Youth Suicide Prevention Research Articles

Decreases in Suicide Deaths and Attempts Linked to the White Mountain Apache Suicide Surveillance and Prevention System, 2001-2012.

We evaluated the impact of a comprehensive, multitiered youth suicide prevention program among the White Mountain Apache of Arizona since its implementation in 2006. Using data from the tribally mandated Celebrating Life surveillance system, we compared the rates, numbers, and characteristics of suicide deaths and attempts from 2007 to 2012 with those from 2001 to 2006. The overall Apache suicide death rates dropped from 40.0 to 24.7 per 100 000 (38.3% decrease), and the rate among those aged 15 to 24 years dropped from 128.5 to 99.0 per 100 000 (23.0% decrease). The annual number of attempts also dropped from 75 (in 2007) to 35 individuals (in 2012). National rates remained relatively stable during this time, at 10 to 13 per 100 000. Although national rates remained stable or increased slightly, the overall Apache suicide death rates dropped following the suicide prevention program. The community surveillance system served a critical role in providing a foundation for prevention programming and evaluation.

Data Linkage Strategies to Advance Youth Suicide Prevention: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop.

Linking national, state, and community data systems to data from prevention programs could allow for longer-term assessment of outcomes and evaluation of interventions to prevent suicide. To identify and describe data systems that can be linked to data from prevention studies to advance youth suicide prevention research. A systematic review, an environmental scan, and a targeted search were conducted to identify prevention studies and potentially linkable external data systems with suicide outcomes from January 1990 through December 2015. Studies and data systems had to be U.S.-based and include persons aged 25 years or younger. Data systems also had to include data on suicide, suicide attempt, or suicidal ideation. Information about participants, intervention type, suicide outcomes, primary analytic method used for linkage, statistical approach, analyses performed, and characteristics of data systems was abstracted by 2 reviewers. Of 47 studies (described in 59 articles) identified in the systematic review, only 6 were already linked to data systems. A total of 153 unique and potentially linkable data systems were identified, but only 66 were classified as "fairly accessible" and had data dictionaries available. Of the data systems identified, 19% were established primarily for research, 11% for clinical care or operations, 29% for administrative services (such as billing), and 52% for surveillance. About one third (37%) provided national data, 12% provided regional data, 63% provided state data, and 41% provided data below the state level (some provided coverage for >1 geographic unit). Only U.S.-based studies published in English were included. There is untapped potential to evaluate and enhance suicide prevention efforts by linking suicide prevention data with existing data systems. However, sparse availability of data dictionaries and lack of adherence to standard data elements limit this potential. Agency for Healthcare Research and Quality.

Does community-based suicide prevention decrease suicide attempts? Strategies for reaching zero suicide

ABSTRACT FROM: Godoy Garraza L, Walrath C, Goldston DB, et al . Effect of the Garrett Lee Smith Memorial Suicide Prevention Program on suicide attempts among youths. JAMA Psychiatry 2015;72:1143–9....

Data Linkage Strategies to Advance Youth Suicide Prevention.

Linking national, State, and community data systems, such as those used for medical service billing, to existing data from suicide prevention efforts could facilitate the assessment of longer term outcomes. Our objective was to identify and describe data systems that can be linked to data from studies of youth suicide prevention interventions and to identify analytic approaches to advance youth suicide prevention research. We conducted a systematic review to identify studies of suicide prevention interventions and three types of searches to identify data systems providing suicide-related outcomes: (1) a literature search, (2) an environmental scan of gray literature, and (3) a targeted search, through contact with relevant individuals, in six States, two cities, and one tribal community. Two independent reviewers screened all results. Studies and data systems had to be based in the United States; include individuals between 0 and 25 years of age; and include suicide, suicide attempt, or suicide ideation as an outcome. Of the 47 studies (described in 59 articles) of suicide prevention interventions identified in our systematic review, only 6 studied outcomes by linking to external data systems and only 12 explored treatment heterogeneity through the effects of moderators such as gender or race/ethnicity. We identified 153 unique and potentially linkable external data systems, 66 of which we classified as "fairly accessible" with data dictionaries available. There is potential for linking existing data systems with suicide prevention efforts to assess the broader and extended impact of suicide prevention interventions. However, sparse availability of data dictionaries and lack of adherence to standard data elements limit the potential utility of linking prevention efforts with data systems.

