The impact of universal suicide-prevention programs on the help-seeking attitudes and behaviors of youths

Youth Suicide Prevention Programming among the Mississippi Band of Choctaw Indians: Effects of the Lifelines Student Curriculum

Suicide continues to be a leading cause of mortality for young people. Given persistent intersecting forms of disadvantage, Native American adolescents are especially vulnerable to mental health adversities and other suicide risk factors. The Mississippi Band of Choctaw Indians (MBCI) implemented the Choctaw Youth Resilience Initiative (CYRI), a five-year SAMHSA-funded project that began in 2019. This study uses Choctaw student pre-test/post-test survey data to examine the effectiveness of the Hazelden Lifelines Suicide Prevention Training curriculum for youth. A lagged post-test design was used, whereby post-surveys were administered at least one month after program completion. Several intriguing results were observed. First, the lagged post-test model was subject to some pre-to-post attrition, although such attrition was comparable to a standard pre/post design. Second, analyses of completed surveys using means indicated various beneficial effects associated with the Lifelines curriculum implementation. The greatest benefit of the program was a significant change in student perceptions concerning school readiness in response to a suicidal event. Some opportunities for program improvement were also observed. Our study sheds new light on suicide prevention training programs that can be adapted according to Native American youth culture. Program implementation and evaluation implications are discussed in light of these findings.

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

BACKGROUND

Suicidal 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.

METHODS

We 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.

RESULTS

A 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.

CONCLUSIONS

These 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 REGISTRATION

The study was preregistered in the German Clinical Trials Register (registration number: DRKS00017045; registration date: 02/04/2019).

School-based self-harm prevention programs: A systematic review with implications for international implementation

Both self-harm and suicidal behaviors have been targeted through school-based prevention programs, many of which have been developed in the United States. The aims of this systematic review were to assess effects of school-based prevention programs on suicide and self-harm and to evaluate whether they are fit to the exporting culture. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our inclusion criteria, structured according to population/problem, intervention, control/comparison, outome, were: children and youth up to 19 years of age, school-based programs at universal, selective or indicated levels compared with teaching as usual or with other programs, and outcomes of suicide or self-harm measured at least 10 weeks after intervention. Studies without a control group or using non-behavioral outcomes were excluded. A comprehensive and systematic literature search was conducted from the 1990s to March 2022. Risk for bias was assessed with checklists adapted from the Cochrane Risk of Bias (ROB) tool. A total of 1,801 abstracts were retrieved. Five studies fulfilled our inclusion criteria, but one had high risk for bias. Confidence in the evidence for effect was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE). Studies included in this review were evaluated with respect to applicability in the context of international export. Only two school-based programs demonstrated efficacy in preventing suicidal behaviors. Although implementation of evidence-based interventions is a crucial next step, further replication with simultaneous attention to dissemination and implementation issues are called for. Funding and registration: conducted on assignment by the Swedish government. The protocol is available at the SBU website in Swedish.

Self-stigmatization of high-school students seeking professional psychological help: the chain-mediating effect of perceived social support and optimism

Background

Research has shown that stigmatization of professional psychological help-seeking is an important factor influencing attitudes toward seeking professional psychological help (ATSPPH). However, how perceived social support (PSS) and optimism have a mediating role is not clear.

Objective

Examine the associations between ATSPPH, self-stigmatization of seeking help, PSS, and optimism in a cohort of Chinese high-school students (HSSs).

Methods

An offline survey was conducted in three high schools in Chongqing (China) from 20 February to 20 May 2023. Participants were HSSs recruited through their teachers. A total of 2,159 HSSs completed a survey on demographic information as well as the Self-Stigmatization of Seeking Help (SSOSH) score, ATSPPH, Perceived Social Support Scale (PASS), and Life Orientation Test (LOT). Mediation analyses were conducted using the "Process" macro in SPSS 26.0 to estimate the direct and indirect effects of self-stigmatization of seeking psychological help on ATSPPH.

Results

Self-stigmatization of seeking psychological help was significantly and negatively related to ATSPPH among HSSs. Self-stigmatization of psychological help-seeking influenced ATSPPH through three pathways: (a) separate mediating effect of PSS (effect = -0.029); (b) separate mediating effect of optimism (effect = -0.069); (c) chain-mediating effect of PSS and optimism (effect = -0.017). These data suggested that self-stigmatization of psychological help-seeking could influence ATSPPH directly and indirectly through PSS and optimism.

Conclusion

PSS and optimism mediated the relationship between self-stigmatization of seeking help and ATSPPH. Improving the ability of HSSs to perceive social support and cultivating optimism could help improve the self-stigmatization of help-seeking and promote a positive attitude toward professional help-seeking.

Combatting negative bias: a mental contrasting and implementation intentions online intervention to increase help-seeking among individuals with elevated depressive symptomatology

Background

There are many reasons why individuals with depression may not seek help. Among those with elevated depressive symptomatology, some previous interventions aimed at increasing help-seeking have unintentionally decreased help-seeking intentions. Beck's cognitive theory of depression posits that individuals with elevated depressive symptomatology process information differently from those without depression (i.e., increased cognitive errors, negative bias); potentially explaining the iatrogenic results of previous interventions. Mental contrasting and implementation intentions (MCII; a self-regulatory strategy) interventions have successfully influenced physical and mental health behaviors. However, MCII has not been used specifically for initiating help-seeking for depression. The goal of this research was to ascertain whether an online MCII intervention could increase actual help-seeking or the intention to seek help for depression.

Method

Two online randomized pre-post experiments were conducted to measure the primary outcome measures 2 weeks post-intervention (Study 1 collected Summer 2019: information-only control ["C"], help-seeking MCII intervention ["HS"], and comparison MCII intervention ["E"]; Study 2 collected Winter 2020: "C" and "HS"). At Time 1, adults recruited from MTurk had a minimum Beck Depression Inventory (BDI-II) score of 14 (mild depressive symptoms) and were not seeking professional help.

