Evaluation of indicated suicide risk prevention approaches for potential high school dropouts

The influence of sexual violence on suicide risk among runaway youth in South Korea: The multiple additive moderating effect of peer attachment and parental attachment

BACKGROUND

Runaway youth without an adequate and safe place are vulnerable to sexual violence. Sexual violence is strongly associated with suicide risk, but peers and family are important factors in attenuating the negative outcomes of sexual violence; however, research on this relationship is insufficient because previous studies have focused only on runaway youth's problematic behavior.

OBJECTIVE

This study's specific aims were as follows: 1) to verify the association between sexual violence and suicide risk among runaway youth, and 2) to assess whether peer and parental attachment moderated the association between sexual violence and suicide risk among runaway youth.

PARTICIPANTS AND SETTING

The participants comprised 232 runaway youth (51.3 % girls); more than half were aged 17-19 years and approximately two-thirds of them had experienced child abuse.

METHODS

Self-administered questionnaires were provided to the participating runaway youth in youth shelters in South Korea. The data were analyzed using a multiple additive moderating model that simultaneously included moderating and control variables.

RESULTS

In total, 18.5 % of runaway youth were exposed to sexual violence (10.6 % boys, 26.1 % girls). Sexual violence victimization affected suicide risk among runaway youth. Peer attachment alleviated the negative relationship between sexual violence and suicide risk, and acted as a protective factor. Although the moderating effect of parental attachment was not significant, it significantly influenced suicide risk.

CONCLUSION

Our findings demonstrate that runaway youth are vulnerable to sexual violence victimization, especially severe types of sexual violence. Our study verified the role of peer and parental attachment in the association between sexual violence and suicide risk among runaway youth. These findings suggest the need to improve positive peer and parent relationships to mitigate suicide risk among runaway youth.

Reducing suicidal ideation in African American adolescents: A randomized controlled clinical trial

OBJECTIVE

Suicide rates among African American adolescents have increased exponentially in recent years. The socioecological stressors that can increase suicide risk for African American adolescents, in conjunction with unique suicide risk manifestations within this group, require culturally sensitive preventive interventions. This study examines the efficacy of the Adapted-Coping With Stress course (A-CWS), a culturally tailored preventive intervention, to reduce suicidal ideation in African American adolescents, utilizing a randomized controlled design.

METHOD

Participants included 410 ninth-grade students in a large Midwestern city; most students identified as Black/African American. Participants were randomly assigned to either the A-CWS intervention or standard care control condition. All participants were assessed at baseline, immediately postintervention, and 6 and 12 months postintervention.

RESULTS

Treatment effects were examined using latent growth models comparing suicidal ideation trajectories in control and intervention conditions. Analyses were conducted using both intention-to-treat and treatment-as-received samples (i.e., intervention condition participants who attended at least 80% of sessions). In both intention-to-treat and treatment-as-received analyses, there was a significant treatment effect: Individuals in the A-CWS intervention condition with higher baseline ideation evidenced a superior reduction in suicidal ideation over the course of the study, relative to their counterparts in the standard care control condition.

CONCLUSION

Findings indicate that the A-CWS preventive intervention is efficacious in reducing suicidal ideation among African American adolescents with higher levels of baseline suicidal ideation and that effects sustain over time, with the strongest effect evidenced 12 months postintervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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.

Child maltreatment and youth suicide risk: A developmental conceptual model and implications for suicide prevention

Experiences of child abuse and neglect are risk factors for youth suicidal thoughts and behaviors. Accordingly, suicide risk may emerge as a developmental process that is heavily influenced by the rearing environment. We argue that a developmental, theoretical framework is needed to guide future research on child maltreatment and youth (i.e., adolescent and emerging adult) suicide, and to subsequently inform suicide prevention efforts. We propose a developmental model that integrates principles of developmental psychopathology and current theories of suicide to explain the association between child maltreatment and youth suicide risk. This model bears significant implications for future research on child maltreatment and youth suicide risk, and for suicide prevention efforts that target youth with child maltreatment experiences.

