Suicidal Ideation Among Children and Young Adults in a 24/7 Messenger-Based Psychological Chat Counseling Service

Abstract

BackgroundSuicidality in children and young adults is a pervasive problem: approximately 40% of respondents in epidemiological surveys in German schools reported suicidal ideation, while up to 9% reported a suicide attempt in the past. While there is compelling evidence for the effectiveness of telephone-based hotline services, an increasing preference of adolescents for messenger-based counseling services can be observed. Therefore, the present study aims to investigate the utilization behavior and user satisfaction of users contacting a German messenger-based chat counseling service (“krisenchat”) regarding suicidal ideation.MethodsThe present cross-sectional study analyzed retrospective anonymous data on sociodemographic variables, utilization behavior, and user satisfaction of krisenchat users who used the service between May 2020 and July 2021. Chi-square-tests were used to identify associations of sociodemographic characteristics and utilization behavior with suicidal ideation. Mann-Whitney-U-tests were used to compare the user satisfaction and the recommendation-to-others-rate between suicidal and non-suicidal krisenchat-users.ResultsIn total, chat data of N = 11,031 users were collected. Of the n = 6,962 users included in the final analysis, n = 1,444 (20.7%) contacted krisenchat because of suicidal ideation. The average user experiencing suicidal ideation was 17 years old, female and currently not receiving other treatment. Further, suicidal ideation was significantly and positively associated with age and non-suicidal self-injury. Regarding utilization patterns, there were significant positive associations between suicidal ideation and counseling session count, mean amount of messages sent, and mean amount of words used per message by the user. User satisfaction was high, with 64.7% (n = 413) of users that answered the feedback survey and experiencing suicidal ideation rating the help they received as at least “good” and a recommendation rate of 89.6% (n = 571). Most importantly, no differences were found between users reporting suicidal ideation and those that do not regarding satisfaction and the probability of recommending the service.ConclusionResults imply satisfaction with the counseling service among users with suicidal ideation. Nevertheless, there is a need for further research into messenger-based counseling services regarding the prevention of suicidal behavior in children, youths, and young adults. Longitudinal studies are especially needed to assess the effectiveness of messenger-based interventions.Study RegistrationDRKS00026671.

The Impact of a Messenger-Based Psychosocial Chat Counseling Service on Further Help-Seeking Among Children and Young Adults: Longitudinal Study

“…In a recent systematic review on the state of youth helplines, which is at least partly comparable to the krisenchat service, the authors concluded that helplines may provide a beneficial service to youth and that psychosocial concerns are the main reasons for contacting these services [ 45 ]. This result is in line with previous evaluations of krisenchat [ 32 , 33 ]. The authors also concluded from the results of the review that there is a lack of literature owing to a lack of controlled trials on the one hand, and complex methodological/ethical barriers preventing such trials on the other [ 45 ].…”

“…The first cross-sectional evaluation showed a high acceptance, feasibility, and user satisfaction of this service [ 32 ]. The results indicated a high need for a 24/7 accessible, anonymous, and low-threshold online help service to offer rapid stress relief in acute crises such as suicidality [ 33 ]. Besides its goal to increase the mental health literacy of users, krisenchat aims to refer users in need to professional help services or personal contacts [ 32 ].…”

Digital Health Intervention Towards Suicidal Ideation Among Adolescents

“…The results of the article review show that digital health interventions that are often used to overcome suicidal ideation vary the most, namely interventions via the internet/websites in eight articles (Bailey et al, 2020;De Jaegere et al, 2019;Han et al, 2019 ;Hetrick et al, 2017;Iorfino et al, 2017;Robinson et al, 2016;Spijker et al, 2012;Sueki et al, 2014), messenger two articles (Kohls et al, 2022;Sindahl et al al., 2019), and two mobile phone applications (Rodante et al, 2022;Torok et al, 2022).…”

“…Two studies used the messaging feature, or Short Messaging Service (SMS), on smartphones as a means of intervention. Among them, some use messages from social media such as WhatsApp, which is called Krisenchat (Kohls et al, 2022).…”

“…Education provided by researchers includes Cognitive Behavior Therapy (CBT) (Bailey et al, 2020;De Jaegere et al, 2019;Hetrick et al, 2017;Robinson et al, 2016;Rodante et al, 2022 ;Spijker et al, 2012), Dialectical Behavior Therapy (DBT) (De Jaegere et al, 2019;Spijker et al, 2012), Problem Solving Therapy (PST) (De Jaegere et al, 2019;Spijker et al ., 2012), and Mindfulness Based Cognitive Therapy (MBCT) (Bailey et al, 2020;Rodante et al, 2022;Spijker et al, 2012) which is provided through a module which can be downloaded (Bailey et al, 2020;De Jaegere et al, 2019;Iorfino et al, 2017;Robinson et al, 2016;Spijker et al, 2012), read when there is notification of tips related to psychoeducational material (Rodante et al, 2022), using audio/mp3 tracks (Bailey et al, 2020;Hetrick et al, 2017;Robinson et al, 2016), video (Hetrick et al, 2017;Robinson et al, 2016), messages both via SMS and chat via social media such as Whatsapp (Kohls et al, 2022;Sindahl et al, 2019), email, video calls (Iorfino et al, 2017), and focus group discussions through Video Conferences/Web Conferences such as Zoom/GoToMeeting ( Han et al, 2019). The results of the review show that the use of interventions via the website is cheaper in terms of price compared to traditional treatments or interventions that are usually carried out face-to-face (Spijker et al, 2012).…”