Youth Suicide Prevention Research Articles

Issues Most Important to Parents After Their Children's Suicide Attempt: A Pilot Delphi Study.

Suicide is the third leading cause of death for people aged 15-24 and results in 4,600 lives lost each year. One important risk factor for completed suicide is a nonlethal suicide attempt. To date, little research has been conducted on the needs of parents of adolescents who have made a nonlethal suicide attempt. The goal of this pilot study was to describe the most important concerns of parents whose children have made a nonlethal suicide attempt from the perspective of adolescent mental health professionals. A two-round Delphi technique was utilized with an interdisciplinary panel of adolescent mental health experts to gain consensus on what issues are most important to parents after their children's suicide attempt. Panelists described the following as most important to parents after their children's nonlethal suicide attempt: keeping their children safe; identifying what caused or triggered the suicide attempt; strategies to prevent another suicide attempt; and communication and building trust for the future. An advanced understanding of the issues most important to parents whose children have made a nonlethal suicide attempt has implications for clinicians in creating acceptable and useful interventions aimed at preventing youth suicide.

A Youth Suicide Prevention Plan for Canada: A Systematic Review of Reviews.

We conducted an expedited knowledge synthesis (EKS) to facilitate evidence-informed decision making concerning youth suicide prevention, specifically school-based strategies and nonschool-based interventions designed to prevent repeat attempts. Systematic review of review methods were applied. Inclusion criteria were as follows: systematic review or meta-analysis; prevention in youth 0 to 24 years; peer-reviewed English literature. Review quality was determined with AMSTAR (a measurement tool to assess systematic reviews). Nominal group methods quantified consensus on recommendations derived from the findings. No included review addressing school-based prevention (n = 7) reported decreased suicide death rates based on randomized controlled trials (RCTs) or controlled cohort studies (CCSs), but reduced suicide attempts, suicidal ideation, and proxy measures of suicide risk were reported (based on RCTs and CCSs). Included reviews addressing prevention of repeat suicide attempts (n = 14) found the following: emergency department transition programs may reduce suicide deaths, hospitalizations, and treatment nonadherence (based on RCTs and CCSs); training primary care providers in depression treatment may reduce repeated attempts (based on one RCT); antidepressants may increase short-term suicide risk in some patients (based on RCTs and meta-analyses); this increase is offset by overall population-based reductions in suicide associated with antidepressant treatment of youth depression (based on observational studies); and prevention with psychosocial interventions requires further evaluation. No review addressed sex or gender differences systematically, Aboriginal youth as a special population, harm, or cost-effectiveness. Consensus on 6 recommendations ranged from 73% to 100%. Our EKS facilitates decision maker access to what is known about effective youth suicide prevention interventions. A national research-to-practice network that links researchers and decision makers is recommended to implement and evaluate promising interventions; to eliminate the use of ineffective or harmful interventions; and to clarify prevention intervention effects on death by suicide, suicide attempts, and suicidal ideation. Such a network could position Canada as a leader in youth suicide prevention.

Preventing Youth Suicide

Suicide is the third leading cause of death among youth aged 10 to 14 years and the second among those aged 15 to 24. Investigators examined whether the nationwide Garrett Lee Smith Memorial Youth Suicide Prevention program reduced youth suicide. As part of a comprehensive initiative, the program teaches individuals who have regular contact with youth aged 10 to 24 …

When self-reliance is not safe: associations between reduced help-seeking and subsequent mental health symptoms in suicidal adolescents.

The majority of suicidal adolescents have no contact with mental health services, and reduced help-seeking in this population further lessens the likelihood of accessing treatment. A commonly-reported reason for not seeking help is youths’ perception that they should solve problems on their own. In this study, we explore associations between extreme self-reliance behavior (i.e., solving problems on your own all of the time), help-seeking behavior, and mental health symptoms in a community sample of adolescents. Approximately 2150 adolescents, across six schools, participated in a school-based suicide prevention screening program, and a subset of at-risk youth completed a follow-up interview two years later. Extreme self-reliance was associated with reduced help-seeking, clinically-significant depressive symptoms, and serious suicidal ideation at the baseline screening. Furthermore, in a subset of youth identified as at-risk at the baseline screening, extreme self-reliance predicted level of suicidal ideation and depressive symptoms two years later even after controlling for baseline symptoms. Given these findings, attitudes that reinforce extreme self-reliance behavior may be an important target for youth suicide prevention programs. Reducing extreme self-reliance in youth with suicidality may increase their likelihood of appropriate help-seeking and concomitant reductions in symptoms.

Impact of the Garrett Lee Smith youth suicide prevention program on suicide mortality.