Suicide prevention in childhood and adolescence: a narrative review of current knowledge on risk and protective factors and effectiveness of interventions

INTRODUCTION

Suicide is a global mental health problem for people of all ages. While rates of suicide in children and adolescents are reported as lower than those in older populations worldwide, they represent the third leading cause of death in 15-19-year-olds. The rates are higher among boys than girls worldwide, though the death rates for girls exceed those for boys in Bangladesh, China, India, and Nepal. There has been a general decrease in adolescent suicide rates over recent decades. However, increases are reported in South East Asia as well as South America over the same time period.

METHODS

A narrative review method has been used to summarize current knowledge about risk and protective factors for suicide among children and adolescents and to discuss evidence-based strategy for suicide prevention in this age group.

RESULTS

Identified suicide risk and protective factors for children and adolescents largely overlap with those for adults. Nevertheless, developmental characteristics may strengthen the impact of some factors, such as decision-making style, coping strategies, family and peer relationships, and victimization. The implementation of evidence-based suicide preventive strategies is needed. Restricting access to lethal means, school-based awareness and skill training programs, and interventions delivered in clinical and community settings have been proven effective. The effectiveness of gatekeeper training and screening programs in reducing suicidal ideation and behavior is unproven but widely examined in selected settings.

DISCUSSION

Since most studies have been conducted in western countries, future research should assess the effectiveness of these promising strategies in different cultural contexts. The use of more rigorous study designs, the use of both short- and long-term follow-up evaluations, the larger inclusion of individuals belonging to vulnerable groups, the evaluation of online intervention, and the analysis of programs' cost-effectiveness are also required.

Mechanisms of Change in the Prevention of Depression: An Indicated School-Based Prevention Trial at the Transition to High School

OBJECTIVE

Depression represents a major public health concern, and prevalence increases significantly during adolescence. The high school transition may exacerbate the risk of depression for youth with pre-existing vulnerability. The High School Transition Program (HSTP) is a brief, skills-based intervention that has demonstrated efficacy in preventing depression in adolescents. The current study aimed to evaluate the theorized mechanisms of change of the HSTP intervention by testing a multiple mediation model including school attachment (SA) and self-esteem (SE) as two mediators of treatment outcomes.

METHOD

Students (N= 497; 61.5% girls) with elevated depressive symptoms, identified for the intervention program via an eighth-grade screening, were randomized to a brief intervention (n = 247) or the HSTP (n = 233) from 2003 to 2008. Participants completed measures at five time points. The first assessment occurred at the start of the second semester of eighth grade and the last assessment occurred at the end of ninth grade. A multiple mediation model tested whether SA and SE contributed to changes in depression for youth in the HSTP.

RESULTS

The mediation model, including contemporaneously assessed SE and SA, was not supported. There was evidence of sequential mediation, such that students who participated in the HSTP intervention reported higher SA, which in turn predicted improved SE, and in turn contributed to amelioration of depressive symptoms.

CONCLUSION

The HSTP intervention ameliorated depressive symptoms by targeting factors specific to the school transition (ie, SA). Results suggest youth at risk for depression may benefit from prevention efforts that enhance students' capacity to effectively manage identified environmental stressors, such as school transitions.

CLINICAL TRIAL REGISTRATION INFORMATION

Middle School to High School Transition Project: Depression and Substance Abuse Prevention; https://clinicaltrials.gov/; NCT00071513.

Reasons for Living and Coping with Suicidal Ideation among Adolescents in Malaysia

Introduction

The rate of suicide ideation everywhere continues to increase, and adolescents are therefore at risk of displaying suicidal behaviour. This study examined the protective role of the reasons for living and coping strategies in reducing suicidal ideation among young adolescents in Malaysia.

Methods

A cross-sectional survey was conducted among 176 adolescents aged between 13 and 19 years of age with the majority being Malay and Muslim. The Brief Reasons for Living for Adolescents (BRFL-A), Jalowiec Coping Scale and Suicide Ideation Scale were employed.

Results

The results showed that the reasons for living and palliative coping strategy correlated negatively with suicide ideation; although, further analysis using multiple regression revealed that family alliance and optimistic and palliative coping strategies were found to be significant reasons for living that protect adolescents from suicidal thoughts. Also, those adolescents who used emotive and evasive coping strategies had higher suicidal ideation.

