Digital Narrative Bibliotherapy as a Scalable Intervention for Suicidal Thoughts

NCT05351645 | Completed

• 1 other identifier: IRB19-0843
• Study Type: interventional
• Target: 864
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this study was to determine whether reading about others' experiences with suicide can help reduce suicidal thoughts. To investigate this issue, the investigators recruited users from an internet support community. The investigators randomized participants to two separate groups: a Treatment group and a Control group. Participants in the treatment group read one first-person narrative about suicide each day for 14 days, and answered questions before and after reading the narrative. Participants in the Control group answered questions once per day during the 14-day trial period and did not receive the narrative intervention until after the initial study ended. All participants completed a follow-up questionnaire two weeks after the end of the 14-day trial period.

Conditions

Suicidal Ideation

Keywords

Suicide; suicidal ideation; daily diary; randomized controlled trial

Outcome Measures

Primary Outcomes (1)

• Suicidal Thoughts

  Participants self-reported their current desire to die on a Likert-type scale. Responses were made using a 9-point Likert-type scale ranging from 1 (not at all) to 10 (definitely). Higher scores indicate higher feelings of suicidal thoughts.

  14-day trial period with a follow-up assessment two weeks later

Secondary Outcomes (2)

• Optimism

  14-day trial period with a follow-up assessment two weeks later

• Connectedness

  14-day trial period with a follow-up assessment two weeks later

Study Arms (2)

Treatment

ACTIVE COMPARATOR

Participants in the Treatment arm were assigned to read one each day during the two-week trial period. These articles described a personal experience suicide from a first-person perspective, and included positive messages. Before and after reading these articles, participants in the Treatment arm answered brief questions assessing current suicidal thoughts and other constructs. Participants in the Treatment group were administered follow-up questionnaires 14 days after the completion of the trial period to assess suicidal thoughts and other constructs.

Behavioral: Treatment

Control

NO INTERVENTION

Participants in the Control arm answered questionnaires one time per day assessing suicidal thoughts and among other constructs (the same items as the Treatment group) during the two-week trial. Control participants did not receive the positive suicide related stories during the two-week trial period. Participants in the control group completed follow-up questionnaires 14 days after the completion of the trial period to assess suicidal thoughts and other constructs (the same items as the Treatment group). After the follow-up phase was complete, participants in the Control group received the same intervention as those in the Treatment group.

Interventions

Treatment BEHAVIORAL

Once per day for a 14-day trial period, participants in the Treatment group were assigned to read a first-person narrative about a past issue with suicidal thoughts or behaviors. These narratives each contained positive elements, such as providing details about how the author had overcome issues with suicide, suggesting that people with suicidal thought are "not alone," or encouraging people with suicidal thoughts/behaviors to have hope.

Treatment

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 or above
• English as primary language
• Having thought about suicide in the past 12 months

You may not qualify if:

• a high level of suicide intent (as indicated by a 7 or greater on a 10-point scale of intent to act on suicidal thoughts)

Sponsors & Collaborators

• Harvard University: lead

Study Sites (1)

Harvard University

Cambridge, Massachusetts, 02138, United States

Location

Related Publications (48)

• Akhouri, D. (2018). Bibliotherapy as a Self Management Method to Treat Mild to Moderate Level of Depression. International Journal of Research in Social Sciences. Vol. 8 Issue 7, July 2018.

  BACKGROUND

• Anderson L, Lewis G, Araya R, Elgie R, Harrison G, Proudfoot J, Schmidt U, Sharp D, Weightman A, Williams C. Self-help books for depression: how can practitioners and patients make the right choice? Br J Gen Pract. 2005 May;55(514):387-92.

  PMID: 15904559 BACKGROUND

• Berkley-Patton J, Goggin K, Liston R, Bradley-Ewing A, Neville S. Adapting effective narrative-based HIV-prevention interventions to increase minorities' engagement in HIV/AIDS services. Health Commun. 2009 Apr;24(3):199-209. doi: 10.1080/10410230902804091.