Urban American Indian Community Perspectives on Resources and Challenges for Youth Suicide Prevention.

American Indian (AI) youth have some of the highest rates of suicide of any group in the United States, and the majority of AI youth live in urban areas away from tribal communities. As such, understanding the resources available for suicide prevention among urban AI youth is critical, as is understanding the challenges involved in accessing such resources. Pre-existing interview data from 15 self-identified AI community members and staff from an Urban Indian Health Organization were examined to understand existing resources for urban AI youth suicide prevention, as well as related challenges. A thematic analysis was undertaken, resulting in three principal themes around suicide prevention: formal resources, informal resources, and community values and beliefs. Formal resources that meet the needs of AI youth were viewed as largely inaccessible or nonexistent, and youth were seen as more likely to seek help from informal sources. Community values of mutual support were thought to reinforce available informal supports. However, challenges arose in terms of the community's knowledge of and views on discussing suicide, as well as the perceived fit between community values and beliefs and formal prevention models.

Outcomes of a Suicide Prevention Gatekeeper Training Program Among School Personnel.

Gatekeeper suicide prevention programs train staff to increase the identification and referral of suicidal individuals to the appropriate resources. We evaluated Act on FACTS: Making Educators Partners in Youth Suicide Prevention (MEP), which is an online training program designed to enhance the knowledge of suicide risk factors and warning signs as well as improve participants' attitudes and self-efficacy/confidence. School personnel (N = 700) completed a survey administered before and immediately after the training to assess gains in training outcomes and to evaluate participants' satisfaction with the training. Results indicated that MEP participants demonstrated significant increases in suicide knowledge, attitudes, and self-efficacy. Moreover, exploratory analyses revealed moderating effects of professional role on pre-/posttest changes in self-efficacy, but not suicide knowledge or attitudes. Specifically, guidance counselors demonstrated significantly smaller increases in self-efficacy/confidence compared with teachers and classroom aids, whereas teachers demonstrated significantly larger increases in self-efficacy/confidence compared with administrators. The majority of school personnel who completed the MEP program were satisfied with the training content and experience. Although the current findings are promising, more rigorous evaluations employing randomized controlled research designs are warranted to adequately determine the effectiveness of the MEP program.

Late use of electronic media and its association with sleep, depression, and suicidality among Korean adolescents

ObjectiveThe aim of this study was to investigate the association of adolescents’ last electronic media use time with their sleep and mood disturbances, including depression and suicidality. We also examined whether sleep disturbances and duration mediated the relationship between last media use time and mood disturbances. MethodsThis cross-sectional, school-based, online survey was administered by the Sleep Center at Samsung Medical Center and the Korea Centers for Disease Control and Prevention (KCDC) in 2011. A total of 26,395 participants (12,593 male and 13,802 female) were recruited from 150 middle and high schools representative of nationwide adolescents from 15 administrative districts in Korea. The sleep habits of participants on weekdays and weekends were evaluated using a questionnaire. Sleep disturbances, depression, and suicidality were assessed using the Korean versions of the Global Sleep Assessment Questionnaire, Epworth Sleepiness Scale, and Beck 19-item Scale for Suicide Ideation. We also collected last media use time, from which we subtracted actual bedtime. ResultsLate electronic media use was significantly associated with increased mood disturbances including depression and suicidality directly, but not indirectly via sleep duration or disturbances. ConclusionOur results suggest that adolescents might benefit from the restricted use of electronic media after bedtime in terms of their mood and sleep. Moreover, education regarding media use at night might be helpful in preventing youth suicide.

