• Bibtex: @comtois2019
  • Bibliography: Comtois, K. A., Kerbrat, A. H., DeCou, C. R., Atkins, D. C., Majeres, J. J., Baker, J. C., & Ries, R. K. (2019). Effect of Augmenting Standard Care for Military Personnel With Brief Caring Text Messages for Suicide Prevention: A Randomized Clinical Trial. JAMA Psychiatry, 76(5), 474–483. https://doi.org/10.1001/jamapsychiatry.2018.4530

Example citation

My notes

  • Text messages delivered over 12 months
  • n = 657
  • No main effect on suicidal ideation or hospitalization due to suicidal events
  • Fewer suicide attempts in caring contacts (9%) compared to TAU (14.9%) at one-year follow-up

Looks like they link to a certain website with info and such. But they also allowed participant responses and acted accordingly.

If a participant replied to a scheduled text with more specific content than positive or neutral comments, such as, “I’m fine, thanks,” or “Hope things are good for you too,” a response was incorporated into the next scheduled outgoing text message. If a response was requested (eg, resources, referrals), the CCs responded. If replies indicated distress, CCs’ general strategy was to express understanding and caring and confirm the participant’s access to behavioral health resources, personalizing these as appropriate on the basis of information gathered at baseline (eg, specifying the participant’s therapist’s name or the name of the clinic the participant had been attending). Replies indicating suicide risk were responded to immediately by telephone. Throughout the trial, less than 5% of responses indicated distress, and only 5 indicated suicidality.


Accessible and cost-effective interventions for suicidality are needed to address high rates of suicidal behavior among military service members. Caring Contacts are brief periodic messages that express unconditional care and concern and have been previously shown to prevent suicide deaths, attempts, ideation, and hospitalizations.To test the effectiveness of augmenting standard military health care with Caring Contacts delivered via text message to reduce suicidal thoughts and behaviors over 12 months.This randomized clinical trial was conducted at 3 military installations in the southern and western United States. Soldiers and Marines identified as being at risk of suicide were recruited between April 2013 and September 2016. The final follow-up was in September 2017.Both groups received standard care, and the Caring Contacts group also received consisted of 11 text messages delivered on day 1, at week 1, at months 1, 2, 3, 4, 6, 8, 10, and 12, and on participants’ birthdays.Primary outcomes were current suicidal ideation and suicide risk incidents (hospitalization or medical evacuation). Secondary outcomes were worst-point suicidal ideation, emergency department visits, and suicide attempts. Suicidal ideation was measured by the Scale for Suicide Ideation, suicide risk incidents, and emergency department visits by the Treatment History Interview; attempted suicide was measured by the Suicide Attempt Self-Injury Count.Among 658 randomized participants (329 randomizely assigned to each group), data were analyzed for 657 individuals (mean [SD] age, 25.2 [6.1] years; 539 men [82.0%]). All participants reported suicidal ideation at baseline, and 291 (44.3%) had previously attempted suicide. Of the 657 participants, 461 (70.2%) were assessed at 12 months. Primary outcomes were nonsignificant. There was no significant effect on likelihood or severity of current suicidal ideation or likelihood of a suicide risk incident; there was also no effect on emergency department visits. However, participants who received Caring Contacts (172 of 216 participants [79.6%]) had lower odds than those receiving standard care alone (179 of 204 participants [87.7%]) of experiencing any suicidal ideation between baseline and follow-up (odds ratio, 0.56 [95% CI, 0.33-0.95]; P = .03) and fewer had attempted suicide since baseline (21 of 233 [9.0%] in the group receiving Caring Contacts vs 34 of 228 [14.9%] in the standard-care group; odds ratio, 0.52 [95% CI, 0.29-0.92]; P = .03).This trial provides inconsistent results on the effectiveness of caring text messages between primary and secondary outcomes, but this inexpensive and scalable intervention offers promise for preventing suicide attempts and ideation in military personnel. Additional research is needed.ClinicalTrials.gov identifier: NCT01829620 PDF: comtois_2019_effect_of_augmenting_standard_care_for_military_personnel_with_brief_caring.pdf