Adolescent Decision-Making: The Value of Perceived Behavioral Control in Predicting Engagement in Suicide Prevention Behaviors

Youth Participatory Action Communication Research: A Model for Developing Youth-Driven Health Campaigns

Youth offer valuable insight on health communication needs and solutions in their communities. We propose youth participatory action communication research (YPACR) as a model for health campaign development that engages youth perspectives in applying systematic theory-informed communication research to addressing youth-identified health priorities. YPACR informed a series of paid high school internship programs in West Philadelphia, in which youth interns identified mental health help-seeking communication as a need among peers. In Phase 1, guided by the reasoned action approach and Hornik & Woolf method, youth interns conducted a survey measuring behavioral beliefs, normative beliefs, and control beliefs associated with mental health help-seeking, as well as trusted sources of mental health information, among local high school students. Survey results suggested control (self-efficacy) was an important message target and peers were trusted mental health information sources. In Phase 2, youth interns developed TikTok-style messages focused on strengthening control beliefs and promoting a youth-selected mental health support resource. Youth interns distributed an online survey experiment to test whether youth-created messages shown alongside resource information increased help-seeking self-efficacy compared to an information-only control. The YPACR framework contributed to youth-relevant campaign goals, study measurements, recruitment approaches, data interpretation, and message design. We discuss the benefits and challenges of this youth-driven health campaign development model and recommendations for future research.

Examining Individual and Service Delivery Context Variables and Their Association with the Effectiveness of QPR Suicide Prevention Gatekeeper Training

Suicide prevention training programs have spread rapidly within child and public-serving organizations, due to the alarming increase in youth suicide rates. Yet, within these organizations, roles and responsibilities can shape attitudes and intentions related to suicide prevention, thereby influencing the uptake of prevention efforts. As such, various organizational and individual factors can predict uptake, adoption, and maintenance of prevention efforts (Fixsen et al., 2005). To date, few studies have examined the service delivery context in understanding training effectiveness, especially as it relates to QPR (Question Persuade and Refer), one of the most widely disseminated suicide prevention gatekeeper programs. The purpose of this longitudinal study was to evaluate whether individual and organizational characteristics influenced the effectiveness and sustainability of training outcomes, and whether such differences existed among diverse child and public-serving delivery sectors. Several training outcomes that align with the Theory of Planned Behavior (Ajzen, 1991) were examined, including confidence, attitudes, social norms, and suicide prevention behaviors. Measures were assessed prior to and 90 days after the QPR program among a sample of 858 professionals. Community support personnel uniquely showed improvements on social norms while juvenile justice and child welfare workers engaged in more suicide prevention behaviors post training. While trainees across sectors had improved suicide prevention attitudes, law enforcement personnel were the exception. Organizational climate predicted change in suicide prevention attitudes, confidence, and social norms. Trainees who were older, Latinx, and Black had the most improvement on several training outcome variables, but these findings also varied within service sectors.

Profiles, Transitions, and Resilience Factors of Suicide Risk in Early Chinese Adolescents

As a severe public health concern directly endangering life safety, adolescent suicide has been extensively investigated in variable-centered studies. However, gaps remain in the knowledge of heterogeneous suicide risk patterns and their developmental nature. Additionally, little is known about protective factors associated with suicide risk patterns and changes. This study applied person-centered approaches to explore suicide risk profiles and transitions over time in early Chinese adolescents, along with their protective factors. A total of 1518 junior high school students (49.6% girls, Mage = 13.57, SD = 0.75) participated in two surveys within a 12-month interval. Latent Profile Analysis and Latent Transition Analysis were used to model the profiles and transitions of suicide risk. Three risk profiles were identified at both time points: low risk profile (73.9, 78.3%), medium risk-high threat profile (16.2, 10.2%), and high risk profile (9.9, 10.2%). Low risk profile was stable, while medium risk-high threat and high risk profiles showed great transitions over 12 months. Sense of control, meaning in life, and regulatory emotional self-efficacy served as protective factors against suicide risk profiles and transitions. Findings underscore the importance of comprehensively illustrating suicide risk states from multiple aspects, as well as understanding the fluid nature of transitions between different risk states. Prevention and intervention strategies aimed at enhancing resilience, such as increasing sense of control, perceived meaningfulness, and belief in emotional regulation, may contribute to reducing the risk of suicide among adolescents.

