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

Abstract

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 CrisisCounselor 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.

Crisis text‐line interventions: Evaluation of texters' perceptions of effectiveness

“…Given the high prevalence of mental health symptoms among CTL texters and the small proportion who reported receiving professional help (Pisani et al, 2022), our findings underscore a need to focus within and beyond CTL on long-term needs of texters with the most severe mental health concerns. Several of the current findings highlight that the most distressed texters (those with high depression, anxiety, social isolation and frequent texting) felt less relieved at the end of their crisis conversation than asymptomatic texters or those who texted only once during the study period.…”

“…Of 380,850 unique, valid texters who texted on behalf of themselves during the study period, 85,877 (22.5%) responded to at least the texter survey's first item: “Did you find this conversation helpful?” We selected each texter's first conversation in which they completed the first item, yielding a dataset wherein one conversation represented each unique texter. The sample's demographic characteristics are described in detail in our companion article (Pisani et al, 2022). In brief, 65.6% of the 81,056 texters reporting their age were aged 14–24; the remainder were 13 or younger (10.3%); 25–44 (19.8%); 45–64 (4.1%) and 65 or older (0.2%).…”

“…The number of conversations each texter had with CTL during the study period was derived from their metadata containing timestamps of incoming and outgoing messages (Pisani et al, 2022), and grouped as: 1 conversation, 2–10, ≥10.…”

“…Data preparation and statistical analyses were conducted using SAS 9.4 (Inc., 2013) and R version 3.6.3 (R Core Team, 2020). A detailed description of data preparation and the comparison of the texters with a survey to those without are described in Pisani et al (2022). We explored an inverse probability weighting procedure using 237 independent variables from the CC reports, metadata (e.g., time of day, number of messages in a conversation), and counts of word sequences from text messages to adjust for differences.…”

“…How to cite this article: Gould, M. S., Pisani, A., Gallo, C., Ertefaie, A., Harrington, D., Kelberman, C., Green, S. (2022). Crisis text-line interventions: Evaluation of texters' perceptions of effectiveness.…”