Social Media-Based Professional Intervention vs Resource Provision for Youth With Suicidal Ideation or Behavior: Protocol for a Randomized Controlled Trial.

backgroundDespite high prevalence of suicidal ideation and behavior, adolescents and young adults often underuse mental health services due to both structural and personal barriers. Simultaneously, massive social media (SM) expansion has introduced new mental health threats, while also creating vital spaces where adolescents and young adults can express psychological distress, seek support, and access mental health information. Designed as a bridge to care and a counterbalance to digital risks, the Équipe en Ligne de Prévention du Suicide (ELIOS) project connects adolescents and young adults with suicidal ideation or behaviors with a team of professionally trained web clinicians (nurses or psychologists supervised by a psychiatrist) through SM platforms. ELIOS is currently being evaluated within the Online Referral and Intervention to Prevent Adolescent and Young Adult Suicide (ORIAS) trial to assess its efficacy.

objectiveWe assessed the ELIOS system's efficacy over simple resource provision for adolescents and young adults with suicidal ideation or behaviors.

methodsORIAS is a single-center, open-label, 2-arm randomized controlled trial with balanced parallel groups. It will recruit 386 participants aged 18-25 years who spontaneously reach out via the ELIOS Facebook Messenger account with recent suicidal ideation. Eligible adolescents and young adults are randomized to receive either the ELIOS intervention or conventional mental health resources (control group). The ELIOS intervention consists of web-clinicians offering initial support, risk evaluation, counseling, and progressive referral to mental health care. The primary endpoint is the reduction in suicidal ideation intensity at 3 months, measured using the Columbia Suicide Severity Rating Scale. Secondary endpoints include suicide attempts, use of health care services, psychological distress, attitudes toward help-seeking, participant satisfaction, and usage metrics of the intervention at 3 months. The primary endpoint will be compared between the 2 study arms using a constrained longitudinal data analysis model. Secondary endpoints assessed at 3 months will be compared between groups using logistic regression models for binary variables and analysis of covariance for continuous variables.

resultsThe ORIAS study was funded in November 2018, and data collection began in October 2022. As of December 2025, 375 participants had been recruited. Recruitment is expected to conclude in April 2026. Data analysis will be conducted between April and December 2026, with the first publication anticipated in early 2027.

conclusionsELIOS is the first suicide prevention system embedded directly within the SM environment and daily digital practices of adolescents and young adults. By offering easy, personalized, and timely access to professional help, ELIOS can address help-seeking barriers and reduce suicidality. While the ORIAS trial highlights the inherent challenges of conducting traditional interventional research within dynamic SM settings, it is poised to generate high-quality evidence on the feasibility, acceptability, and effectiveness of digital suicide prevention interventions. These findings could inform and support the broader integration of similar models within public health systems.

trial registrationClinicalTrials.gov NCT04642157; https://clinicaltrials.gov/study/NCT04642157. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/83303.