High school health teachers' perceived self-efficacy in identifying students at risk for suicide

Research, practice, and data informed investigations of child and youth suicide: A science to service and service to science approach

BACKGROUND

Suicide rates for children and adolescents have been increasing over the past 2 decades. In April 2023, the National Institute of Mental Health (NIMH) convened a two-day workshop to address child and youth suicide.

PURPOSE

The workshop focus was to discuss the state of the science and stimulate a collaborative response between researchers, death investigators, and data collection teams to build a science to service and service to science approach toward understanding - and ultimately preventing - this growing problem of child and youth suicide.

HIGHLIGHTS

Topics that meeting participants highlighted as worthy of further consideration for research and practice were: increasing awareness among death investigators, medical examiners, and coroners that child suicide deaths under age 10 years do occur and should be investigated and documented accordingly; emphasizing the value of science based protocols for child and youth death investigations to enhance consistency of approaches; and articulating needs for postvention services to suicide loss survivors.

OUTCOMES

The importance of collecting an accurate and complete cause and manner of death (i.e., unintentional, suicide, homicide, undetermined) among all child decedents, and demographic information such as race, ethnicity, and sexual/gender minority status was underscored as critical for enhanced surveillance. For prevention efforts, approaches to assessing and understanding suicidal thoughts and behaviors among diverse groups of children, and the variability in proximal and distal risk factors are needed to inform opportunities for preventive interventions for diverse communities. The need for consistent measures and processes to improve death investigations, fatality review committees, and coordination between data collection systems and agencies was also raised.

PRACTICAL APPLICATIONS

Collaborations among researchers, death investigators, and data collection teams can help to fully describe the child and youth suicide crisis and provide actionable information for new research, and prevention and response efforts.

Teachers as Youth Suicide Prevention Gatekeepers: An Examination of Suicide Prevention Training and Exposure to Students at Risk of Suicide

Background

Teachers are important gatekeepers in suicide prevention for children and youth, yet little is known about factors that contribute to suicide prevention training effectiveness and the influence of student suicidality on teachers' role as gatekeepers.

Objective

This study examined teachers' attitudes and self-efficacy in suicide prevention including an examination of suicide prevention training and exposure to student suicidality. Researchers examined incremental prediction of the relationship between teachers' self-efficacy, outcome expectations, and outcome values following prevention training.

Methods

Participants included teachers in PreK-12th grade schools in the United States (N = 505). Researchers used non-parametric statistics to examine group level differences and a structural equation model (SEM) to test the proposed theoretical model.

Results

Teachers who experienced a student death by suicide reported significantly higher levels of gatekeeper reluctance than teachers who had not experienced a student death by suicide (p < 0.01). Similarly, teachers who encountered students with suicidal thoughts reported greater levels of gatekeeper reluctance (p < 0.01) and higher self-efficacy to engage in suicide prevention (p < 0.05) compared to teachers who had not had this exposure. Results of the SEM indicated an adequate goodness of fit and fit statistics [χ2 (87) = 194.420, p = 0.000; CFI = 0.95; RMSEA = 0.05]. The model remained in-tact when exposure to student suicide was added.

Conclusions

Findings support the importance of supporting teachers continued engagement in youth suicide prevention and prevention training that targets specific outcomes in teachers' attitudes and efficacy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10566-022-09699-5.

The Teacher Expectations and Values for Suicide Prevention Scale

Background: Teachers play a critical role in youth suicide prevention, yet few psychometrically sound instruments exist to measure teachers' expectations and values regarding suicide prevention. Aims: This study examined the factor structure and psychometric properties of the Teacher Expectations and Values for Suicide Prevention (TEVSP) Scale. Method: The TEVSP was administered to 500 teachers in the United States. Confirmatory factor analysis was used to determine the factor structure and bivariate correlations were used to investigate convergent and discriminant validity. Mann-Whitney U tests investigated group differences in TEVSP scores between participants who had received suicide training and those who had not. Results: Results support a three-factor hierarchical model with strong internal consistency and evidence of validity. Significant differences were found in TEVSP scores between groups. Limitations: There is a need to further explore the psychometric properties of the scale across samples and face-to-face methods. Conclusion: The TEVSP is a sound instrument that can be used to measure teachers' expectations and values for suicide prevention.