Results

Study 1 (N = 74) indicated that the intervention was feasible, provided preliminary support, and clarified intervention components for Study 2. Study 2 (N = 224) indicated that the HS group reported greater intentions to seek help and actual help-seeking than the C group. Proportionally, actual help-seeking was more likely among individuals who received the HS intervention and either did not perceive themselves as depressed at Time 2 or had BDI-II scores indicating that their depressive symptomatology decreased from Time 1.

Limitations

Participation was limited to US residents who self-reported data.

Discussion

These studies indicate that a brief online MCII intervention to encourage help-seeking is feasible and preliminarily successful. Future studies should consider using ecological momentary assessment measurements to establish the temporal precedence of intervention effects and whether MCII is effective for encouraging help-seeking among individuals prone to experiencing cognitive errors who may not be experiencing negative bias (e.g., bipolar disorder or anxiety). Clinicians may find this method successful in encouraging ongoing treatment engagement.

Exploring the Association Between Suicide Prevention Public Service Announcements and User Comments on YouTube: A Computational Text Analysis Approach

In the United States, suicide rates have increased by 30% over the past few decades. Public service announcements (PSAs) are effective health promotion vehicles and social media can help spread PSAs to hard-to-engage individuals who may benefit from intervention efforts, yet the most meaningful characteristics of PSAs for influencing health promotion attitudes and behaviors are inconclusive. This study applied content and quantitative text analyses to suicide prevention PSAs and comments on YouTube to assess the relationships between message frame, message format, and the level of sentiment and help-seeking language within them. Seventy-two PSAs were analyzed for gain/loss-framing and narrative/argument-format, and 4,335 related comments were analyzed for positive/negative sentiment and frequency of help-seeking language use. Results indicate that a higher ratio of positive comments was more likely to be found on gain-framed and narrative-formatted PSAs, and a higher ratio of comments with help-seeking language was more likely to be found on narrative-formatted PSAs. Implications and future research are discussed.

Two Halves of the Same Whole: A Framework to Integrate Autism and Mental Health Services

Given the higher rates of co-occurring mental health issues experienced by autistic people, there is a pressing need to implement an effective framework that integrates autism services with appropriate mental health services. This paper discusses the impact of mental illness on the person with autism and their families, and the current challenges they face when accessing mental health support. A framework for service providers is proposed to support the mental health needs and preferences of autistic people. The paper concludes by highlighting the importance of health professionals utilising mental health interventions appropriate for autistic people, including autism-specific suicide prevention and awareness programs.

Adolescent, parent, and provider perspectives on school-related influences of mental health in adolescents with suicide-related thoughts and behaviors

Previous research supports a link between school-related factors, such as bullying and school connectedness, and suicidal thoughts and behaviors. To deepen understanding of how school experiences may function as both protective and risk factors for youth struggling with suicidal thoughts and behaviors, this qualitative study explored multiple perspectives. Specifically, in-depth interviews were conducted with adolescents previously hospitalized for a suicidal crisis (n = 19), their parents (n = 19), and the professionals they may interact with in schools and hospitals (i.e., school professionals [n = 19] and hospital providers [n = 7]). Data were analyzed using applied thematic analysis revealing three main themes related to perceptions of how school experiences can positively or negatively impact mental health, including (a) school activities, (b) school social experiences, and (c) school interventions. An emergent theme related to the complexity of suicide-related risk identified the ways in which school experiences may intersect with other environmental, biological, and psychological factors. Findings underscore the need for school-based approaches to address the unique academic, social, and emotional needs of students with suicide-related risk that complement the supports and services provided in their home and community.

Awareness and preferences about suicide crisis support service options among college students in India: A cross sectional study

BACKGROUND

Our objective was to explore the awareness about suicide support services and preferred service options during a suicide crisis among college going young adults.

METHODS

Between September 2016 and February 2017, we invited students from colleges affiliated to three major universities in a coastal district of South India to participate in a cross-sectional survey.

RESULTS

A total of 1890 usable responses were obtained. Most participants (n = 1633, 86.4%) were unaware of any suicide crisis support options. Most commonly listed options were support from family members, peer groups, counselling and psychiatric consultation. These were also endorsed as most preferred support options.

CONCLUSION

There is a low level of awareness about suicide support services among young Indian adults. There is a need for coordinated efforts to raise awareness and promote uptake of suicide support services in this group.

Community and bystander interventions for the prevention of suicide: Protocol for a systematic review

Suicide has a wide reaching and devastating impact on society. This article presents a study protocol for a systematic review of the literature on community and bystander interventions to reduce the incidence of suicide. These interventions are focused on people other than the person at-risk and are designed to increase awareness of warning signs and knowledge of how to most effectively respond. While there have been many studies undertaken on community and bystander intervention programs, we lack a synthesis of evidence regarding how an effective program is created and implemented. The proposed systematic review will address this gap by presenting the first comprehensive review on this topic. The specific aims of the review are to: (1) determine whether community and bystander interventions effectively increase bystander action to prevent suicide and, if so; (2) to understand what creates an effective community suicide intervention. The insights gathered will inform policy and guide investment in better evidence-based suicide interventions for the future.

The Influence of Pop Songs Referencing Anxiety, Depression, and Suicidal Ideation on College Students' Mental Health Empathy, Stigma, and Behavioral Intentions

U.S. college students' general mental health is rapidly declining, and scholars have observed significant increases in references to depression, suicide, and mental health metaphors in popular music. Given that college students are spending more time than ever before listening to popular music, this survey aimed to assess some of the potential implications. College students (N = 253) completed an online survey about their exposure to contemporary pop songs that reference mental health difficulties such as anxiety, depression, and suicidal ideation. Both college students' increased perceived personal connection (PPC) with the songs referencing mental health difficulties and parasocial relationships (PSR) with their performing artists were associated with increased mental health empathy. This increased mental health empathy mediated outcomes including reduced mental health stigma, increased support for public mental health resources, and increased willingness to support others struggling with their mental health. Neither PPC with the song nor PSR with the song's artist was associated with personal willingness to seek mental health help. However, post hoc analyses revealed that college students who reported stronger PPC to these songs also reported that they use music to "deal with their own mental health issues." This study's findings suggest that pop music artists who open up about mental health difficulties may have potential as novel message sources in communication campaigns designed to improve mental health outcomes among college students.

