{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:46:13Z","timestamp":1791992773420,"version":"4.4.0"},"reference-count":12,"publisher":"American Medical Association (AMA)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"abstract":"\n Importance<\/jats:title>\n Caring letters (CL) is one of the only suicide prevention interventions to ever reduce suicide mortality in a randomized clinical trial, but the results have not been replicated. The US Department of Veterans Affairs Veterans Crisis Line (VCL) CL intervention was previously evaluated, but suicide mortality data were not available at that time.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To examine the association of the VCL CL intervention with suicide mortality among US veterans, and to determine whether there are differences in outcomes by signatory.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This prespecified secondary analysis of a randomized clinical trial includes a randomized parallel trial of US veterans, combined with an observational comparison of no CL receipt with any CL receipt. Veterans Health Administration (VHA) patients (aged \u226518 years) who contacted the VCL between June 11, 2020, and June 10, 2021, were randomized to receive CL from either a VA clinician or a peer veteran signatory. Veterans who contacted the VCL between June 11, 2018, and June 10, 2021, and did not receive the intervention were included as an observational historical control group. Suicide mortality analyses were completed between March and September 2025.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Veterans received 9 CL messages over a period of 1 year from either a clinician or peer veteran signatory. The signatory was randomly assigned.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n The main outcome for these analyses was suicide mortality among veterans in the 12 months following the index VCL contact. Suicide mortality was compared using \u03c7\n 2<\/jats:sup>\n tests and time-to-event models.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n This study included 227\u202f502 VHA patients (mean [SD] age, 53.6 [16.9] years; 84.4% men) who contacted the VCL. A total of 87\u202f926 veterans received the CL intervention; the remaining 139\u202f576 comprised the historical control group. A total of 625 suicides (0.27%) occurred during the study period. The suicide mortality rate was similar between the CL and historical control groups (0.29% and 0.27%, respectively;\n P<\/jats:italic>\n \u2009=\u2009.31). Within the CL group, outcomes did not differ between peer letter and clinician letter recipients (0.21% and 0.22%;\n P<\/jats:italic>\n \u2009=\u2009.95).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this analysis, among VHA patients who contacted the VCL, CL receipt was not associated with suicide mortality, and no differences in outcomes were identified by signatory. Future research should explore the potential benefits of increased health care utilization, a finding reported in the parent trial.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n isrctn.org Identifier:\n ISRCTN27551361<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2026.2866","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:00:50Z","timestamp":1791990050000},"source":"Crossref","is-referenced-by-count":0,"title":["Caring Letters and Suicide Mortality Among US Veterans Who Contacted the Veterans Crisis Line"],"prefix":"10.1001","author":[{"given":"Mark A.","family":"Reger","sequence":"first","affiliation":[{"name":"US Department of Veterans Affairs (VA) Puget Sound Health Care System, Tacoma, Washington"},{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle"},{"name":"Now with VA Office of Research and Development, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa M.","family":"Garrido","sequence":"additional","affiliation":[{"name":"Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts"},{"name":"Boston University School of Public Health, Boston, Massachusetts"},{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MaryGrace","family":"Lauver","sequence":"additional","affiliation":[{"name":"Veterans Crisis Line, Office of Suicide Prevention, VA Central Office, US Department of Veterans Affairs, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Manchester","sequence":"additional","affiliation":[{"name":"US Department of Veterans Affairs (VA) Puget Sound Health Care System, Tacoma, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sivagaminathan","family":"Palani","sequence":"additional","affiliation":[{"name":"Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts"},{"name":"Boston University School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Legler","sequence":"additional","affiliation":[{"name":"Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts"},{"name":"Boston