  PMID: 19415552 BACKGROUND

• Berry N, Lobban F, Belousov M, Emsley R, Nenadic G, Bucci S. #WhyWeTweetMH: Understanding Why People Use Twitter to Discuss Mental Health Problems. J Med Internet Res. 2017 Apr 5;19(4):e107. doi: 10.2196/jmir.6173.

  PMID: 28381392 BACKGROUND

• Betzalel, N., & Shechtman, Z. (2017). The impact of bibliotherapy superheroes on youth who experience parental absence. School Psychology International, 38(5), 473-490.

  BACKGROUND

• Bietti LM, Tilston O, Bangerter A. Storytelling as Adaptive Collective Sensemaking. Top Cogn Sci. 2019 Oct;11(4):710-732. doi: 10.1111/tops.12358. Epub 2018 Jun 28.

  PMID: 29954043 BACKGROUND

• Booker, J.A., & Dunsmore, J.C.. (2017). Expressive Writing and Well-Being During the Transition to College: Comparison of Emotion-Disclosing and Gratitude-Focused Writing Jordan A. Journal of Social and Clinical Psychology. 36(7), 580-606.

  BACKGROUND

• Bower P, Richards D, Lovell K. The clinical and cost-effectiveness of self-help treatments for anxiety and depressive disorders in primary care: a systematic review. Br J Gen Pract. 2001 Oct;51(471):838-45.

  PMID: 11677710 BACKGROUND

• Curtin SC, Tejada-Vera B, Anderson RN. Death Rates by Marital Status for Leading Causes of Death: United States, 2010-2019. Natl Vital Stat Rep. 2021 Oct;70(10):1-17.

  PMID: 34662268 BACKGROUND

• Crimp, D. (1987) How to have promiscuity in an epidemic. AIDS: Cultural Analysis/Cultural Activism, 43: 237-271. Https:// doi:10.2307/3397576

  BACKGROUND

• Cuijpers P. Bibliotherapy in unipolar depression: a meta-analysis. J Behav Ther Exp Psychiatry. 1997 Jun;28(2):139-47. doi: 10.1016/s0005-7916(97)00005-0.

  PMID: 9194011 BACKGROUND

• Cuijpers P, Donker T, van Straten A, Li J, Andersson G. Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychol Med. 2010 Dec;40(12):1943-57. doi: 10.1017/S0033291710000772. Epub 2010 Apr 21.

  PMID: 20406528 BACKGROUND

• Curtin, S.C., Warner, M. (2016). Increase in Suicide in the United States, 1999-2014. National Center for Health Statistics, Center for Disease Control.

  BACKGROUND

• Davies F, Shepherd HL, Beatty L, Clark B, Butow P, Shaw J. Implementing Web-Based Therapy in Routine Mental Health Care: Systematic Review of Health Professionals' Perspectives. J Med Internet Res. 2020 Jul 23;22(7):e17362. doi: 10.2196/17362.

  PMID: 32706713 BACKGROUND

• Eichenberg C. Internet message boards for suicidal people: a typology of users. Cyberpsychol Behav. 2008 Feb;11(1):107-13. doi: 10.1089/cpb.2007.9924.

  PMID: 18275323 BACKGROUND

• Evans K, Tyrer P, Catalan J, Schmidt U, Davidson K, Dent J, Tata P, Thornton S, Barber J, Thompson S. Manual-assisted cognitive-behaviour therapy (MACT): a randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. Psychol Med. 1999 Jan;29(1):19-25. doi: 10.1017/s003329179800765x.

  PMID: 10077290 BACKGROUND

• Franklin JC, Fox KR, Franklin CR, Kleiman EM, Ribeiro JD, Jaroszewski AC, Hooley JM, Nock MK. A brief mobile app reduces nonsuicidal and suicidal self-injury: Evidence from three randomized controlled trials. J Consult Clin Psychol. 2016 Jun;84(6):544-57. doi: 10.1037/ccp0000093. Epub 2016 Mar 28.

