Youth Suicide Prevention Programs Research Articles

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.

Community Mental Health Treatment for Suicidality: Implementation of a Culturally Adapted Youth Suicide Prevention Program

Community Mental Health Treatment for Suicidality: Implementation of a Culturally Adapted Youth Suicide Prevention Program

Evaluating the Effectiveness of Suicide Prevention Gatekeeper Trainings as Part of an American Indian/Alaska Native Youth Suicide Prevention Program

According to the Centers for Disease Control suicide rates in 2022 for American Indian/Alaska Native youth are 2.5 times higher than the national average. An Urban Indian Health Organization’s response to this crisis was to provide community and State-wide Gatekeeper trainings between 2012 and 2019 to teach trainees (N = 810) to respond appropriately to youth at-risk of suicide. We report data on pre-, post-, and six-month follow-up surveys with trainees. Data were analyzed using generalized linear models repeated measures to test within-subject, and between-subject mean score changes on suicide prevention-related measures “knowledge,” “ask directly,” “respond,” “comfort,” and “preparedness.” Results indicated improved capacity to be prepared to address suicide in the short term and that having a graduate degree enhanced baseline suicide prevention knowledge. Over time those with less education benefited the most and better retained content. Future Trainings should engage young people and those with less education to realize the largest benefit.

HHS awards funding to states, tribes and colleges to prevent youth suicide

The U.S. Department of Health and Human Services (HHS) on June 1, through the Substance Abuse and Mental Health Services Administration, awarded $5.9 million to states, tribes and college campuses for youth suicide prevention programs. Of the total $5.9 million, $3.6 million was awarded to states and tribes under the Garrett Lee Smith (GLS) State/Tribal Youth Suicide Prevention and Early Intervention Program. The remaining $2.3 million was awarded to college campuses under the GLS Campus Suicide Prevention Program, which enhances mental health services for all college students, including those at risk for suicide, depression, serious mental illness/serious emotional disturbances, and/or substance use disorders that can lead to school failure.

Psychiatric Comorbidity Among Sexual and Gender Minority Youth and Young Adults at Risk for Suicide

Abstract Background Compared with peers, young sexual and gender minorities (SGM) are at a four to seven-fold increased risk of attempting suicide. Prior epidemiological studies, mainly focusing on monomorbid inequalities and without conducting diagnostic clinical interviews, have been unable to report robust data on psychiatric comorbidities among those who attempted suicide. The purpose of this presentation is to describe the presence of current psychiatric comorbidities among SGM youth and young adults at elevated risk for repeat suicide attempts. Methods A diverse convenience sample of SGM youth and young adults with a lifetime history of suicide attempts and current suicidal ideation was recruited for an open-phase suicide prevention trial in San Diego, CA. At baseline, participants underwent a 15-module DIAMOND interview for adults or computerized K-SADS for minors, and a battery of self-report questionnaires. Results Among the 31 participants (Mage = 22 years [Range: 16, 29]; 100% sexual, 52% gender, and 61% racial/ethnic minority), 27 (87%) participants met criteria for any mood disorder, 24 (77%) for any anxiety disorder, 16 (52%) for any trauma or stress disorder, and 2 (6%) for any psychotic disorder. One (3%) participant did not meet criteria for any psychiatric diagnoses, while five (16%) met criteria for a single and 25 (81%) for multiple diagnoses. The average number of diagnoses was 3.2 (Range: 0, 7). Additionally, 20 (65%) participants met the cut-off for likely ADHD, 20 (65%) for possible borderline personality disorder, and 21 (68%) for likely body dysmorphic disorder, with 11 (35%) within the 90th percentile for reference eating disorder severity. Conclusions The degree of psychiatric comorbidities in the sample of SGM youth and young adults at elevated risk for suicide was high. Beside direct suicide risk mitigation efforts, suicide prevention programs that target young SGM with a history of attempts should screen for untreated psychiatric disorders. Key messages • LGBTQ+ youth and young adults at elevated risk for repeat suicide attempts experience a high degree of psychiatric comorbity. • Beyond suicide risk mitigation, LGBTQ+ youth suicide prevention programs should focus on untreated psychiatric comorbidities.

Self-harming behavior in relation to exposure to inter-personal violence among youth and young adults in Colombia

The effects of violence exposure on the risk of self-harming behaviors of youth in low- and middle-income countries is not well-understood. Using household survey data from one nationally representative sample and one sample from conflict-affected areas, we examined violence exposure and self-harm among Colombian youth aged 13–24. Survey-weighted prevalence ratios comparing self-harming behaviors by exposure to violence were estimated with Poisson log-linear models, controlling for age, sex, education and food insecurity. Compared to unexposed youth, those exposed to violence in both home and community settings were 7.97 (95% confidence interval [CI]:2.72–23.36) times more likely in the conflict-affected sample, and 21.05 (95% CI: 8.80–50.34) times more likely in the national sample to report having attempted suicide. Among Colombian youth, exposure to violence as either witness or victim was associated with greater prevalence of self-harming behaviors. Youth suicide prevention programs can address exposures to violence as a risk factor for self-harm.