We examined whether a reduction in youth suicide mortality occurred between 2007 and 2010 that could reasonably be attributed to Garrett Lee Smith (GLS) program efforts. We compared youth mortality rates across time between counties that implemented GLS-funded gatekeeper training sessions (the most frequently implemented suicide prevention strategy among grantees) and a set of matched counties in which no GLS-funded training occurred. A rich set of background characteristics, including preintervention mortality rates, was accounted for with a combination of propensity score-based techniques. We also analyzed closely related outcomes that we did not expect to be affected by GLS as control outcomes. Counties implementing GLS training had significantly lower suicide rates among the population aged 10 to 24 years the year after GLS training than similar counties that did not implement GLS training (1.33 fewer deaths per 100 000; P = .02). Simultaneously, we found no significant difference in terms of adult suicide mortality rates or nonsuicide youth mortality the year after the implementation. These results support the existence of an important reduction in youth suicide rates resulting from the implementation of GLS suicide prevention programming.

Youth Suicide Prevention and Crisis Services for Children and Families in Siberia

The rates of youth suicide in the Russian Federation are among the highest in the world, however, there is a 60-fold difference in the rates across the Russian regions, with Siberia having one of the highest rates of child and adolescent suicide. The objective of the study is to examine the relation of registered psychiatric morbidity to the prevalence of child and adolescent suicide in Siberia. Statistical analysis of the time trends showed substantial progressive decrease in primary adolescent morbidity from 2009 to 2013 and statistically significant decrease in prevalence of child and adolescent suicide from 2011 to 2013 in twelve Siberian regions. Registered morbidity in Siberian Federal District was closely related to the prevalence of child and adolescent suicide: the more registered psychiatric disorders and the higher rate of primary morbidity in the region, the lower child and adolescent suicide rates. The identification of mental disorders in children explained more than 40% of the variance in child suicide rates across the twelve Siberian regions, whereas registered psychiatric morbidity in adolescence explained more than 57% of the variance in adolescent suicide rates. These findings attest to the social impact of child and adolescent mental health services and provide a strong case for the development of appropriate needed services. A Multidimensional Youth Suicide Prevention Programme implemented in health care system of Siberian region is presented. The programme includes monitoring of suicidal behaviour and high-risk groups, early crisis help for children and families and information campaigns.

Gender differences in suicide prevention responses: implications for adolescents based on an illustrative review of the literature.

Background: There are well-documented gender differences in adolescent suicidal behavior; death by suicide is more common in males, while nonfatal suicide attempts are more common among females. Over the past three decades, researchers have documented the effectiveness of a myriad of suicide prevention initiatives. However, there has been insufficient attention to which types of suicide prevention interventions are effective in changing attitudes and behaviors for young males and females. In this review of the literature, we consider common examples of primarily universal suicide prevention programs from three implementation settings: school-based, community-based, and healthcare-based. Our purpose is to delineate how the potential gender bias in such strategies may translate into youth suicide prevention efforts. Methods: Research in which gender was found to moderate program success was retrieved through online databases. Results: The results that feature programming effects for both males and females are provocative, suggesting that when gender differences are evident, in almost all cases, females seem to be more likely than males to benefit from existing prevention programming. Conclusions: We conclude by considering recommendations that may benefit males more directly. Implications for adolescent suicide prevention in particular are discussed. Personalization of suicide intervention is presented as a promising solution to reduce suicide rates.

Science from Evaluation: Testing Hypotheses about Differential Effects of Three Youth-Focused Suicide Prevention Trainings

As part of an evaluation component of a youth suicide prevention, a quasi-experimental repeated measures design tested hypotheses about two brief suicide prevention gatekeeper trainings (Question, Persuade, Refer [QPR] and RESPONSE) and one longer suicide intervention skills training (Applied Suicide Intervention Skills Training [ASIST]). All three trainings showed large changes in prevention attitudes and self-efficacy, largely maintained at follow-up. ASIST trainees had large increases in asking at-risk youth about suicide at follow-up. Convergent with other research, modeling and role-play in training are crucial to increased prevention behaviors. Practice and research implications are discussed, including social work roles in suicide prevention and research.

Suicide prevention in rural communities: Perspectives from a Community of Practice.