  PMID: 27018530 BACKGROUND

• Franz PJ, Nook EC, Mair P, Nock MK. Using Topic Modeling to Detect and Describe Self-Injurious and Related Content on a Large-Scale Digital Platform. Suicide Life Threat Behav. 2020 Feb;50(1):5-18. doi: 10.1111/sltb.12569. Epub 2019 Jul 2.

  PMID: 31264733 BACKGROUND

• Glicken, M.D. (2009) Using Evidence-Based Practice to Diagnosis and Assess Psychosocial Difficulties in Older Adults. In: Practical Resources for the Mental Health Professional, Evidence-Based Counseling and Psychotherapy for an Aging Population. Academic Press, Pages 71-99, https://doi.org/10.1016/B978-0-12-374937-6.00004-8.

  BACKGROUND

• Gray, J. B. (2009). The power of storytelling: Using narrative in the healthcare context. Journal of Communication in Healthcare, 2(3), 258-273. doi:10.1179/cih.2009.2.3.258

  BACKGROUND

• Gualano MR, Bert F, Martorana M, Voglino G, Andriolo V, Thomas R, Gramaglia C, Zeppegno P, Siliquini R. The long-term effects of bibliotherapy in depression treatment: Systematic review of randomized clinical trials. Clin Psychol Rev. 2017 Dec;58:49-58. doi: 10.1016/j.cpr.2017.09.006. Epub 2017 Sep 29.

  PMID: 28993103 BACKGROUND

• Gucciardi E, Jean-Pierre N, Karam G, Sidani S. Designing and delivering facilitated storytelling interventions for chronic disease self-management: a scoping review. BMC Health Serv Res. 2016 Jul 11;16:249. doi: 10.1186/s12913-016-1474-7.

  PMID: 27401836 BACKGROUND

• Jaroszewski AC, Morris RR, Nock MK. Randomized controlled trial of an online machine learning-driven risk assessment and intervention platform for increasing the use of crisis services. J Consult Clin Psychol. 2019 Apr;87(4):370-379. doi: 10.1037/ccp0000389.

  PMID: 30883164 BACKGROUND

• Jiang, M., Ammerman, B.A., Zeng, Q. et al. Phrase-level pairwise topic modeling to uncover helpful peer responses to online suicidal crises. Humanit Soc Sci Commun 7, 36 (2020). https://doi.org/10.1057/s41599-020-0513-5

  BACKGROUND

• Karin E, Crane MF, Dear BF, Nielssen O, Heller GZ, Kayrouz R, Titov N. Predictors, Outcomes, and Statistical Solutions of Missing Cases in Web-Based Psychotherapy: Methodological Replication and Elaboration Study. JMIR Ment Health. 2021 Feb 5;8(2):e22700. doi: 10.2196/22700.

  PMID: 33544080 BACKGROUND

• Lewis C, Pearce J, Bisson JI. Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review. Br J Psychiatry. 2012 Jan;200(1):15-21. doi: 10.1192/bjp.bp.110.084756.

  PMID: 22215865 BACKGROUND

• Sheehan L, Oexle N, Armas SA, Wan HT, Bushman M, Glover L, Lewy SA. Benefits and risks of suicide disclosure. Soc Sci Med. 2019 Feb;223:16-23. doi: 10.1016/j.socscimed.2019.01.023. Epub 2019 Jan 21.

  PMID: 30690334 BACKGROUND

• Llewellyn-Beardsley J, Rennick-Egglestone S, Callard F, Crawford P, Farkas M, Hui A, Manley D, McGranahan R, Pollock K, Ramsay A, Saelor KT, Wright N, Slade M. Characteristics of mental health recovery narratives: Systematic review and narrative synthesis. PLoS One. 2019 Mar 28;14(3):e0214678. doi: 10.1371/journal.pone.0214678. eCollection 2019.

  PMID: 30921432 BACKGROUND

• Mattingly, C. and Garro, L. C. (2000) 'Narrative and the Cultural Construction of Illness and Healing', University of California Press, Berkeley, CA.