Conclusion

Cultural and social values continue to play an important role in protecting adolescents in Malaysia from suicidal behaviour.

At-a-glance - Bringing equity into the fold: a review of interventions to improve mental health

In Canada, it is challenging to find examples of positive population mental health interventions that meet scientific standards of evidence. It is even more difficult to identify effective interventions that address health equity. The discrepancy between standards of evidence in the health sciences, and the evidence that can be gleaned from social experiments, is not new. Efforts to reconcile these differences show a general tendency toward controlled interventions in public health. However, it is possible to extract findings from quasi-experimental interventions that meet scientific standards while also showing promise of positive impacts on mental health equity. This article describes work undertaken in 2015 to begin to address this evidence gap.

Suicide Attempt Resiliency in American Indian, Hispanic, and Anglo Youth in New Mexico: The Influence of Positive Adult Relationships

The purpose of this study was to identify whether positive relationships with adults at home, school, and in the community are protective for suicide among American Indian/Alaska Native, Hispanic, and Anglo adolescents. Using data from the New Mexico version of the 2015 Centers for Disease Control and Prevention Youth Risk Behavior Survey, we found that positive relationships with adults affected past-year suicide attempts differently in youth from the 3 groups. The final multivariable model for American Indian/Alaska Native youth included only positive relationships with adults in the home. Among Hispanic and Anglo youth, adults in the home and also in the community were protective.

Cluster-randomised controlled trial of an occupational therapy intervention for children aged 11-13 years, designed to increase participation to prevent symptoms of mental illness

BACKGROUND

The impact of occupational therapy on mental health outcomes for children is largely unexplored. The aim of this study was to investigate an evidence-based occupational therapy intervention designed to increase participation in daily occupations to prevent symptoms of mental illness for children and run in schools.

METHODS

The study used a pragmatic, cluster-randomised controlled trial design with two arms. Fourteen clusters (schools), equating to 151 child participants, were stratified by school decile-rank category and block randomised. Blinding of participants post-randomisation was not feasible; however, outcomes assessors were blinded. Outcomes were measured at baseline, after the parallel and crossover phases, and at follow-up; and were anxiety symptoms (primary), depression symptoms, self-esteem, participation and wellbeing. Intention-to-treat analysis was applied and mixed linear modelling was used to account for clusters and repeated measures, and to adjust for covariates identified.

RESULTS

This trial found significant positive effects of the intervention on child-rated satisfaction with their occupational performance and teacher-rated child anxiety. No evidence was found to support the effect of the intervention on anxiety and depression symptoms, self-esteem and wellbeing.

CONCLUSIONS

This was the first known cluster-randomised controlled trial to investigate an occupational therapy intervention promoting emotional wellbeing in a non-clinical sample of children. No compelling evidence was found to support the use of the intervention in schools in its current format, however, results were promising that the focus on occupations influenced participation. Recommendations are made to redesign the intervention as an embedded intervention in the classroom, cotaught by teachers and including parental involvement.

Annual Research Review: Suicide among youth - epidemiology, (potential) etiology, and treatment

BACKGROUND

Suicide is a leading cause of death and a complex clinical outcome. Here, we summarize the current state of research pertaining to suicidal thoughts and behaviors in youth. We review their definitions/measurement and phenomenology, epidemiology, potential etiological mechanisms, and psychological treatment and prevention efforts.

RESULTS

We identify key patterns and gaps in knowledge that should guide future work. Regarding epidemiology, the prevalence of suicidal thoughts and behaviors among youth varies across countries and sociodemographic populations. Despite this, studies are rarely conducted cross-nationally and do not uniformly account for high-risk populations. Regarding etiology, the majority of risk factors have been identified within the realm of environmental and psychological factors (notably negative affect-related processes), and most frequently using self-report measures. Little research has spanned across additional units of analyses including behavior, physiology, molecules, cells, and genes. Finally, there has been growing evidence in support of select psychotherapeutic treatment and prevention strategies, and preliminary evidence for technology-based interventions.

