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

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. 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. 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. 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. 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. Text-based
communication
 Lack of social,
emotional and non
verbal cues…
 Interpretation,
inference,
transference….

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. 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. 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. 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. 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. 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. 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. 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. 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. Suicide risk
exploration
 No exploration 11%
 Superficial exploration
63%
 Adequate or elaborate
exploration 28%

17. Safety plan
 No safety plan 60%
 Superficial 24%
 Adequate 17%

18. Correlations
 Directivity ↑
 Suicide risk
exploration ↑
 Respect ↑
 Safety plan ↑
 Length of session ↑
 Suicide risk ↑
exploration
 Safety plan ↑

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. 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. 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