School- and Community-Based Youth Suicide Prevention Interventions: Hot Idea, Hot Air, or Sham?

Suicide in young people is a significant health concern, with numerous community- and school-based interventions promising to prevent suicide currently being applied across Canada. Before widespread application of any one of these, it is essential to determine its effectiveness and safety. We systematically reviewed the global literature on one of the most common community suicide prevention interventions in Canada and summarized data on 2 commonly applied school-based suicide prevention programmes. None of these has demonstrated effectiveness in preventing youth suicide or safety in application. Concurrently with their widespread distribution in Canada, the suicide rate in young women has increased-the first time in over 3 decades. Policy and regulatory implications of these findings are discussed.

Sexual and Gender Minority Youth Suicide: Understanding Subgroup Differences to Inform Interventions.

Sexual and gender minority (SGM) youth are disproportionately affected by suicide-related thoughts and behaviors relative to their heterosexual and/or non-transgender peers. Theory and empirical evidence suggest that there are unique factors that contribute to this elevated risk, with distinguishable differences among SGM subgroups. Although SGM youth suicide prevention research is in its nascence, initial findings indicate that interventions which focus on family support and acceptance may be beneficial. It is critical that we develop and test tailored interventions for SGM youth at risk for suicide, with specific attention to subgroup differences and reductions in suicide-related thoughts and behaviors as outcomes.

An Aboriginal youth suicide prevention project in rural Victoria

ABSTRACTObjective: To describe an Aboriginal youth suicide prevention project developed by Njernda Aboriginal Corporation.Method: This is a descriptive study of an Aboriginal youth suicide prevention project developed by Njernda Aboriginal Corporation based in Echuca, Victoria. Information about the program was obtained from interviewing the project worker and the social and emotional wellbeing worker. Further information was obtained about the program by examining activity registers, program flyers and posters.Results: The Aboriginal youth suicide prevention project was designed and implemented by Njernda Aboriginal Corporation over a period of three years. The main components of the project were building resilience, early intervention response and immediate postvention support. Resilience was built through the Bullroarer program, the Red Dust Healing program and community awareness programs. Another program, the Jekkora group was developed and implemented as an early intervention response. A postvention service is in the planning stage.Conclusions: During a three-year period Njernda Aboriginal Corporation established community resilience building and early intervention programs. Developing and implementing a comprehensive suicide prevention plan at the community level requires adequate time as well as support from mainstream services. These findings therefore have implications for future planning of Aboriginal suicide prevention projects.

Impulsivity and Suicidality in Adolescent Inpatients.

Suicide is the second leading cause of death among adolescents, and impulsivity has emerged as a promising marker of risk. The present study tested whether distinct domains of impulsivity are differentially associated with suicide ideation, plans, and attempts. Adolescents (n = 381; boys = 106, girls = 275) aged 13-19years (M = 15.62, SD = 1.41) were recruited from an acute, residential treatment program. Within 48h of admission to the hospital, participants were administered structured clinical interviews assessing mental health disorders and suicidality. Following these interviews, participants completed self-report questionnaires assessing symptom severity and impulsivity. Consistent with past research, an exploratory factor analysis of our 90-item impulsivity instrument resulted in a three-factor solution: Pervasive Influence of Feelings, Feelings Trigger Action, and Lack of Follow-Through. Concurrent analysis of these factors confirmed hypotheses of unique associations with suicide ideation and attempts in the past month. Specifically, whereas Pervasive Influence of Feelings (i.e., tendency for emotions to shape thoughts about the self and the future) is uniquely associated with greater suicidal ideation, Feelings Trigger Action (i.e., impulsive behavioral reactivity to emotions) is uniquely associated with the occurrence of suicide attempts, even after controlling for current psychiatric diagnoses and symptoms. Exploratory gender analyses revealed that these effects were significant in female but not male adolescents. These findings provide new insight about how specific domains of impulsivity differentially increase risk for suicide ideation and attempts. Implications for early identification and prevention of youth suicide are discussed.