CONCLUSIONS

There is much work to be done to better understand suicidal thoughts and behaviors among youth. We strongly encourage future research to: (1) continue improving the conceptualization and operationalization of suicidal thoughts and behaviors; (2) improve etiological understanding by focusing on individual (preferably malleable) mechanisms; (3) improve etiological understanding also by integrating findings across multiple units of analyses and developing short-term prediction models; (4) demonstrate greater developmental sensitivity overall; and (5) account for diverse high-risk populations via sampling and reporting of sample characteristics. These serve as initial steps to improve the scientific approach, knowledge base, and ultimately prevention of suicidal thoughts and behaviors among youth.

Suicide prevention in educational settings: a review

OBJECTIVES

Youth suicide rates are unacceptably high. Schools have long been accepted as an appropriate setting for suicide prevention activities. This review aims to synthesise the evidence for all types of suicide prevention interventions across educational settings.

METHODS

The review draws on two previous reviews conducted by the authors. In order to be included, studies had to test a specific suicide prevention intervention in an educational setting, have a suicide-related outcome and target young people.

RESULTS

A totally of 21 studies were included: 17 were conducted in school settings and four in universities. Seven of the school-based studies (41%) and one of the university studies (25%) were randomised controlled trials. Overall, the trials conducted in schools reported positive effects, as did four of the non- randomised controlled trials. Two of the university-based studies reported positive effects. Both universal and indicated interventions showed positive results; no iatrogenic effects were reported.

CONCLUSIONS

School-based studies can have a positive impact on suicide-related behaviour and, overall, do not appear to cause harm. Study quality is variable, and the number of studies conducted in school settings far exceed those conducted in universities. These gaps need to be addressed by future research.

Randomized trial of telephone versus in-person delivery of a brief psychosocial intervention in post-stroke depression

Background

A psychosocial behavioral intervention delivered in-person by advanced practice nurses has been shown effective in substantially reducing post-stroke depression (PSD). This follow-up trial compared the effectiveness of a shortened intervention delivered by either telephone or in-person to usual care. To our knowledge, this is the first of current behavioral therapy trials to expand the protocol in a new clinical sample. 100 people with Geriatric Depression Scores ≥ 11 were randomized within 4 months of stroke to usual care (N = 28), telephone intervention (N = 37), or in-person intervention (N = 35). Primary outcome was response [percent reduction in the Hamilton Depression Rating Scale (HDRS)] and remission (HDRS score < 10) at 8 weeks and 12 months post treatment.

Results

Intervention groups were combined for the primary analysis (pre-planned). The mean response in HDRS scores was 39% reduction for the combined intervention group (40% in-person; 38% telephone groups) versus 33% for the usual care group at 8 weeks (p = 0.3). Remission occurred in 37% in the combined intervention groups at 8 weeks versus 27% in the control group (p = 0.3) and 44% intervention versus 36% control at 12 months (p = 0.5). While favouring the intervention, these differences were not statistically significant.

Conclusions

A brief psychosocial intervention for PSD delivered by telephone or in-person did not reduce depression significantly more than usual care. However, the comparable effectiveness of telephone and in-person follow-up for treatment of depression found is important given greater accessibility by telephone and mandated post-hospital follow-up for comprehensive stroke centers.

Clinical Trial Registration URL: https://register.clinicaltrials.gov, unique identifier: NCT01133106, Registered 5/26/2010

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-017-2819-y) contains supplementary material, which is available to authorized users.

Psychosocial interventions for self-harm, suicidal ideation and suicide attempt in children and young people: What? How? Who? and Where?

We reviewed the evidence for the effectiveness of indicated individual psychosocial interventions for the treatment of self-harm, suicidal ideation and suicide attempts in children and young people, with a particular emphasis on the emerging use of electronic methods to deliver psychological interventions. In total, 16 randomised controlled trials (RCTs) were identified, none of which included children under the age of 12 years. Cognitive-behavioural therapy is the most commonly implemented approach in RCTs until now, although problem-solving therapy, interpersonal psychotherapy, social support and distal support methods by provision of a green card and regular receipt of postcards have also been investigated. Young people have been recruited into RCTs within schools, outpatient clinics, emergency departments and inpatient facilities. Face-to-face delivery of therapy has dominated the intervention trials thus far; however, the use of the internet, social media and mobile devices to deliver interventions to young people and other family members allows for a more novel approach to suicide prevention in youth going forward.

