Chatsafe Netherlands: Improving Safe Suicide Communication for Young People on Social Media (CSNL)

Testing the Impact of #ChatsafeNL in a Randomized Controlled Trial: Does a Social Media Intervention Improve Dutch Young People's Safe Online Communication About Suicide?

Suicide is the leading cause of death among young people (YP) aged 10 to 25 years in the Netherlands. In addition, YP report high rates of suicidal ideation (16%). While suicidal behavior is a complex phenomenon with many factors and causes, the role of social media is becoming more prominent, especially for YP. Social media has been shown to be a source where YP can find support, but it's also a place where suicidal behavior is glorified or normalized, which can be triggering or harmful to other social media consumers.

The #Chatsafe guidelines were developed by Orygen Australia to better equip young people to communicate safely about suicide on social media. These guidelines are supported by a social media campaign to make the content of the guidelines more accessible to them. The #Chatsafe intervention consists of both the guidelines and the social media campaign. A small-scale Australian feasibility study showed promising results in terms of the acceptance and safety of the campaign, and safety regarding communicating about suicide on social media platforms. Currently, in Australia it is tested to what extent these results hold up in a Randomized Controlled Trial (RCT) (Robinson et al., 2023).

With funding from the Dutch National Agenda for Suicide Prevention, a contextualized replication study is conducted. The aim of this study is to determine whether the #Chatsafe intervention has an effect on the way in which Dutch YP communicate online about suicide.

Study Overview

• Status: Recruiting
• Conditions: Communication; Social Media; Suicide Prevention
• Intervention / Treatment: Behavioral: Social Media campaign

Detailed Description

The #Chatsafe guidelines were developed by Orygen to better equip YP to communicate safely about suicide on social media. These guidelines are supported by a national social media campaign to make the content of the guidelines more accessible to the target group. The #Chatsafe intervention consists of both the guidelines and a social media campaign. A small-scale Australian feasibility study showed promising results in terms of acceptance and safety of the campaign, as well as the willingness of young people to intervene against suicide, their perceived self-efficacy, confidence, and safety regarding communicating about suicide on social media platforms. To test whether the effects hold up in a controlled setting, a Randomized Controlled Trial (RCT) is conducted.

With funding from the Dutch National Agenda for Suicide Prevention, commissioned by 113 Suicide Prevention, the #Chatsafe campaign is being translated to fit the Dutch context through a co-design process involving end users. To investigate whether this campaign has the intended effect in the Netherlands, a contextualized replication study into the efficacy of ChatsafeNL (Chatsafe Netherlands) is conducted in a controlled setting. The aim of the research is to determine whether the #ChatsafeNL intervention affects how YP, both with and without suicidal ideation, communicate online about suicide. A group receiving #ChatsafeNL content (intervention group) will be compared with a group who received content about sexual health and wellbeing (control group).

In the current study, the efficacy of the #ChatsafeNL intervention is tested in an RCT. The intervention condition (#ChatsafeNL social media intervention) is compared with a control intervention (sexual health campaign). The intervention phase lasts 8 weeks. Participants will be recruited over a period of 6-12 months.

Participants are asked to complete a self-report questionnaire at three different times, namely prior to the intervention (baseline, T1), immediately after the 8-week intervention (T2) and 4 weeks post-intervention (T3). During the intervention period, participants receive campaign content every week for 8 weeks. They are offered a short questionnaire to monitor safety and assess the evaluation of the content.

Initially, the campaign is developed for Instagram. This may expand to other social media platforms later on.

• Study Type: Interventional
• Enrollment (Estimated): 400
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Elke Elzinga, dr; Phone Number: 020 3113883; Email: e.elzinga@113.nl
• Study Contact Backup: Name: Saskia Mérelle, dr; Phone Number: 020 3113883; Email: s.merelle@113.nl

Study Locations

• Netherlands
  • Noord Holland
    • Amsterdam, Noord Holland, Netherlands, 1105 BP
      • Recruiting
      • 113 Suicide Prevention
      • Contact: Elke Elzinga, dr; Phone Number: 020 3113883; Email: e.elzinga@113.nl
      • Contact: Saskia Mérelle, dr; Phone Number: 020 3113883; Email: s.merelle@113.nl

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• age between 16-25 years,
• living in the Netherlands and speaking Dutch,
• see themselves as active social media user,
• is willing to share mobile phone number with the research team.