Influence of Parental Attitude Toward Psychiatric Help on Their Children's Suicidal Ideation: A Convenience Sample Study on One South Korean Middle School.

Depression, depression stigma, and attitude toward psychiatric help are associated factors of suicide in adolescents. As parents are the main decision-makers of receiving professional help for their children’s depression and suicide, parental factors influencing their children’s suicide should be examined. Moreover, parents’ help-seeking attitude for their own mental health problems could affect their children’s mental health problems. Therefore, this study examined the serial mediation of adolescents’ depression, depression stigma, and attitude toward psychiatric help in the relationship between parental attitude toward psychiatric help and the suicidal ideation of their children, using data of 103 parent–child pairs. A cross-sectional study was conducted by employing a self-administered survey. A serial mediation analysis was performed using Amos 25.0. Parental attitude toward psychiatric help directly and indirectly influenced children’s suicidal ideation. Children’s depression stigma, attitude toward psychiatric help, and depression mediated the relationship of parental attitude toward psychiatric help and their children’s suicidal ideation. When parents have a more positive attitude toward psychiatric help, their children’s suicidal ideation become more decreased. Enhancing only parental attitude toward psychiatric help may make a positive change on their children’s suicidal ideation. The study findings imply that when developing and applying youth suicide prevention programs, how parents affect their children’s suicidal ideation should be considered as well as adolescents’ depression stigma, attitude toward psychiatric help, and depression. Given the results of this study, healthcare providers may better evaluate the effectiveness of their intervention programs for preventing adolescents’ suicide.

Suicidality in 12-Year-Olds: The Interaction Between Social Connectedness and Mental Health.

Suicidal thoughts and behaviors (STB) are a leading cause of death in adolescence. To date, most research with youth has focused on risk factors for suicide; and less attention has been paid to resilience factors. This study examined whether positive beliefs and social connectedness moderate associations between mental health symptoms and STB. A community sample of 12-year-olds (N = 60) completed self-report questionnaires on their STB, mental health symptoms, positive beliefs and social connectedness. Nearly 20% of the adolescents reported STB. STB was associated with increased mental health symptoms and lower scores on the resilience measures. A significant moderating effect of social connectedness showed that youth with a combination of poor mental health and high levels of social support exhibited lower levels of STB. There was no significant moderating effect of positive beliefs. These results indicate that social support should be screened for in primary care and incorporated into youth suicide prevention programs.

3.61 YOUTH SUICIDE IN SAIPAN AND THE INTRODUCTION OF A PREVENTION PROGRAM

A 2017 survey in Saipan, the capital of the Commonwealth of the Northern Mariana Islands (CNMI) demonstrated an alarmingly high rate of youth suicidality compared with the mainland United States. The Garrett Lee Smith Youth Suicide Prevention Program (GLSYSPP) is a grant provided by SAMHSA to give states with youth suicide prevention strategies. This grant was awarded in Saipan in March 2018. This study aims to examine suicidal behavior in a cohort of youth referred to GLSYSPP in Saipan. Specifically, we will study demographic and environmental factors associated with suicidal ideation (SI) and suicide attempts (SA) and the most common methods of completing suicide. We will also evaluate the effectiveness of GLSYSPP interventions. We hypothesize that males would be more likely than females, and multi-ethnic youth would be more likely than mono-ethnic youth, to report familial conflict and instability.

Removing Barriers to Treatment: Evaluation of a Youth Suicide Prevention Program

This study examined the effectiveness of a suicide prevention program that provides free and accessible counseling services to suicidal youth. Children and adolescents who underwent a suicide risk assessment at a Colorado school (n = 99) were referred for counseling through the Second Wind Fund (SWF), a non-profit organization dedicated to the prevention of youth suicide. Each of these clients presented with at least 1 barrier to treatment such as no or inadequate insurance or lack of transportation. Through SWF, clients received up to 12 counseling sessions at no charge. Clients ranged from 8 to 18 years of age. Of the 99 clients, 93 completed the Suicide Ideation Questionnaire-Junior (SIQ-Jr) at the beginning and end of treatment. Results indicated that SIQ-Jr scores were significantly lower at the end of treatment. Follow-up surveys were sent to referral sources at the end of the subsequent school year to examine longer-term effectiveness of SWF services. The majority of clients did not require any additional intervention and none went on to die by suicide. Study results indicate that the removal of financial and social barriers can increase access to and participation in treatment and reduce suicidal thoughts and behaviors. Implications for practice, including suicide risk assessment and outside referrals are discussed.

Long-term impact of the Garrett Lee Smith Youth Suicide Prevention Program on youth suicide mortality, 2006-2015.

