Worker Skills Associated with Outcomes in Suicidal-related Youth Chat Sessions

Introduction: Text-based chatlines have become preferred entry points for youth seeking mental health support, yet most research examines dedicated crisis services rather than general chatlines where suicide emerges alongside diverse concerns. This study compared suicidal-related and non-suicidal sessions within a general youth chatline to identify session characteristics and worker skills associated with positive outcomes.Methods: We analyzed 1,710 chat sessions (202,336 messages) from QuickChat, a Singapore youth chatline between 2016 and 2020. Large language models classified sessions as suicidal or self-harm related (n=406, 24%) or non-suicidal (n=1,304, 76%). User-reported outcomes measured service quality and coping ability. Twelve therapeutic skills were coded from 79,587 worker messages. Multilevel regression models examined skill-outcome associations.Results: Suicidal-related sessions were significantly longer, contained more messages, and yielded lower outcomes. Suicidal ideation was most prevalent (85%), followed by self-harm (43%). In suicidal sessions, normalization demonstrated the strongest associations with all outcomes, followed by teaching/psychoeducation and making strengths explicit. These patterns differed substantially from non-suicidal sessions.Conclusion: Suicidal-related sessions within general chatlines demand greater engagement and differentiated responses from workers. Normalization and psychoeducation emerge as effective techniques for improving outcomes in suicidal chats. These findings provide actionable guidance for training frontline workers in general youth services.