Saving Lives: A Systematic Review on the Efficacy of Theory-Informed Suicide Prevention Programs

Suicide is a global epidemic. This review assessed the scope and effectiveness of suicide prevention programs. Systematic literature searches were conducted using PsycINFO, ERIC and MEDLINE to retrieve articles published between January 2007 and March 2017 and fulfilled inclusion criteria (studies evaluating the efficacy of theory/model-informed suicide prevention programs in increasing participant knowledge or skills when presented with a peer at risk of suicide). The review is informed by PRISMA guidelines. Of 1398 studies identified, 25 were reviewed and most: targeted professionals; were 1-4-day workshops; were underpinned by 21 different theories; taught less detail to the community than professionals; and improved target outcomes. Current programs, although effective, are limited by their inaccessibility, narrow content for the community and substantial variability in theory base. Future suicide prevention programs will benefit from being informed by a more specific theory, delivered through technology, targeting more of the community and improving methodological rigour.

Enhancing Community Suicide Risk Assessment and Protective Intervention Action Plans Through a Bystander Intervention Model-Informed Video

Aim: The effects of a bystander intervention model (BIM)-informed intervention (video) for the general community on participant risk of suicide assessment ability (ROSAA) and protective intervention ability (PIA) were compared with an active control (non-BIM-informed video). Method: Video interventions with 628 participants (M_age = 47.99, SD_age = 17.34, range = 18-85 years) were conducted online. ROSAA and PIA were assessed immediately preintervention, postintervention, and at 2 months follow-up (n = 126). Results: Linear mixed model analyses indicated that the experimental and control conditions improved on both outcome variables postintervention/Time 2 (T2); however, the former yielded better outcomes than the latter (moderate ESs in both variables). Follow-up/Time 3 (T3) experimental ROSAA scores were higher than Time 1 (T1) and lower than T2 scores. Follow-up experimental PIA scores were higher than T1 and lower than T2 scores. Follow-up control ROSAA scores were higher than those of T1 and similar to T2. Follow-up control PIA scores were similar to T1 and T2 scores. Limitations: Limitations of the study include: sample homogeneity, small n at follow-up, self-report data only (no observable behavior was tested), fair inter-rater reliability, and a brief follow-up time frame. Conclusion: Current community information increased ROSAA and PIA. A BIM-informed intervention significantly enhanced these effects, which seemed to wane somewhat over time with the effect being lower at follow-up compared with postintervention. The BIM should be explored further as a basis for community suicide prevention interventions.

Effectiveness of gatekeepers' training for suicide prevention program among medical professionals and medical undergraduate students of a medical college from Western India

INTRODUCTION

Suicide risk among Indigenous populations is a multifaceted phenomenon, influenced by biological, psychological, and social factors at the individual level, as well as cultural, political, and economic issues at the family and community level. The global prevalence of depression among medical students was recently estimated to be 28.0 % according to a meta-analysis of 77 studies. In the field of suicide prevention, the term gatekeeper refers to "individuals in a community who have face-to-face contact with large numbers of community members as part of their usual routine." They may be trained to "identify persons at risk of suicide and refer them to treatment or supporting services as appropriate". In our study we aimed to improved attitude and knowledge in gatekeeper to improve detection and referral of individuals who are at risk of suicide.

METHODS AND MATERIAL

We adapted an evidence-based gatekeeper training into a two-hour, multi-modal and interactive event for medical professional and undergraduate students. Then we evaluated the intervention compared to free-recall knowledge and attitudes questions were examined before and after participation in a student and faculty gatekeeper training program. Focus groups with students enriched interpretation of quantitative results.

STATISTICAL ANALYSIS USED

Knowledge, attitudes, and skills of both students and teachers were analyzed by Mann-Whitney U-test. Comparison of knowledge, attitudes, and skills between both groups was analyzed by Wilcoxon signed-rank test.

RESULTS

Undergraduate students developed more positive attitude for suicidal behavior where faculties developed more confident in their skill after training sessions.

CONCLUSION

brief gatekeeper training found effective in improving knowledge about suicide. Also, increasing participants' accuracy to identify warning signs, risk factors and protective factors about suicide.

Referral patterns and demographic factors predict treatment dropout in suicidal youth

INTRODUCTION

Due to increasing suicide rates, treatment engagement among suicidal youth is paramount. Identification of factors that predict treatment dropout could aid in bolstering treatment engagement. In this study, we examine whether demographic factors, specific treatment referrals, and interactions among referrals predict treatment dropout in youth deemed at risk for suicide.

METHODS

Youth (N = 3606) were screened for suicide using the Early Identification, Referral, and Follow-up (EIRF) system across three community behavioral health centers. If considered at-risk, all were provided mental health referrals and some were provided family support, crisis hotline, and/or school support referrals. Analyses were performed to analyze dropout patterns based on the binary logistic regression framework.

RESULTS

Being older (OR = 1.06, p < 0.001) and being male (OR = 1.28, p < 0.001) were related to greater odds of dropping out from referrals, while being referred to family support (OR = 0.13, p < 0.001), and being referred to a crisis hotline (OR = 0.58, p < 0.001) were associated with smaller odds of dropping out. Interactions were also analyzed.

CONCLUSION

Monitoring utilization and referral patterns is essential to appropriately meet the needs of youth at-risk for suicide. Specifically, referring youth for family support and to use a crisis hotline may be particularly helpful in retaining treatment engagement.

Considerations in the assessment of help-seeking and mental health service use in suicide prevention research

OBJECTIVE

The connection of individuals at elevated suicide risk to mental healthcare services represents a critical component of suicide prevention efforts. This article provides recommendations for enhancing the assessment of help-seeking and mental health service use within the context of suicide prevention research.

METHOD

We discuss evidence-based and theoretical rationale for improving current approaches to assessing help-seeking and mental health service use among at-risk individuals.

