TY - JOUR AU - Van der Burgt, Margot C A AU - Mérelle, Saskia AU - Brinkman, Willem-Paul AU - Beekman, Aartjan T F AU - Gilissen, Renske PY - 2024 DA - 2024/9/5 TI - Breaking Down Barriers to a Suicide Prevention Helpline: Web-Based Randomized Controlled Trial JO - JMIR Ment Health SP - e56396 VL - 11 KW - barrier reduction intervention KW - suicidal ideation KW - self-help KW - suicide prevention helpline KW - randomized controlled trial KW - help-seeking KW - suicide KW - RCT KW - self-test KW - effectiveness KW - prevention KW - middle-aged KW - behavioral KW - attitudinal KW - website visitors KW - website visitor KW - website KW - men KW - suicide prevention AB - Background: Every month, around 3800 people complete an anonymous self-test for suicidal thoughts on the website of the Dutch suicide prevention helpline. Although 70% score high on the severity of suicidal thoughts, <10% navigate to the web page about contacting the helpline. Objective: This study aimed to test the effectiveness of a brief barrier reduction intervention (BRI) in motivating people with severe suicidal thoughts to contact the suicide prevention helpline, specifically in high-risk groups such as men and middle-aged people. Methods: We conducted a fully automated, web-based, randomized controlled trial. Respondents with severe suicidal thoughts and little motivation to contact the helpline were randomly allocated either to a brief BRI, in which they received a short, tailored message based on their self-reported barrier to the helpline (n=610), or a general advisory text (care as usual as the control group: n=612). Effectiveness was evaluated using both behavioral and attitudinal measurements. The primary outcome measure was the use of a direct link to contact the helpline after completing the intervention or control condition. Secondary outcomes were the self-reported likelihood of contacting the helpline and satisfaction with the received self-test. Results: In total, 2124 website visitors completed the Suicidal Ideation Attributes Scale and the demographic questions in the entry screening questionnaire. Among them, 1222 were randomized into the intervention or control group. Eventually, 772 respondents completed the randomized controlled trial (intervention group: n=369; control group: n=403). The most selected barrier in both groups was “I don’t think that my problems are serious enough.” At the end of the trial, 33.1% (n=122) of the respondents in the intervention group used the direct link to the helpline. This was not significantly different from the respondents in the control group (144/403, 35.7%; odds ratio 0.87, 95% CI 0.64‐1.18, P=.38). However, the respondents who received the BRI did score higher on their self-reported likelihood of contacting the helpline at a later point in time (B=0.22, 95% CI 0.12‐0.32, P≤.001) and on satisfaction with the self-test (B=0.27, 95% CI 0.01‐0.53, P=.04). For male and middle-aged respondents specifically, the results were comparable to that of the whole group. Conclusions: This trial was the first time the helpline was able to connect with high-risk website visitors who were hesitant to contact the helpline. Although the BRI could not ensure that those respondents immediately used the direct link to the helpline at the end of the trial, it is encouraging that respondents indicated that they were more likely to contact the helpline at a later point in time. In addition, this low-cost intervention provided greater insight into the perceived barriers to service. Follow-up research should be focused on identifying the added value of other components (eg, video or photo material) in the BRI and increasing its effectiveness, especially for men and middle-aged people. Trial Registration: ClinicalTrials.gov NCT05458830; https://clinicaltrials.gov/study/NCT05458830 International Registered Report Identifier (IRRID): RR2-10.2196/41078 SN - 2368-7959 UR - https://mental.jmir.org/2024/1/e56396 UR - https://doi.org/10.2196/56396 DO - 10.2196/56396 ID - info:doi/10.2196/56396 ER -