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The Challenges of Detecting Suicidal Callers in Text-Based Youth Helplines

17th European Symposium on Suicide & Suicidal Behaviour, Ghent, Belgium. 2018

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The Challenges of Detecting Suicidal Callers in Text-Based Youth Helplines

  1. 1. The challenges of detecting suicidal callers in text-based youth helplines LOUIS-PHILIPPE CÔTÉ; BRIAN L. MISHARA CENTER FOR RESEARCH AND INTERVENTION ON SUICIDE, ETHICAL ISSUES AND END-OF-LIFE PRACTICES UNIVERSITÉ DU QUÉBEC À MONTRÉAL, CANADA
  2. 2. The challenges of detecting suicidal callers in text-based youth helplines  Challenges related to ….  Mission and objectives of youth helplines  Staff and training issues in youth helplines  Nature of text-based communication  We will illustrate these challenges by presenting the results of a study in progress
  3. 3. Youth helplines are general helplines  They are used by youth …  To get information on a wide variety of topics  To discuss sensitive topics with a trusted adult anonymously  To express distress (sometimes suicidal ideations) and get help
  4. 4. Youth helplines are general helplines  No systematic suicide risk assessment policies  Handling suicidal callers is a minor aspect of their overall training  Suicide risk assessment skills are not practiced often
  5. 5. Youth helplines helpers are not (usually)…  Psychologists or psychiatrists  No comprehensive clinical interviews  Scientists or suicidologists  No complex validated scales  Psychics or magicians  No thoughts reading…
  6. 6. Text-based communication  Lack of social, emotional and non verbal cues…  Interpretation, inference, transference….
  7. 7. In summary, the main challenges …  Suicide risk assessment is an uncommon practice in youth general helpline  Suicide risk assessment in text-based youth helplines is more about helpers perceptions than objective description or prediction  Gathering data on suicidality in text-based youth helplines is a complex operation
  8. 8. Research questions  How effective are text-based youth helpline in detecting suicidal children?  Generally speaking, Is there an underestimation of the number of suicidal callers in text-based youth helplines statistics?
  9. 9. Current study  Evaluation of text-based youth helpline in Quebec (Canada)  Good public image  Often given as a reference in newspaper articles or in tv show
  10. 10. This study has three main objectives:  1) to estimate the proportion of suicidal individuals among the youths contacting a text-based youth helpline  2) to determine the proportion of the suicidal youths who mention their suicidal ideations in their conversation with the service  3) to assess the proportion of interventions with suicidal youths where the counselor performs a suicidal risk assessment
  11. 11. Method Post-intervention questionnaire  Satisfaction (3 items)  During the past 12 months, did you ever seriously consider attempting suicide?  Have you ever tried to commit suicide?  BDI-13 Suicide item  postintervention suicidal ideations Content analysis  Callers  Age, gender  Reason (s) of the call  Apparent suicidality  No (no indications)  Maybe (indirect verbalizations)  Yes (explicit verbalizations)  Helpers  Suicide risk investigation & action plan
  12. 12. Sample Postintervention questionnaire •n.2820 •Response rate ≈15% Suicidal ideations – 12 months •n.1314 (42%) Suicide attempt(s) •n. 671 (21%) Content analysis (in progress) •n.283  2820 youths who contacted the service answered the postintervention questionnaire  42% reported having experienced serious suicidal ideation in the past 12 months  35% reported having attempted suicide in their lifetime
  13. 13. Sample Postintervention questionnaire •n.2820 •Response rate ≈15% Suicidal ideations – 12 months •n.1314 (42%) Suicide attempt(s) •n. 671 (21%) Content analysis (in progress) •n.283  2820 answered the postintervention questionnaire  42% reported serious suicidal ideation in the past 12 months  35% reported having attempted suicide in their lifetime  Content analysis (n.283)  Recent suicidal ideation + suicide attempt(s)  Age: 16.52 / Female: 88 %
  14. 14. First reason for contact  45% of kids who talked about their suicidal ideations called to talk about suicide  55% of kids who talked about their suicidal ideations called for another reason than suicide  Mental illness symptoms is the most common reason
  15. 15. Exploration & revelation of suicidal ideations (SI)  All interventions involving suicidality  78% SI revealed by the caller  Primary reason for contact  90 % SI revealed by the caller  Secondary reason for contact  66 % SI revealed by the caller
  16. 16. Suicide risk exploration  No exploration 11%  Superficial exploration 63%  Adequate or elaborate exploration 28%
  17. 17. Safety plan  No safety plan 60%  Superficial 24%  Adequate 17%
  18. 18. Correlations  Directivity ↑  Suicide risk exploration ↑  Respect ↑  Safety plan ↑  Length of session ↑  Suicide risk ↑ exploration  Safety plan ↑
  19. 19. Post-intervention suicidal ideation kids who did talked about suicide 10 % reported no post- intervention ideations 45 % reported they think that death would free them 45 % reported explicit suicide ideations
  20. 20. Post-intervention suicidal ideation kids who did not talked about suicide: 35 % reported no post- intervention ideations 39 % reported they think death would free them 26 % reported explicit suicide ideations
  21. 21. Conclusion  We need to find creative ways to identify suicidal youth  Pre-intervention questionnaire?  Machine learning and NLP ?  Post-intervention questionnaire with follow up?  Better training in handling suicidal callers in text-based youth helpline  Evidence based practices

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