RESULTS

Recommendations are offered within three domains: (a) consideration of the spectrum of connection to care, (b) assessment of the degree to which mental healthcare services seek to and effectively target suicidal symptoms, and (c) evaluation of the sources and types of treatment and care sought and received by at-risk individuals.

CONCLUSIONS

To further our understanding of how to bolster connection to care and improve experiences with mental healthcare services among individuals at elevated suicide risk, it is imperative that stakeholders precisely capture the degree, efficacy/effectiveness, and nature of care sought and received by individuals. In so doing, research gaps might be better identified and, ultimately, mental healthcare services might be better leveraged as tools to prevent suicide and support individuals in creating lives they perceive to be worth living.

An Intervention for Mental Health Literacy and Resilience in Organized Sports

PURPOSE

In this study, we tested the effectiveness of a multicomponent sports-based program aimed at promoting early intervention, help seeking, and resilience among a sample of adolescent male sport participants.

METHODS

The Ahead of the Game program comprised four intervention components and a messaging campaign. Two components targeted mental health literacy, intentions to seek and provide help, and resilience among adolescent boys. A mental health literacy program for parents and a coach education program to assist in the support of athletes' psychological needs were also included. We evaluated the program using a nonrandomized controlled trial matching two regional communities. In total, 350 sport participants (mean, 14.53 yr) were included in an intervention group, whereas 466 (mean, 14.66 yr) received usual practice in a matched control community. One hundred and eighty parents or caregivers and eight coaches also participated in the intervention components. Between-group mean differences on the primary and secondary outcomes were analyzed using linear mixed models, adjusted for clustering at club level, participant age, and socioeconomic status.

RESULTS

Significant positive group-time interactions were found for the primary outcomes of depression and anxiety literacy, intentions to seek help from formal sources, confidence to seek mental health information, and resilience. We also found a significant positive group-time interaction for the secondary outcome of well-being. There were no group-time interactions for social distance (stigma), intentions to seek help from informal sources, implicit beliefs about adversity, perceived familial support, or psychological distress.

CONCLUSIONS

Given the high rates of sport participation worldwide and the increasing focus on mental health in this domain, translation and dissemination of the program may be warranted after replication.

Non-communicable diseases among adolescents: current status, determinants, interventions and policies

BACKGROUND

Addressing non-communicable disease (NCDs) is a global priority in the Sustainable Development Goals, especially for adolescents. However, existing literature on NCD burden, risk factors and determinants, and effective interventions and policies for targeting these diseases in adolescents, is limited. This study develops an evidence-based conceptual framework, and highlights pathways between risk factors and interventions to NCD development during adolescence (ages 10-19 years) and continuing into adulthood. Additionally, the epidemiologic profile of key NCD risk factors and outcomes among adolescents and preventative NCD policies/laws/legislations are examined, and a multivariable analysis is conducted to explore the determinants of NCDs among adolescents and adults.

METHODS

We reviewed literature to develop an adolescent-specific conceptual framework for NCDs. Global data repositories were searched from Jan-July 2018 for data on NCD-related risk factors, outcomes, and policy data for 194 countries from 1990 to 2016. Disability-Adjusted Life Years were used to assess disease burden. A hierarchical modeling approach and ordinary least squares regression was used to explore the basic and underlying causes of NCD burden.

RESULTS

Mental health disorders are the most common NCDs found in adolescents. Adverse behaviours and lifestyle factors, specifically smoking, alcohol and drug use, poor diet and metabolic syndrome, are key risk factors for NCD development in adolescence. Across countries, laws and policies for preventing NCD-related risk factors exist, however those targeting contraceptive use, drug harm reduction, mental health and nutrition are generally limited. Many effective interventions for NCD prevention exist but must be implemented at scale through multisectoral action utilizing diverse delivery mechanisms. Multivariable analyses showed that structural/macro, community and household factors have significant associations with NCD burden among adolescents and adults.

CONCLUSIONS

Multi-sectoral efforts are needed to target NCD risk factors among adolescents to mitigate disease burden and adverse outcomes in adulthood. Findings could guide policy and programming to reduce NCD burden in the sustainable development era.

School-Based Prevention in Very Remote Settings: A Feasibility Trial of Methods and Measures for the Evaluation of a Social Emotional Learning Program for Indigenous Students in Remote Northern Australia

Purpose: Skills for Life (SFL) is a social-emotional curriculum for Indigenous middle school students that was co-developed with educators and community members in a remote community of northern Australia. This preliminary study aimed to test the feasibility of processes and methods of data-gathering, the reliability of youth self-report measures, and to identify the direction of effects for an evaluation of a longer-term pilot of the curriculum.

Design/Methodology/Approach: Indigenous Students in years 7–9 of a remote school participated in SFL over 2 years. The Strengths and Difficulties Questionnaire (SDQ), Kessler 6 (K6), and a purpose-designed Connected Self Scale (CSS) were administered to 63 students pre- and post-program.

Findings: Only the K6, Prosocial behavior (SDQ), and two CSS subscales showed sufficient internal consistency for analysis. Change was positive but non-significant for SDQ and CSS. There was evidence of a dosage effect: students receiving the intervention over 2 years showed greater reduction in psychological distress than other students. There was no evidence of iatrogenic effects.

Conclusions: The feasibility pilot is a critically important phase in the development of evaluation design and cjhoice of evaluation measures for challenging remote settings. This study found that evaluation of SFL with culturally and linguistically distinct Indigenous middle school students using self-report measures is feasible. However, the SDQ may not be suitable for this project. High levels of psychological distress suggest the need to investigate sources of life stress and potential supports for adolescent resilience in this context. This preliminary pilot aimed to trial methods and measures for evaluation of a social-emotional curriculum developed specifically for remote Australian Indigenous students who are at risk of poor psychosocial outcomes. No studies have examined the appropriateness of standardized self-report measures for evaluation of SEL with this student population in remote school settings.