“You can't break…when you're already broken”: The importance of school climate to suicidality among LGBTQ youth

ABSTRACTSuicide has been a longstanding problem among sexual and gender minority youth in Canada. The goal of the article is to examine the link between suicidality and school climate within a theoretically informed framework and a mixed methods approach. Qualitative and quantitative findings are presented using data from more than 3,700 secondary students from the National Climate Survey of Homophobia and Transphobia in Canadian Schools (Taylor & Peter, 2011a). The findings show that even modest efforts to shift the balance of heteronormative discourse on behalf of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) students can have profound effects on the experiences and perceptions of sexual and gender minority youth, which we argue would go a long way in reducing incidents of suicidality among LGBTQ youth. In many jurisdictions across Canada, LGBTQ-inclusive policies have attempted to improve school climates and reduce the effects of homophobia and transphobia in schools. These initiatives, along with the work done by Egale Canada to create a National Youth Suicide Prevention Strategy, are important steps in addressing the needs of LGBTQ youth.

Protective Role of Religious Involvement Against Depression and Suicidal Ideation Among Youth with Interpersonal Problems.

This study examined religious involvement-private religious practices (PRP), organizational religiousness (OR), and religious support (RS)-in relation to depressive symptoms and suicidal ideation (SI) and its protective role, considering youths' school and parent-family connectedness. Youth, ages 12-15 (n=161), were screened for peer victimization, bullying perpetration, and low social connectedness, and assessed for depressive symptoms, SI, school connectedness, parent-family connectedness, and religious involvement. Results indicated PRP and RS were associated with lower levels of depressive symptoms; PRP and OR were associated with less SI. Controlling for connectedness, PRP remained associated with less SI only. Results suggest the importance of considering religious involvement as a target of youth depression and suicide prevention interventions.

Suicide Prevention Strategies for Improving Population Health.

Suicide is a public health problem that accounts for more than 1 million deaths annually worldwide. This article addresses evidence-based and promising youth suicide prevention approaches at the primary, secondary, and tertiary levels. Coordinated, developmentally timed, evidence-based suicide prevention approaches at all intervention levels are likely to reduce youth suicide. For most youth who die by suicide, there are opportunities for intervention before imminent risk develops. Current research in suicide prevention points to the value of investing in "upstream" universal interventions that build skills and resilience as well as policies that enable access to care and protection from lethal means.

Exploring general practitioners' views and experiences on suicide risk assessment and management of young people in primary care: a qualitative study in the UK.

ObjectiveTo explore general practitioner (GP) views and experiences of assessing, communicating with and managing suicidal young people with the aim of co-producing an educational intervention on youth suicide prevention tailored to GPs’ perceived needs.DesignQualitative focus group study using framework analysis.Setting5 inner city general practices in Nottingham.Participants28 GPs took part (9 males) with mean age of 37 years. The median number of years of professional experience was 13. Participants were recruited through convenience sampling based on accessibility, interest in the study and willingness to participate.Results3 themes emerged from the data in relation to GP's attitudes and beliefs towards suicide; the challenges GPs experience when it comes to the assessment and management of suicide risk in young people; and optimal ways of addressing some of these challenges through the provision of specialist education and training targeting GPs’ knowledge and clinical skills in this field.ConclusionsThe findings revealed wide variations in the understanding and operationalisation of risk among GPs, which has subsequent implications to how GPs perceive risk should be assessed. GP education on suicide risk assessment and management in youth should promote a holistic understanding and assessment of risk and its individual, social and contextual influences.

National Institutes of Health Pathways to Prevention Workshop: Advancing Research to Prevent Youth Suicide

National Institutes of Health Pathways to Prevention Workshop: Advancing Research to Prevent Youth Suicide

THE CHALLENGES OF SCHOOL-BASED YOUTH SUICIDE PREVENTION: EXPERIENCES AND PERCEPTIONS OF MENTAL HEALTH PROFESSIONALS IN SOUTH AFRICAN SCHOOLS.

