School-based Suicide Prevention Programs Research Articles

Comparative Outcomes of Three School-Based Cognitive-Behavioral Interventions for Adolescent Suicide Prevention in Hong Kong.

Background/Objectives: This study assessed the effectiveness of a school-based suicide prevention program in Hong Kong. Methods: 105 secondary school students aged 14-16, identified as having high levels of depression and suicidal ideation. Participants were divided into three intervention groups: one for adolescents only, another for adolescents with peers, and a third for adolescents with parental involvement. All groups engaged in weekly online exercises. Repeated measures ANOVA was used to analyze the within-group and between-group differences in the levels of adolescents' suicidal ideation, depression and anxiety. Results: The results indicated a statistically significant reduction in suicidal ideation, depression and anxiety levels after participation in all three groups. No statistically significant between-group differences were identified, meaning the effects of the three interventions on the measured outcomes were similar. Conclusions: This study demonstrates the promise of implementing school-based suicide prevention programs in the Hong Kong context.

Promoting Protective Factors for Suicidal Behavior in Adolescents at Risk

Abstract: Theoretical Background: Suicide is among the leading causes of death for young people and a major public health concern. While intervention programs targeting youth at risk seem promising, more research is warranted to determine what works for whom. The HEYLiFE universal school-based suicide prevention program aims to promote three putative protective factors, namely, knowledge about mental health, agency, and help-seeking intention in students aged 14 years and older. While its overall efficacy was confirmed previously, specific effects in adolescents with different risk profiles remain to be determined. Objective: We explored whether program efficacy differed for students aged 14 – 18 years (mean age M= 16.2 years, SD = 1.2 years) at low, medium, and high risk for suicidality. Method: A pre–post within-group comparison trial was designed to evaluate the HEYLiFE suicide prevention program in a convenience sample of 304 adolescents from five public schools. The data of 218 adolescents (45.2 % female) with completed data sets were analyzed. Using a two-step cluster analysis, we identified three distinct at-risk clusters for suicidality based on self-reported suicidality, depression, impulsivity/carelessness, and avoidance. We then applied a mixed-model analysis of covariance to evaluate program efficacy in these clusters. Results: While knowledge improved to a similar degree across all clusters, agency and help-seeking intentions improved in the low- and medium-risk cluster but not in the high-risk cluster. Efficacy across time ranged from small to medium effects. Conclusion: Our results confirm that the HEYLiFE suicide prevention program is efficacious for the majority of students. The promotion of protective factors among students with different risk profiles is a viable strategy for universal suicide prevention, although efforts are warranted to specifically target individuals exhibiting the greatest risk for suicide.

Adapting a youth suicide prevention program for rural communities in the United States: a feasibility study

Rural youth suicide represents a major source of mental health inequity in the United States (US). School-based suicide prevention programs may provide an effective avenue to address this mental health crisis among rural youth. This study’s primary goal is to demonstrate the feasibility and acceptability of a novel implementation approach (utilizing teachers from a neighboring school) for delivering the Youth Aware of Mental Health (YAM) program, an evidence-based, universal youth suicide prevention curriculum, to high school students in rural Montana. We will recruit approximately 1300 9th grade student in four Montana schools. Using a non-inferiority design, we will randomize classrooms in each school to be instructed by a teacher from another school (YAM-TE; experimental) or a traditional external instructor (YAM-EXT; control). We will assess program fidelity of both YAM training and implementation via independent observer and instructor-reporter ratings. Youth will complete measures of acceptability at post-YAM and outcome measures at pre-YAM, post-YAM, and 12 month follow-up. Standard and mixed linear and logistic regression models will be used to test the main hypothesis that the YAM-TE does not differ from YAM-EXT regarding fidelity (teachers) and acceptability (teachers and youth). Exploratory analyses will test moderation of the intervention effect (e.g., sex, poverty) and the mediating effect of mental health literacy, belongingness, and perceived burdensomeness on the intervention effect. Results of this pilot study will inform the development of subsequent, fully powered noninferiority trials. Our long-term goal is to scale YAM-TE for implementation across rural US communities or, if culturally appropriate, more globally.