Suicide Prevention Public Service Announcements

Background: Suicide prevention public service announcements (PSAs) help to disseminate information about suicide and help-seeking options. However, little is known about how individuals at risk for suicide recall PSAs. Aims: The current project assessed which features of suicide prevention PSAs are recalled by young adult participants and whether there are differences between those who are at low or high risk for suicide. Method: Participants (N = 140) viewed a simulated suicide prevention billboard that consisted of a main message, help-seeking message, and graphical features. Participants provided written recollections of the billboard features approximately 15 min post-viewing, which were coded and analyzed. Results: High-risk participants were significantly less likely than low-risk participants to include a description of the help-seeking message in their written recall. Few group differences were noted in the recall of the main message or graphical features. Limitations: Recall was limited to short-term recall based on a single exposure. Efforts to enhance internal validity (e.g., measurement of suicide risk) and external validity (e.g., a balanced sample regarding sex and race) are recommended. Conclusions: Results suggest that new tactics may need to be considered when developing suicide prevention messages, including crafting help-seeking messages that are more easily committed to memory for target audiences.

Performance, Cost-Effectiveness, and Representativeness of Facebook Recruitment to Suicide Prevention Research: Online Survey Study

BACKGROUND

Researchers are increasingly using social media advertisements to recruit participants because of their many advantages over traditional methods. Although there is growing evidence for the effectiveness and cost-effectiveness of social media recruitment in the health sciences, no studies have yet examined this in the context of suicide prevention, which remains to be a highly stigmatized and sensitive topic.

OBJECTIVE

This study aims to recruit a general community sample to complete a survey on suicide literacy, stigma, and risk via Facebook advertisements. Specifically, we aim to establish the performance of the advertisements, cost-effectiveness, sample representativeness, and the impact of gender-specific advertising on recruiting men into the study.

METHODS

From June 2017 to March 2019, we released Facebook advertisements targeted at adults 18 years or older, residing in the New South Wales (NSW) trial or control regions, and involved in the LifeSpan suicide prevention trial. Cost-effectiveness was examined descriptively using metrics provided by Facebook. Chi-square analyses were conducted to determine demographic differences between our sample and the general NSW population as well as the impact of gender-specific advertisements on gender engagement.

RESULTS

The 14 Facebook advertisement campaigns reached a total of 675,199 people, yielding 25,993 link clicks and resulting in 9603 individuals initiating the survey (7487 completions) at an overall cost of Aus $2.81 (US $2.01) per participant. There was an overrepresentation of younger (P=.003), female (P=.003), highly educated (P<.001) participants and mental health conditions (P<.001) compared with the total NSW population. The use of male-specific advertisements resulted in a significantly higher proportion of men completing the survey relative to gender-neutral advertisements (38.2% vs 24.6%; P<.001).

CONCLUSIONS

This study demonstrates the potential of Facebook to be an effective, low-cost strategy for recruiting a large sample of general community participants for suicide prevention research. Strategies to improve sample representativeness warrant further investigation in future research.

The Impact of Referral to Mental Health Services on Suicide Death Risk in Adolescent Suicide Survivors

Objectives

This study aims to examine the effect of adolescent suicide survivors' experience on suicide death risk, and the effect of referral to mental health services (hereafter referral) in this regard.

Methods

This study used the data of 878 suicide-deceased and suicide-attempted adolescents aged 8-19 years, managed by the Suicide and School Mental Health Institute from 2016 to 2018.

Results

Regression analysis for main effects showed that although suicide experience had no direct effect on suicide death, non-referral status was associated with a greater risk of death by suicide. While the "non-suicide survivor with non-referral" and "suicide survivor with non-referral" groups showed 1.87 [adjusted odds ratio=1.87, 95% confidence interval (CI)=1.21-2.89] and 4.59 (adjusted odds ratio= 4.59, 95% CI=2.02-10.42) times higher odds of suicide death, respectively, the "suicide survivor with referral" group showed no difference compared to the "non-suicide survivor with referral" group.

Conclusion

From these findings, there is a need to strengthen referral to mental health services and apply complicated grief treatment to improve the mental health of adolescent suicide survivors.

Analysing regional unemployment rates, GDP per capita and financial support for regional suicide prevention programme on suicide mortality in Japan using governmental statistical data

OBJECTIVES

To explore the mechanisms of reduced suicide mortality in Japan, which decreased from 25.7 to 16.5 per 100 000 people following the comprehensive suicide prevention programme from 2009 to 2018, the present study determined the relationship between regional suicide mortality, socioeconomic data (GDP per capita, unemployment rates) and financial support for regional suicide prevention programmes.

DESIGN AND SETTING

Stepwise multiple regression analysis was used to determine the effects of regional GDP per capita, unemployment rates and implementation amount of financial support for regional suicide prevention programmes (Emergency Fund to Enhance Community-Based Suicide Countermeasures-EFECBSC) on age and gender disaggregated suicide mortalities in Japan between 2009 and 2018. Data on each prefecture's complete unemployment rates, GDP per capita and implementation amount of EFECBSC sub-divisions were derived from an official Japanese governmental database.

RESULTS

Both prefectural enlightenment and intervention model programmes were found to lead to a decrease in male suicide mortality, but were less effective in reducing female suicide mortality. Municipal enlightenment and intervention model programmes were also less effective in reducing suicide mortality. Municipal development programmes for listener and leader led to a greater decrease in suicide mortality for both men and women compared with such programmes at the prefectural level. Contrary to our expectations, reduced complete unemployment rate only reduced suicide mortality in the older male population without affecting female suicide mortality.

CONCLUSION

The study findings suggest an inverse relationship between financial support and suicide mortality in Japan. Furthermore, independent factors in the reduction of suicide mortality rates provide important information for planning evidence-based and cost-effective regional suicide prevention programmes.

