Caring Contacts and Suicidality Among American Indian and Alaska Native Communities: A Randomized Clinical Trial.

In 30 seconds

The CARE study was a blinded, two-group randomized clinical trial of 709 American Indian and Alaska Native adults with active suicidality across five communities. It compared culturally adapted Caring Contacts—scheduled, brief messages expressing care over 12 months—plus optimal available resources with those resources alone. At 12 months, suicidal ideation and past-year suicide attempts declined in both groups, but there were no statistically significant between-group differences. The trial therefore found no evidence that Caring Contacts improved suicidal outcomes beyond optimal available resources alone.

Key findings

• At 12 months, mean SIQ-Jr scores were 22.7 with Caring Contacts and 23.1 with enhanced usual care; no significant between-group difference was found.
• Past-year suicide attempts at follow-up were reported by 34/240 participants (14.2%) in the Caring Contacts group and 39/238 (16.4%) in enhanced usual care, without a significant between-group difference.
• Overall, 454 participants (64.0%) provided 12-month follow-up data.

Why it matters

The trial tests a culturally adapted, low-cost approach in communities where connectedness and belonging are important strengths. Although outcomes improved over time in both groups, the absence of a significant added benefit cautions against assuming that supportive messages alone improve suicidal outcomes beyond available resources. The similar changes also highlight the potential importance of baseline engagement and other supports, which warrant further study.

What to keep in mind

Only 64.0% of participants provided 12-month follow-up data, and the abstract reports no statistically significant between-group differences.