"It's like an epidemic, we don't know what to do": The perceived need for and benefits of a suicide prevention programme in UK schools.

Despite emerging evidence for the effectiveness of school-based suicide prevention programmes worldwide, there are few being implemented in the United Kingdom, and their social validity (i.e., the feasibility, acceptability, and utility) is not yet known. We aimed to conduct a scoping study to determine: (1) the social validity and potential benefits of school-based suicide prevention interventions, (2) the perceived need for such interventions, and (3) barriers and facilitators to implementation. A total of 46 participants took part. Semi-structured interviews were conducted with mental health professionals (N = 8), school staff (N = 8), and parents whose children had experienced suicidal ideation/behaviours (N = 3) in England. Focus groups were also completed with children and young people (N = 27) aged 15-18 across three state secondary schools. Data were analysed using thematic framework analysis. Three themes were identified: (1) the need for and importance of suicide prevention in children and young people, (2) schools as a setting for delivery, and (3) key components of suicide prevention programmes. Participants overwhelmingly agreed that there is a need for a greater and more consistent emphasis on school-based suicide prevention. School appears to be an acceptable location for suicide prevention, and participants felt discussions about suicide should begin at the start of secondary school. However, there are potential barriers that need to be considered, including tailoring for neurodiversity, challenging cultural/family beliefs and stigma, managing personal experiences of suicidal thoughts or previous bereavement from suicide, and a lack of existing training for school staff.

Addressing help-seeking, stigma and risk factors for suicidality in secondary schools: short-term and mid-term effects of the HEYLiFE suicide prevention program in a randomized controlled trial

BackgroundSuicidal ideation and suicide attempts present a serious public health concern among adolescents and young adults. School-based suicide prevention programs are a key tool for addressing this problem. However, more research is necessary to assess their effectiveness, acceptability, and safety. In response, the HEYLiFE suicide prevention program was developed to enhance help-seeking, reduce stigma towards suicidal peers and diminish risk factors for suicidality. This article presents the evaluation findings of the HEYLiFE program in German secondary schools.MethodsWe conducted a randomized-controlled trial measuring short-term pre-post within-group effects in the intervention group only and mid-term effects at 6-months-follow-up compared to a waitlist-control group. Schools were assigned randomly to the intervention or control group (no blinding). We recruited students ≥12 years of age. Primary outcomes were knowledge about suicidality, attitudes towards suicidality, stigma towards a suicidal peer, help-seeking intentions and behaviours, risk factors for suicidality. The data was analysed with linear mixed models and generalized linear mixed models.ResultsA total of N = 745 students participated (n = 353 intervention group, n = 392 control group). We observed favourable short-term effects on knowledge, attitudes towards suicidality and fear towards a suicidal peer. Unexpectedly, the program also led to an increase in desire for social distance and a decrease in prosocial emotions towards a suicidal peer. The mid-term effects of the program were exclusively favourable, resulting in enhanced attitudes towards help-seeking while protecting from a sharper rise in risk-factors for suicidality and from an increase in social distance. The program had more favourable effects on females and on students aged >13 years. The program was well-received by the students, and no serious adverse events were reported.ConclusionsThese findings demonstrate the effectiveness of the HEYLiFE universal suicide prevention program in addressing variables associated with suicidal ideation and suicide attempts among adolescents on the mid-term. The short-term negative effects on stigma and more negative effects on males should be addressed in the future. Future evaluation studies should examine its effects on suicidality and its effectiveness within populations at high risk.Trial registrationThe study was preregistered in the German Clinical Trials Register (registration number: DRKS00017045; registration date: 02/04/2019).

Secondary Principals’ Perceptions and Practices for Implementing Student Suicide Prevention Programs

We explored secondary school principals’ knowledge of suicide prevention programs, their perceptions of the logistical and cultural barriers associated with suicide prevention program adoption, and their justification for adopting (or not adopting) suicide prevention programs in their schools. Principals, as positional leaders of schools, can lead the adoption and support of school-based suicide prevention programs for their students. Using a phenomenology framework, we conducted semi-structured interviews of eight secondary school principals working in public schools in the south-central United States. The principals readily identified the importance of supporting students’ mental health to enhance their learning as a justification for implementing suicide prevention programs for their students. They shared how limited staffing, time, perception of school responsibility for student mental health, and lack of knowledge of available suicide prevention resources were logistical, cultural, and knowledge barriers to adopting suicide prevention programs for students. Our research has profound implications for practice.