Exclusion Criteria:

None, if participants meet the inclusion criteria, they can principally participate in the study; having suicidal ideation is not a reason for exclusion. An extensive safety procedure is drawn up, which describes how the safety of the participants is monitored.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; #Chatsafe suicide prevention content.	Behavioral: Social Media campaign; Participants receive content three times a week; in total 24 pieces of content in 8 weeks. The content can consist of one or more photos or images with a caption (explanation in text).
Active Comparator: Control; Sexual health and wellbeing content	Behavioral: Social Media campaign; Participants receive content three times a week; in total 24 pieces of content in 8 weeks. The content can consist of one or more photos or images with a caption (explanation in text).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safe communication about suicide online	This outcome measure was specially developed for the Chatsafe Australia study, it will be measured by the purpose-designed #Chatsafe online safety questionnaire (Robinson et al., 2023) immediately after intervention. It is based upon an adapted version of the Perceived Safety Questionnaire. It consists of 4 different subscales, for each of which a sum score will be calculated: general use, seeing content, responding to content and interacting with content on social media. Overall sum score on communicating about self-harm and suicide on social media (25 items) ranges from 25-100, where higher scores reflect more safe communication. In addition, vignettes will be used to calculate scores concerning: sharing experiences of suicide online score, responding online to someone at risk and communication online about a suicide that has occurred (range 53-265). Here, also higher scores reflect more safe communication.	Before, immediately after intervention and at 4 week follow up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Confidence when communicating about suicide online	measured by the #Chatsafe online safety questionnaire	Before, immediately after intervention and at 4 week follow up
Willingness to intervene against suicide online	measured via the Willingness to Intervene Questionnaire	Before, immediately after intervention and at 4 week follow up
Self-efficacy online	measured by the Internet Self-Efficacy Questionnaire	Before, immediately after intervention and at 4 week follow up
Safety of the #ChatsafeNL materials	measured by the weekly evaluation survey	Before, immediately after intervention and at 4 week follow up
Acceptability of the #ChatsafeNL intervention	measured by the evaluation questions	Before, immediately after intervention and at 4 week follow up
Safety of the #ChatsafeNL intervention	This is measured, among other things, by the number (or absence of) adverse events during the study period, such as a response to item 9 of the Patient Health Questionnaire that indicates they experience suicidal ideation, a response to the weekly questionnaire indicating that participants find the content disturbing, responses to the questionnaire that indicates that certain campaign content distressed participants and whether the research team was contacted by respondents to report distress or risk of self-harm or suicide.	Before, immediately after intervention and at 4 week follow up

Collaborators and Investigators

• Sponsor: 113 Suicide Prevention
• Collaborators: Orygen; Mind
• Investigators: Principal Investigator: Saskia Mérelle, dr, 113 Suicide Prevention

Publications and helpful links

General Publications

• Robinson J, La Sala L, Cooper C, Spittal M, Rice S, Lamblin M, Brown E, Nolan H, Battersby-Coulter R, Rajaram G, Thorn P, Pirkis J, May-Finlay S, Silenzio V, Skehan J, Krysinska K, Bellairs-Walsh I. Testing the Impact of the #chatsafe Intervention on Young People's Ability to Communicate Safely About Suicide on Social Media: Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2023 Feb 17;12:e44300. doi: 10.2196/44300.
• La Sala L, Pirkis J, Cooper C, Hill NTM, Lamblin M, Rajaram G, Rice S, Teh Z, Thorn P, Zahan R, Robinson J. Acceptability and Potential Impact of the #chatsafe Suicide Postvention Response Among Young People Who Have Been Exposed to Suicide: Pilot Study. JMIR Hum Factors. 2023 May 19;10:e44535. doi: 10.2196/44535.
• La Sala L, Teh Z, Lamblin M, Rajaram G, Rice S, Hill NTM, Thorn P, Krysinska K, Robinson J. Can a social media intervention improve online communication about suicide? A feasibility study examining the acceptability and potential impact of the #chatsafe campaign. PLoS One. 2021 Jun 15;16(6):e0253278. doi: 10.1371/journal.pone.0253278. eCollection 2021.

Study record dates

Study Major Dates

• Study Start (Actual): April 8, 2024
• Primary Completion (Estimated): December 1, 2024
• Study Completion (Estimated): March 1, 2025

Study Registration Dates

• First Submitted: April 2, 2024
• First Submitted That Met QC Criteria: April 9, 2024
• First Posted (Actual): April 15, 2024

Study Record Updates

• Last Update Posted (Actual): May 1, 2024
• Last Update Submitted That Met QC Criteria: April 30, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Suicide prevention; Suicidal Ideation; Communication; Social Media
• Additional Relevant MeSH Terms: Behavioral Symptoms; Self-Injurious Behavior; Suicide; Suicide Prevention
• Other Study ID Numbers: ChatsafeNL; 2023.0348 (Other Identifier: Medical Ethics Committee VUmc)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The data will be made available upon reasonable request

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No