Breaking down barriers

This thesis evaluated some of the preventive measures of 113 Suicide Prevention and explored the barriers that individuals face when seeking help for suicidal thoughts. This thesis was divided into three parts: Part I centred around the SUPRANET Community programme, a two-year multi-component suicide prevention programme. The studies in Part II evaluated the impact of the COVID-19 lockdowns on the demand for the helpline and the nature of the coronavirus-related problems of help-seekers. Part III described the design and results of a randomised controlled trial among the anonymous website visitors of 113 Suicide Prevention with severe suicidal ideation, aimed to reduce barriers to the helpline. The first study evaluates the effectiveness of a public awareness campaign in achieving attitudinal change in the general public. Respondents who indicated having seen the campaign showed more openness towards seeking professional help and were considerably more likely to be familiar with Dutch helpline than those who did not. Surprisingly, campaign awareness also seemed to relate to a higher perceived taboo on suicide and a lower estimation of the value of professional help. Our repeated cross-sectional study on the effectiveness of the SUPRANET Community programme on attitudinal changes in the general public showed that respondents in the intervention regions viewed professional help as more valuable and were more often familiar with the Dutch helpline than respondents in the control region. Although the ‘high exposure’ region seemed to perform better on various key variables, the differences were too small to be statistically significant. We could, therefore, not conclude that there was an exposure-response relationship in which higher exposure to the programme led to greater attitudinal change and brand awareness. Part II examined the impact of the pandemic on the helpline. Results revealed a steady rise in demand for the helpline, but with no distinctive relation with the lockdown measures. Approximately a quarter of the analysed chat and phone call conversations during the first lockdown were labelled as coronavirus-related by the counsellors. Most frequently mentioned conversation topics were: the interruption to or changes in professional care, loneliness and social isolation, lack of distractions, loss of routine and/or structure and ways to find a distraction from suicidal thoughts and rumination. A follow-up study that was carried out together with the Flemish suicide prevention helpline. showed that almost 20% of conversations were coronavirus-related, with ‘loneliness and social isolation’ primarily registered in more than half of those conversations, followed by ‘a lack of distractions and loss of routine’, ‘increase in feelings of depression and/or anxiety’ and ‘feelings of entrapment or being stuck at home’. Stricter government lockdown measures were related to a higher number of coronavirus-related conversations in the helplines. Part III presented the design and results of the first randomised controlled trial on the website of the Dutch suicide prevention helpline. In this study, we aimed to test whether it is possible to motivate people with severe suicidal ideation and little to no motivation to contact the helpline by providing more tailored information about their self-reported barriers in a so-called ‘’barrier reduction intervention’. In total, 2,124 website visitors completed the questions in the entry screening questionnaire. In both groups, the most selected barriers were “I don’t think that my problems are serious enough”, “I don’t think that 113 can help me”, and “I’m scared to talk about my feelings”. Results showed that a short text-based ‘barrier reduction intervention’ could not motivate people to use a direct link to the helpline immediately after the intervention. However, the intervention group reported higher satisfaction with the self-test and a greater intention to contact the helpline at a later point in time.