Instrumental Support Calls vs. Caring Contacts Texts to Prevent Suicide in Adolescents and Adults: The SPARC Randomized Clinical Trial

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.