CARE – Caring Texts: A Strength-based, Suicide Prevention Trial in Four Native Communities

At a glance

Funded by: NIMH 2016-2024
Principal Investigator(s): Lonnie Nelson Kate Comtois
Research Team:
Participating Agencies:
Research Setting: Five native communities in Montana, Oklahoma, South Dakota, and Alaska


Persistent disparities in quality of health and healthcare across diverse racial, ethnic, and socio-economic populations are well-documented in the United States. American Indian and Alaska Native (AI/AN) people in the US experience many behavioral health disparities, particularly with regard to post-traumatic stress, depression, substance misuse, and suicide.

The US AI/AN population is composed of more than 5 million Americans and more than 500 federally recognized tribes with diverse cultural values, beliefs, and practices. It is essential to ensure that behavioral health interventions are both culturally relevant and embrace common and unique community strengths and values with regard to intervention design and delivery.

Caring Contacts is one of the few suicide prevention interventions with demonstrated success in diverse populations, but its acceptability and effectiveness have not been evaluated in AI/AN communities. Using community engaged cultural adaptation (Phase 1), we conducted focus groups and semi-structured interviews with AI/AN adults, healthcare providers, and leaders in four communities to improve study design and maximize intervention acceptability and cultural fit; we are currently completing a randomized controlled trial of the culturally adapted intervention (Phase 2).


  • Data collection complete, data analysis underway


  • Jansen, K. J., Shaw, J. L., Comtois, K. A., Elliott-Groves, E., Slaney, T., Avey, J. P., & Nelson, L. (2023). Culturally Adapting Caring Contacts for Suicide Prevention in Four Alaska Native and American Indian Communities. Archives of Suicide Research27(1), 89–106.
  • Bogic, M., Hebert, L. E., Evanson, A., Wright, B. D., Petras, A., Jansen, K., Shaw, J., Comtois, K. A., & Nelson, L. (2023). “Keep up the messages, sometimes it was a lifesaver”: Effects of cultural adaptation on a suicide prevention clinical trial in American Indian/Alaska Native communities. Behaviour Research and Therapy, 166, 104333.
  • Hebert, L. E., Fruhbauerova, M., Evanson, A., Bogic, M., Petras, A., Shaw, J., Muller, C. J., Nelson, L., & Comtois, K. A. (2022). Caring Texts, a strength-based, suicide prevention trial in 5 native communities: Research design and methods. Contemporary Clinical Trials123, 106966–106966.