Promoting the Community's Ability to Detect and Respond to Suicide Risk Through an Online Bystander Intervention Model-Informed Tool

Background: The public health sector has advocated for more innovative, technology-based, suicide prevention education for the community, to improve their ability to detect and respond to suicide risk. Emerging evidence suggests addressing the bystander effect through the Bystander Intervention Model (BIM) in education material may have potential for suicide prevention. Aims: The current study aimed to assess whether BIM-informed tools can lead to improved readiness, confidence and intent in the community to detect and respond to suicide risk in others. Method: A sample of 281 adults recruited from the community participated in a randomized controlled trial comprising a factsheet designed according to the BIM (intervention group) and a standard factsheet about suicide and mental health (control group). Participants' self-reported detecting and responding to suicide risk readiness, confidence, and intent when presented with a suicidal peer was tested pre- and postintervention and compared across time and between groups. Results: The intervention group had significantly higher levels of detecting and responding to suicide risk readiness, confidence, and intent than the control group at postintervention (all p < .001) with moderate-to-large effect sizes. Limitations: The study was limited by a homogenous sample, too low numbers at follow-up to report, and self-report data only. Conclusion: This study demonstrates BIM-informed suicide prevention training may enhance the community's intervention readiness, confidence, and intent better than current standard material. Further testing in this area is recommended. While results were statistically significant, clinical significance requires further exploration.

Kognito's Avatar-Based Suicide Prevention Training for College Students: Results of a Randomized Controlled Trial and a Naturalistic Evaluation

OBJECTIVE

To evaluate the efficacy and effectiveness of Kognito At Risk for College Students, an online, interactive suicide prevention gatekeeper training.

METHODS

In Study 1, a randomized controlled trial was conducted to test the efficacy of Kognito. Retention of participants at follow-up was strong. In Study 2, administrative records were used to follow the help-seeking behavior of Kognito trainees for one academic year, contrasted with untrained students.

RESULTS

In Study 1, between-group changes in gatekeeper attitudes were large at time-two, but attenuated modestly by 2-month follow-up. Kognito trainees referred more peers at 2-month follow-up (Cohen's d = .56, p < .05) - training 4 students in Kognito produces 1 more peer referred. In Study 2, the help-seeking rate of Kognito trainees (14.4%) was two-times the rate (6.8%) of untrained students (p < .001). Training 14 students in Kognito leads to 1 more self-referral to the Counseling Center.

CONCLUSIONS

This first randomized controlled trial of the college student version of Kognito validates the findings of less rigorous studies. Few brief suicide prevention trainings have shown changes in trainee behaviors such as referrals of at-risk peers and trainees actual help-seeking behavior. These results are promising that Kognito may outperform other similar suicide prevention trainings.

The effects of educational interventions on suicide: A systematic review and meta-analysis

BACKGROUND

Suicide is a major public health problem. Educational interventions for preventing suicidal behaviour are widely used, although little is known regarding the collective effectiveness of these interventions.

AIM

We evaluated the existing evidence for the effectiveness of education interventions in the prevention of suicidal behaviour.

METHODS

In this systematic review and meta-analysis, we searched multiple databases using terms related to suicide prevention. The articles were reviewed by two independent reviewers, and the quality of evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data from individual studies were combined in meta-analyses.

RESULTS

We identified 41 studies evaluating two different types of interventions: school-based education interventions and gatekeeper training. Education interventions showed significant gains in terms of knowledge and attitudes, though the effects seem to vary depending on subjects' personal characteristics. School-based education interventions significantly reduced suicidal ideation and suicide attempts in youths. Gatekeeper training showed no significant effect on suicide attempts or gatekeeper skills, though the quality of evidence for the estimate, according to GRADE criteria, was rated as very low.

CONCLUSION

The results of this study indicate that school-based education interventions are effective in preventing suicidal ideation and suicide attempts. In clinical practice, as well as in research, the development and implementation of educational interventions should focus on participants' individual characteristics.

Depression's response to fear tactics: An integration of health promotion principles, eye-tracking technology and clinical tools

OBJECTIVE

The main objective of this study was to utilize eye-tracking technology and self-report measures to test the effectiveness of varying strengths of fear appeals when educating about the seriousness of depression and motivate depressed individuals to engage in health-information-seeking.

METHODS

We analyzed data from 117 university employees affected by a range of depression symptoms who were randomly assigned to a low-threat, moderate threat, and high-threat message condition in a lab-based experimental setting. Attention patterns were captured while participants viewed the health message. A particular emphasis was placed on understanding the role of valence and arousal in determining attention patterns.

RESULTS

Attentional processes induced emotions (valence) and intensity (arousal) and differed by strength of fear appeal, but were not influenced by symptoms of depression in this study. Arousal mediated the effects of strong fear appeals on attitudes toward information-seeking, whereas negative emotions did not.

CONCLUSION AND PRACTICE IMPLICATIONS

Until further research suggests otherwise, caution is warranted when utilizing fear appeals that are highly arousing for health education and promotion.

Mental disorder comorbidity and suicidal thoughts and behaviors in the World Health Organization World Mental Health Surveys International College Student initiative

OBJECTIVES

Comorbidity is a common feature of mental disorders. However, needs assessment surveys focus largely on individual disorders rather than on comorbidity even though the latter is more important for predicting suicidal thoughts and behaviors. In the current report, we take a step beyond this conventional approach by presenting data on the prevalence and correlates (sociodemographic factors, college-related factors, and suicidal thoughts and behaviors) of the main multivariate profiles of common comorbid Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV disorders among students participating in the first phase of the World Health Organization World Mental Health International College Student initiative.

METHOD

A web-based mental health survey was administered to first year students in 19 colleges across eight countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, United States; 45.5% pooled response rate) to screen for seven common DSM-IV mental disorders: major depression, mania/hypomania, generalized anxiety disorder, panic disorder, attention-deficit/hyperactivity disorder, alcohol use disorder, and drug use disorder. We focus on the 14,348 respondents who provided complete data; 38.4% screened positive for at least one 12-month disorder.

RESULTS

Multivariate disorder profiles were detected using latent class analysis (LCA). The least common class (C1; 1.9% of students) was made up of students with high comorbidity (four or more disorders, the majority including mania/hypomania). The remaining 12-month cases had profiles of internalizing-externalizing comorbidity (C2; 5.8%), internalizing comorbidity (C3; 14.6%), and pure disorders (C4; 16.1%). The 1.9% of students in C1 had much higher prevalence of suicidal thoughts and behaviors than other students. Specifically, 15.4% of students in C1 made a suicide attempt in the 12 months before the survey compared with 1.3-2.6% of students with disorders in C2-4, 0.2% of students with lifetime disorders but no 12-month disorders (C5), and 0.1% of students with no lifetime disorders (C6).