Developing effective suicide prevention approaches for rural settings is critical for reducing rates nationwide. Although suicide is a public health problem that affects everyone, suicide rates are generally higher in rural areas (Hirsch, 2006). From October 2013 to April 2014, the Suicide Prevention Resource Center (SPRC) convened a Community of Practice (CoP), an interactive peer learning group of 26 organizations including state suicide prevention coordinators and federal Garrett Lee Smith youth suicide prevention grantees, to discuss challenges and strategies of rural suicide prevention work. They agreed that rural areas have limited mental health providers, barriers in accessing available providers, and stigma around talking about and seeking mental health treatment. In a series of virtual meetings, they shared experiences and strategies in 5 areas: improving access to treatment, addressing crisis response, using data to plan and evaluate prevention efforts, working cross culturally, and environmental changes. Drawing on these CoP discussions and prior research on effective approaches, SPRC developed 5 recommendations for rural suicide prevention: (a) train primary care professionals to screen for suicide risk, (b) use incentives to encourage mental health professionals to work in rural areas, (c) strengthen crisis centers' capacity to link to local resources, (d) establish crisis response protocols for the local community, and (e) target suicide prevention programming to community or population needs by collaborating with state partners to access local data on suicide deaths, attempts, and risk and protective factors. Language: en

A systematic review of evaluated suicide prevention programs targeting indigenous youth.

Indigenous young people have significantly higher suicide rates than their non-indigenous counterparts. There is a need for culturally appropriate and effective suicide prevention programs for this demographic. This review assesses suicide prevention programs that have been evaluated for indigenous youth in Australia, Canada, New Zealand, and the United States. The databases MEDLINE and PsycINFO were searched for publications on suicide prevention programs targeting indigenous youth that include reports on evaluations and outcomes. Program content, indigenous involvement, evaluation design, program implementation, and outcomes were assessed for each article. The search yielded 229 articles; 90 abstracts were assessed, and 11 articles describing nine programs were reviewed. Two Australian programs and seven American programs were included. Programs were culturally tailored, flexible, and incorporated multiple-levels of prevention. No randomized controlled trials were found, and many programs employed ad hoc evaluations, poor program description, and no process evaluation. Despite culturally appropriate content, the results of the review indicate that more controlled study designs using planned evaluations and valid outcome measures are needed in research on indigenous youth suicide prevention. Such changes may positively influence the future of research on indigenous youth suicide prevention as the outcomes and efficacy will be more reliable.

청소년 자살예방을 위한 임상미술치료 프로그램

Purpose: The purpose of this study is to examine the effects of clinical art therapy programs utilized at schools on adolescents' suicidal thoughts and stress relief and to validate their effectiveness as a type of adolescent suicide prevention program. Methods: 12 sessions of clinical art therapy for youth suicide prevention were provided, once a week for 90 minutes, for 20 students at five middle schools in Seoul who were at high risk of committing suicide. By using the paired sample t-test, the study presented qualitative data on the analysis of pre- and post- questionnaires and on the subjects’ EEG test and saliva test. Results: First, through the clinical art therapy program, the subjects’ happiness index improved significantly while their scores of depression and suicidal ideation (suicidal thoughts) decreased. Second, in the EEG and saliva test conducted after the art therapy sessions, emotional stability increased and stress was reduced significantly. Third, according to the results of pre- and post- K-HTP tests and individual activities, the subjects started to recognize the seriousness of suicide and show emotional stability and positive changes in overall attitudes, valuing the rights and life of their own ‘precious selves’ (self respect). Conclusion: The results of this study indicate that the clinical art therapy program is significantly effective at preventing suicidal ideation by reducing suicidal impulses and depression, by increasing the happiness index, which can serve as a protective factor against suicide, and by increasing emotional stability while reducing stress. Based on the results, there is a need to develop policy measures regarding art therapy programs which can be utilized at schools.

Awareness, attitudes, and use of crisis hotlines among youth at-risk for suicide.

Crisis hotlines have been central to suicide prevention efforts; however, utilization among youth remains low. A sample of at-risk youth was surveyed about their awareness, utilization, and attitudes toward local and national crisis hotlines. Youth reported low rates of awareness and utilization, yet expressed a strong interest in phone hotlines (41% vs. 59% for new media categories combined). Youth reported stigma, but that help-seeking could be positively influenced by peers and adults in their support system. Implications include making crisis services available across several mediums and the importance of engaging trusted others in youth suicide awareness campaigns and prevention efforts.

Expanding and Democratizing the Agenda for Preventing Youth Suicide: Youth Participation, Cultural Responsiveness, and Social Transformation

Suicidal behaviours in young people are among the most challenging issues faced by educators, policy makers, and practitioners. A small number of youth suicide prevention programs have been identified as promising. At the same time, many contemporary approaches to youth suicide prevention take insufficient account of the social or cultural context and privilege the expertise of adults and researchers. In large part, this is a consequence of how scientific knowledge is constructed. By engaging young people as knowledgeable collaborators and by paying attention to broader socio-political and cultural contexts in understanding sources of suffering, a more flexible and enriched approach to youth suicide prevention research and practice is envisioned.

