- Adolescents showed significantly lower SI/SB at 12 months with two-way Caring Contacts versus Instrumental Support Calls (ADM = -0.64, 95% CI = -1.11, -0.18).
- Among adults, SI/SB scores at 6 months were higher with Caring Contacts versus Instrumental Support Calls (ADM = 0.50, 95% CI = 0.12, 0.88).
- SPARC trial indicates optimal follow-up differs by age: adolescents benefit from sustained two-way CC; adults benefit from early intensive ISC.
Am J Psychiatry. 2026 Oct 28:appiajp20260157. doi: 10.1176/appi.ajp.20260157. Online ahead of print.
ABSTRACT
OBJECTIVE: The authors sought to determine whether augmenting usual suicide care with follow-up in the form of instrumental support calls (ISC) or two-way Caring Contacts texts (CC) works best to reduce suicidal ideation and behavior (SI/SB) in adolescents and adults.
METHODS: The Suicide Prevention Among Recipients of Care (SPARC) Trial is a pragmatic comparative effectiveness randomized clinical trial stratified by age, with participants randomized in a 1:1 ratio to ISC or CC. Participants were adolescents (12-17 years, N=723) and adults (18+ years, N=797) who screened at risk for suicide in emergency departments (N=9) and primary care clinics (N=36) between May 2021 and July 2022; primary data collection was completed in August 2023. Outcomes included Columbia-Suicide Severity Rating Scale SI/SB score at 6 months (primary) and 12 months (secondary).
RESULTS: Adolescents (N=723; mean age, 14.9 years [SD=1.6]) were mostly female (75%), White (84.1%), and non-Hispanic (84.2%). Adults (N=797; mean age, 38.3 years [SD=15.9]) were mostly female (70%), White (89.1%), and non-Hispanic (90%). At 6 months, outcomes were similar by condition among adolescents, but among adults, SI/SB scores were significantly higher among those receiving CC compared to those receiving ISC (adjusted difference in means [ADM]=0.50, 95% CI=0.12, 0.88). At 12 months, adolescents’ SI/SB scores were significantly lower in the CC compared with the ISC condition (ADM=-0.64, 95% CI=-1.11, -0.18), but outcomes were similar by condition among adults.
CONCLUSIONS: The best suicide prevention follow-up care may vary by age, with adolescents benefiting most from longer-term connection-focused two-way CC and adults benefiting most from more intensive early instrumental support through ISC.
PMID:42946687 | DOI:10.1176/appi.ajp.20260157
Share Evidence Blueprint
Save to Google Notes
Search Google Scholar
Save as PDF
⭐ My Revision List