Youth suicidal behaviour poses a significant public health concern. Mental health care professionals working in schools have an important role to play in youth suicide prevention initiatives, although little is known of the experiences of this group of professionals in the developing world. The aim of this study was to explore the experiences of mental health professionals working in South African schools and document their insights, attitudes and beliefs regarding youth suicidal behaviour. In-depth semi-structured interviews were conducted with seven school-based mental health care professionals and data were analysed using Thematic Analysis. Participants reported that they relied on a reactive strategy by responding to youths who were in crisis. They were challenged by a lack of support from faculty staff, lack of access to resources, and heavy caseloads. Findings highlight the need for a proactive and collaborative approach to suicide prevention among mental health care professionals, teachers and parents in South African schools and improved training and supervision.

Nges Siy (I love you): A community-based youth suicide intervention in northern British Columbia

This youth suicide prevention research project is an example of a partnership between Carrier Sekani Family Services (CSFS) and the University of Northern British Columbia (UNBC), funded by the Canadian Institutes of Health Research (CIHR), Institute of Aboriginal Peoples’ Health, that directly responds to goals of ethical research conducted in First Nations’ communities. Through the use of mixed methods, the project investigated the effectiveness of community-based interventions in preventing suicide and tracked youth self-esteem, depression, and other indicators over the course of the project. The knowledge gained from this research project will help guide CSFS and its member communities in offering programs and services that will assist in reducing incidence of suicide.

Resilience as key factors in the prevention of youth suicide: Promising perspectives

Resilience as key factors in the prevention of youth suicide: Promising perspectives

Effect of the Garrett Lee Smith Memorial Suicide Prevention Program on Suicide Attempts Among Youths.

Youth suicide prevention is a major public health priority. Studies documenting the effectiveness of community-based suicide prevention programs in reducing the number of nonlethal suicide attempts have been sparse. To determine whether a reduction in suicide attempts among youths occurs following the implementation of the Garrett Lee Smith Memorial Suicide Prevention Program (hereafter referred to as the GLS program), consistent with the reduction in mortality documented previously. We conducted an observational study of community-based suicide prevention programs for youths across 46 states and 12 tribal communities. The study compared 466 counties implementing the GLS program between 2006 and 2009 with 1161 counties that shared key preintervention characteristics but were not exposed to the GLS program. The unweighted rounded numbers of respondents used in this analysis were 84 000 in the control group and 57 000 in the intervention group. We used propensity score-based techniques to increase comparability (on background characteristics) between counties that implemented the GLS program and counties that did not. We combined information on program activities collected by the GLS national evaluation with information on county characteristics from several secondary sources. The data analysis was performed between April and August 2014. P < .05 was considered statistically significant. Comprehensive, multifaceted suicide prevention programs, including gatekeeper training, education and mental health awareness programs, screening activities, improved community partnerships and linkages to service, programs for suicide survivors, and crisis hotlines. Suicide attempt rates for each county following implementation of the GLS program for youths 16 to 23 years of age at the time the program activities were implemented. We obtained this information from the National Survey on Drug Use and Health administered to a large national probabilistic sample between 2008 and 2011. Counties implementing GLS program activities had significantly lower suicide attempt rates among youths 16 to 23 years of age in the year following implementation of the GLS program than did similar counties that did not implement GLS program activities (4.9 fewer attempts per 1000 youths [95% CI, 1.8-8.0 fewer attempts per 1000 youths]; P = .003). More than 79 000 suicide attempts may have been averted during the period studied following implementation of the GLS program. There was no significant difference in suicide attempt rates among individuals older than 23 years during that same period. There was no evidence of longer-term differences in suicide attempt rates. Comprehensive GLS program activities were associated with a reduction in suicide attempt rates. Sustained suicide prevention programming efforts may be needed to maintain the reduction in suicide attempt rates.