Suicidal Mortality and Motives Among Middle-School, High-School, and University Students

The suicide mortality rate per 100 000 population (SMRP) consistently decreased before the COVID-19 pandemic outbreak in Japan and then unexpectedly increased during the pandemic. However, the underlying mechanisms remain poorly understood. To identify trends in and factors associated with suicidal mortality and motives among students in Japan from 2007 to 2022. In this cross-sectional study, data on SMRPs among Japanese middle-school, high-school, and university students were obtained from the government suicide database Suicide Statistics of the National Police Agency. Age-dependent and temporal fluctuations in annual SMRPs, disaggregated by suicidal motive (7 categories and 52 subcategories), sex, and school, were analyzed using linear mixed-effect and joinpoint regression models, respectively. Total suicide numbers from 2007 to 2022 were as follows: 760 male middle-school students, 635 female middle-school students, 2376 male high-school students, 1566 female high-school students, 5179 male university students, and 1880 female university students. The mean (SD) student populations from 2007 to 2022 were as follows: 1 752 737 (81 334) male middle-school students, 1 675 572 (78 824) female middle-school students, 1 648 274 (67 520) male high-school students, 1 614 828 (60 032) female high-school students, 1 652 689 (32 724) male university students, and 1 229 142 (57 484) female university students. Among male students, the leading motives were school-related factors (underachievement and worrying about the future), followed by family-related and health-related motives. Among female students, school-related and family-related motives decreased, but health-related motives showed an age-dependent increase. The SMRPs of middle-school male students and female students were almost equal (mean [SD], 2.7 [1.0] vs 2.4 [1.4]), but the age-dependent increase in SMRPs among male students was pronounced (mean [SD], high-school vs university male students, 9.1 [2.4] vs 19.6 [3.0]; high-school vs university female students, 6.1 [2.4] vs 9.6 [1.8]). However, the incidence of suicide among high-school students associated with health-related motives was greater in female students. The majority of suicides associated with major impactable suicidal motives (school-related, health-related, and family-related motives) began increasing before the pandemic. Changes in SMRP associated with interpersonal relationships, such as conflict with classmates or parents, were not significant, but the rates increased greatly during the pandemic. School-related, health-related, and family-related problems were major motives, whereas the impacts of health-related and family-related motives increased and decreased with age, respectively. Notably, most SMRPs associated with major impactable motives (underachievement, conflict with a parent or classmate, and mental illnesses) had already begun increasing in the late 2010s, indicating that recent increasing SMRPs among school-aged individuals were associated with pandemic-related factors and other factors affecting this generation before the pandemic. It may be inappropriate to uniformly apply research findings based on school-aged individuals to school-based suicide prevention programs for students in middle school, high school, and university.

Saving and Empowering young lives in PAKistan (SEPAK): An Exploratory Cluster Randomized Controlled Trial (cRCT)