University School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolie E.","family":"Bourgeois","sequence":"additional","affiliation":[{"name":"Veterans Crisis Line, Office of Suicide Prevention, VA Central Office, US Department of Veterans Affairs, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha G.","family":"Auty","sequence":"additional","affiliation":[{"name":"Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts"},{"name":"Boston University School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"issue":"6","key":"ybr260006r3","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1176\/appi.ps.52.6.828","article-title":"A randomized controlled trial of postcrisis suicide prevention.","volume":"52","author":"Motto","year":"2001","journal-title":"Psychiatr Serv"},{"issue":"2","key":"ybr260006r4","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1037\/a0018697","article-title":"The interpersonal theory of suicide.","volume":"117","author":"Van Orden","year":"2010","journal-title":"Psychol Rev"},{"issue":"1","key":"ybr260006r5","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1037\/ser0000645","article-title":"Caring contacts for suicide prevention: a systematic review and meta-analysis.","volume":"20","author":"Skopp","year":"2023","journal-title":"Psychol Serv"},{"issue":"4","key":"ybr260006r6","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.8064","article-title":"Caring letters sent by a clinician or peer to at-risk veterans: a randomized clinical trial.","volume":"7","author":"Reger","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"Suppl 1","key":"ybr260006r8","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1111\/1475-6773.13985","article-title":"Development of the Veterans Crisis Line caring letters suicide prevention intervention.","volume":"57","author":"Reger","year":"2022","journal-title":"Health Serv Res"},{"issue":"22","key":"ybr260006r10","doi-asserted-by":"publisher","first-page":"1998","DOI":"10.1001\/jama.2025.4347","article-title":"CONSORT 2025 statement: updated guideline for reporting randomised trials.","volume":"333","author":"Hopewell","year":"2025","journal-title":"JAMA"},{"issue":"12","key":"ybr260006r11","doi-asserted-by":"publisher","first-page":"1234","DOI":"10.1176\/appi.ps.20220632","article-title":"Qualitative evaluation of a caring letters suicide prevention intervention for the Veterans Crisis Line.","volume":"74","author":"Landes","year":"2023","journal-title":"Psychiatr Serv"},{"issue":"2","key":"ybr260006r12","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14381","article-title":"Are suicides underreported? The impact of coroners versus medical examiners on suicide reporting.","volume":"60","author":"Fernandez","year":"2025","journal-title":"Health Serv Res"},{"key":"ybr260006r1","unstructured":"2025 National Veteran Suicide Prevention Annual Report. US Department of Veterans Affairs Office of Suicide Prevention. 2025. Accessed February 12, 2026. https:\/\/www.mentalhealth.va.gov\/docs\/data-sheets\/2025\/2025_National_Veteran_Suicide_Prevention_Annual_Report_PART_2_FINAL.pdf"},{"key":"ybr260006r2","unstructured":"VA\/DoD clinical practice guideline for assessment and management of patients at risk for suicide. Department of Veterans Affairs and Defense Health Agency. 2024. Accessed February 10, 2026. https:\/\/www.healthquality.va.gov\/HEALTHQUALITY\/guidelines\/MH\/srb\/VADOD-CPG-Suicide-Risk-Full-CPG-2024_Final_508.pdf"},{"key":"ybr260006r7","unstructured":"Are caring letters from other veterans or counselors more effective at preventing suicide attempts in US military veterans who have contacted the Veterans Crisis Line? isrctn.com identifier: ISRCTN27551361. Updated September 12, 2024. Accessed September 17, 2026. https:\/\/www.isrctn.com\/ISRCTN27551361"},{"key":"ybr260006r9","unstructured":"Program Guide 1200.21: VHA operations activities that may constitute research. US Department of Veterans Affairs Office of Research and Development. January 9, 2019. Accessed February 10, 2026. https:\/\/www.research.va.gov\/resources\/policies\/ProgramGuide-1200-21-VHA-Operations-Activities.pdf"}],"container-title":["JAMA Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/articlepdf\/2854927\/jamapsychiatry_reger_2026_br_260006_1790709818.55202.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:00:53Z","timestamp":1791990053000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/fullarticle\/2854927"}},"subtitle":["A Prespecified Secondary Analysis"],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":12,"URL":"https:\/\/doi.org\/10.1001\/jamapsychiatry.2026.2866","relation":{},"ISSN":["2168-622X"],"issn-type":[{"value":"2168-622X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10,14]]}}}