Overview of the Healthy Thinking Trial

Suicide is the most common cause of death in Australians aged 15-44 and the tenth most common cause of death overall for Australian males. However, many people with suicidal thoughts are reluctant to seek help.

The Internet can play an important role in overcoming obstacles for seeking help by providing accessible and anonymous prevention efforts.

The Healthy Thinking trial aims to test the effectiveness of a web-based self-help program for people with suicidal thoughts. The major aim of this Randomised Controlled Trial (RCT) is to determine whether an evidence-based web-based self-help program, found to be effective in a Dutch population, reduces levels of suicidal thoughts in the Australian context. The trial is currently underway and is seeking to recruit more than 400 participants, aged 18 – 65 years who have experienced suicidal thoughts and have not attempted suicide in the past month.

Trial type

 Web-based, self-help program

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Rationale

Prevalence

In Australia, approximately 2,500 persons die by suicide each year, which accounts for 1.5% of all deaths.

The estimated annual prevalence of attempted suicide in Australian adults is 0.4% (65,000 persons). Suicidal thoughts are experienced by an estimated 2.3% of Australian adults (almost 400,000 people). The estimated financial cost of suicide and non-fatal suicidal behaviour in Australia is $17.5B (in 2007/2008 dollars) or 1.3% of GDP. About 90% of unplanned and 60% of planned first attempts occur within one year after first thinking about suicide (Kessler, Borges, & Walters, 1999). These figures show the need to aim prevention at the onset of suicidal thoughts.


Help negation & Internet

It has been estimated that 44% of persons with suicidal thoughts in high-income countries are not receiving treatment.

The most frequently reported barriers for seeking help include attitudinal barriers and low perceived need for treatment. Other factors that may play a role in help negation include shame, fear of losing autonomy and negative attitudes towards health care providers. By providing accessible and anonymous prevention the Internet could play an important role in overcoming obstacles for seeking help. Online suicide prevention initiatives in Israel and the Netherlands have already shown an enormous need for this kind of support. However, studies are needed to examine the effectiveness of online suicide prevention.


Prevention and treatment programs

There is a lack of evidence-based suicide prevention strategies and treatments.

This trial builds on earlier work conducted by researchers at VU University Amsterdam in the Netherlands, who developed and pilot tested the initial self-help website for suicidal ideation.

Their research demonstrated the website improved suicidal thinking among people with moderate to severe thoughts. We are currently trialling the English version in conjunction with VU University Amsterdam. In this trial, we have sought to enhance participant online experience whilst increasing the visual appeal of the website, and incorporating instant messaging via SMS to support the key strategies.

Aims

Primary aim: The major aim of this RCT is to determine whether the web-based self-help program reduces levels of suicidal thoughts in the Australian context.

Secondary aims: To determine whether the web-based program reduces suicide plans, increases the capacity to cope with suicidal thoughts, and promotes a positive approach to living.

Contributors

Helen Christensen
Bregje Van Spijker
Daniela Solomon
Ad Kerkhof
Andrew Mackinnon
Phil Batterham

Research trial

The effectiveness of a web-based self-help intervention to reduce suicidal thoughts: A randomized controlled trial
BAJ Van Spijker, A Van Straten, A Kerkhof
Trials 11 (1), 25

Funding

Australian Rotary Health Grant 2012 – NHMRC Project Grant APP1046317