IntroductionSuicide is a leading cause of death among young people and most deaths by suicide occur in low and middle-income countries. School is the best place where we can identify and respond to youth suicide risk. School-based interventions for suicide prevention in young people have been successful across US, Europe and Australia, but require adaptations to be acceptable and feasible in Pakistan.ObjectivesTo develop and test culturally adapted preventative interventions for suicidal behaviours among pupils in secondary schools in Pakistan. The qualitative component aimed at exploring the views of students, parents, teachers and general practitioners on cultural adaptation, experience of participation, areas of improvement and suggestions for scale-up of the school-based suicide prevention program (SEPAK).MethodsA clustered randomised controlled trial. The four culturally modified interventions 1) Linking Education and Awareness of Depression and Suicide Awareness (LEADS) Training for pupils (students=260) 2) the Question, Persuade, and Refer (QPR) for teachers (students=203) 3) QPR for parents (students=445); 4) Screening by Professionals (Profscreen) (students=260) were compared against control intervention (educational posters) (students=227). Structured questionnaires were administered at baseline and 1-month post-intervention to assess suicidal behaviours, psychological well-being and quality of life. A total of 8 focus groups (FGs) were conducted at pre and post intervention stage with each stakeholders.ResultsPatient and public involvement and Engagement (PPIE) was strongly embedded in the project to ensure meaningful benefits for participants. A total of 40 schools were recruited from 8 cities across Pakistan. A total of 243 students attended LEADS intervention, 92 teachers and 304 parents completed QPR training, and 9 general practitioners were trained in ProfScreen. The retention rate at follow-up was 99% that shows feasibility of delivering intervention package in Pakistan. All participants marked SEPAK as effective in identifying risk of and preventing self-harm and suicide in young people and in improving pathways to treatment. Interventions were perceived as helpful in improving knowledge about mental health, impact of mental health difficulties on functioning, reducing stigma, equipping stakeholders to identify and signpost at-risk people. Improvement in clinical and teaching practice as well as understanding others behaviors were also reported.ConclusionsThis study suggest feasibility of integrating a suicide prevention program in existing educational system and highlights positive role of creating awareness about suicide in youth, introduction of school-based mental health programs, parental counseling and strengthening of the health system by training general practitioners in early identification of suicide risk and promoting suicide prevention strategiesDisclosure of InterestNone Declared

『스킴』에서 장애/질병 서사 연구

Skim (2008) by Mariko Tamaki and Jillian Tamaki is a semi-graphic memoir based on the coming-of-age story of Kimberly Keiko Cameron, a Japanese-Canadian queer girl whose nickname is Skim. Skim is 16 years old and attending a Catholic girls’ high school in Toronto in the 1990s, where most students are white and thin. Due to her non-whiteness, queerness, fatness, depression, and interest in Wicca, Skim experiences discrimination, marginalization, and exclusion at school, which lead to daily trauma for her. Trapped within in her loneliness, Skim eats as a defense mechanism against the normalized daily trauma. This eating, in a vicious circle, leads to more fatness and causes her to become an object of ridicule and stigmatization, ultimately leading to suicidal depression. Skim is singled out as a person who is the most likely to commit suicide at school and thus faces institutional control, surveillance, discipline, and oppression led by her teachers and peers, who consider Skim’s fatness (a physical disability) and depression (a mental illness) to be an individual problems to be fixed or eliminated with the help of school-based suicide prevention programs. In this paper, I will examine how Skim helps readers understand youth suicidal depression and eating disorders in connection with sexism, ableism, racism, sanism, and heterosexual normativity, all of which are deeply rooted in Canadian society. In addition, I show how Skim, presented in a diary format, resists the triumphant narrative of “getting better” and ultimately contributes to eliminating the prejudice that young people marginalized due to fatness, queerness, non-whiteness, and suicidal depression face, making them powerless, passive, and voiceless in Canadian society.

32.4 Vulnerable Voices: Utilizing Community-Engagement and Advocacy to Promote School-Based Suicide Prevention Programs

The participant will discuss the impact of school-based suicide prevention programs on suicide rates among adolescents, and the participant will learn practical ways to advocate for suicide prevention programs within their community. The increasing rates of suicide among adolescents has become a major public health concern. In 2019, suicide was the second leading cause of death for individuals aged 10 to 24 years old. Adolescents in this age range spend a significant amount of time in school. As a result, school-based mental health programs have become an avenue for addressing suicidality, and districts that have incorporated suicide prevention programs have reduced suicidality among their students.

