# Effectiveness of text-based support for parents of suicidal adolescents following emergency department visits

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $788,464

## Abstract

PROJECT SUMMARY
Emergency department (ED) visits for suicidal ideation and attempts in adolescents are rising, underscoring a
need for effective interventions preventing post-ED recurrence in youth suicidal crises. Parents are tasked with
implementing post-discharge suicide prevention recommendations (e.g., lethal means restriction, attending to
suicide warning signs, providing support), highlighting opportunities for parent-facing interventions to improve
post-ED youth outcomes.
Leveraging accessible text messaging, together with a Just
-In-Time Adaptive
Intervention (JITAI) framework designed to tailor support based on individuals’ unique and changing needs, our
goal is to examine the effectiveness of an adaptive text-based intervention for parents of suicidal youth
transitioning from ED care. We build on results from our NIMH-funded pilot of a text-based intervention with
two components, provided to parents for 6 weeks after ED discharge: (1) adolescent-centered (A-C) texts,
encouraging parental engagement in suicide prevention activities to promote youth safety; and (2) parent-
centered (P-C) texts, intended to enhance parents’ own well-being. In addition to feasibility and acceptability,
promising pilot results showed that the intervention improved key mechanisms of action and was associated
with lower post-ED youth suicide attempts. We expand on this pilot work to determine the effectiveness of the
text-based intervention in a full-scale multi-site trial and to investigate its implementation potential. In this
hybrid type 1 effectiveness-implementation trial, 420 parents of adolescents presenting with suicide risk across
two EDs will be randomized to standard ED services alone or paired with the 6-week text-based intervention
integrating A-C and P-C components. An embedded full-scale MRT in the intervention arm, with twice-daily
micro-randomizations to deliver (vs. not deliver) P-C messages, will inform a JITAI providing tailored parent-
directed support. The specific aims are to: (1) Compare standard ED services with and without the text-based
intervention on the primary outcome of youth suicidal behavior (actual, interrupted, aborted attempts) 12 weeks
after ED discharge and on two secondary outcomes of time-to-suicidal behavior and time-to-return ED visits
within 24 weeks; (2) Using the embedded MRT, determine if delivering vs. not delivering P-C messages
impacts proximal (within hours) outcomes of parental stress (primary) as well as parental positive and negative
affect (secondary); and (3) To support uptake in EDs, engage stakeholders to assess implementation barriers
and facilitators and produce an implementation package. Secondary aims are to examine if mechanisms of
action (parents’ engagement in suicide prevention activities, self-efficacy) mediate the intervention’s impact on
youth suicidal behavior, and to investigate time-varying parent and adolescent moderators (e.g., affect,
functioning) of micro-randomizations to identify wh...

## Key facts

- **NIH application ID:** 10938489
- **Project number:** 1R01MH137012-01
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Ewa Karina Czyz
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $788,464
- **Award type:** 1
- **Project period:** 2024-08-01 → 2028-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10938489

## Citation

> US National Institutes of Health, RePORTER application 10938489, Effectiveness of text-based support for parents of suicidal adolescents following emergency department visits (1R01MH137012-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10938489. Licensed CC0.

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