Geospatial suicide clusters and emergency responses: An analysis of text messages to a crisis service.

Suicide is a leading cause of death globally, and certain locations experience clusters of increased frequencies of suicidal behaviours. Prevention efforts are warranted in these locations to prevent contagion effects, and there is increasing interest in technology-supported suicide prevention interventions. Crisis support services are also implementing online and mobile health support. This study investigated the relationship between geospatial suicide clusters in the US and service use, and emergency responses initiated by, a text message-based crisis support service. 103,570 conversations involving 64,391 unique users over a two-year period were de-identified, analysed, and mapped to the state and county level. Moderate correlations were observed between service user rate and suicide mortality (ρ=0.53), and active rescues and suicide mortality (ρ=0.46). Suicide clusters were associated with a non-significant increase in service use (p=0.06) and active rescues (p=0.48). While it was not possible to observe significant cluster effects within this dataset, future analysis involving data collected through mobile health platforms may lead to better identification of risk at an individual level.