A Trauma- and Justice, Equity, Diversity, and Inclusion (JEDI)-Informed Approach to Suicide Prevention in School: Black Boys’ Lives Matter

Black boys have been dying by suicide at an increasing rate. Although the reasons for this increase are unknown, suicide in Black boys is likely influenced by multiple, intersecting risk factors, including historical and ongoing trauma. Schools can serve as an important mechanism of support for Black boys; however, without intentional antiracist frameworks that acknowledge how intersecting identities can exacerbate risk for suicide, schools can overlook opportunities for care and perpetuate a cycle of racism that compromises the mental health of Black youth. By recognizing their own implicit biases, modeling antiracist practices, listening to and recognizing the strengths and diversity of Black youth, and fostering school-family-community partnerships, school psychologists can help transform the school environment to be a safe and culturally affirming place for Black youth. This paper outlines how school psychologists can apply a trauma- and Justice, Equity, Diversity, and Inclusion (JEDI)-informed approach to suicide prevention in order to more holistically support Black boys, disrupt patterns of aggressive disciplinary procedures, and improve school-based suicide prevention programs. By applying this lens across a multitiered systems of support (MTSS) framework, school psychologists can help to prevent the deaths of Black boys and begin to prioritize the lives of Black boys. Impact Statement This article calls on school psychologists to take a trauma- and Justice, Equity, Diversity, and Inclusion (JEDI)-informed approach for school-based suicide prevention and interventions. The sociopolitical context of suicide risk and protective factors in Black boys, as well as the influence of intersecting identities on these factors, underscores the importance of antiracist approaches towards building school-community-family partnerships. A trauma and JEDI-informed approach to suicide prevention necessitates a culturally responsive collective impact team and culturally grounded approaches to prevention and intervention across a multitiered systems of support for prioritizing Black boys’ lives.

Under the Surface: The Role of Covert Cues in Peer Suicide Risk Referrals.

Suicidal thoughts and behaviors are highly prevalent among adolescents, and peers are often the first, and sometimes only, people to know about youth suicidality. Since many adolescents do not directly disclose suicidal thoughts, school-based suicide prevention programs aim to train youth to recognize warning signs of suicide in their peers that serve as "cues" to refer at-risk peers to an appropriate adult. However, peer-presented cues vary widely in presentation, and adolescents are more likely to recognize overt (i.e., obvious or explicit) as opposed to covert (i.e., hidden or implied) cues. The type of cue exhibited may, in turn, affect whether adolescents make a referral to an adult. The current study examined whether training suicide prevention influences referral intentions for overt and covert suicide cues. Participants included 244 high school students (54% female; M age = 16.21) in the Southeastern United States who received suicide prevention training (SOS; Signs of Suicide) as part of their health curriculum. Prior to training, students endorsed higher referral intentions for peers exhibiting overt compared to covert cues. Training was associated with increased intentions to refer peers across cue type, but referral intentions for covert cues improved significantly from pre to post-training while those for overt cues remained high and stable. Findings suggest that suicide prevention training might differentially improve students' ability to detect and respond appropriately to less obvious indicators of suicide risk. These findings may inform the adaptation and development of future, more nuanced school-based suicide prevention programming.

Evaluating the Signs of Suicide Program: Middle School Students at Risk and Staff Acceptability

Students at risk of suicide can be identified effectively through school-based prevention programs such as Signs of Suicide (SOS), which incorporate both psychoeducation and screening components. Prior research has focused on high school students; however, there is limited research in middle schools, and even less is known of school staff’s responsiveness to these programs. The current study evaluated the implementation of SOS with students at two U.S. middle schools (N = 2,537; 49% female) and through a treatment evaluation survey completed by school implementation staff (N = 26; 89% female). Nearly 20% of students emerged as at risk for suicide; risk was significantly higher among females, sixth graders, students with lower socioeconomic status, and students eligible for special education or accommodation plans. Most staff rated SOS as an acceptable program, and qualitative feedback regarding strengths and barriers is described. These findings advance practical knowledge for effectively implementing school-based suicide prevention programs and may guide school psychologists in advocating for and implementing such interventions. Impact Statement Suicide is the second leading cause of death among youth in the U.S., and prevention programs delivered in school settings have been effective at identifying and supporting these students. Nearly 20% of students participating in a suicide prevention program emerged as at risk for suicide, with several groups of students at significantly higher risk. Staff implementing this program generally reported positive perceptions of its acceptability, while also identifying several barriers and suggestions for improving future implementations.

Dos and Don'ts in Designing School-Based Awareness Programs for Suicide Prevention.

