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Filiatreau LM, Tutlam N, Brathwaite R, Byansi W, Namuwonge F, Mwebembezi A, Sensoy-Bahar O, Nabunya P, Neilands TB, Cavazos-Rehg P, McKay M, Ssewamala FM. Effects of a Combination Economic Empowerment and Family Strengthening Intervention on Psychosocial Well-being Among Ugandan Adolescent Girls and Young Women: Analysis of a Cluster Randomized Controlled Trial (Suubi4Her). J Adolesc Health 2023; 72:S33-S40. [PMID: 37062582 PMCID: PMC10157657 DOI: 10.1016/j.jadohealth.2022.11.250] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/15/2022] [Accepted: 11/08/2022] [Indexed: 04/18/2023]
Abstract
PURPOSE Economic empowerment and family strengthening interventions have shown promise for improving psychosocial well-being in a range of populations. This study investigates the effect of a combination economic and family strengthening intervention on psychosocial well-being among Ugandan adolescent girls and young women (AGYW). METHODS We harnessed data from a three-arm cluster randomized controlled trial among AGYW aged 14-17 years in 47 Ugandan secondary schools. Schools were randomized to either a youth development account intervention (YDA) [N = 16 schools], YDA plus a multiple family group intervention (YDA + MFG) [N = 15 schools], or bolstered standard of care (BSOC) [N = 16 schools]. We estimated the effect of each intervention (BSOC = referent) on three measures of psychosocial well-being: hopelessness (Beck's Hopelessness Scale), self-concept (Tennessee Self-Concept Scale), and self-esteem (Rosenberg Self-Esteem Scale) at 12 months following enrollment using multi-level linear mixed models for each outcome. RESULTS A total of 1,260 AGYW (mean age, 15.4) were enrolled-471 assigned to YDA (37%), 381 to YDA + MFG (30%), and 408 to usual care (32%). Over the 12-month follow-up, participants assigned to the YDA + MFG group had significantly greater reductions in hopelessness and improvements in self-esteem outcomes compared to BSOC participants. Those enrolled in the YDA arm alone also had significantly greater reductions in hopelessness compared to BSOC participants. DISCUSSION Combination interventions, combining economic empowerment (represented here by YDA), and family-strengthening (represented by MFG) can improve the psychosocial well-being of AGYW. The long-term effects of these interventions should be further tested for potential scale-up in an effort to address the persistent mental health treatment gap in resource-constrained settings.
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Affiliation(s)
- Lindsey M Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Nhial Tutlam
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Rachel Brathwaite
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - William Byansi
- Boston College School of Social Work, Chestnut Hill, Massachusetts
| | - Flavia Namuwonge
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | | | - Ozge Sensoy-Bahar
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, California
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Mary McKay
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri.
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Gijzen MWM, Rasing SPA, Creemers DHM, Engels RCME, Smit F. Effectiveness of school-based preventive programs in suicidal thoughts and behaviors: A meta-analysis. J Affect Disord 2022; 298:408-420. [PMID: 34728296 DOI: 10.1016/j.jad.2021.10.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 10/01/2021] [Accepted: 10/23/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Suicidal thoughts and behaviors (STBs) among adolescents have hardly decreased despite preventative efforts. School-based prevention programs could have a great reach, yet suicide prevention is not an easy topic to address. To increase acceptability of school-based suicide prevention, it is important to evaluate whether programs that target known risk factors of STBs, such as depression, could be equally effective. METHODS We conducted a systematic literature search in major electronic databases. Outcomes were suicidal ideation and behaviors. Multivariate random effects meta-regression-analyses were conducted. RESULTS Eleven primary studies met the inclusion criteria, totalling 23,230 participants. The post-test effect size was small for both suicidal ideation (g = 0.15) and suicidal behaviors (g = 0.30). Meta-regression indicated that targeting known risk factors of STBs was not a significant modifier of effect size for ideation, indicating equal effectiveness. However, it was significant modifier of effect for behaviors, but only one intervention targeted know risk factors. Effects at follow-up (3-12 months) were also significant but small for both outcomes. LIMITATIONS Substantial heterogeneity between studies was noted. Only few and small sample size studies could be included that targeted known risk factors of STBs. Therefore, these results should be interpreted with caution. CONCLUSIONS School-based prevention of STBs shows some promise within three months post-test assessments, and potentially also have effects that are sustained over time. More studies are needed to make conclusions regarding school-based interventions that target risk factors of STBs.
