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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.
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