Evaluation of the 113Online Suicide Prevention Crisis Chat Service: Outcomes, Helper Behaviors and Comparison to Telephone Hotlines

Abstract

Recognizing the importance of digital communication, major suicide prevention helplines have started offering crisis intervention by chat. To date there is little evidence supporting the effectiveness of crisis chat services. To evaluate the reach and outcomes of the 113Online volunteer-operated crisis chat service, 526 crisis chat logs were studied, replicating the use of measures that were developed to study telephone crisis calls. Reaching a relatively young population of predominantly females with severe suicidality and (mental) health problems, chat outcomes for this group were found to be comparable to those found for crisis calls to U.S. Lifeline Centers in 2003-2004, with similar but not identical associations with specific helpers' styles and attitudes. Our findings support a positive effect of the 113Online chat service, to be enhanced by practice standards addressing an apparent lack of focus on the central issue of suicidality during chats, as well as by the development of best practices specific for online crisis intervention.

Texting for Help: Processes and Impact of Text Counseling with Children and Youth with Suicide Ideation

“…Although different measures were used, it is relevant to mention that researchers at two Canadian suicide helplines found a decreased depressive mood from beginning to the end in 14% (17% for only nonfrequent callers) of calls (Mishara & Daigle, ). In a study of the American national suicide prevention network, a decrease in depressive mood was observed in 18.3% of the suicidal callers (Mishara et al., ), and a Dutch study of an online suicide helpline found improvement in visitors’ emotional states in 36.1% to 48.5% of the sessions (Mokkenstorm et al., ). In this context, the results of this study suggest the relevance of text counseling to help some texters during the course of a session.…”

“…This of course should be taken into account when comparing the results with studies using external raters (Mishara & Daigle, ; Mishara et al., ). Previous studies have shown that perceived support is a stronger predictor of changes in mental health than support received (Mokkenstorm et al., ), so it makes sense to ask the participants themselves when measuring constructs such as being taken seriously, well‐being, and self‐confidence. However, the weakness of this method, compared to the use of external raters, is the large dropout rate with the positive bias that goes with it—as indicated in the current study.…”

“…Such a positive bias for self‐rated outcome measures in helpline research is suggested and discussed by Mokkenstorm et al. () and Mishara et al. ().…”

“…Behaviors associated with collaborative problem solving were associated with positive outcomes, but just engaging in active listening was not (Mishara et al., ). A similar Dutch study conducted at a chat‐based crisis helpline for suicidal people showed a positive association between measures on the Crisis Call Outcome Rating Scale and counseling sessions with a higher level of using a supportive approach and good contact, collaborative problem solving and active listening (Mokkenstorm et al., ). However, this study did not show any relationship between counselor style and changes in the clients’ emotional state and suicidal ambivalence—partly due to a high degree of missing data since suicidal ambivalence was not explored in 64.1% of the session segments (first and last 10 min of session) subjected to analysis (Mokkenstorm et al., ).…”

“…A growing body of research has consistently shown that helplines are effective tools in reducing distress and suicidality for help‐seekers. Most of these studies concern telephone‐based services (Gould, Kalafat, HarrisMunfakh, & Kleinman, ; King, Nurcombe, Bickman, Hides, & Reid, ; Lester, ; Mishara & Daigle, ; Mishara et al., ) and one concerns chat‐based interventions (Mokkenstorm et al., ). To our knowledge, there are no published studies on the efficacy of text‐based suicide helpline services.…”