In this randomized controlled trial of 658 Soldiers and Marines, augmenting standard care with Caring Contacts did not reduce current suicidal ideation or suicide risk events at 12 month follow-up. However, Caring Contacts reduced the odds of having any suicidal ideation by 44% (80% vs. 88%) and making a suicide attempt by 48% (9% vs. 15%).

Service members screening positive for mental health concerns, including suicide, frequently do not attend behavioral health outpatient care—and dropping out of care is also common. Barriers to care such as stigma and organizational obstacles (e.g., difficulty getting time off work to attend treatment) are persistent despite considerable efforts within the DoD to reduce them. Service members are also highly transient, with care potentially being disrupted by multiple factors. Mental health problems also contribute to attrition from military service. This highlights the need for suicide prevention interventions that do not require ongoing visits to a behavioral health clinic and that can follow a service member to another installation, on deployment, and into civilian life.

In the 1970s, a psychiatrist named Jerome Motto demonstrated that non-demanding caring letters sent over a long-term period could prevent suicide among high-risk individuals. Today, Motto’s intervention remains one of the only interventions to ever show a reduction in death by suicide. 

Based on Motto’s intervention, but using 21st-century technology, Comtois and colleagues conducted a randomized controlled trial of a Caring Contacts via text message intervention with active duty Soldiers and Marines at risk for suicide. The researchers wanted to know if Caring Contacts would reduce suicidal ideation, suicide attempts, and suicide-related inpatient admissions, medical evacuations, and emergency department visits. 658 participants were randomly assigned to receive 11 Caring Contacts over 12 months in addition to standard care or standard care alone. 

Caring Contacts were authored by a study clinician who had met with and gotten to know each participant during a baseline assessment. Caring Contacts in this study were brief and focused solely on expressing care, interest, and support, e.g., “Hey Joe- hope things are going well and you’re having a good week.” When participants replied, study clinicians responded according to a study protocol that was ultimately revised to allow for natural, caring interaction, e.g., responding to “I’m good this week” with “I’m so glad to hear it!”

Outcomes were evaluated at 12 months. Contrary to hypotheses, augmenting standard care with Caring Contacts did not reduce current suicidal ideation at 12 months or hospital-based care to prevent suicide. However, Caring Contacts reduced the odds of experiencing any suicidal ideation throughout the follow-up period and reduced the odds of making a suicide attempt. 

This inexpensive intervention offers promise for preventing suicide attempts and ideation in military personnel and provides the military with a practical and scalable tool to reduce suicide risk.