CONCLUSIONS

In line with prior research, comorbid mental disorders were common; however, sociodemographic correlates of LCA profiles were modest. The high level of comorbidity underscores the need to develop and test transdiagnostic approaches for treatment in college students.

Should We Activate Risk Perceptions in the Context of Suicide Prevention? Examining Fear Appeals, Help-Seeking Determinants, and Help-Seeking Sources Among University Employees Who Suffer from Depression

Health promotion strategies have largely focused on activating risk perceptions for health conditions in resistant at-risk populations in order to induce behavior change. Yet, doing so remains a questionable approach when promoting help-seeking behaviors among individuals who suffer from depression because clinical symptoms can negatively affect interpretations and responses to such efforts. This study sought to test the effects and effectiveness of risk-based health messaging utilizing fear appeals on help-seeking determinants, intentions, and sources. One hundred seventeen university employees affected by symptoms of depression were recruited to participate in a lab-based experimental setting. Participants were randomly assigned to one of three message conditions that differed in strength of fear appeal (low, moderate, high) when inducing suicide risk perceptions and promoting help-seeking. Consistent with previous research, participants indicated high stigma perceptions and low intentions to seek help. Risk-based messaging strategies such as fear appeals did not have an effect on help-seeking intentions in this sample. Intentions were largely determined by positive outcome expectations and social norms, whereas efficacy perceptions were positive and not a predictor of help-seeking intentions. Participants were most likely to seek help from intimate partners and friends and least likely to utilize a help-line. Health promotion messages should contain cues that activate, rather than change, the already positive outcome expectations of seeking help when targeting at-risk populations. Future research should explore possibilities for health promotion and education among support networks of those who suffer from depression and anxiety.

Seeking professional help for suicidal ideation: A comparison between Chinese and Australian university students

Suicide is the second leading cause of death in Chinese university students and research examining their professional help-seeking is limited. This study aims to investigate: (i) professional help-seeking intentions for suicidal ideation among Chinese university students, with comparison to Australian university students, (ii) relationships between suicide literacy, social support, suicide stigma, self-reliance and help-seeking intentions, and (iii) self-recognised barriers to help-seeking. Chinese (N = 208) and Australian (N = 128) university students were recruited to complete an online cross-sectional survey assessing their intentions to seek professional help if they experienced suicidal ideation. One-third of the surveyed Chinese and Australian students expressed reluctance to seek professional help. Self-reliance was endorsed by both countries' university students as an important barrier. Suicide literacy, suicide stigma, and social support were not found to have a significant relationship with help-seeking intentions. The high costs of mental health services (Australian university students) and informal support from family and friends (Chinese university students) were identified as critical barriers to help seeking by participants. Results from this study suggest self-reliance is a potentially important barrier to professional help-seeking, whereas, suicide literacy and suicide stigma may have limited influence on help-seeking intentions among student populations.

What's the Risk in Seeking Help for Depression? Assessing the Nature and Pleasantness of Outcome Perceptions Among Individuals With Depressive Symptomatology

Despite a growing mental health crisis in the United States, empirical indicators of what could make a depression help-seeking message effective and why are currently not available. Even worse, some depression help-seeking messages can activate negative beliefs among depressed individuals that may make help-seeking even less likely than before. The current study is based on the premise that normative theoretical frameworks used for health promotion purposes might not work in populations affected by depression. Addressing a primary driver for health behavior change in gain-and-loss framing, the present research examines the nature of risk perceptions regarding help-seeking among those with depressive symptomatology who have not yet sought help ( N = 738) to inform more effective suicide prevention efforts. Previously, quantitative analyses revealed that the effectiveness of gain-and-loss framing, particularly on attitudes toward help-seeking, depends on the severity of depressive symptomatology. Whereas a persuasive gain-frame advantage was found for those with mild and severe depression symptoms, both framing strategies appeared to backfire and worsen attitudes among those with moderately severe depression symptoms. The present study enriches those results by conducting an in-depth analysis of risk perceptions regarding help-seeking to inform more effective depression help-seeking messages. Risk perceptions were primarily indicative of stigma and the related resistance to seeking help. Judgment and mistreatment were expected not only from the general public but also from the mental health professionals from whom help should be sought. Theoretical and practical implications are discussed.

Intention to Enact and Enactment of Gatekeeper Behaviors for Suicide Prevention: an Application of the Theory of Planned Behavior

Gatekeeper training for suicide prevention was evaluated on a college campus to examine the impact of training on gatekeeper enactment of behaviors in support of suicide prevention and identify predictors of enactment of gatekeeper behaviors. Trained gatekeepers (N = 216) displayed greater perceived knowledge and self-efficacy for suicide prevention and reported higher rates of self-reported actual gatekeeper behaviors, including inquiring about suicidal ideation and referring for mental health treatment when they encountered someone in distress, compared to their untrained counterparts (N = 169). Consistent with the Theory of Planned Behavior, SEM results indicated that attitudes, self-efficacy, and perceived knowledge explained intentions to engage in gatekeeper behaviors, accounting for 59% of the variance in intentions to inquire about suicidal ideation and supporting the role of attitudes and perceived behavioral control in intentions to act. These intentions explained self-reported actual gatekeeper behaviors among participants who encountered someone in distress, with each one-point increase in intention associated with nearly twice the likelihood of both inquiring about suicidal ideation and referring someone for mental health care. On the other hand, self-reported situational barriers were associated with a decreased likelihood of referral behavior, indicating the role of actual behavioral control over volitional actions. Findings support the value of gatekeeper training for promoting factors that influence the likelihood of action on behalf of suicide prevention.

