988 Suicide & Crisis Lifeline: Messaging and Communications to People at Higher Risk for or Disproportionately Impacted by Suicide
988 Suicide & Crisis Lifeline Communication Toolkit
Since July 2022, 988 has been the national 3-digit hotline for mental health resources and suicide prevention. Though 988 responded to 5 million contacts in its first year, we must increase awareness and use of this valuable resource.
With the nationwide transition to 988, a need arose for 988-specific formative research among groups at higher risk for or disproportionately impacted by suicide to help support culturally sensitive, responsive, effective, and successful 988 communications: First, to make more people aware of 988 across the country, then to promote overall help seeking, and instill trust and confidence in the service.
The 988 Formative Research Project fills a critical research gap and supports more informed 988 messaging and implementation efforts. The project was conducted to:
- Uncover knowledge, attitudes, beliefs, and perceptions about accessing crisis services among populations at higher risk for or disproportionately impacted by suicide.
- Identify and explore barriers and motivators to accessing crisis services among these populations.
- Inform culturally sensitive, responsive, and effective messaging development to help individuals access 988 in times of crisis.
- Identify “trusted messengers” that population groups turn to when facing difficult mental health challenges.
After a careful review of 2022 U.S. suicide data, project partners identified eight study populations, including:
- American Indian/Alaska Native youth and young adults (ages 13-34)
- Asian American, Native Hawaiian, and Pacific Islander youth and young adults (ages 13-34)
- Black youth and young adults (ages 13-34)
- Hispanic youth and young adults (ages 13-34)
- Individuals who have attempted suicide or experienced serious thoughts of suicide during their lifetime (ages 13+)
- LGBTQIA+ youth and adults (ages 13-49)
- People with disabilities (ages 13+)
- Rural older men (ages 49+)
The research also includes groups identified as trusted messengers by the eight populations at higher risk for suicide or disproportionately impacted by suicide, including:
The trusted messenger study is currently underway and will be published in Spring 2024.
The 988 Formative Research is an important starting point for 988 messaging efforts, intended to produce insights that can be used by the field to make research-informed decisions about how to encourage help-seeking, including use and/or access to 988. It also generated evidence-based message frames that can be tested, validated, and enhanced through additional message testing and research.
The 988 Formative Research Project is a collaborative effort led by the National Action Alliance for Suicide Prevention (Action Alliance), the Suicide Prevention Resource Center (SPRC), and the Ad Council Research Institute (ACRI), and supported by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Populations at Higher Risk for or Disproportionately Impacted by Suicide
This study consisted of three research phases: an environmental scan, qualitative phases (conducted October 31-November 18, 2022; June 12-20, 2023; and July 26-August 4, 2023), and a quantitative phase conducted in May 2023.
Environmental Scan: The environmental scan reviewed key issues in mental health and their prevalence among specific communities, suicide- and suicide prevention-related statistics, insights specific to 988, past campaigns promoting national suicide prevention hotlines and similar services, and evidence-based best practices in health communications.
Qualitative Phase: The qualitative phase, focused on understanding the eight populations at higher risk for or disproportionately impacted by suicide and their past experiences with crisis resources (including 988), consisted of 81 60-minute webcam interviews. Participants of these populations represented a mix of gender, ages (within each cohort’s age range), household income, urbanicity and education. The qualitative phase was designed to inform the later quantitative survey tool and subsequent message frame iterations.
Quantitative Phase: A 20-minute online survey (offered in English, Spanish, and Mandarin) was conducted in May 2023 among N=5,451 U.S. teens and adults ages 13-65 (age of the oldest participants) to validate findings in the qualitative phase and to deeply understand people at higher risk for or disproportionately impacted by suicide. The overall sample included the following breakdowns of key cohorts analyzed for this study:
- N=403 American Indian/Alaska Native youth and young adults (ages 13-34)
- N=400 Asian American, Native Hawaiian, and Pacific Islander (AANHPI) youth and young adults (ages 13-34)
- N=400 Black youth and young adults (ages 13-34)
- N=402 Hispanic youth and young adults (ages 13-34)
- N=1,969 Individuals who have attempted suicide or experienced serious thoughts of suicide during their lifetime (ages 13+)
- N=465 LGBTQIA+ youth and adults (ages 13-49)
- N=1,390 People with disabilities (ages 13+)
- N=400 Rural older men (ages 49+)
Although the study focuses on populations at higher risk for or disproportionately impacted by suicide, this report includes data that reflects responses by the general population sample as a reference point of context for the reader to understand differences across cohorts and contextual differences between cohorts and a nationally represented sample of the general public.
- N=5,451 Gen Pop Core (ages 13+)
- N=1,639 Gen Pop ages 13-34
- N=2,596 Gen Pop ages 49+
For detailed information about the research methodology and to access study instruments, please download the 988 Formative Research Protocol
Guidance Panels and Research Advisors
Use these materials to help disseminate findings.
The project team brought together diverse public and private sector partners and subject matter experts who advocate for and work directly with the identified populations at higher risk to serve as Guidance Panel members. Guidance Panel members provided input and guidance around how best to interpret and share the findings to enhance outreach efforts among study populations. The project team also collaborated with several research advisors who shared their feedback and perspectives throughout the study to help inform our work.