Adolescent Suicide

Suicide Interventions

Crisis Centers and Hotlines

Background

Crisis centers and hotlines are based on the premise that suicide is often associated with a critical stress event, it is usually approached with ambivalence, and the wish to commit suicide is seen as a way to solve an immediate problem. Crisis centers and hotlines are designed to deal with the immediate crisis, and use the individual’s ambivalence to convince them that there are other means of solving the problem other than suicide. Some hotlines are aimed specifically at teens and are manned by teens. 

There have been no studies of the impact of crises services established specifically for teens. The evaluations which have been done are correlational studies examining the relationship between the establishment of a hotline and the suicide rate.


Review of crisis center and hotline studies:

Author

Miller et al., 1984

Study design and target population

Time series analysis

US, 1968-1973 data 

All ages

Intervention

Comparison of 25 counties in US which had no crisis centers in 1968-69 but had centers in 1970 to 50 counties with the same number of crisis centers throughout time period

Outcomes

Suicide mortality rates

Results

There was a 55% decrease in the suicide rate for white females <25 years in the counties which initiated crisis centers compared to an 85% increase in the suicide rate in counties which maintained status quo. No change for other female age groups or for males.

Study quality and conclusions

Young white females are the most frequent callers to suicide crisis centers so the reduction in the rate of suicide following their introduction is plausible.



Author

Barraclough et al., 1977

Study design and target population

Controlled study in the UK: comparison of boroughs with Samaritan centers to:

(1) Nearest non-Samaritan borough matched as closely as possible on demographic, health, social and economic factors.

(2) Same as 1 but excluded pairs if they had centers opened within 3 years of one another.

(3) Boroughs matched on pre-intervention suicide rates.

(4) Boroughs matched on the % single-person households.

Intervention

Crisis centers and hotlines (the Samaritans)

Outcomes

Suicide rates for the 3 years before opening of a center to the 3 years following the opening.

Results

Differences in changes in suicide rates intervention -control:

(1) -3%

(2) +.4%

(3) +9.2%

(4) -.6%

Study quality and conclusions

No evidence of an effect of the centers.

Controlled study which was strengthened by use of 4 different types of controls.



Author

Bridge et al., 1977

Study design and target population

Cross-sectional analysis, comparing counties in North Carolina with and without crisis centers

North Carolina, 1970

Intervention

Crisis centers

Outcomes

County-specific suicide centers

Results

Change in R2 for presence of a crisis center was 0.001 with suicide rate as the outcome variable

Study quality and conclusions

Although it is a somewhat unsophisticated analysis, there is no evidence for an effect of the presence of a crisis center on suicide rates.



Author

Weiner, 1969

Study design and target population

Time series analysis with comparison to cities without centers, 1955-1967

California, all ages

Intervention

Crisis center hotline

Outcomes

Suicide rates in Los Angeles and San Francisco compared to San Diego and San Bernardino without crisis centers

Results

Rates of suicide increased by 17% in Los Angeles and 30% in San Francisco with crisis centers and decreased by 1.5% in San Diego and 13% in San Bernardino without crisis centers.

Study quality and conclusions

Ecological study and its inherent weaknesses. 

However, no evidence for an effect of the centers on suicide rates

Summary of studies on hotlines and crisis centers

Except for the Miller study, there are no convincing data that these centers and hotlines are effective in reducing suicide rates.

Recommendations on hotlines and crisis centers

At the present time, these centers cannot be recommended as a primary prevention strategy for suicide. There may be other goals which these centers accomplish which justify the resource use.