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People in serious distress were more likely to have heard of and use the 988 Suicide and Crisis Lifeline, but many said they probably wouldn't use it again.

In a survey of nearly 5,000 U.S. adults, those with serious distress were significantly more likely to have heard of the lifeline, which launched in July 2022, than those with no distress (47.4% vs 40.4%, P=0.007), according to Jonathan Purtle, DrPH, MSc, of New York University in New York City, and colleagues.

And a larger proportion of those with serious distress used the lifeline compared with those with moderate or no distress (6% vs 1% and 0.2%, P<0.001), they reported in .

But a smaller proportion of those with serious distress reported being very likely to use 988 in the future compared with those with no distress (22.3% versus 26.2%), though this wasn't statistically significant, they found.

"Our data suggest the 988 Lifeline is being used the most by people with serious psychological distress, which is a good thing," Purtle told 番茄社区app in an email.

But he acknowledged that a "smaller proportion of people than we expected reported being 'very likely' to use the 988 Lifeline in the future if they or a loved one were experiencing suicidality or a mental health crisis. However, data not presented in the current study show that similarly small proportions of people were very likely to reach out to sources such as a mental health professional, psychologist [or] psychiatrist, friend [or] family member, or someone in their religious network."

Christine Crawford, MD, MPH, a psychiatrist at Boston University who wasn't involved in the study, told 番茄社区app that the lower likelihood of using 988 or planning to use it again could be attributed to an individual's expectations.

"The supports that are available through 988 look different depending on which part of the country you live in because it's all based on available community resources," Crawford said, noting that wait times or delays can be particularly discouraging.

Those delays may leave some respondents reconsidering calling 988 again, she added. Crawford noted that expectations can also differ based on an individual's race.

"On average, people who experience higher rates of psychological distress tend to be Black and brown individuals," she said. "What we do know to be true is that historically, Black and brown individuals are quite reluctant to call 911. I wonder if that factors into 988, given that there are situations in which when you do call 988, the police will still arrive at your house."

For their study, the researchers conducted a nationally representative web-based survey from June 9 to June 19, 2023. Past 30-day psychological distress was assessed using the Kessler K6 Scale. Respondents were asked whether they had heard of 988, had used 988 for themselves, and whether they would be likely to use it in the future.

A total of 4,942 respondents completed the psychological distress questionnaire. About half were female (51%) and the mean age was 48.1 years. Nearly 8% had serious distress, 20.4% had moderate distress, and 71.8% had no distress.

In adjusted analyses, having serious or moderate distress was significantly associated with higher odds of having heard of the 988 Lifeline compared with those with no distress (adjusted OR 1.45, 95% CI 1.16-1.82, P=0.001 and aOR 1.27, 95% CI 1.09-1.47, P=0.002, respectively).

Serious distress was also significantly associated with a far higher likelihood of having called 988 compared with those with no distress (aOR 31.96, 95% CI 12.01-85.08, P<0.001). Moderate distress was also tied to a greater odds of having called 988 but to a lesser extent (aOR 5.15, 95% CI 1.78-14.89, P=0.003), the researchers reported.

As for calling the hotline again, the researchers found that among the 23 respondents with serious distress who'd called once, only 7 (29%) were very likely to use it in the future.

The study may be limited in its generalizability, and by the fact that implementation of the 988 hotline has varied between states. State-level analyses weren't conducted.

Still, Purtle and colleagues concluded that there is "a need for more research about satisfaction with the 988 Lifeline among people with serious distress and the extent to which the 988 Lifeline, and the resources it connects users to, meets their needs."

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