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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
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
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
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
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…
Text-based
communication
 Lack of social,
emotional and non
verbal cues…
 Interpretation,
inference,
transference….
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
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?
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
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
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
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
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 %
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
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
Suicide risk
exploration
 No exploration 11%
 Superficial exploration
63%
 Adequate or elaborate
exploration 28%
Safety plan
 No safety plan 60%
 Superficial 24%
 Adequate 17%
Correlations
 Directivity ↑
 Suicide risk
exploration ↑
 Respect ↑
 Safety plan ↑
 Length of session ↑
 Suicide risk ↑
exploration
 Safety plan ↑
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
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
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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The Challenges of Detecting Suicidal Callers in Text-Based Youth Helplines

  • 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