Self-Harm in Adolescents: A Self-Report Survey in Schools from Lisbon, Portugal

The study aims to determine the prevalence of self-harm (SH) and related psychosocial factors in a large sample of Portuguese adolescents. A total of 1,713 pupils, aged 12 to 20 years, completed an anonymous questionnaire in a school setting. In all, 7.3% reported at least 1 episode of SH: rates were 3 times higher for females than males. Almost half reported repeated SH, most commonly self-cutting. Anxiety, depression, and substance abuse were linked to SH, and particularly repeated SH. Anxiety, trouble with the police, and exposure to SH or suicide of others, were independently associated with SH in both genders. These findings indicate that SH is a public health concern in Portugal as in other European countries.

Differences in the Effectiveness of Psychosocial Interventions for Suicidal Ideation and Behaviour in Women and Men: A Systematic Review of Randomised Controlled Trials

The objective of this study was to explore outcomes of preventive programs and psychosocial treatments for suicidal ideation and behaviour in gender sub-groups in mixed gender studies and in studies limited to one gender. The method used was a systematic review of randomized controlled trials (RCTs) which included women or men only, or reported and/or examined outcomes of psychosocial interventions in mixed gender samples. A total of 27 (18%) of RCTs reported or examined differences in intervention outcomes. Of the mixed gender RCTs, 5 (33%) reported greater effectiveness for females than males. The review identified promising interventions in female-only samples. None of the trials reported greater effectiveness of the intervention in men. The majority of reviewed studies looking at treatment outcomes in gender sub-groups showed no differences between women and men or indicated that some psychosocial interventions are effective for women. There is a need for studies which look at gender effects and development of interventions more effective and appealing for men at risk of suicide.

Characteristics of Youth With Combined Histories of Violent Behavior, Suicidal Ideation or Behavior, and Gun-Carrying

BACKGROUND

Youth reporting combined histories of nonfatal violence, suicidal ideation/behavior, and gun-carrying (VSG) are at risk for perpetrating fatal interpersonal violence and self-harm.

AIMS

We characterized these youth to inform prevention efforts.

METHOD

We analyzed 2004 data from 3,931 seventh-, ninth-, and 11-12th-grade youth and compared VSG youth (n = 66) with non-gun carrying youth who either had no histories of violence or suicidal thoughts/behavior (n = 1,839), histories of violence (n = 884), histories of suicidal thoughts/behaviors (n = 552), or both (n = 590). We compared groups based on demographic factors, risk factors (i.e., friends who engage in delinquency, peer-violence victimization, depressive symptoms, illicit substance use), and protective factors (i.e., school connectedness, parental care and supervision). Regression models identified factors associated with VSG youth.

RESULTS

Illicit substance use and having friends who engage in delinquency were more common among VSG youth in all comparisons; almost all VSG youth had high levels of these factors. Depressive symptoms were positively associated with VSG youth versus youth without either violent or suicide-related histories and youth with violent histories alone. School connectedness and parental supervision were negatively associated with VSG youth in most comparisons.

CONCLUSION

Family-focused and school-based interventions that increase connectedness while reducing delinquency and substance use might prevent these violent tendencies.

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.

Direct versus indirect psychosocial and behavioural interventions to prevent suicide and suicide attempts: a systematic review and meta-analysis

BACKGROUND

Psychosocial and behavioural interventions that address suicidal thoughts and behaviour during treatment (direct interventions) might be more effective in preventing suicide and suicide attempts than indirect interventions that address symptoms associated with suicidal behaviour only (eg, hopelessness, depression, anxiety, quality of life). To test this hypothesis, we did a systematic review and meta-analysis of psychosocial and behavioural interventions aimed at preventing suicide and suicide attempts.