Text mining analysis of teachers' reports on student suicide in South Korea

A teacher as a suicide prevention gatekeeper has an important role in identifying suicide risks and warning signs in students. After a student's suicide, teachers in Korea have to write a student suicide case report based on their direct and indirect observations. In particular, the section 'characteristic of student suicide' of this report contains valuable information about the suicide; however, it is unstructured, and thus cannot be analyzed using conventional statistical methods. We aimed to identify the characteristics of observed Korean students, who have committed suicide, using text mining techniques as well as to improve our understanding of suicidal behaviors in the school contexts. Therefore, a series of text mining techniques: topic analysis, word correlation, and word frequency analysis, in three problem categories: health, school, and family problems, were used to analyze the characteristics of student suicides. Topic analysis showed that only 30% of the student suicide case reports identified problematic student characteristics related to suicide. Correlations between words showed that words in one problem category were often correlated with words in other problem categories. Frequency word analysis showed that the three problem categories varied across gender and school levels. These results provide interesting insights into the characteristics of suicides among Korean students and important implications for suicide intervention in the education field.

An Investigation of Gatekeeper Training and Self-Efficacy for Suicide Intervention Among College/University Faculty

Background: Suicide is a major global issue; US college students may be at greater risk and faculty may play a crucial role in prevention. Aims: The primary purpose of the present study was to examine: the level of confidence of college/university faculty in identifying at-risk students, to what extent they believed that their actions might reduce suicide, and their knowledge and experiences of their school's policies regarding intervention with at-risk students. Method: Data from 507 higher education faculty across the US were obtained via an online survey tool. Participants consisted mostly of professors and all had completed some level of graduate school. Results: Most participants reported believing it is the college/university faculty's role to identify students at risk for suicide; however, many reported that their institution did not provide gatekeeper training. Participants who had received gatekeeper training were more confident in identifying and assisting at-risk students. Limitations: The study did not determine participants' actual policy knowledge or the various types and lengths of training received. Conclusion: More widespread gatekeeper training for college/university faculty may provide benefits to faculty's confidence and could promote increased assistance for at-risk students.

School-based gatekeeper training programmes in enhancing gatekeepers' cognitions and behaviours for adolescent suicide prevention: a systematic review

Suicide is a leading cause of death in adolescence. School provides an effective avenue both for reaching adolescents and for gatekeeper training. This enables gatekeepers to recognize and respond to at-risk students and is a meaningful focus for the provision of suicide prevention. This study provides the first systematic review on the effectiveness of school-based gatekeeper training in enhancing gatekeeper-related outcomes. A total of 815 studies were identified through four databases (Ovid Medline, Embase, PsycINFO and ERIC) using three groups of keywords: 'school based', 'Suicide prevention programme' and 'Gatekeeper'. Fourteen of these studies were found to be adequate for inclusion in this systematic review. The improvement in gatekeepers' knowledge; attitudes; self-efficacy; skills; and likelihood to intervene were found in most of the included studies. Evidence of achieving improvement in attitudes and gatekeeper behaviour was mixed. Most included studies were methodologically weak. Gatekeeper training appears to have the potential to change participants' knowledge and skills in suicide prevention, but more studies of better quality are needed to determine its effectiveness in changing gatekeepers' attitudes. There is also an urgent need to investigate how best improvements in knowledge and skills can be translated into behavioural change.

Undergraduate Education Majors' Knowledge about Suicide

Undergraduate education majors' knowledge about suicide was evaluated to identify what training they may need about suicide prevention and to explore the hypothesis that individuals previously exposed to suicide in their social context may hold higher suicide-related knowledge than those without. 71 college students completed the 50-item Expanded Revised Facts on Suicide Quiz to examine their knowledge about suicide. While overall knowledge was low for general information and for specific items concerning suicide among youth and elderly persons, knowledge was high on several items important for suicide prevention work. Higher suicide-related knowledge was found for knowing a suicide attempter, providing partial support for the hypothesis that personal experience with suicidal people may correspond with greater knowledge about suicide.

Teachers' Knowledge of Facts and Myths about Suicide

Suicidal behavior is a serious public health concern that has prompted the development of prevention strategies, which include increasing community members' knowledge about suicide. Given that teachers are in a key position to recognize and respond to suicidal behavior, this study examined teachers' knowledge about suicide to identify how they need to be educated relative to its prevention. 82 Canadian school teachers from middle and high schools were administered a revised version of the 32-item Facts on Suicide Quiz to examine their knowledge of suicide. Analysis indicated that general information about suicide was limited, while knowledge of clinically relevant information about suicide, e.g., “Suicide rarely happens without warning,” was relatively high.

