Table 1.

Review of Crisis Line Evaluation Studies

Citation (listed chronologically)	Evaluation Design	Evaluation Findings
Weiner, 1969	A comparison of suicide rates in Los Angeles County before and after the introduction of a crisis hotline. Also, comparisons were made with the suicide rates in other California counties (one of the other three counties had a prevention program, two did not).	Researchers did not find a decrease in the suicide rate of Los Angeles Country after implementation of the program, but rather an increase. The suicide rate seemed to increase slightly with the rise in number of calls.
Bidwell, Bidwell, and Tsai, 1971	An evaluation of the demographic data records from a three-year period from September 1, 1966, to August 31, 1969, of crisis hotline calls were compared with data from those who had died by suicide. Names were compared to see whether the reported names of those who had committed suicide were found within the call logs of the help line.	The findings support the hypothesis that suicidal attempters and suicides constitute two epidemiological populations, albeit overlapping, and that the crisis intervention method of the suicide prevention programs can reach the first group but not the second. In other words, the demographics of the callers more closely resembled the attempters group, rather than the suicide completion group.
Lester, 1971	The census tract of 214 callers (of 626 possible) was identified and correlated with census tracts of local suicides for 1966–68.	Census tracts in Buffalo with one or more suicide in 1966–68 accounted for 86 percent of callers and 81.6 percent of the population.
Litman, 1976	Among a group of persons in contact with a crisis center, this study compared an experimental group that received outbound calls (Continuing Relationship Maintenance, or CRM), once per week for an average of 18 months per person with a control group.	No differences in completed suicides, suicide risk, or willingness to accept help. CRM group was less likely to live alone, had more improved personal relationships, better use of professional help, and less depression.
Leenaars and Lester, 1995	Pearson correlation between provincial suicide rates and (a) absolute number of crisis centers, (b) density of crisis centers per capita, and (c) density of crisis centers per area.	All correlations negative, though no statistical tests of significance were performed.
Mishara and Daigle, 1997	Trained observers listened to and coded calls in real time to ascertain the relative effectiveness of the volunteers' various intervention styles on the reduction of psychological distress of the callers. The volunteers' ability to encourage the caller to make a “no suicide contract” was also assessed.	An overall decrease in depressed mood was found from the beginning to the end of calls, but depression only decreased in 14 percent of calls and remained the same in 85 percent of calls. There was also a significant decrease in suicide urgency from the beginning to the end of the call (urgency decreased in 27 percent of calls), especially for non-chronic callers. Contracts were made in 68 percent of calls, more frequently with chronic callers. Calls were classified as “Rogerian style” or “directive style.” Those volunteers using Rogerian style had significantly more decreases in caller depression and more contracts.
Fiske and Arbore, 2000	The study measured depressive symptoms, hopelessness, and life satisfaction before and after clients received 1 year of services (including warmline with both inbound and outbound calls) from the agency.	A paired t-test revealed a significant reduction in hopelessness among the clients. There were no significant changes in depressive symptoms or life satisfaction. There were no changes in hopelessness, depressive symptoms, or life satisfaction in the comparison group.
King, Nurcombe, Bickman, Hides, and Reid, 2003	Independent raters quantify changes in suicidality over the course of a call or counseling session by reviewing the first 5 minutes when suicidality first became evident and last 5 minutes of the call.	Decreases in callers' mental state and suicidal ideation occurred from the beginning to the end of the call; a decrease in calls rated to be at “imminent risk” and an increase in those rated as “no suicide urgency” was also observed.
Mishara, Houle, and Lavoie, 2005	Pre-test, post-test, and follow-up questionnaires were administered to participants who received each of five different support styles, including telephone counseling, though participants were not randomly assigned. Questionnaires contained questions about the callers themselves as well as about the suicidal man. Questionnaires to family/friends addressed issues such as coping mechanisms and utilization of resources, whereas the questionnaires related to the suicidal man included topics such as suicidal behaviors and alcoholism. Some topic areas overlapped. No control group.	There were no differences across the five support styles. Participants reported that suicidal men were less likely to have suicide attempts or ideation and depressive symptoms post-training, and these effects were maintained at the 6-month follow-up. The programs did not increase knowledge/use of resources for the participants or suicidal man. Participants reported that treatment did not reduce the suicidal man's use of alcohol/drugs. On the pre-test questionnaire, participants also reported some reasons for not discussing the man's suicidal intentions with him: 32 percent cited not wanting to upset the suicidal person and 21 percent reported feeling embarrassed or ashamed to discuss the issue of suicide.