Why an alternative to suicide prevention gatekeeper training is needed for rural Indigenous communities: presenting an empowering community storytelling approach

The need for effective youth suicide prevention is uncontested, and is particularly urgent for Indigenous populations. The Indigenous youth suicide rates in some North American communities can be 18 times greater than for other young people. Despite the clear need, evidence in support of Indigenous youth suicide prevention strategies remain mixed. The most common approach to youth suicide prevention – gatekeeper training – may have limited effects in Indigenous communities. Based on recent work undertaken with Indigenous leaders in rural Alaska, we describe culturally grounded, practical alternatives that may be more effective for Indigenous communities. We highlight the ways in which research informed, grassroots interventions can address cultural, practical and systemic issues that are relevant when addressing risks for suicide on a community level. Built on a transactional-ecological framework that gives consideration to local contexts, culture-centric narratives and the multiple, interacting conditions of suicide, the innovative approach described here emphasizes community and cultural protective factors in Indigenous communities, and extends typical suicide prevention initiatives in ways that have important implications for other ethnically diverse communities.

Primary Prevention Research in Suicide

At the American Association of Suicidology’s (AAS) 46th Annual Conference in Austin, Texas (http://www.suicidology.org/web/guest/education-and-training/annualconference), participants were challenged to address why there has not been more progress in reducing the rates of completed suicides (Berman, 2013). A draft of recommendations from the National Action Alliance for Suicide Prevention’s Research Prioritization Task Force was presented at the meeting and subsequently published in this journal (National Action Alliance for Suicide Prevention [NAASP], 2013a, 2013b). The purpose of this commentary is to address this challenge by emphasizing the importance of employing a disease etiology strategy that integrates molecular data with clinical data, environmental data, and health outcomes in a dynamic, iterative fashion. The recommendations of the Research Prioritization Task Force tackle important public health program issues and are embedded within seven key questions, summarized as: 1. Why do people become suicidal? 2. How do we better detect/predict risk? 3. What interventions prevent suicidal behavior? 4. What are the effective services for treating suicidal persons and preventing suicidal behavior? 5. How do we reduce stigma? 6. What are the suicide prevention interventions outside of health-care settings? 7. Which existing and new infrastructure needs are required to further reduce suicidal behavior? (NAASP, 2013b; Silverman et al., 2013)

Tribally Based Suicide Prevention Programs: A Review of Current Approaches

Tribally Based Suicide Prevention ProgramsA Review of Current Approaches Puneet Chawla Sahota (bio) and Sarah Kastelic (bio) INTRODUCTION Suicide is a major health challenge in American Indian/Alaska Native (AI/AN) communities, particularly among the youth. In 2004, suicide was the second leading cause of death for AI/ANs of all age groups. Among individuals between ten and fourteen years old, 13.5% of deaths were from suicide, which is nearly twice the national rate of 7.2%.1 Many factors contribute to the high prevalence of suicide in AI/AN communities, including individual factors (mental illness, substance abuse, feelings of hopelessness or isolation, impulsive behavior, and a history of violence, substance abuse, or family history of mental illness) and group factors (historical trauma, poverty, unemployment, and geographic isolation).2 Actions are needed at both the federal and tribal levels to prevent suicide, and some initial important steps have been taken. To address the challenges of youth suicide in Indian Country, a bill titled 7th Generation Promise: Indian Youth Suicide Prevention Act of 2009 was incorporated into health care reform legislation enacted in March 2010 (Patient Protection and Affordable Care Act, 2010).3 This legislation authorizes two demonstration projects aimed at preventing youth suicide in AI/AN communities. To assist tribes in preventing youth suicide, the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (DHHS) published [End Page 77] a detailed guide in 2010.4 The guide, To Live to See the Great Day That Dawns: Preventing Suicide by American Indian and Alaska Native Youth and Young Adults, is an excellent resource. Below, we present fifteen policy and practice recommendations for further supporting tribally based suicide prevention efforts. By “tribally based” we mean efforts that are tailored to the unique contexts of individual tribes and Native communities, which may include adaptations of mainstream programs or newly designed local suicide prevention programs, such as those based on spiritual or cultural traditions. The aim of this project was to review the range of approaches being used in tribally based suicide prevention programs and make recommendations about how policy makers, tribal communities, health care providers, and other service providers might better support locally tailored efforts to prevent suicide. As we describe in the next section, our goal in this paper was not to capture an exhaustive list of strategies being used in tribally based suicide prevention programs. Rather, we reviewed existing literature and consulted a select group of key informants in order to broadly describe the landscape—the commonalities and distinctive elements of these strategies—at a level of detail necessary to identify practice and policy change recommendations for a tribal leader and program staff audience. While these recommendations are targeted to supporting suicide prevention efforts in AI/AN communities, we also believe they have broader relevance for other community-based suicide prevention programs. PAPER DEVELOPMENT AND RESEARCH METHODS We developed this paper in collaboration with expert, key informant interviewees. For a list of the organizations and individuals who were interviewed or consulted by e-mail, please see Figure 1. This paper was originally intended to be a white paper for tribal leaders, not an academic research paper. Our initial goal was to write a paper for tribal communities that would review existing academic literature on suicide prevention and develop resulting recommendations about best practices and policies specifically for tribal governments. However, the initial literature review and conversations with experts in the field revealed that many successful tribal suicide prevention programs were not included in published academic articles, and that there was a need for publications about culturally appropriate tribal strategies. For this reason, we sought to review the landscape of tribally based suicide prevention programs. We conducted this broad review by reading published academic literature and “gray” literature (i.e., policy reports, white papers, program brochures, Web sites) as well as interviewing and corresponding with key informants working in the field of tribal suicide prevention. [End Page 78] In reflecting on key informants’ comments, we felt that there was a great deal of important information shared which was not already available in the academic literature. We also felt that this information...