School-wide staff and faculty training in suicide risk awareness: successes and challenges

PROBLEM

Rates of youth suicide and suicidal behavior remain high despite prevention efforts. Training high school personnel as gatekeepers is an important strategy.

METHODS

Training was implemented in a school district's five comprehensive high schools. Surveys were conducted before and after training sessions, which targeted all adults working at the high school. Two hundred thirty-seven individuals completed the pretest and/or posttest.

FINDINGS

Participants reported gains in knowledge, confidence, and feelings of competence in recognizing, approaching, and connecting distressed youth to school-based resources. Training was well received.

CONCLUSION

Training is acceptable and appropriate for school personnel. Increasing the number of school personnel who participate in the training is challenging.

Promoting CARE: including parents in youth suicide prevention

This study evaluated the effectiveness of augmenting a youth suicide-preventive intervention with a brief, home-based parent program. A total of 615 high school youth and their parents participated. Three suicide prevention protocols, a youth intervention, a parent intervention, and a combination of youth and parent intervention, were compared with an "intervention as usual" (IAU) group. All groups experienced a decline in risk factors and an increase in protective factors during the intervention period, and sustained these improvements over 15 months. Results reveal that the youth intervention and combined youth and parent intervention produced significantly greater reductions in suicide risk factors and increases in protective factors than IAU comparison group.

The Role of Teachers in School-Based Suicide Prevention: A Qualitative Study of School Staff Perspectives

In response to concerns over youth suicide, there has been an increase in school-based suicide prevention programs. However, we know little about teacher perspectives on school-based suicide prevention and mental health programs. This study examined teacher roles in the implementation of a district-wide suicide prevention program through focus groups and interviews with middle school teachers, administrators, and other school personnel. Study results highlighted teachers' critical role in detecting students at risk for suicide. Factors that appeared to facilitate teacher participation in the suicide prevention program included well-defined crisis policies and procedures, communication of these procedures, collaboration across staff, and the presence of on-campus mental health resources. Participants identified a need for direct teacher training on risk factors for suicide, crisis response, and classroom management. Other strategies for improving suicide prevention efforts included in-school trainings on mental health resources and procedures, regular updates to these trainings, and greater visibility of mental health staff.

Preliminary effectiveness of surviving the teens(®) suicide prevention and depression awareness program on adolescents' suicidality and self-efficacy in performing help-seeking behaviors

BACKGROUND

Suicide ranks as the third leading cause of death among youth aged 15-24 years. Schools provide ideal opportunities for suicide prevention efforts. However, research is needed to identify programs that effectively impact youth suicidal ideation and behavior. This study examined the immediate and 3-month effect of Surviving the Teens® Suicide Prevention and Depression Awareness Program on students' suicidality and perceived self-efficacy in performing help-seeking behaviors.

METHODS

High school students in Greater Cincinnati schools were administered a 3-page survey at pretest, immediate posttest, and 3-month follow-up. A total of 1030 students participated in the program, with 919 completing matched pretests and posttests (89.2%) and 416 completing matched pretests and 3-month follow-ups (40.4%).

RESULTS

Students were significantly less likely at 3-month follow-up than at pretest to be currently considering suicide, to have made a suicidal plan or attempted suicide during the past 3 months, and to have stopped performing usual activities due to feeling sad and hopeless. Students' self-efficacy and behavioral intentions toward help-seeking behaviors increased from pretest to posttest and were maintained at 3-month follow-up. Students were also more likely at 3-month follow-up than at pretest to know an adult in school with whom they felt comfortable discussing their problems. Nine in 10 (87.3%) felt the program should be offered to all high school students.

CONCLUSIONS

The findings of this study lend support for suicide prevention education in schools. The results may be useful to school professionals interested in implementing effective suicide prevention programming to their students.

University students' perceived self-efficacy in identifying suicidal warning signs and helping suicidal friends find campus intervention resources

Currently, suicide is the third leading cause of death among youth 18 to 24 years of age and the second leading cause of death on college campuses. A sample of students (N = 1,019) from three midwestern universities were surveyed regarding their perceived self-efficacy in identifying suicide warning signs and campus suicide intervention resources. The results indicated that 11% strongly believed they could recognize a friend at suicidal risk, while 17% strongly believed they could ask a friend if he or she was suicidal. Students who had received high school suicide prevention education and who had ever had a family member or friend express suicidal thoughts to them were those most confident in recognizing a friend at risk, asking a friend if he/she is suicidal, and helping a friend to see a counselor. Most (71%) were not aware of on-campus help resources. These findings underscore the importance of suicide prevention education throughout the high school and college years.