Mishara, Chagnon, and Daigle, 2007a	Trained observers listened to and coded calls in real time. The professional helpers were rated on different categories: their ability to conduct a suicide risk assessment in accordance with American Association of Suicidology accreditation, their ability to send emergency rescue if needed, and their ability to intervene according to existing theories related to active listening and collaborative problem-solving models.	81 percent of calls had a good initial rapport between helpers and callers. Only one-half of helpers asked about suicidal ideation. Of the callers who were reporting ideation, 46 percent were not asked about a plan; most were not asked about prior attempts.
Mishara, Chagnon, and Daigle, 2007b	Trained observers listened to and coded calls in real time. This evaluation is related to Mishara, Chagnon, and Daigle, 2007a. It looks to analyze whether there is a correlation between the behavior of the helpers and any short-term outcomes seen in the callers.	Empathy, respect, supportive approach, good contact, and collaborative problem solving were significantly related to positive outcomes. Active listening was not related to outcomes.
Meehan and Broom, 2007	Call logs were completed by volunteers, and 535 callers between March and September 2004 were mailed a questionnaire on their perceptions of the service (only 41 mailed the form back). The form included satisfaction for call, reasons for call, and time it took after learning about hotline to call.	Demographic data on callers presented; those who completed the questionnaire were generally happy with how their call was handled.
Gould, Kalafat, Munfakh, and Kleinman, 2007	Counselors at eight crisis centers conducted standardized assessments at the beginning and end of calls, and also asked if they could follow-up in 1–2 weeks with the caller. Follow-up calls were made by independent research interviewers.	Seriously suicidal individuals reached out to telephone crisis services. Significant decreases in suicidality were found during the course of the telephone session, with continuing decreases in hopelessness and psychological pain in the following weeks. A caller's intent to die at the end of the call was the most potent predictor of subsequent suicidality.
Kalafat, Gould, Munfakh, and Kleinman, 2007	Counselors at eight crisis centers conducted standardized assessments at the beginning and end of calls, and also asked if they could follow up in 1–2 weeks with the caller. Follow-up calls were made by independent research interviewers.	Significant decreases in callers' crisis states and hopelessness were found during the course of the telephone session, with continuing decreases in crisis states and hopelessness in the following weeks. A majority of callers were provided with referrals and/or plans of action for their concerns, and approximately one-third of those provided with mental health referrals had followed up with the referral by the time of the follow-up assessment. While crisis service staff coded these callers as nonsuicidal, at follow-up nearly 12 percent of them reported having suicidal thoughts either during or since their call to the center.
Ho, Chen, Ho, Lee, Chen, and Chou, 2011	The evaluation uses a pre-test/post-test design to evaluate the effectiveness of a center's programs, using monthly Bureau of Health data to track suicide rate changes since the center's opening in 2006.	From 2005 to 2008, suicide rates decreased, Kaohsiung Suicide Prevention Center (KSPC) crisis line calls increased, the number of KSPC telephone counseling sessions increased, and suicide attempt reporting increased.
Gould, Munfakh, Kleinman, and Lake, 2012	Lifeline callers who had received a mental or behavioral health care referral were interviewed two weeks after their call to assess depression, referral follow-through, and barriers to utilization both in suicidal callers and non-suicidal crisis callers.	Decreases in callers' mental state and suicidal ideation occurred from the beginning to the end of the call; a decrease in calls rated to be at “imminent risk” and an increase in those rated as “no suicide urgency” were also observed.
Knox, Kemp, McKeon, and Katz, 2012	Administrative data on calls to the Veteran's Crisis Line, which was established in July 2007, are reviewed.	Since the inception of the Department of Veterans Affairs' (VA) suicide hotline, the percentage of veterans self-identifying as veterans has increased from 30 percent to just over 60 percent, as of September 30, 2010; the volume of calls as of this time was 171,000. Seventy percent of callers were male veterans, and those who disclosed their age were between 40 and 69 years old. Approximately 4,000 referrals were made to the VA's suicide prevention coordinators as of 2008; there were 16,000 referrals at the end of September 2010.
Gould, Cross, Pisani, Munfakh, and Kleinman, 2013	Trained observers listened to and coded calls in real time across 17 call centers nationwide. Centers were offered staggered ASIST training, and analyses used hierarchical regression to evaluate relevant outcomes (counselors' interventions, callers' behavior change, the relation between the two, and effects over time) on the basis of whether centers had or had not received ASIST training.	Call counselors trained in ASIST had significantly positive intervention behaviors on six of 23 metrics, including longer calls and four of seven behavior changes (less suicidal, depressed, and overwhelmed; more hopeful). No relationship between time since training and outcomes. All behaviors that ASIST significantly impacted were associated with improved caller outcomes.