Unraveling Crisis Text Services: Perceptions and Experiences among Low-income Young Adults with Suicidal Ideation - ABSTRACT Suicide was the third leading cause of death for young adults aged 15-24 in 2021. Young adults experienced increased suicidal ideation during the COVID-19 pandemic and are at an elevated risk for suicidal ideation and suicide attempts. Health systems have struggled to meet the mental health needs of young adults. Crisis text services are free, anonymous, and rapidly accessible resources that can provide critical mental health resources for low-income young adults. In 2020, the largest crisis text service organization engaged in conversations with 844,000 texters, 30% aged 18-24. In July 2022, the federal government established the 988 national suicide crisis line (which connects users to the National Suicide Prevention Lifeline) and volume rose 45% in the first week of service, demonstrating the high demand for crisis text service. Crisis text services can be accessed by young people with low financial resources who may not access care because of rurality, cost, or lack of insurance coverage for mental healthcare. Crisis text services can link to primary care for people who otherwise do not have access to health services and constitute a free resource that clinicians can recommend to patients. Despite the widespread use of crisis text services, little is known about perceptions and experiences using crisis text services among young adults. A better understanding of how young adults use or choose not to use crisis text services during a mental health crisis could improve the effectiveness of crisis text services. This project will use sequential explanatory mixed methods to address two specific aims: Aim 1 Describe low-income young adults' help-seeking behaviors, motivations, barriers to use, and impact of crisis text services for suicidal ideation through a web-based survey with 100-125 low- income young adults who have experienced SI in the past six months. Participants will be recruited using social media. Quantitative close-ended survey items will be analyzed descriptively, describing differences between young adults who engaged with crisis text services and those who did not. Qualitative open-ended survey items will be analyzed using thematic analysis and used to direct the focus of Aim 2 interviews. Aim 2 Explore perceptions of and experiences with crisis text services among low-income young adults with suicidal ideation via in-depth interviewing with adults aged 18-24. The sample will include those who engaged with a crisis text service for suicidal ideation (n=20) and those who did not engage with a crisis text service when experiencing suicidal ideation (n=20). Participants will be recruited via social media, healthcare providers, and local organizations and interviewed via synchronous text, phone, or videoconference. Data will be analyzed using grounded theory. This research will support health service improvements for AHRQ priority populations, including adolescents and those who are low-income and rural. Findings from this study can be used to inform suicide prevention interventions, crisis text service refinement, and as pilot data for future crisis text service research.