. Background: Despite the promising evidence for the effectiveness of school-based awareness programs in decreasing the rates of suicidal thoughts and suicide attempts in young people, no guidelines on the targets and methods of safe and effective awareness programs exist. Aims: This study intends to distill recommendations for school-based suicide awareness and prevention programs from experts. Method: A three-stage Delphi survey was administered to an expert panel between November 2018 and March 2019. A total of 214 items obtained from open-ended questions and the literature were rated in two rounds. Consensus and stability were used as assessment criteria. Results: The panel consisted of 19 participants in the first and 13 in the third stage. Recommended targets included the reduction of suicide attempts, the enhancement of help-seeking and peer support, as well as the promotion of mental health literacy and life skills. Program evaluation, facilitating access to healthcare, and long-term action plans across multiple levels were among the best strategies for the prevention of adverse effects. Limitations: The study is based on opinions of a rather small number of experts. Conclusion: The promotion of help-seeking and peer support as well as facilitating access to mental health-care utilities appear pivotal for the success of school-based awareness programs.

A meta-analysis of suicide prevention programs for school-aged youth

Suicide is an increasingly prevalent cause of death among adolescents across all demographics. Schools can be effective settings for identification and prevention of suicide due to the amount of time that students spend in school. This study presents a meta-analysis of school-based suicide prevention programs for students and school staff on the following outcomes: suicide awareness, helping skill, suicide behavior, psychological wellness, and psychological distress outcomes. A total of 27 studies were identified via 5 databases. Results suggest that suicide prevention programs have the largest impact on suicide awareness (k = 18, g = 0.72) and helping skill (k = 15, g = 0.43) compared to suicide behavior (k = 8, g = 0.17), psychological wellness (k = 7, g = 0.16), and psychological distress (k = 9, g = 0.16). However, results are limited by the availability of previous research. We conclude with a discussion of limitations, implications for practice, and directions for future research.

Use of Alcohol, Tobacco, and Caffeine and Suicide Attempts: Findings From a Nationally Representative Cross-sectional Study.

In this study, the association between students’ substance use and suicide attempts in the past 1 year was examined using secondary data from the 13th Korea Risk Behavior Web-based Survey. Participants were 7th- to 12th-grade students and 50.9% were male. A binominal logistic regression analysis was used to investigate the association between past experience of substance use (alcohol, tobacco, and caffeine) and suicide attempts after controlling for sociodemographic and psychological factors. Compared with no use, daily use of alcohol (odds ratio [OR] = 8.00), caffeine (OR = 2.13), and tobacco (OR = 1.41) was associated with increased odds of suicide attempts. These results indicate that school-based suicide prevention programs should cover awareness, surveillance, and treatment referral for these 3 substances. Moreover, mental health professionals should monitor intake of these substances when evaluating risk of suicide attempts in youth.

The Role of the School Nurse in Suicide Interventions: An Integrative Review.

Suicide rates among children and adolescents have continued to rise over the past decade indicating the need for school-based suicide prevention programs. School nurses (SNs) are well positioned to assist in assessment, early identification, and intervention of at-risk students. This integrative review aimed to (1) critically examine the role of the SN in school-based suicide interventions, (2) explore potential barriers preventing the SN from participating in suicide interventions, and (3) recommend strategies to build capacity for principles of school nursing practice in suicide intervention. The National Association of School Nurses' Framework for 21st Century School Nursing Practice was used to categorize interventions and outcomes related to suicide prevention. Findings demonstrate a lack of reported nursing interventions directly linked to student outcomes and suggest obscurity in the role of the SN. Recommendations for future research and strategies to build capacity for principles of school nursing practice are provided.