METHODS

For this systematic review and meta-analysis, we searched MEDLINE and PsycINFO from inception to Dec 25, 2015, for randomised controlled trials that reported suicides or suicide attempts as an outcome, irrespective of participants' diagnoses or the publication language. We excluded studies with pharmacological or device-based interventions, those that targeted communities or clinicians, primary prevention trials, and trials that reported events of non-suicidal self-injury as suicide attempts. Trials that had no suicides or suicide attempts in both groups were also excluded. Data were extracted by one investigator and independently verified by a second investigator. We used random-effects models of the odds ratio (OR) based on a pooled measure of suicides and the number of individuals who attempted suicide, immediately post-treatment and at longer-term follow-up.

FINDINGS

Of 2024 unique abstracts screened, 53 articles met eligibility criteria and reported on 44 studies; 31 studies provided post-treatment data with 6658 intervention group participants and 6711 control group participants at baseline, and 29 studies provided follow-up data. The post-treatment difference between direct interventions and indirect interventions did not reach statistical significance at the 0·05 level (OR 0·62 [95% CI 0·45-0·87] vs 0·93 [0·77-1·12], p=0·06) and represented a large effect size (Cohen's d=0·77). At longer-term follow-up, the difference was not significant (OR 0·65 [0·46-0·91] vs 0·82 [0·70-0·96], p=0·25) but still represented a medium effect size (Cohen's d=0·47). These effect sizes emphasise the clinical importance of direct interventions. Post-hoc subgroup and sensitivity analyses showed that our results are robust and unlikely to be notably affected by between-study heterogeneity or publication bias.

INTERPRETATION

Psychosocial and behavioural interventions that directly address suicidal thoughts and behaviour are effective immediately post-treatment and long term, whereas treatments indirectly addressing these components are only effective long term. Moreover, although the differences shown between direct and indirect strategies were non-significant, the difference in favour of direct interventions represented a large post-treatment improvement and medium improvement at longer-term follow-up. On the basis of these findings, clinicians working with patients at risk of suicide should address suicidal thoughts and behaviours with the patient directly. Although direct interventions are effective, they are not sufficient, and additional efforts are needed to further reduce death by suicide and suicide attempts. Continued patient contact might be necessary to retain long-term effectiveness.

FUNDING

National Institute of Nursing Research.

A systematic review of psychosocial suicide prevention interventions for youth

Youth suicide is a significant public health problem. A systematic review was conducted to examine the effectiveness of school, community and healthcare-based interventions in reducing and preventing suicidal ideation, suicide attempts and deliberate self-harm in young people aged 12-25 years. PsycInfo, PubMed and Cochrane databases were searched to the end of December 2014 to identify randomised controlled trials evaluating the effectiveness of psychosocial interventions for youth suicide. In total, 13,747 abstracts were identified and screened for inclusion in a larger database. Of these, 29 papers describing 28 trials fulfilled the inclusion criteria for the current review. The results of the review indicated that just over half of the programs identified had a significant effect on suicidal ideation (Cohen's d = 0.16-3.01), suicide attempts (phi = 0.04-0.38) or deliberate self-harm (phi = 0.29-0.33; d = 0.42). The current review provides preliminary support for the implementation of universal and targeted interventions in all settings, using a diverse range of psychosocial approaches. Further quality research is needed to strengthen the evidence-base for suicide prevention programs in this population. In particular, the development of universal school-based interventions is promising given the potential reach of such an approach.

Cluster-randomised controlled trial of an occupational therapy group intervention for children designed to promote emotional wellbeing: study protocol

Background

Symptoms of anxiety and depression are common in childhood, as are risk factors that undermine wellbeing: low self-esteem and limited participation in daily occupations. Current treatments focus primarily on modifying internal cognitions with insufficient effect on functional outcomes. Occupational therapists have a role in measuring and enabling children’s functional abilities to promote health and wellbeing. To-date there is no evidence for the use of occupational therapy as an intervention to promote mental health or increase self-esteem, participation and wellbeing in a preventative context. The aim of this cluster-randomised controlled study is to investigate the effectiveness of an 8-week occupational therapy group intervention (Kia Piki te Hauora) at reducing symptoms of anxiety and depression and improving self-esteem, participation and wellbeing in children aged 11–13 years.

