Abstract
BackgroundSuicide is a leading cause of death for children and youth in the United States. Although school based programs have been the principal vehicle for youth suicide prevention efforts for over two decades, few have been systematically evaluated. This study examined the effectiveness of the Signs of Suicide (SOS) prevention program in reducing suicidal behavior.Methods4133 students in 9 high schools in Columbus, Georgia, western Massachusetts, and Hartford, Connecticut were randomly assigned to intervention and control groups during the 2001–02 and 2002–03 school years. Self-administered questionnaires were completed by students in both groups approximately 3 months after program implementation.ResultsSignificantly lower rates of suicide attempts and greater knowledge and more adaptive attitudes about depression and suicide were observed among students in the intervention group. Students' race/ethnicity, grade, and gender did not alter the impact of the intervention on any of the outcomes assessed in this analysis.ConclusionThis study has confirmed preliminary analysis of Year 1 data with a larger and more racially and socio-economically diverse sample. SOS continues to be the only universal school-based suicide prevention program to demonstrate significant effects of self-reported suicide attempts in a study utilizing a randomized experimental design. Moreover, the beneficial effects of SOS were observed among high school-aged youth from diverse racial/ethnic backgrounds, highlighting the program's utility as a universal prevention program.Trial registrationclinicaltrials.gov NCT000387855.
Highlights
Suicide is a leading cause of death for children and youth in the United States
Major epidemiologic studies conducted over the past decade in the US and Canada indicate that thoughts about suicide over the past year have been reported by 17–24% of youth, with actual suicide attempts in the past year reported by 5–10% [3,4]
The effect of exposure to the intervention on the four outcomes in the following three months (Y) was estimated with the following model: Y = B0 + B1–9Controls1–9 + B10G1 where G1 is a dummy variable for intervention status; and Controls1–9 refers to those variables that were significantly related to suicide attempts in preliminary analysis
Summary
Suicide is a leading cause of death for children and youth in the United States. school based programs have been the principal vehicle for youth suicide prevention efforts for over two decades, few have been systematically evaluated. In the year 2000, 32,655 patients aged 10–19 years were admitted to US hospitals as a result of suicide attempts [5] In response to this problem, a number of diverse approaches to suicide prevention have been introduced into high school curricula in the past 20 years. To date the only universal prevention program to curtail suicidal behavior in a randomized study is Signs of Suicide (SOS), a program developed by the creators of National Depression Screening Day. Based on evidence from the first year of a 2 year study involving over 2100 students in 5 schools [10], the SOS program was added to SAMHSA's National Registry of Effective Programs (NREP) and has been widely adopted, with 675 schools across the country implementing SOS during the 2004–05 school year. Findings regarding the benefits of SOS were bolstered by a recent randomized trial that found no evidence of iatrogenic effects of a similar suicide screening program [11], allaying longstanding concerns about the potential negative effects of suicide prevention programs on emotionally vulnerable youth [12]
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