The association between Japanese students’ help-seeking behaviour and their reliable adults

Introduction In Japan, suicide ranks as the first leading cause of death among students. It is reported that one of the reasons for this is that Japanese children have lower self-esteem than children in most Western countries. Schools are expected to provide appropriate opportunities for suicide prevention. Evidence supported that suicide vulnerability in youth can be reduced when school-based programs teach coping skills and positive ways of self-esteem. Moreover, it is also important for students when seeking help how they communicate with adults nearby. However, few study reported the association between student's relationship with adults nearby and their help-seeking behavior. In order to provide school-based suicide prevention program promoting self-esteem in students, we tried to clarify the association between student's relationships with familiar adults and help-seeking behavior of students. Methods We assigned 434 students of primary and junior high schools in Adachi City, Tokyo to participate school-based program during 2017 school years. This program was specially designed for primary and junior high school students and was presented in one session (45-minutes) by a public-health nurse and teachers. Students were asked to complete self-administered questionnaires before implementing the program. Questionnaires asked about their relationships with adults nearby such as parents, teachers, and neighbors and their intention to seek support when they have some trouble. Results A total of 181 valid responses were obtained. Among them, 25% of participants are primary school students and 75% are junior high school students. Boys are 29.8% of respondents. Over half of the students (59.6%) answered that they had/have had some troubles, most of which was concern about the study. When students feel troubled, 68.5% of them consult with someone or ask someone's advice. Students who recognized adults nearby as reliable people have more consulted with others when they had some troubled (P-value = 0.017). The self-esteem was significantly higher among students who had reliable adults than students who answered they have no reliable adult close to them (P-value Conclusions The findings of this study suggested that building a reliable relationship with adults close to students can influence their help-seeking behaviors and their higher self-esteem. In view of primary suicide prevention strategy, it could be more effective for students to learn how to find supportive adults and to seek to help them when problems arise, in addition to coping skills. Further study is needed to evaluate the school-based programs, which teach students adaptive ways of help-seeking behavior.

Evaluation of a multimodal school-based depression and suicide prevention program among Dutch adolescents: design of a cluster-randomized controlled trial

BackgroundSince 2010, suicide has been the most important cause of mortality in youth aged 15 to 29 years in the Netherlands. Depression is an important risk factor for suicidal behaviors (i.e., suicide ideation, deliberate self-harm, planning, and suicide attempts) in adolescents. Adolescents who develop depressive symptoms, are also at risk for adult depression. This developmental continuity is especially noticeable in adolescents compared to other age groups; therefore, it is necessary to develop preventive strategies for teens. This study will test a multimodal school-based approach to suicide and depression prevention, which integrates universal and targeted approaches and includes various stakeholders (schools, adolescents, parents, and mental health professionals) simultaneously.MethodsWe will perform a cluster randomized controlled trial (RCT) with an intervention and control condition to test the effectiveness of a school-based multimodal stepped-prevention program for depression and suicidal behaviors in adolescents. Adolescents in their second year of secondary education will participate in the study. The participants in the intervention condition will receive the entire multimodal stepped-preventive program comprising early screening and detection of suicidal behaviors and depressive symptoms, a safety net consisting of gatekeepers at school, followed by universal and indicated prevention. The participants in the control condition will undergo only the screening and the safety net of gatekeepers at schools. They will complete assessments at baseline, post-intervention, and 6, 12, and 24-month follow-up. Primary outcome will be suicidal behaviors measured at 12-months follow-up. Additionally, the present study will identify mechanisms that mediate and moderate the program effects and test the effect of the program on various secondary outcomes.DiscussionIf the school-based multimodal stepped-prevention program proves to be effective, it could be implemented in schools on a large scale.Trial registrationThe study is registered in the Dutch Trial Register (NTR6622).

The Relation between Descriptive Norms, Suicide Ideation, and Suicide Attempts among Adolescents

This study examined the relationship between adolescents' beliefs about the prevalence of youth suicide ideation (ideation descriptive norms) and suicide attempts (attempt descriptive norms) with self-reported suicide ideation and attempts. Descriptive norms, suicide ideation, and suicide attempts as well as gender, race/ethnicity, and exposure to family, peer, and others' suicide were assessed in 2,109 students at six suburban New York State high schools. After controlling for demographic variables and exposure to suicide, elevated ideation descriptive norms and attempt descriptive norms were associated with higher rates of suicide ideation and lifetime suicide attempts among adolescents. Adolescents who believed suicide ideation and attempts to be more widespread among peers (i.e., elevated ideation and attempt descriptive norms) were more likely to endorse suicide ideation and attempts. Correcting these descriptive norms may be a worthwhile goal for school-based suicide prevention programs.