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Saskia Mérelle

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Content-based recommender support system for counselors in a suicide prevention chat helpline

Design and evaluation study

Journal article - Salim Salmi, Saskia Mérelle, W.P. Brinkman

Background: The working environment of a suicide prevention helpline requires high emotional and cognitive awareness from chat counselors. A shared opinion among counselors is that as a chat conversation becomes more difficult, it takes more effort and a longer amount of time to compose a response, which, in turn, can lead to writer's block. Objective: This study evaluates and then designs supportive technology to determine if a support system that provides inspiration can help counselors resolve writer's block when they encounter difficult situations in chats with help-seekers. Methods: A content-based recommender system with sentence embedding was used to search a chat corpus for similar chat situations. The system showed a counselor the most similar parts of former chat conversations so that the counselor would be able to use approaches previously taken by their colleagues as inspiration. In a within-subject experiment, counselors' chat replies when confronted with a difficult situation were analyzed to determine if experts could see a noticeable difference in chat replies that were obtained in 3 conditions: (1) with the help of the support system, (2) with written advice from a senior counselor, or (3) when receiving no help. In addition, the system's utility and usability were measured, and the validity of the algorithm was examined. Results: A total of 24 counselors used a prototype of the support system; the results showed that, by reading chat replies, experts were able to significantly predict if counselors had received help from the support system or from a senior counselor (P=.004). Counselors scored the information they received from a senior counselor (M=1.46, SD 1.91) as significantly more helpful than the information received from the support system or when no help was given at all (M=-0.21, SD 2.26). Finally, compared with randomly selected former chat conversations, counselors rated the ones identified by the content-based recommendation system as significantly more similar to their current chats (β=.30, P<.001). Conclusions: Support given to counselors influenced how they responded in difficult conversations. However, the higher utility scores given for the advice from senior counselors seem to indicate that specific actionable instructions are preferred. We expect that these findings will be beneficial for developing a system that can use similar chat situations to generate advice in a descriptive style, hence helping counselors through writer's block.@en

Breaking Down Barriers to a Suicide Prevention Helpline

Protocol for a Web-Based Randomized Controlled Trial

Journal article - Margot C.A. van der Burgt, Margot C.A. van der Burgt, Saskia Mérelle, W.P. Brinkman, Aartjan T.F. Beekman, Aartjan T.F. Beekman, Renske Gilissen

Background: Globally, suicide is among the leading causes of death, with men being more at risk to die from suicide than women. Research suggests that people with suicidal ideation often struggle to find adequate help. Every month, around 4000 people fill in the anonymous self-test for suicidal thoughts on the website of the Dutch suicide prevention helpline. This self-test includes the Suicidal Ideation Attributes Scale (SIDAS), which educates users about the severity of their suicidal thoughts. The vast majority (70%) of people who complete the self-test score higher than the cutoff point (≥21) for severe suicidal thoughts. Unfortunately, despite this, less than 10% of test-takers navigate to the web page about contacting the helpline. Objective: This protocol presents the design of a web-based randomized controlled trial that aims to reduce barriers to contacting the suicide prevention helpline. The aim of this study is 2-fold: (1) to measure the effectiveness of a brief barrier reduction intervention (BRI) provided in the self-test motivating people with severe suicidal thoughts to contact the Dutch suicide prevention helpline and (2) to specifically evaluate the effectiveness of the BRI in increasing service use by high-risk groups for suicide such as men and middle-aged people. Methods: People visiting the self-test for suicidal thoughts on the website of the suicide prevention helpline will be asked to participate in a study to improve the self-test. Individuals with severe suicidal thoughts and little motivation to contact the helpline will be randomly allocated either to a brief BRI, in which they will receive a short tailored message based on their self-reported barrier to the helpline (n=388) or care as usual (general advisory text, n=388). The primary outcome measure is the use of a direct link to contact the helpline after receiving the intervention or control condition. Secondary outcomes are the self-reported likelihood of contacting the helpline (on a 5-point scale) and satisfaction with the self-test. In the BRI, participants receive tailored information to address underlying concerns and misconceptions of barriers to the helpline. A pilot study was conducted among current test-takers to identify these specific barriers. Results: The pilot study (N=1083) revealed multiple barriers to contacting the helpline. The most prominent were the belief that a conversation with a counselor would not be effective, fear of the conversation itself, and emotional concerns about talking about suicidal thoughts. Conclusions: Our study will provide insight into the effectiveness of a brief BRI designed to increase the use of a suicide prevention helpline provided in a self-test on suicidal thoughts. If successful, this intervention has the potential to be a low-cost, easily scalable, and feasible method to increase service use for helplines across the world.@en