Methods/design

In this two-arm, pragmatic, cluster-randomised controlled trial, 154 children will be recruited from 14 schools. All mainstream schools in the region will be eligible and a convenience sample of 14 schools, stratified by decile ranking (i.e. low, medium, and high) will be recruited. Eight to twelve students aged 11–13 years from each school will be recruited by senior school personnel. Following consent, schools will be randomised to either the intervention or waitlist control arm of the trial. The study will employ a parallel and one-way waitlist-to-intervention crossover design. Each cluster’s involvement will last up to 19 or 31 weeks depending on allocation to the intervention or waitlist respectively. The primary outcome is symptoms of anxiety and secondary outcomes are symptoms of depression, self-esteem, participation in daily occupations and wellbeing. Outcome measurement will be repeated at baseline, post-intervention and again at 8–9 weeks follow-up. Planned statistical analyses will utilise repeated measures analysis of covariance. The primary analysis will be based on an intention-to-treat analysis set and include only parallel data. The crossover data will only be used in secondary analyses.

Discussion

This is the first cluster-randomised controlled trial to investigate an occupational therapy intervention promoting emotional wellbeing in a non-clinical sample of children. Results will contribute to the limited evidence base for occupational therapists in this field and potentially support investment in these services.

Trial registration

Australia/New Zealand Clinical Trials Register: ACTRN12614000453684.

Feasibility of a web-based gatekeeper training: implications for suicide prevention

Web-based training programs have advantages such as increased scheduling flexibility and decreased training costs. Yet the feasibility of applying them to injury prevention programs such as suicide prevention gatekeeper training has not been empirically verified. Two studies were conducted to assess the feasibility and effectiveness of a web-based version of the Question, Persuade, and Refer (QPR) gatekeeper training program. Results of Study 1 revealed that participants in a web-based training demonstrated significant gains in knowledge of suicide prevention, self-efficacy for suicide prevention, and behavioral intentions to engage in suicide prevention, as compared to those in a control group. Results of Study 2 further showed that the web-based training may be as effective as the face-to-face QPR training across pre- (T1) and post training (T2); however, knowledge, self-efficacy, and behavioral intentions in both groups generally declined from T2 to 6-months after the training. Overall, these results provide initial evidence to support the feasibility of adopting web-based media to deliver gatekeeper training. Moreover, the present findings suggest the need to understand how to maintain gatekeepers' knowledge, confidence, motivation, and skills after training.

The public health approach to reducing suicide: opportunities for curriculum development in psychiatry residency training programs

The authors review the current status of suicide prevention curricula in psychiatry training programs, describe the public health approach to suicide prevention, discuss public health strategies for reducing suicides and the unique role played by psychiatrists with respect to suicide prevention, and offer public health-oriented suicide prevention curriculum guidelines for psychiatry residents.

School difficulties and co-occurring health risk factors: substance use, aggression, depression, and suicidal behaviors

PROBLEM

Effective prevention requires understanding vulnerable populations, early signs of health risks, and the impact of social contexts. We tested a model of co-occurring mental health risks among at-risk youth experiencing school difficulties.

METHODS

We analyzed data from a random sample of 336 at-risk youth, grades 9-12, who completed a comprehensive risk/protective factors assessment.

FINDINGS

Simultaneously controlling for correlations among health risks, we observed systematic associations among risk factors, with generally consistent patterns for males and females.

CONCLUSIONS

The findings underscore the importance of developing interventions that incorporate contextual influences and of identifying common adaptable strategies for attenuating co-occurring health risks for at-risk youth.

Parents-CARE: a suicide prevention program for parents of at-risk youth

TOPIC

Families play an important role in youth suicide prevention, as both a source of protection and a source of risk, and thus are an important target for adolescent suicide prevention programs.

PURPOSE

This article describes in detail Parents-CARE, a brief youth suicide prevention program for parents, for which effectiveness has been demonstrated. Engaging parents in preventive intervention can be challenging; therefore, the feasibility, acceptability, and relevance of the program to parents are examined.

SOURCES USED

A total of 289 households participated in Parents-CARE. Parent attendance data and parent and interventionist process data are utilized to demonstrate the positive response by parents to the program.

CONCLUSION

The Parents-CARE program was highly attended, and ratings demonstrate that parents were engaged in the program. Ratings show parents found the program both acceptable and relevant. Hence, the program described is promising for clinicians working with at-risk youth as they seek brief, accessible, and effective interventions that include parents in order to amplify the effects of an individual intervention approach.