Overheard in the halls: what adolescents are saying, and what teachers are hearing, about health issues

BACKGROUND

Schools have long been recognized as an excellent place to offer health education and supportive services. Teachers are among the most important influences in the lives of school-aged children and can provide valuable insight into the health issues important to adolescents. The purpose of this study was to examine the potential role general academic teachers may play in facilitating adolescent health promotion efforts.

METHODS

To determine what teachers think about the role of health promotion in schools and what tools and topics they would find most helpful as critical advisers to students, we administered a 28-question survey at staff development meetings in 4 New York City schools.

RESULTS

Teachers agreed that schools were an important venue for discussing and providing health messages. More than half of those surveyed reported having overheard student discussions about health once a week or more, and 70% stated that they had been actively approached by students 1-3 or more times per semester with reports of personal problems or health issues. Teachers expressed concern about their ability to handle student mental, behavioral, and reproductive health problems and desired additional staff development workshops to address these needs.

CONCLUSIONS

Teachers felt that schools were important places to promote dialogue about health and accept the importance of playing a broader role in the lives of youth beyond education. To enhance the prospect of health-promoting interactions between teachers and students, attention must be paid to developing the overall skill and comfort level of teachers with respect to adolescent health concerns.

Control-group study of an intervention training program for youth suicide prevention

Few studies have examined whether training can improve competency in intervening with suicidal youths. In this study we attempted to verify the effectiveness of such a training program on helper competency. Forty-three helpers who received the training were compared with 28 helpers who did not. Participants who received the training improved in knowledge, attitudes, and intervention skills following the training, compared with the control group across measures. Their gains were maintained at 6-month follow-up. In this sample, implementation of a one-time training program improved helpers' competencies in youth suicide intervention.

Parents' and teachers' concordance with children's self-ratings of suicidality: findings from a high-risk sample

This study examined concordance between adult and child reports of child suicidality using a sample of 1,046 8-year-old children at risk for, or having experienced, maltreatment. Concordance was low with both caregivers and teachers. For children reporting no suicidality, caregiver-child agreement was associated with few transitions in caregiver and low social withdrawal and aggression, and teacher-child agreement was associated with non-White ethnicity, good academic performance, and low thought problems. For children reporting suicidality, care-giver-child agreement was associated with perceptions of child mental health needs, aggression, and somatic complaints, and teacher-child agreement was associated with thought problems.

Perceived academic performance, self-esteem and locus of control as indicators of need for assessment of adolescent suicide risk: implications for teachers

INTRODUCTION

There is currently a need for research into indicators that could be used by non-clinical professionals working with young people, to inform the need for referral for further clinical assessment of those at risk of suicide.

METHOD

Participants of this repeated measures longitudinal study, were 2603, 2485, and 2246 school students aged 13, 14, and 15, respectively, from 27 South Australian Schools.

RESULTS

Perceived academic performance, self-esteem and locus of control are significantly associated with suicidality. Further, logistic regression of longitudinal results suggests that perceived academic performance, over and above self-esteem and locus of control, in some instances, is a good long-term predictor of suicidality.

Perceived academic performance as an indicator of risk of attempted suicide in young adolescents

This study investigated perceived academic performance and self-reported suicidal behavior in adolescents (n = 2,596), mean age 13 years, from 27 South Australian high schools. Groups perceiving their academic performance as failing, below average, average and above average were significantly different on measures of self-esteem, locus of control, depressive symptoms, suicidal thoughts, plans, threats, deliberate self-injury, and suicide attempts. Multivariate logistic regression analyses revealed that failing academic performance (compared to above average) is associated with a five-fold increased likelihood of a suicide attempt, controlling for self-esteem, locus of control and depressive symptoms. Teachers should note that a student presenting with low self-esteem, depressed mood and perceptions of failure may be at increased risk for suicidal thoughts and behaviors, and need referral for clinical assessment.

Youth suicide risk and preventive interventions: a review of the past 10 years

OBJECTIVE

To review critically the past 10 years of research on youth suicide.

METHOD

Research literature on youth suicide was reviewed following a systematic search of PsycINFO and Medline. The search for school-based suicide prevention programs was expanded using two education databases: ERIC and Education Full Text. Finally, manual reviews of articles' reference lists identified additional studies. The review focuses on epidemiology, risk factors, prevention strategies, and treatment protocols.