INTRODUCTION TO THE SPECIAL ISSUE ON YOUTH SUICIDE PREVENTION: RESEARCH, POLICY, AND PRACTICE

We are pleased to introduce this special issue of the International Journal of Child, Youth and Family Studies (IJCYFS) on youth suicide prevention. This issue brings together a diverse and exciting range of perspectives on the topic of youth suicide prevention. Original research, theoretical contributions, and critical reflections on practice are all represented here, underscoring the importance of multiple and collaborative approaches to addressing youth suicide, which is a leading cause of death among this age group.

Levels of responsibility in school-based suicide prevention: Legal requirements, ethical duties, and best practices.

Youth suicide is a national public health problem with devastating consequences. In an attempt to address it, schools have been viewed as appropriate venues for focused efforts at youth suicide prevention. School personnel have both legal and ethical responsibilities to prevent youth suicide whenever possible, a situation that is most likely to occur if evidence–based “best practices” in prevention and intervention are implemented. There are differing levels of responsibility within these three domains, with each succeeding level having a corresponding – and more stringent – modification in requirements. The purpose of this article is to describe these three levels, proceeding from the lowest level of responsibility (i.e., legal requirements) to the highest (i.e., best practices). Implications of these different levels of responsibility for school personnel engaged in youth suicide prevention efforts are discussed.

INTRODUCTION TO THE SPECIAL ISSUE ON YOUTH SUICIDE PREVENTION: RESEARCH, POLICY, AND PRACTICE

We are pleased to introduce this special issue of the International Journal of Child, Youth and Family Studies (IJCYFS) on youth suicide prevention. This issue brings together a diverse and exciting range of perspectives on the topic of youth suicide prevention. Original research, theoretical contributions, and critical reflections on practice are all represented here, underscoring the importance of multiple and collaborative approaches to addressing youth suicide, which is a leading cause of death among this age group.

IT’S TIME TO TALK ABOUT IT: UTILIZING A COMMUNITY-BASED RESEARCH APPROACH TO DEVELOP A FAMILY GUIDE FOR YOUTH SUICIDE PREVENTION

Utilizing principles from family-driven care and community-based research, community members and researchers collaborated to uncover the experiences, perceptions, and needs of families whose children had been impacted by mental illness and suicide. Using a flexible and iterative process involving in-depth qualitative interviews, four themes emerged: (a) the need for greater awareness about youth suicide; (b) the need to provide clear and direct steps to obtain help for at-risk youths; (c) the need to learn how to locate and access resources to seek help and overcome barriers to care; and (d) the importance of involving and empowering families to get involved in the design and increased utilization of treatment services and suicide prevention efforts. Further thematic content analysis revealed specific content areas that served as the foundation for the creation of a family-focused guide on youth suicide prevention. Preliminary findings with community stakeholders suggest that the family guide, It’s Time to Talk About it, is a useful and motivational resource that enhances awareness on how to prevent youth suicide and how families can become more involved in treatment and advocacy efforts. This paper provides an example of how to engage and partner with community participants throughout the stages of planning, developing, implementing, and disseminating a community-based suicide prevention effort.