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Affiliation(s)
- Mandy W M Gijzen
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), P.O. Box 725, Utrecht 3500 AS, the Netherlands; Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands; GGZ Oost Brabant, P.O. Box 3, Boekel 5427 ZG, the Netherlands.
| | - Sanne P A Rasing
- GGZ Oost Brabant, P.O. Box 3, Boekel 5427 ZG, the Netherlands; Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, Nijmegen 6500 HE, the Netherlands
| | - Daan H M Creemers
- GGZ Oost Brabant, P.O. Box 3, Boekel 5427 ZG, the Netherlands; Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, Nijmegen 6500 HE, the Netherlands
| | - Rutger C M E Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands
| | - Filip Smit
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), P.O. Box 725, Utrecht 3500 AS, the Netherlands; Department of Clinical, Neuro and Developmental Psychology and Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, P.O. Box 7057, Amsterdam 1007 MB, the Netherlands
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A Population-Based Examination of Suicide and Child Protection System Involvement. J Adolesc Health 2021; 69:465-469. [PMID: 33814278 DOI: 10.1016/j.jadohealth.2021.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/26/2021] [Accepted: 02/10/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to provide a population-based analysis of child protection system (CPS) involvement among children and adolescents who died by suicide. METHODS We performed a case-control study of child and adolescent suicide and CPS involvement. Using linked birth, death, and CPS records, we longitudinally followed all children born in California in 1999 and 2000 (N = 1,052,333) in CPS and death records through 2017. Cases were defined as children who died in California and had a manner of death coded as suicide using the International Classification of Diseases, 10th revision (n = 170). Each suicide case was matched to four living controls, and children were classified based on CPS exposure: no history, reported for alleged child maltreatment, substantiated for child maltreatment, and placed in foster care. Crude suicide rates were documented, and conditional logistic regression models were used to estimate the adjusted odds of suicide. RESULTS Among children and adolescents who died by suicide, 56.5% had a history of past allegations of abuse or neglect. Children with any CPS history had three times the odds of suicide compared to children with no history. No additional risk was found for children substantiated or placed in foster care compared to children with only an allegation. CONCLUSIONS Suicide risk is not isolated to the relatively small group of children and youth placed in foster care. Findings reinforce the importance of increased attention to the experiences of the larger universe of children who remain at home after alleged or substantiated maltreatment.
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Murray RM, Conroy E, Connolly M, Stokes D, Frazer K, Kroll T. Scoping Review: Suicide Specific Intervention Programmes for People Experiencing Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136729. [PMID: 34206560 PMCID: PMC8297158 DOI: 10.3390/ijerph18136729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/01/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022]
Abstract
Background: The homeless population are among the most vulnerable groups to experience suicide ideation and behavior. Several studies have shown that people who are homeless experience more significant suicidal ideation and behavior than the general population. However, there is limited information about what suicide interventions exist, to what extent they are grounded in robust research, and which intervention components effectively reduce suicidal ideation and behavior in the homeless community. This research aimed to characterise the current evidence base in the area of suicide prevention for homeless individuals. Methods: A scoping review guided by Arksey and O’Malley’s five-stage framework was conducted and a narrative synthesis was performed. Pubmed, EMBASE, PsychInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Open Grey, and Bielefeld Academic Search Engine were searched up to 8 May 2020. Results: A total of 3209 records were identified through database and grey literature searching. Three studies are included in this review. Key outcomes identify suicide intervention prevention programmes; similarities and differences across interventions, and examples of staff training. A quality review of the studies was completed. Conclusion: A stark gap in the evidence of suicide specific prevention interventions targeted at homeless populations.
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Affiliation(s)
- Rachael McDonnell Murray
- The Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh EH8 9AG, UK
- Correspondence:
| | - Eilis Conroy
- The Academic Unit of Neurology, Trinity College Dublin, Dublin D02 PN40, Ireland;
| | | | - Diarmuid Stokes
- University College Dublin Library, University College Dublin, Dublin D04 V1W8, Ireland;
| | - Kate Frazer
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin D04 V1W8, Ireland; (K.F.); (T.K.)
| | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin D04 V1W8, Ireland; (K.F.); (T.K.)
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Decker MR, Wilcox HC, Holliday CN, Webster DW. An Integrated Public Health Approach to Interpersonal Violence and Suicide Prevention and Response. Public Health Rep 2019; 133:65S-79S. [PMID: 30426878 PMCID: PMC6243443 DOI: 10.1177/0033354918800019] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Violence is a leading source of morbidity and mortality in the United States. In this article, we suggest a public health framework for preventing community violence, intimate partner violence and sexual violence, and suicide as key forms of interpersonal and self-directed violence. These types of violence often co-occur and share common risk and protective factors. The gender, racial/ethnic, and age-related disparities in violence risk can be understood through an intersectionality framework that considers the multiple simultaneous identities of people at risk. Important opportunities for cross-cutting interventions exist, and intervention strategies should be examined for potential effectiveness on multiple forms of violence through rigorous evaluation. Existing evidence-based approaches should be taken to scale for maximum impact. By seeking to influence the policy and normative context of violence as much as individual behavior, public health can work with the education system, criminal justice system, and other sectors to address the public health burden of interpersonal violence and suicide.