RESULTS

There has been a dramatic decrease in the youth suicide rate during the past decade. Although a number of factors have been posited for the decline, one of the more plausible ones appears to be the increase in antidepressants being prescribed for adolescents during this period. Youth psychiatric disorder, a family history of suicide and psychopathology, stressful life events, and access to firearms are key risk factors for youth suicide. Exciting new findings have emerged on the biology of suicide in adults, but, while encouraging, these are yet to be replicated in youths. Promising prevention strategies, including school-based skills training for students, screening for at-risk youths, education of primary care physicians, media education, and lethal-means restriction, need continuing evaluation studies. Dialectical behavior therapy, cognitive-behavioral therapy, and treatment with antidepressants have been identified as promising treatments but have not yet been tested in a randomized clinical trial of youth suicide.

CONCLUSIONS

While tremendous strides have been made in our understanding of who is at risk for suicide, it is incumbent upon future research efforts to focus on the development and evaluation of empirically based suicide prevention and treatment protocols.

Prevention of youth suicide: how well informed are the potential gatekeepers of adolescents in distress?

Australia has one of the higher rates of suicide among young people. Although a role for doctors and teachers in the prevention of youth suicide has been suggested, no prior Australian study has assessed adequately the level of suicide knowledge held by these professionals. Knowledge about adolescent suicide was investigated using the Adolescent Suicide Behaviour Questionnaire, a 39-item instrument developed for the purpose. The stratified random sample comprised 404 general practitioners and 481 teachers from 56 secondary schools. General practitioners and teachers scored, on average, 71% and 59% of the questionnaire items correct, respectively. There was wide individual variability: The number of items correct ranged from 4 to 38 for general practitioners and 0 to 34 for teachers. Strengths and deficits in knowledge across the two professions are discussed in terms of the potential gatekeeping role of these professionals in suicide prevention.

Using path analysis to examine adolescent suicide attempts, life satisfaction, and health risk behavior

This study determined if differences existed between four race/gender groups in regard to attempted suicide among a randomly selected, cross-sectional population of 4,565 public high school students in South Carolina. A modified Youth Risk Behavior Survey was designed to gather information on quality of life, life satisfaction, and six risk-behavior categories. Data first were analyzed using logistic regression analysis and subsequently analyzed using path analysis. Results suggest several independent variables (feelings of intimidation, alcohol and cocaine use, self-perceptions of mental health, self-perceptions of body weight, dieting practices, bulimic episodes, and physical and sexual abuse) were associated significantly (p < .01) with adolescent attempted suicide either directly or indirectly through mediating variables. Significant associations among risk behaviors, mediating variables, and self-reported attempted suicide varied across the four race/gender groups, indicating a need to further study differences noticed in each race/gender scheme.

Developing a comprehensive school suicide prevention program

Since the 1950s, the suicide rate for adolescents more than tripled, and suicide currently ranks as the third-leading cause of death among 15-to-24 year-olds. Comprehensive school suicide prevention programs should include primary, secondary, and tertiary prevention components. This paper discusses these components as they relate to suicide prevention, and it provides practical steps for incorporating each component within a school system. All steps are based on a review of the professional literature. Three questions are explored: What can school professionals do to help in preventing adolescent suicide? What should school professionals do when a student threatens suicide? What should school professionals do after a student commits suicide?

Project SOAR: a training program to increase school counselors' knowledge and confidence regarding suicide prevention and intervention

School counselors are often the lead individuals in school suicide prevention programs. All school counselors in Dallas, Texas, receive training through Project SOAR (Suicide, Options, Awareness, and Relief), a suicide prevention program. This study assessed Dallas school counselors' knowledge of suicidal risk factors and perceived ability to initiate appropriate steps when confronted with a suicidal student. A two-page, 44-item survey was distributed to all Dallas school counselors attending a mandatory meeting in spring 1999. A total of 186 school counselors (75%) responded. Most had been a school counselor for less than 10 years and one-half received initial SOAR training less than four years ago. The majority strongly agreed that they could recognize suicidal warning signs, assess a student's risk for suicide, and offer support to a suicidal student. In addition, most knew the intervention steps to take when a student assessed at high suicidal risk. When compared to school counselors nationwide, these counselors reported increased confidence in identifying students at suicidal risk.