  BACKGROUND

• McKendree-Smith NL, Floyd M, Scogin FR. Self-administered treatments for depression: a review. J Clin Psychol. 2003 Mar;59(3):275-88. doi: 10.1002/jclp.10129.

  PMID: 12579545 BACKGROUND

• Mitchell KJ, Ybarra ML. Online behavior of youth who engage in self-harm provides clues for preventive intervention. Prev Med. 2007 Nov;45(5):392-6. doi: 10.1016/j.ypmed.2007.05.008. Epub 2007 May 21.

  PMID: 17599399 BACKGROUND

• Monroy-Fraustro D, Maldonado-Castellanos I, Aboites-Molina M, Rodriguez S, Sueiras P, Altamirano-Bustamante NF, de Hoyos-Bermea A, Altamirano-Bustamante MM. Bibliotherapy as a Non-pharmaceutical Intervention to Enhance Mental Health in Response to the COVID-19 Pandemic: A Mixed-Methods Systematic Review and Bioethical Meta-Analysis. Front Public Health. 2021 Mar 15;9:629872. doi: 10.3389/fpubh.2021.629872. eCollection 2021.

  PMID: 33796496 BACKGROUND

• Naher AF, Rummel-Kluge C, Hegerl U. Associations of Suicide Rates With Socioeconomic Status and Social Isolation: Findings From Longitudinal Register and Census Data. Front Psychiatry. 2020 Jan 14;10:898. doi: 10.3389/fpsyt.2019.00898. eCollection 2019.

  PMID: 31992995 BACKGROUND

• Nguyen HL, Allison JJ, Ha DA, Chiriboga G, Ly HN, Tran HT, Nguyen CK, Dang DM, Phan NT, Vu NC, Nguyen QP, Goldberg RJ. Erratum to: Culturally adaptive storytelling intervention versus didactic intervention to improve hypertension control in Vietnam: a cluster randomized controlled feasibility trial. Pilot Feasibility Stud. 2017 Jun 15;4:2. doi: 10.1186/s40814-017-0149-4. eCollection 2018.

  PMID: 28702217 BACKGROUND

• Niederkrotenthaler T, Gould M, Sonneck G, Stack S, Till B. Predictors of psychological improvement on non-professional suicide message boards: content analysis. Psychol Med. 2016 Dec;46(16):3429-3442. doi: 10.1017/S003329171600221X. Epub 2016 Sep 22.

  PMID: 27654957 BACKGROUND

• Nitschke JP, Forbes PAG, Ali N, Cutler J, Apps MAJ, Lockwood PL, Lamm C. Resilience during uncertainty? Greater social connectedness during COVID-19 lockdown is associated with reduced distress and fatigue. Br J Health Psychol. 2021 May;26(2):553-569. doi: 10.1111/bjhp.12485. Epub 2020 Oct 25.

  PMID: 33099800 BACKGROUND

• Oexle N, Waldmann T, Staiger T, Xu Z, Rusch N. Mental illness stigma and suicidality: the role of public and individual stigma. Epidemiol Psychiatr Sci. 2018 Apr;27(2):169-175. doi: 10.1017/S2045796016000949. Epub 2016 Dec 6.

  PMID: 27919303 BACKGROUND

• Perrin PB, Pierce BS, Elliott TR. COVID-19 and telemedicine: A revolution in healthcare delivery is at hand. Health Sci Rep. 2020 Jun 3;3(2):e166. doi: 10.1002/hsr2.166. eCollection 2020 Jun. No abstract available.

  PMID: 32500101 BACKGROUND

• Rahmat, H. K., Muzaki, A., & Pernanda, S. (2021, March). Bibliotherapy as An Alternative to Reduce Student Anxiety During Covid-19 Pandemic: a Narrative Review. In Proceeding International Conference on Science and Engineering (Vol. 4, pp. 379-382).