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Affiliation(s)
- Michele R Decker
- 1 Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 2 Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Holly C Wilcox
- 3 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Charvonne N Holliday
- 1 Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniel W Webster
- 4 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 5 Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Beharie N, Jessell L, Osuji H, McKay MM. The Association Between Shelter Rules and Psychosocial Outcomes Among Homeless Youth Residing in Family Shelters. FAMILIES IN SOCIETY : THE JOURNAL OF CONTEMPORARY HUMAN SERVICES 2017; 98:113-120. [PMID: 30002568 PMCID: PMC6039122 DOI: 10.1606/1044-3894.2017.98.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite growing numbers of homeless youth living in shelters with caregivers, little research has explored the impact of the shelter environment on emotional well-being. As such, this study assesses the relationship between shelter rules and two psychosocial outcomes among youth in New York City family shelters. Additionally, the direct effect of trauma and the moderating effect of difficulty following shelter rules on psychosocial outcomes was assessed. Youth with difficulty following shelter rules reported significantly more depressive symptoms, but less substance use. Trauma was found to be associated with increased depression and substance use. Difficulty following shelter rules was found to moderate the association between trauma and substance use. Recommendations for future interventions and the creation of shelter policies are discussed.
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Affiliation(s)
- Nisha Beharie
- Postdoctoral research fellow, New York University Rory Meyers College of Nursing
| | | | - Hadiza Osuji
- Postdoctoral research fellow, New York University
| | - Mary M McKay
- Neidorff Family and Centene Corporation Dean of the Brown School, Washington University in St. Louis, and Senior Research Scientist, New York University
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Connell AM, McKillop HN, Dishion TJ. Long-Term Effects of the Family Check-Up in Early Adolescence on Risk of Suicide in Early Adulthood. Suicide Life Threat Behav 2016; 46 Suppl 1:S15-22. [PMID: 27094106 PMCID: PMC4889021 DOI: 10.1111/sltb.12254] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The impact of the Family Check-Up (FCU), a school-based prevention program, as delivered in public secondary schools on suicide risk across adolescence, was examined. Students were randomly assigned to a family-centered intervention (N = 998) in the sixth grade and offered a multilevel intervention that included (1) a universal classroom-based intervention, (2) the FCU (Dishion, Stormshak, & Kavanagh, 2011), and (3) family management treatment. Engagement with the FCU predicted significant reductions in suicide risk across adolescence and early adulthood.
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Affiliation(s)
| | | | - Thomas J. Dishion
- Arizona State University, REACH Institute & Oregon Research Institute
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Gewirtz AH, DeGarmo DS, Zamir O. Effects of a Military Parenting Program on Parental Distress and Suicidal Ideation: After Deployment Adaptive Parenting Tools. Suicide Life Threat Behav 2016; 46 Suppl 1:S23-31. [PMID: 27094107 PMCID: PMC5113712 DOI: 10.1111/sltb.12255] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Few studies have examined whether parenting prevention programs might mitigate risk for suicidality in parents, yet parent suicidality is a strong risk factor for offspring suicidality. We report results from a randomized controlled trial of a parenting program for deployed National Guard and Reserve families with a school-aged child. Intent-to-treat analyses showed that random assignment to the parenting program (ADAPT) was associated with improved parenting locus of control (LOC). Improved parenting LOC was concurrently associated with strengthened emotion regulation which predicted reductions in psychological distress and suicidal ideation at 12 months postbaseline. Results are discussed in the context of ongoing efforts to reduce suicide rates in military populations.
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Affiliation(s)
- Abigail H. Gewirtz
- Department of Family Social Science & Institute of Child Development, & Institute for Translational Research in Children’s Mental Health, University of Minnesota
| | - David S. DeGarmo
- Prevention Science Institute, Department of Educational Methodology, Policy, and Leadership, University of Oregon
| | - Osnat Zamir
- Institute for Translational Research in Children’s Mental Health, University of Minnesota
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Reider EE, Sims BE. Family-Based Preventive Interventions: Can the Onset of Suicidal Ideation and Behavior Be Prevented? Suicide Life Threat Behav 2016; 46 Suppl 1:S3-7. [PMID: 27094108 PMCID: PMC4839188 DOI: 10.1111/sltb.12252] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Suicide is the second leading cause of death for youth aged 10-24. Research informed prevention efforts have the opportunity to decrease risk for suicidal ideation and behavior before it is manifested. Indeed, there is a small body of research findings demonstrating both proximal and distal effects of preventive interventions delivered in childhood and adolescence on suicidal ideation and/or behavior. These efforts build off of other secondary analyses of prevention research that has demonstrated benefits for multiple types of youth outcomes. This supplement provides "proof of concept" that family-based preventive interventions aimed at reducing a number of risk factors for suicide (e.g., substance use, externalizing, and internalizing behavior) can prevent suicidal ideation and behaviors.
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Affiliation(s)
- Eve E Reider
- National Center for Complementary and Integrative Health (NCCIH), Bethesda, MD, USA
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