Latina Adolescents Health Risk Behaviors and Suicidal Ideation and Suicide Attempts: Results from the National Youth Risk Behavior Survey 2001-2013

Suicidal ideation and suicide attempts are more common in Latina adolescents than White or African-American adolescents. Several health risk behaviors have been identified as being associated with Latina adolescent suicides. However, to date, no study has identified the consistency and stability of these risk behaviors over time. This study utilized the national Youth Risk Behaviors Survey from 2001 to 2013 to estimate the prevalence of suicidal ideation, suicide attempts, and health risk behaviors associated with suicidal behaviors in Latina adolescents. Our analysis found the prevalence of suicidal ideation and suicide attempts varied significantly over the 13-year study span, decreasing from 2001 to 2009 and increased from 2011 to 2013. The analyses found 11 health risk behaviors that were significantly associated with both suicidal ideation and suicide attempts that did not vary over time. The stability of these 11 health risk behaviors associated with suicidal behaviors could be useful to school personnel to identify early at risk Latina adolescents who may benefit from school and community mental health resources.

Increasing Help-Seeking Outcomes among People with Elevated Depressive Symptomatology with Public Service Announcements: An Examination of Functional Matching and Message Sidedness

The current experimental study assessed the utility, and potential harm, of depression public service announcements (D-PSAs) that were matched, moderately matched, or mismatched based on attitude function (i.e., social-adjustive or object-appraisal) and either one-sided or refutational two-sided. US adults (N = 567) with mild to severe depressive symptomatology were randomly assigned to view control messages or one set of D-PSAs. Results indicate that functionally matched D-PSAs, regardless of message sidedness, caused more favorable help-seeking outcome expectations, attitudes, and intentions compared to the control messages. Exposure to the mismatched D-PSAs, particularly refutational, led to less-favorable help-seeking outcome expectations, attitudes, and intentions compared with the control condition. Help-seeking outcomes among those exposed to the moderately matched messages were not significantly different from those exposed to the control messages, with the exception of those exposed to the one-sided moderately matched messages. The one-sided moderately matched messages resulted in lower help-seeking intentions than the control messages. Overall, results indicate that if messages can be tailored to match the recipients' attitude functions, help-seeking outcomes among people with heightened depressive symptomatology can be increased. However, the results also indicate that some D-PSAs can have negative effects.

Matching Message Design and Depressed Cognition: An Exploration of Attention Patterns for Gain- and Loss-Framed Depression Help-Seeking Messages

Although disproportionally affected by depression, most depressed college students do not seek the help they need. Research has recently uncovered the potential negative effects of depression help-seeking messages if depressed cognition is not considered in the health message design process. It is unclear if depression determines whether and how individuals pay attention to gain- and loss-framed depression help-seeking messages-a mechanism that has significant implications for the strategic planning of health communication interventions. In order to enable the effective matching of message design and audience features, this study investigated attention patterns for gain (n = 75)- and loss (n = 78)-framed depression help-seeking messages using eye-tracking technology and self-report measures. The results confirmed that depression is a characteristic of risk avoidance and negative cognition. Depressed participants tended to pay more attention to disease information that was placed in a loss-framed rather than a gain-framed depression help-seeking message. Using negative message framing strategies for health messages seeking to educate about depression symptoms might therefore be a useful persuasive strategy-particularly when disseminated to vulnerable populations affected by depression. Furthermore, the present study emphasizes the effective use of eye-tracking technology in communication research.

Depression, help-seeking perceptions, and perceived family functioning among Spanish-Dominant Hispanics and Non-Hispanic Whites

INTRODUCTION

Guided by Beck's (1967) cognitive theory of depression, we assessed whether perceived family functioning (PFF) mediated the relationship between depressive symptomatology and help-seeking inclinations.

METHODS

Study 1 included 130 Spanish-Dominant Hispanics and Study 2 included 124 Non-Hispanic Whites obtained using online crowd sourcing. Participants completed measures of depressive symptomatology, PFF, and several scales measuring aspects of help seeking inclinations and self-stigma. Study 2 also included an experiment. With an eye toward potential future interventions, we assessed the malleability of PFF. Specifically, participants were randomly assigned to recall positive or negative family experiences and then PFF was measures for a second time.

RESULTS

Both studies found PFF mediates the relationship between depressive symptomatology and the help seeking scales. Among non-depressed people, the positive manipulation improved PFF; however, among participants with elevated depressive symptomatology, writing about a positive family experience worsened PFF.

LIMITATION

With the exception of the experiment, most of the data were cross-sectional. For the experiment, it is possible that different manipulations or primes could have different effects.

CONCLUSION

Whether investigating responses from Spanish-Dominant Hispanics or Non-Hispanic Whites, PFF mediates the negative relationship between heightened depressive symptomatology and familial help-seeking beliefs, as well as self-stigma. However, even though the mediation analysis offers preliminary support that increasing PFF can potentially increase help-seeking behaviors of Hispanic and Non-Hispanic White people with depression, the results of the interaction analysis, specifically the negative impact of writing about positive family memories on people with elevated depression, illustrates the challenges of persuading people with depression.

Outcomes of a Suicide Prevention Gatekeeper Training Program Among School Personnel

BACKGROUND

Gatekeeper suicide prevention programs train staff to increase the identification and referral of suicidal individuals to the appropriate resources.

AIMS

We evaluated Act on FACTS: Making Educators Partners in Youth Suicide Prevention (MEP), which is an online training program designed to enhance the knowledge of suicide risk factors and warning signs as well as improve participants' attitudes and self-efficacy/confidence.

METHOD

School personnel (N = 700) completed a survey administered before and immediately after the training to assess gains in training outcomes and to evaluate participants' satisfaction with the training.

RESULTS

Results indicated that MEP participants demonstrated significant increases in suicide knowledge, attitudes, and self-efficacy. Moreover, exploratory analyses revealed moderating effects of professional role on pre-/posttest changes in self-efficacy, but not suicide knowledge or attitudes. Specifically, guidance counselors demonstrated significantly smaller increases in self-efficacy/confidence compared with teachers and classroom aids, whereas teachers demonstrated significantly larger increases in self-efficacy/confidence compared with administrators. The majority of school personnel who completed the MEP program were satisfied with the training content and experience.

CONCLUSION

Although the current findings are promising, more rigorous evaluations employing randomized controlled research designs are warranted to adequately determine the effectiveness of the MEP program.