  BACKGROUND

• Rennick-Egglestone S, Morgan K, Llewellyn-Beardsley J, Ramsay A, McGranahan R, Gillard S, Hui A, Ng F, Schneider J, Booth S, Pinfold V, Davidson L, Franklin D, Bradstreet S, Arbour S, Slade M. Mental Health Recovery Narratives and Their Impact on Recipients: Systematic Review and Narrative Synthesis. Can J Psychiatry. 2019 Oct;64(10):669-679. doi: 10.1177/0706743719846108. Epub 2019 May 2.

  PMID: 31046432 BACKGROUND

• Rogers, S.L. Mortality Statistics: 1916, Seventeenth Annual Report. Department of Commerce, Bureau of the Census. Washington.

  BACKGROUND

• Smith NM, Floyd MR, Scogin F, Jamison CS. Three-year follow-up of bibliotherapy for depression. J Consult Clin Psychol. 1997 Apr;65(2):324-7. doi: 10.1037//0022-006x.65.2.324.

  PMID: 9086697 BACKGROUND

• Stip E, Ostlundh L, Abdel Aziz K. Bibliotherapy: Reading OVID During COVID. Front Psychiatry. 2020 Dec 7;11:567539. doi: 10.3389/fpsyt.2020.567539. eCollection 2020.

  PMID: 33364987 BACKGROUND

• Trout DL. The role of social isolation in suicide. Suicide Life Threat Behav. 1980 Spring;10(1):10-23. doi: 10.1111/j.1943-278x.1980.tb00693.x.

  PMID: 7361340 BACKGROUND

• Weimerskirch PJ. Benjamin Rush and John Minson Galt, II. Pioneers of bibliotherapy in America. Bull Med Libr Assoc. 1965 Oct;53(4):510-26.

  PMID: 5319266 BACKGROUND

• Wootton, B.M., Steinman, S.A., Czerniawski, A. et al. An Evaluation of the Effectiveness of a Transdiagnostic Bibliotherapy Program for Anxiety and Related Disorders: Results From Two Studies Using a Benchmarking Approach. Cogn Ther Res 42, 565-580 (2018). https://doi.org/10.1007/s10608-018-9921-x

  BACKGROUND

• Yuan S, Zhou X, Zhang Y, Zhang H, Pu J, Yang L, Liu L, Jiang X, Xie P. Comparative efficacy and acceptability of bibliotherapy for depression and anxiety disorders in children and adolescents: a meta-analysis of randomized clinical trials. Neuropsychiatr Dis Treat. 2018 Jan 24;14:353-365. doi: 10.2147/NDT.S152747. eCollection 2018.

  PMID: 29416337 BACKGROUND

• Yuen, E.K., Goetter, E.M., Herbert, J., & Forman, E. (2012). Challenges and Opportunities in Internet-Mediated Telemental Health. Professional Psychology: Research and Practice, 43, 1-8.

  BACKGROUND

MeSH Terms

Conditions

Suicidal Ideation; Suicide

Interventions

Therapeutics

Condition Hierarchy (Ancestors)

Self-Injurious Behavior; Behavioral Symptoms; Behavior

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: Participants were not explicitly told which group (Treatment or Control) they were assigned to, but the Treatment group received an article by email each day, in addition to questionnaires, and the Control group received only questionnaires. Thus, Group assignment was likely detectable by participants
• Purpose: TREATMENT
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: Participants were randomized to one of two groups (Treatment and Control) after providing informed consent. Participants in the Treatment group received the digital bibliotherapy intervention, and participants in the Control group were assigned to a waitlist.

Study Record Dates

• First Submitted: January 11, 2022
• First Posted: April 28, 2022
• Study Start: November 20, 2020
• Primary Completion: March 14, 2021
• Study Completion: March 14, 2021
• Last Updated: April 28, 2022

Record last verified: 2022-04

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR, ANALYTIC CODE
• Time Frame: Data will be available from the time of first publication for at least 5 years
• Access Criteria: Researchers affiliated with not-for-profit institutions, and who are interested in this study's data can contact the principal investigator to request access.

Locations

US (1)