Caring Contacts and Suicidality Among American Indian and Alaska Native Communities
9 affiliations
- 1Department of Psychiatry & Behavioral Sciences, School of Medicine, Center for Suicide Prevention & Recovery, Harborview Medical Center, University of Washington, Seattle
- 2Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- 3Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle
- 4Missouri Breaks Industries Research Institute, Eagle Butte, South Dakota
- 5Cherokee Nation, Tahlequah, Oklahoma
- 6Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks
- 7Department of Psychology, University of Alaska Anchorage, Anchorage
- 8Health Promotion Disease Prevention Program, Fort Peck Tribes, Poplar, Montana
- 9Department of Nursing & Systems Science, College of Nursing, Washington State University, Spokane
Abstract
Importance: For American Indian and Alaska Native communities, connectedness and belonging are strengths that may reduce suicide risk.
Objective: To evaluate the effectiveness of culturally-adapted Caring Contacts combined with optimal available resources (intervention) compared with optimal available resources alone (control) in reducing suicidal ideation, suicide attempts, and suicide-related hospitalizations.
Design, Setting, and Participants: The CARE study was a blinded, 2-group randomized clinical trial conducted between May 2018 and September 2023 among 5 American Indian and Alaska Native communities in Alaska, the Northern Plains, and the Southern Plains, including 4 tribal communities and 1 tribal health organization. Participants were English-speaking adults (age ≥18 years) self-identifying as American Indian or Alaska Native with active suicidality. Analysis was conducted January through April 2024.
Intervention: Caring Contacts is a low-cost intervention via brief, nondemanding messages exclusively focused on expressing care and interest sent by text message or greeting card on a pre-determined schedule over 12 months.
Main Outcomes and Measures: Outcomes included suicidal ideation in the past month (measured using the Suicidal Ideation Questionnaire–Junior [SIQ-Jr]), number of suicide attempts, and suicide-related hospitalizations over 12 months. Retention of active suicidality at follow-up was added as an additional outcome.
Results: Of 1390 individuals prescreened for eligibility, 1202 consented and were screened for eligibility, and 709 (457 [64.5%] female; mean [SD] age, 35.4 [11.5] years) were enrolled and randomized, including 357 participants in the control group and 352 participants in the Caring Contacts intervention. Most participants (549 [77.4%]) self-identified as American Indian or Alaska Native only, and 160 participants (22.6%) as American Indian or Alaska Native plus another racial group. More than half of participants (392 [55.3%]) were never married. The mean (SD) SIQ-Jr score at baseline was 42.0 (13.8), and 604 participants (85.2%) had ever made a suicide attempt. Overall, 454 participants (64.0%) provided 12-month follow-up data. Between baseline and the 12-month follow-up, both groups showed significant reductions in suicidal ideation (mean [SD] score: Caring Contacts, 41.4 [13.7] vs 22.7 [15.3]; enhanced usual care, 42.5 [13.9] vs 23.1 [14.5]) and participants with a past-year suicide attempt (Caring Contacts, 169 of 352 participants [48.0%] vs 34/240 participants [14.2%]; enhanced usual care 155 of 357 participants [43.4%] vs 39 of 238 participants [16.4%]); however, no statistically significant between-group differences were found.
Conclusions and Relevance: In this randomized clinical trial of culturally adapted Caring Contacts among American Indian or Alaska Native adults with active suicidality, Caring Contacts did not improve suicidal outcomes beyond optimal available resources alone. Similar improvements in both groups may reflect regression to the mean, the therapeutic impact of compassionate baseline engagement with supportive community staff, or the active components of optimal available resources. Further research should explore these dynamics and other culturally grounded interventions.
