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Reducing Suicide: A National Imperative
seek. Certification is available through the American Association of Suicidology for North American phone help lines, and from the Samaritans for membership in Befrienders International, based in London, England. Yet accreditation or membership does not require formal evaluation of services, nor is monitoring of services provided (Mishara and Daigle, 2001).
Research on the effectiveness of hotlines and crisis intervention is hampered by at least two methodological problems. First, suicide is a low-base rate behavior and studies typically include those who both did and did not have contact with the services in the community. Second, suicide prevention accounts for only 5–20 percent of the services provided by many such organizations (Eastwood et al., 1976; France, 1982; Knickerbocker and McGee, 1973; Lester, 1972). Hence, the noted changes in mental health status of the community may be attributable to other aspects of the organizations’ work.
The research on hotline and crisis center effectiveness in reducing suicide shows three over-arching findings. First, the available data show either reductions (Bagley, 1968) or no change (Barraclough and Jennings, 1977; Lester, 1990) in suicide rates; no increased rates have been documented. Second, until recently young white females most frequently utilized these services (CDC, 1992; Stengel, 1964). Some studies examining suicide rates in white women 25 years and younger found significant decreases in counties with suicide prevention centers (Miller et al., 1984), but only for this demographic. Third, users of these services report high satisfaction with them and often use the services again. Numerous studies have found that about 80 percent of individuals report positive experiences with the hotlines (e.g., King, 1977; Motto, 1971; Stein and Lambert, 1984; Tekavcic-Grad and Zavasnik, 1987). These findings may be inflated due to reporting bias, since response rates to these inquiries range from 40–80 percent and may disproportionally include those who found the intervention helpful. Two researchers found that callers to hotlines may be more likely to attempt than complete suicide (Bagley, 1968), which may limit the potential usefulness of hotlines in reducing suicide rates.
Demographics of hotline use may be changing with an increase in usage by middle aged individuals (Scott, 2000). Baby-boomers are more likely than previous generations to use mental health services including hotlines, so that the demographics of highest usage may follow this cohort. Analogously, the majority of current teenagers look up health information on the Internet as their first resource (Borzekowski and Rickert, 2001a; Flowers-Coulson et al., 2000). Planning for interventions for this demographic will need to address the credibility of Internet health information (Borzekowski and Rickert, 2001).