance child tax credit (CTC) payments may reduce child maltreatment by improving the economic security of some families. No national studies have examined the association between advance CTC payments and child abuse and neglect. This study examines the association between the advance CTC payments and child abuse and neglect-related contacts to the Childhelp National Child Abuse Hotline.

METHODS

A time series study of contacts to the Childhelp National Child Abuse Hotline between January 2019 and December 2022 was used to examine the association between the payments and hotline contacts. An interrupted time series (ITS) exploiting the variation in the advance CTC payments was estimated using fixed effects.

RESULTS

The CTC advance payments were associated with an immediate 13.8% (95% CI -17.5% to -10.0%) decrease in contacts to the hotline in the ITS model. Following the expiration of the advance CTC payments, there was a significant and gradual 0.1% (95% CI +0.0% to +0.2%) daily increase in contacts. Sensitivity analyses found significant reductions in contacts following each payment, however, the reductions were associated with the last three of the six total payments.

CONCLUSION

These findings suggest the advance CTC payments may reduce child abuse and neglect-related hotline contacts and continue to build the evidence base for associations between income-support policies and reductions in child abuse and neglect.

Helplines for Mental Health Support: Perspectives of New York State College Students and Implications for Promotion and Implementation of 988

Mental health and suicide are serious concerns in the U.S. Though many adults report struggling with their mental health, a significant proportion do not receive care for various reasons including stigma, limited availability, long wait times, inability to pay, and a lack of culturally appropriate options. Helplines can be used to fill gaps in care and, though currently underutilized, are a significant focus of the federal government in the implementation of 988. To better understand the factors that facilitate and impede the utilization of helplines, we conducted 14 focus groups with 95 college students attending a public university and two private colleges in upstate New York between April 2019 and October 2020. Participants included undergraduates, graduate students, LGBTQIA + students, student-athletes, and international students. Participants shared several reasons for using helplines including convenience, comfort, immediate support, and privacy and anonymity. On the other hand, participants expressed hesitation as they expected ingenuine interactions with operators and a lack of continuity, they feared police involvement, and they felt that helplines are not for them, as they are marketed for those in a mental health or suicide crisis and their issues are not that severe. LGBTQIA + participants provided additional reasons as to why they use and do not use LGBTQIA+-specific helplines. Together, our findings suggest the need for improved education, marketing, and training around helplines and may be used to inform the implementation and promotion of 988 in its early stages.

Adult female callers' characteristics and mental health status: a retrospective study based on the psychological assistance hotline in Hangzhou

OBJECTIVE

This study aims to analyze the basic characteristics and mental health status of adult female callers to the psychological assistance helpline in Hangzhou City, in order to provide targeted services for effectively intervening in the psychological crises of this group.

METHODS

Data from adult female callers to a helpline in Hangzhou City were collected between 2019 and 2022, encompassing demographic information and discussed issues. The data were analyzed according to age groups, marital status, and call times. The mental health status of the adult female population was measured by two indicators-mood status and suicide risk.

RESULTS

The study included 15,580 adult female callers. Among them, 52.2% were aged 30 and below, 62.1% were unmarried, and 42.6% were from other provinces. The primary types of calls were related to mental health (56.5%), romantic relationships (11%), and marriage/family issues (13%). Adults aged 30 and below had more consultations about romantic relationships, work, and study-related issues compared to those over 30. Those over 30 sought more advice on marriage/family and child education. Younger callers displayed higher levels of depression and suicide risk compared to older callers. Unmarried callers had a higher proportion of moderate depression and suicide risk than married callers. Higher education levels were associated with lower depression levels (OR = 0.631,95%CI:0.439-0.906, P = 0.013) and high-risk proportions (OR = 0.328,95%CI:0.147-0.733, P = 0.007). Late evening callers had a higher high-risk proportion (OR = 5.326,95%CI:2.633-10.775, P < 0.001), and employed individuals had lower high-risk proportions compared to unemployed callers (OR = 0.536,95%CI:0.320-0.897, P = 0.018).

CONCLUSION

The mental health status of female callers aged 30 and below, unemployed individuals, and those calling in the latter part of the night have relatively poorer mental health and are more likely to be at risk for suicide, which needs to be taken seriously, and more professional and targeted intervention services need to be enhanced in the hotline.

Mental Health Emergency Hotlines in the United States: A Scoping Review (2012-2021)

OBJECTIVE

Mental health emergency hotlines provide clinical supports and connection to services. This scoping review describes the current literature on hotlines in the United States, including which populations they do and do not reach, typical call volumes and engagement levels, barriers to and facilitators of implementation, and common call outcomes. The review also identifies gaps in the literature and presents recommendations.

METHODS

A systematic search of peer-reviewed articles on U.S.-based telephone, text, and chat hotlines published between January 2012 and December 2021 retrieved 1,049 articles. In total, 96 articles met criteria for full-text review, of which 53 met full inclusion criteria.

RESULTS

Approximately half of the included studies (N=25) focused on descriptive information of callers, most of whom were females, younger adults, and White; veteran hotlines typically reached older men. Common reasons for calling were suicidality, depression, and interpersonal problems. Of studies examining intervention effects (N=20), few assessed hotlines as interventions (N=6), and few evaluated caller behavioral outcomes (N=4), reporting reduced distress and suicidality among callers after hotline engagement. However, these studies also suggested areas for improvement, including reaching underrepresented high-risk populations. Six studies reported implementation needs, such as investments in data collection and evaluation, staff training, and sustainable funding.

CONCLUSIONS

Hotlines appear to be more effective at reaching some populations than others, indicating that more intensive outreach efforts may be necessary to engage underrepresented high-risk populations. The findings also indicated limited evidence on the relationship between use of hotlines-particularly local text and chat hotlines-and caller outcomes, highlighting an area for further investigation.

Individuals who text crisis text line: Key characteristics and opportunities for suicide prevention

OBJECTIVE

Text-based crisis services are increasingly prominent, with inclusion in the national 988 crisis number launching in 2022. Yet little is known about who uses them. This study seeks to understand the population served by Crisis Text Line (CTL), the largest crisis text service in the United States.

METHODS

Secondary data analysis was conducted on de-identified Crisis Counselor reports, texter post-conversation survey responses, and anonymized text conversation data from 85,877 texters who contacted CTL during a 12-month period. We examined Crisis Counselor's ratings of suicide ideation severity, texters' reports of race, gender, sexual orientation, recent mental health symptoms, and additional sources of help, and logs of frequency of contact.

RESULTS

76% of texters were under 25. 79% were female. 48% identified as other than heterosexual/straight. 64% had only one conversation. 79% were above the clinical cutoff for depression and 80% for anxiety, while 23% had thoughts of suicide. 23% received help from a doctor or therapist, and 28% received help only from CTL.

CONCLUSIONS

CTL reaches a highly distressed, young, mostly female population, including typically underserved minorities and a substantial percentage of individuals who do not receive help elsewhere. These findings support the decision to include texting in the forthcoming national 988 implementation.