Trial Registration: ClinicalTrials.gov Identifier: NCT02825771
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BibTeX
@article{comtois2026caring,
title = {{Caring Contacts and Suicidality Among American Indian and Alaska Native Communities}},
author = {Katherine Anne Comtois and Luciana E. Hebert and Marija Bogic and Anna Evanson and Barbara Wright and Martina Fruhbauerova and Francine Red Willow and Tony Walking and Lori High Elk and Carrie Big Leggins and Elisha Gray Hawk and Theresa Reiter-Lavery and Dorothea Ware and Anthippy Petras and Alexandria Granbois and Kelsey Shepard and Hannah Hudgens and Sam Bradshaw and Tracy Zacher and Jennifer L. Shaw and Kelley Jansen and Kenny Smoker and Lonnie Nelson},
journal = {JAMA Network Open},
year = {2026},
month = nov,
doi = {10.1001/jamanetworkopen.2026.39023},
url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856150},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Caring Contacts and Suicidality Among American Indian and Alaska Native Communities
AU - Katherine Anne Comtois
AU - Luciana E. Hebert
AU - Marija Bogic
AU - Anna Evanson
AU - Barbara Wright
AU - Martina Fruhbauerova
AU - Francine Red Willow
AU - Tony Walking
AU - Lori High Elk
AU - Carrie Big Leggins
AU - Elisha Gray Hawk
AU - Theresa Reiter-Lavery
AU - Dorothea Ware
AU - Anthippy Petras
AU - Alexandria Granbois
AU - Kelsey Shepard
AU - Hannah Hudgens
AU - Sam Bradshaw
AU - Tracy Zacher
AU - Jennifer L. Shaw
AU - Kelley Jansen
AU - Kenny Smoker
AU - Lonnie Nelson
PY - 2026
DA - 2026/11/02
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.39023
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856150
AB - Importance: For American Indian and Alaska Native communities, connectedness and belonging are strengths that may reduce suicide risk. Objective: To evaluate the effectiveness of culturally-adapted Caring Contacts combined with optimal available resources (intervention) compared with optimal available resources alone (control) in reducing suicidal ideation, suicide attempts, and suicide-related hospitalizations. Design, Setting, and Participants: The CARE study was a blinded, 2-group randomized clinical trial conducted between May 2018 and September 2023 among 5 American Indian and Alaska Native communities in Alaska, the Northern Plains, and the Southern Plains, including 4 tribal communities and 1 tribal health organization. Participants were English-speaking adults (age ≥18 years) self-identifying as American Indian or Alaska Native with active suicidality. Analysis was conducted January through April 2024. Intervention: Caring Contacts is a low-cost intervention via brief, nondemanding messages exclusively focused on expressing care and interest sent by text message or greeting card on a pre-determined schedule over 12 months. Main Outcomes and Measures: Outcomes included suicidal ideation in the past month (measured using the Suicidal Ideation Questionnaire–Junior [SIQ-Jr]), number of suicide attempts, and suicide-related hospitalizations over 12 months. Retention of active suicidality at follow-up was added as an additional outcome. Results: Of 1390 individuals prescreened for eligibility, 1202 consented and were screened for eligibility, and 709 (457 [64.5%] female; mean [SD] age, 35.4 [11.5] years) were enrolled and randomized, including 357 participants in the control group and 352 participants in the Caring Contacts intervention. Most participants (549 [77.4%]) self-identified as American Indian or Alaska Native only, and 160 participants (22.6%) as American Indian or Alaska Native plus another racial group. More than half of participants (392 [55.3%]) were never married. The mean (SD) SIQ-Jr score at baseline was 42.0 (13.8), and 604 participants (85.2%) had ever made a suicide attempt. Overall, 454 participants (64.0%) provided 12-month follow-up data. Between baseline and the 12-month follow-up, both groups showed significant reductions in suicidal ideation (mean [SD] score: Caring Contacts, 41.4 [13.7] vs 22.7 [15.3]; enhanced usual care, 42.5 [13.9] vs 23.1 [14.5]) and participants with a past-year suicide attempt (Caring Contacts, 169 of 352 participants [48.0%] vs 34/240 participants [14.2%]; enhanced usual care 155 of 357 participants [43.4%] vs 39 of 238 participants [16.4%]); however, no statistically significant between-group differences were found. Conclusions and Relevance: In this randomized clinical trial of culturally adapted Caring Contacts among American Indian or Alaska Native adults with active suicidality, Caring Contacts did not improve suicidal outcomes beyond optimal available resources alone. Similar improvements in both groups may reflect regression to the mean, the therapeutic impact of compassionate baseline engagement with supportive community staff, or the active components of optimal available resources. Further research should explore these dynamics and other culturally grounded interventions. Trial Registration: ClinicalTrials.gov Identifier: NCT02825771
SN - 2574-3805
ER -