Nudging Parental Actions for Youth Suicide Prevention

Nudging Parental Action With A Randomized Controlled Trial of Text Messaging Intervention for Suicide Prevention

The goal of the study is to determine effectiveness of a behaviorally informed text messaging intervention to help parents increase safety practices and reduce their teens' access to lethal means following a suicide-related emergency department visit.

Study Overview

• Status: Recruiting
• Conditions: Suicide; Suicide Attempt
• Intervention / Treatment: Other: Text-messaging for safety reminders; Other: Text-messaging with safety reminders and risk framing

Detailed Description

This study tests a text messaging program that helps parents keep their teens safe after a visit to the emergency department for suicidal thoughts or behavior. Adolescents face a higher risk of suicide after leaving the emergency department, and limiting access to lethal means such as firearms, medications, or other dangerous items can help prevent suicide. The investigators invite parents and their teens aged 12 to 17 who visit the emergency department at Children's Medical Center Dallas for suicide-related reasons to join the study. After enrolling, families will be randomly assigned to one of three groups. The first group receives usual care, which includes standard counseling about keeping teens safe in the emergency room and no study text messages. The second group receives direct text messages three times a week with reminders about safety reminders. The third group receives risk-framing text messages three times a week, which include safety reminders and information about suicide risk following an emergency room visit to motivate parents to take action. The study measures whether these text messages help parents follow safety recommendations at home. Parents and teens complete short surveys at the start of the study, six weeks later, and twelve weeks later. The study also tracks whether the teen returns to the emergency department or attempts suicide again. The study aims to determine if text messages can increase parental safety practices, reduce teens' access to lethal means, and prevent future suicide attempts. UT Southwestern Medical Center and Children's Health Dallas conduct the study. Messages are delivered through a secure, HIPAA-compliant virtual platform to ensure privacy.

• Study Type: Interventional
• Enrollment (Estimated): 129
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Matthew Nguyen; Phone Number: 469-509-2493; Email: matthew.nguyen@UTSouthwestern.edu
• Study Contact Backup: Name: Amy Conger; Phone Number: 214-4562705; Email: amy.conger@UTSouthwestern.edu

Study Locations

• United States
  • Texas
    • Dallas, Texas, United States, 75287
      • Recruiting
      • Children's Medical Center
      • Contact: Emine Rabia Ayvaci, MD; Phone Number: +16508040602; Email: emine.ayvaci@utsouthwestern.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Guardian must be able and willing to provide informed consent, and the participant must be able and willing to provide assent.
• Parent and adolescent willingness and ability to participate in study procedures and complete assessments at baseline, 6 weeks, and 12 weeks.
• Presentation to the ED for a suicide-related emergency, defined as suicidal ideation within the last 2 weeks or a suicide attempt within the past month.
• Adolescents aged 12-17 years during the consent.
• Access to a mobile phone with text messaging capability for the parent/legal guardian.
• Ability to communicate in English.

Exclusion Criteria:

• Absence of a legal guardian capable of providing consent.
• Parents/legal guardians without access to a mobile phone with texting capability.
• Inability to communicate in English.
• Adolescents in state custody or under legal restrictions that prevent study participation.
• Adolescents involved in the justice system in a manner that would interfere with study participation.
• Adolescents with autism spectrum disorder or intellectual development disorder needing substantial or very substantial support

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control Arm; Treatment as usual (ED-based lethal means counseling)
Active Comparator: Direct Nudge; Thrice-weekly direct text messages encouraging Lethal Mean Restriction practices.	Other: Text-messaging for safety reminders; The intervention consists of thrice-weekly, behaviorally informed text messages delivered to parents over six weeks period.
Experimental: Risk-Framing Nudge Arm; Thrice-weekly direct text messages encouraging Lethal Mean Restriction practices and suicide risk statistics to recalibrate parental risk perception	Other: Text-messaging with safety reminders and risk framing; Thrice-weekly messages incorporating safety precautions and evidence-based suicide risk statistics to recalibrate parental risk perception.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Parent-reported adherence to lethal means restriction (LMR)	Change in parental adherence to lethal means restriction practices will be assessed using the Parent Adherence to Lethal Means Restriction (PA-LMR), a structured parent-report survey measuring adherence to multiple lethal means restriction behaviors. Items are rated on a Likert scale, with total scores ranging from 11 to 55; higher scores indicate greater adherence.	Baseline to 6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adolescent Perceived Access to Lethal Means	Perceived Access to Lethal Means is a self-report measure assessing adolescents' perceptions of their access to potentially lethal methods. Items assess the perceived ease of access, with total scores ranging from 5 to 30; higher scores indicate greater perceived access to lethal means.	Baseline to 6 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Exploratory Outcome	Number of participants (adolescents) with a suicide-related Emergency Department revisit and/or suicide attempt within 12 weeks post-randomization	Baseline to 12 weeks

Collaborators and Investigators

• Sponsor: University of Texas Southwestern Medical Center
• Collaborators: The Texas Child Mental Health Care Consortium (TCMHCC)
• Investigators: Principal Investigator: Emine Rabia Ayvaci, MD, University of Texas Southwestern Medical Center

Publications and helpful links

General Publications

• Barber CW, Miller MJ. Reducing a suicidal person's access to lethal means of suicide: a research agenda. Am J Prev Med. 2014 Sep;47(3 Suppl 2):S264-72. doi: 10.1016/j.amepre.2014.05.028.
• Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science. 1981 Jan 30;211(4481):453-8. doi: 10.1126/science.7455683.
• Bauer BW, Capron DW. How Behavioral Economics and Nudges Could Help Diminish Irrationality in Suicide-Related Decisions. Perspect Psychol Sci. 2020 Jan;15(1):44-61. doi: 10.1177/1745691619866463. Epub 2019 Nov 7.
• Marcus SC, Cullen SW, Xie M, Bridge JA, Caterino JM, Schmutte T, Olfson M. Evaluating the Effect of Routine Lethal Means Counseling in the Emergency Department on Suicide Mortality Among Mental Health Patients. AJPM Focus. 2025 Mar 19;4(4):100336. doi: 10.1016/j.focus.2025.100336. eCollection 2025 Aug.

Study record dates

Study Major Dates

• Study Start (Estimated): June 15, 2026
• Primary Completion (Estimated): June 15, 2027
• Study Completion (Estimated): August 31, 2027

Study Registration Dates

• First Submitted: January 26, 2026
• First Submitted That Met QC Criteria: January 26, 2026
• First Posted (Actual): February 3, 2026

Study Record Updates

• Last Update Posted (Actual): June 3, 2026
• Last Update Submitted That Met QC Criteria: June 1, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: suicide; digital health; lethal means restriction
• Additional Relevant MeSH Terms: Behavioral Symptoms; Self-Injurious Behavior; Behavior; Suicide; Suicide, Attempted
• Other Study ID Numbers: STU20252399; GAA202508-0021 (Other Grant/Funding Number: New and Emerging Children's Mental Health Researchers Initiative)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: No individual participant data is planned to be shared with other researchers.

Drug and device information, study documents

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