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2019 HSR&D/QUERI National Conference Abstract

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4131 — The Effectiveness of Crisis Line Services: A Systematic Review of the Past 30 Years and Opportunities for the Future

Lead/Presenter: Kelly Stearns-Yoder,  Rocky Mountain MIRECC
All Authors: Stearns-Yoder KA (Rocky Mountain MIRECC), Hoffberg, AH (Rocky Mountain MIRECC), Brenner, LA (Rocky Mountain MIRECC)

Objectives:
Crisis line services are an essential component of a public health approach to suicide prevention. The two major goals of crisis line services are to reduce clients' crisis states/risk of suicide, and to enhance access to additional mental health care. However, the effectiveness of crisis line services in meeting these goals is not fully understood, and therefore, a comprehensive review was needed.

Methods:
In May 2018, a systematic search was conducted in Medline, EMBASE, PsycINFO, Web of Science, CINAHL, and Cochrane Library to identify literature published since 1990 that evaluated the effectiveness of crisis line services (phone, chat, and text). 757 records were identified after duplicates removed. Following preliminary screening of titles and abstracts, 158 records were retrieved and assessed for eligibility. Studies were included if they reported on any health- or use-related outcome(s) including suicidal self-directed violence, client mood, satisfaction, compliance, and service utilization, as well as helper responses (e.g., referrals, intervention styles).

Results:
32 records comprising 29 studies met eligibility criteria and were included in a qualitative synthesis. The vast majority (n = 24 out of n = 27; 89%) described crisis calls only, while n = 3 included crisis chat outcomes. The remaining studies (n = 2) looked at the relationship between the number of crisis line centers and suicides in a region. No studies examined crisis line text outcomes. Almost half of studies (n = 14) measured proximal outcomes during a crisis line service, and the remaining measured more distal outcomes ranging from ?2 weeks to 4 years.

Implications:
A variety of methods were utilized to evaluate crisis line effectiveness, including approaches that have not been validated. The risk of bias across included studies was high and quality of evidence was determined to be low. The lack of high quality evidence does not indicate a lack of crisis line effectiveness.

Impacts:
The results of this systematic review provide opportunities to improve on previous research studying the effectiveness of crisis line services, including especially a focus on more distal outcomes.