Comprehensive suicide prevention programs funded through the Garrett Lee Smith Memorial Youth Suicide Prevention Program (GLS) have previously been shown to be associated with lower youth suicide mortality rates 1year following program implementation. However, longer term effects of GLS have yet to be examined. The impact of GLS implementation on youth suicide mortality through 2015 was estimated for U.S. counties initially exposed to state and tribal GLS activities between 2006 and 2009. The analytic approach combined propensity score-based techniques to address potential confounding arising from differences between counties exposed and not exposed to the program along an extensive set of characteristics, including historical suicide rates. Counties exposed to GLS during a single year had youth suicide mortality rates lower than expected and for longer than previously reported following implementation of GLS activities. Youth suicide mortality rates in counties implementing GLS were estimated to be 0.9 per 100,000 youths lower than control counties (p=.029) 1year after the implementation, and 1.1 per 100,000 youths lower than control counties (p=.010) 2years after the implementation. Further, persistent implementation during multiple years was associated with larger effects during longer periods. Additionally, among rural counties, the youth suicide rates 2years after exposure were estimated to be 2.4 per 100,000 youths lower than in the absence of the program (p=.003). There was no significant evidence of a decrease in youth suicide rates three or more years after the GLS activities were discontinued. The effects of GLS comprehensive suicide prevention program were found to be stronger and longer lasting than previously reported, particularly in rural counties. In the face of well-documented increases in national suicide prevention rates, these results support the widespread and persistent implementation of comprehensive, community-based youth suicide prevention programs.

Youth suicide prevention and early intervention grant program—Tribal youth (SAMHSA)

Youth suicide prevention and early intervention grant program—Tribal youth (SAMHSA)

An Economic Evaluation of the Garrett Lee Smith Memorial Suicide Prevention Program.

For more than a decade, the Garrett Lee Smith Youth Suicide Prevention Program has provided funding for community-based suicide prevention programs to states, tribes, and colleges across the United States. Recent studies provided evidence of the program's effectiveness in reducing suicide mortality and suicide attempts among youth. This study compares the cost of implementing the program with the estimated savings resulting from avoided hospitalization and emergency department visits associated with the averted suicide attempts. The findings suggest that the cost of implementing multifaceted community-based suicide prevention strategies may be more than outweighed by savings in the health sector.

Efficacy of Web-Based Collection of Strength-Based Testimonials for Text Message Extension of Youth Suicide Prevention Program: Randomized Controlled Experiment.

BackgroundEquipping members of a target population to deliver effective public health messaging to peers is an established approach in health promotion. The Sources of Strength program has demonstrated the promise of this approach for “upstream” youth suicide prevention. Text messaging is a well-established medium for promoting behavior change and is the dominant communication medium for youth. In order for peer ‘opinion leader’ programs like Sources of Strength to use scalable, wide-reaching media such as text messaging to spread peer-to-peer messages, they need techniques for assisting peer opinion leaders in creating effective testimonials to engage peers and match program goals. We developed a Web interface, called Stories of Personal Resilience in Managing Emotions (StoryPRIME), which helps peer opinion leaders write effective, short-form messages that can be delivered to the target population in youth suicide prevention program like Sources of Strength.ObjectiveTo determine the efficacy of StoryPRIME, a Web-based interface for remotely eliciting high school peer leaders, and helping them produce high-quality, personal testimonials for use in a text messaging extension of an evidence-based, peer-led suicide prevention program.MethodsIn a double-blind randomized controlled experiment, 36 high school students wrote testimonials with or without eliciting from the StoryPRIME interface. The interface was created in the context of Sources of Strength–an evidence-based youth suicide prevention program–and 24 ninth graders rated these testimonials on relatability, usefulness/relevance, intrigue, and likability.ResultsTestimonials written with the StoryPRIME interface were rated as more relatable, useful/relevant, intriguing, and likable than testimonials written without StoryPRIME, P=.054.ConclusionsStoryPRIME is a promising way to elicit high-quality, personal testimonials from youth for prevention programs that draw on members of a target population to spread public health messages.

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.

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.

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.

CONNECTION AND RELATIONAL ENGAGEMENT IN A YOUTH SUICIDE PREVENTION PROGRAM

Vancouver Island Crisis Society has developed a unique approach to suicide prevention for youth and is encouraged to observe the positive impact these programs have had in the lives of students and on school communities as a result. This is the story of the evolution of two such school-based suicide prevention programs: (a) GRASP (Growth, Resilience, Acknowledgement, Suicide, Awareness, Personal Safe Planning); and (b) Speak Out, Reach Out, Help Out. While suicidal despair often thrives in isolation, what power might human connection have to combat it? And could that sense of connection be interwoven into youth suicide prevention programs, not to diminish what is already there but to enrich and enliven current best practices, and research-based information? Throughout this article, I will uncover the possibilities of what can emerge when practice is informed by the professional literature and a purposeful intent to create a sense of connection and relational engagement.