The role of perceived social norms in non-suicidal self-injury and suicidality: A systematic scoping review

Social norms are an important influence on health-related behaviours and intention formation. As both suicidal behaviour and non-suicidal self-injury (NSSI) can be motivated by intentions, perceived social norms may have an important role in suicide and NSSI outcomes, although no existing reviews of this association exist. Following the PRISMA Scoping Review extension guidance, a scoping review based on systematic searches of key databases was conducted to identify published English language studies investigating the role of perceived social norms in suicidality and NSSI. Information regarding the types of social norms studied, their relationship to suicidality/NSSI outcomes, study samples and designs was charted. Thirty-six eligible studies (31 quantitative, 4 qualitative, 1 mixed methods) sampling various populations across mostly non-clinical settings were identified and narratively synthesised. Studies varied in how social norms were operationalised, measured, and investigated/explored. Most studies focused on the role of conformity to perceived masculine social norms or to some form of subjective, descriptive, or injunctive norms; there were limited studies on female/feminine norms, pro-social/protective norms, or broader gender/sexuality norms. Most studies (n = 31) were cross-sectional (quantitative) in design, few were based on existing theories of suicide/NSSI or social norms, and none concurrently tested theories of social norms and NSSI/suicidality. Perceived social norms and stronger conformity to norms were generally associated with worse NSSI/suicidality, although some pro-social norms appeared to be protective (e.g., perceived parental norms for adolescents). Whilst conformity to restrictive perceived social norms may be related to poorer suicide and NSSI outcomes, there is a lack of consistency in the literature in how social norms are defined and measured, a lack of theory-based hypothesis testing, and few longitudinal studies. There is a need for more nuanced, theory-based, investigations of how, when, where, why, and for whom, perceived norms have a causal role in NSSI and suicidality outcomes.

Evaluating Dialectical Behavior Therapy Training With Mental Health Clinicians

A substantial body of research supports dialectical behavior therapy (DBT) as an evidence-based treatment for those with borderline personality disorder (BPD); however, there remains a lack of mental health clinicians trained in this modality, resulting in limited clinician competencies and skills. Furthermore, the effectiveness of DBT trainings with mental health clinicians remains understudied. The present study evaluated a comprehensive 5-day DBT-Linehan Board of Certification training program. Informed by the Theory of Planned Behavior, this study assessed changes in clinician knowledge, attitudes, perceived behavioral control (PBC), intentions, and behaviors relevant to DBT at baseline, posttraining, and 6-month follow-up. Results showed large, significant pre-to-post training improvements in clinicians' knowledge, attitudes, PBC, and intentions related to DBT implementation. Large improvements in knowledge, attitudes, and PBC were sustained at follow-up. A significant improvement in actual behaviors was also found at follow-up. Implications of the present study and directions for future research are discussed.

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.

Gatekeeper training for friends and family of individuals at risk of suicide: A systematic review

AIMS

Gatekeeper training (GKT) is an important suicide prevention strategy. Studies have evaluated the effectiveness of GKT in different populations, often neglecting family and friends who play a vital role in caring for people with suicide risk. This review evaluated GKT programs targeting family and friends to determine their effectiveness in this specific population.

METHODS

Academic databases were searched for studies on GKT programs. Programs involving family and friends caring for people with suicide risk were assessed for any impact on knowledge, self-efficacy, attitudes, and suicide prevention skills.

RESULTS

Seventeen studies were reviewed. GKT showed significant gains on outcomes of interest. Three studies targeted family and friends, with one involving them in program creation and conduction and another adjusting the program after their input.

CONCLUSIONS

GKT programs have potentially positive effects on family and friends caring for people with suicide risk. Few programs address the specific needs of this group, and programs adapted specifically for them are scarce. Future program development recommendations are discussed.