Contributed

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An Interactive Suicide Ideation Self-Test Service for Helping People Resolve Barriers towards Contacting a Suicide Prevention Helpline

Master thesis - S. Chen, W.P. Brinkman, Saskia Mérelle, M.L. Tielman, H. Wang

Suicide prevention is an important global topic, since suicide is being a worldwide serious health issue for decades. In the meantime, people start to pay more attention to mental health issues and Artificial Intelligence is developed and applied in many different fields. Recently, there are many studies been done on using Conversational Agents for mental illness. There are also applications of preventing suicide with Conversational Agents. In the Netherlands, 10.4 suicides happened per 100 thousand inhabitants in 2019. 113 Suicide Prevention is a Dutch national organization with a mission of pursing zero suicides. They are providing multiple services to help people with suicidal thoughts, including a self-test for evaluating suicidal risks anonymously. Even though, people who have taken the self-test receive some suggestions from the 113 websites, they might not contact the 113 helpline for further help. However, it is significant for people with suicide ideation to disclose their thoughts in order to reduce their intention of committing suicide. Therefore, a conversational agent was designed and developed to upgrade the suicide self-test service, which was aiming to resolve test-takers barriers towards contacting the helpline for human help. With the service, the conversational agent interacts with users to help them take the self-test and persuade them to reach for further help by relieving their worriers. A double-blind mixed designed experiment was conducted with 147 healthy general participants and two conditions (traditional questionnaire and interactive service) to verify the hypotheses and evaluate the service. It was hypothesised that participants would have more motivation to contact a helpline for further professional help after taking the self-test in an interactive way than taking the self-test in a traditional questionnaire way. The results showed a significant increase in the traditional questionnaire condition comparing to the interactive service condition. For participants' satisfaction and perceived usefulness, these are higher in the traditional questionnaire condition than the ones in the interactive service condition. In conclusion, the proposed interactive self-test service did not show an expected potential of increasing people's motivation to contact a helpline for professional help. However, the traditional self-test with a textual barrier intervention section showed the potential to motivate people’s help-seeking behavior comparing to the proposed interactive self-test service based on the experiment.

Design and Evaluation of a Conversational Agent Model based on Stance and BDI providing Situated Learning for Triage-Psychologists in the Helpline of 113 Suicide Prevention

Master thesis - J.A. Sirocki, W.P. Brinkman, C.C.S. Liem, M.A. Neerincx, Saskia Mérelle

Objective: This thesis aided the 113 Suicide Prevention (113), the national suicide prevention center for The Netherlands, by investigating technical solutions for the helpline, implementing an e-learning prototype housing six suicidal personas within a conversational agent model, and evaluating and analyzing an experiment on its effect, which entailed interactions with one, two, and three simultaneous chats. Methods: The thesis conducted a participant observation with a total of seven triage-psychologists, organized three focus groups including triage-psychologists, managers, and training personnel with nearly forty participants, and administered an evaluation with thirty participants that included six triage-psychologist and twenty-four counselors regarding a prototype to assist in the training of 113's triage-psychologists. Prototype: The system specification provided a prototype with six personas where triage-psychologists can practice against one or many chatbots, or conversational agents, in different situations that pertain to training for 113. The conversational agents design was based upon the Rose of Leary interpersonal stance and the Beliefs, Desires, and Intentions (BDI) design paradigm. The system focused on how a conversational agent must react to triage-psychologists' inputs with respect to the subtleties in interpersonal communication and negotiation as it pertains to the 113 suicide helpline. Results: Evaluation results indicate that triage-psychologists found the learning environment motivational and the events in the environment as socially realistic. With the additional number of chats, counselors experienced an increase in three measurable areas: 1.) mental effort; 2.) situational awareness demand; and 3.) situational awareness supply; even so, counselors were positive about all learning aspects regarding the new software environment. Conclusion: This work identified the natural language processing, the BDI reasoning model plus natural language generation, and the usability and quality of the prototype as three areas of focus for 113 as they continue to improve their management of the helpline, its training, and research on suicide.