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Background

The mental health of children and young people (CYP) is a major UK public health concern. Recent policy reviews have identified that service provision for CYP with mental health needs is not as effective, responsive, accessible or child-centred as it could be. Following on from a previous National Institute for Health Research (NIHR) study into self-care support for CYP with long-term physical health needs, this study explored self-care support’s potential in CYP’s mental health.

Objectives

To identify and evaluate the types of mental health self-care support used by, and available to, CYP and their parents, and to establish how such support interfaces with statutory and non-statutory service provision.

Design

Two inter-related systematic literature reviews (an effectiveness review with meta-analysis and a perceptions review), together with a service mapping exercise and case study.

Setting

Global (systematic reviews); England and Wales (mapping exercise and case study).

Participants (case study)

Fifty-two individuals (17 CYP, 16 family members and 19 staff) were interviewed across six sites.

Main outcome measures (meta-analysis)

A measure of CYP’s mental health symptomatology.

Data sources (literature reviews)

MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, All Evidence-Based Medicine (EBM) Reviews, Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC).

Review methods

Titles and abstracts of papers were screened for relevance then grouped into studies. Two independent reviewers extracted data from studies meeting the inclusion criteria. A descriptive analysis and meta-analysis were conducted for the effectiveness review; descriptive analyses were conducted for the perceptions review. These analyses were integrated to elicit a mixed-methods review.

Results

Sixty-five of 71 included studies were meta-analysable. These 65 studies elicited 71 comparisons which, when meta-analysed, suggested that self-care support interventions were effective at 6-month [standardised mean difference (SMD) = −0.20; 95% confidence interval (CI) −0.28 to −0.11] and 12-month (SMD = −0.12; 95% CI −0.17 to −0.06) follow-ups. However, judged against Cochrane criteria, the studies were mostly low quality. Key elements of self-care support identified in the perceptions review were the acquisition of knowledge and skills, peer support and the relationship with the self-care support agent; CYP also had different perceptions from adults about what is important in self-care support. The mapping exercise identified 27 providers of 33 self-care support services. According to the case study data, effective self-care support services are predicated on flexibility; straightforward access; non-judgemental, welcoming organisations and staff; the provision of time and attention; opportunities to learn and practise skills relevant to self-care; and systems of peer support.

Conclusions

Mental health self-care support interventions for CYP are modestly effective in the short to medium term. Self-care support can be conceptualised as a process which has overlap with ‘recovery’. CYP and their families want choice and flexibility in the provision of such interventions and a continued relationship with services after the nominal therapy period. Those delivering self-care support need to have specific child-centred attributes.

Future work

Future work should focus on under-represented conditions (e.g. psychosis, eating disorders, self-harm); the role of technology, leadership and readiness in self-care support; satisfaction in self-care support; the conceptualisation of self-care support in CYP’s mental health; and efficacy and cost-effectiveness.

Study registration

PROSPERO number (for the effectiveness review) CRD42012001981.

Funding

The NIHR Health Services and Delivery Research programme.

Student assistance program outcomes for students at risk for suicide

Pennsylvania's response to adolescent suicide is its Student Assistance Program (SAP). SAP has been funded for 27 years although no statewide outcome studies using case-level data have been conducted. This study used logistic regression to examine drug-/alcohol-related behaviors and suspensions of suicidal students who participated in SAP. Of the 46 services, 10 best predicted (p<.01) that these undesirable outcomes would cease. Although no study subjects died by suicide, 42 of 374,626 referred students did die by suicide. Suicidal students who did not participate had double the rate of suicide of suicidal participants of SAP. Students referred for other reasons also killed themselves. Further work must be done to assess all referred students for suicide risk, examine educational outcomes, monitor substance-related crimes and overdoses, and examine school-related factors postmortem. Evidence from this study can be used by researchers to plan future studies and by Pennsylvania's school nurses when planning services.

A systematic review of school-based suicide prevention programs

OBJECTIVE

Suicide is one of the leading causes of death among youth today. Schools are a cost-effective way to reach youth, yet there is no conclusive evidence regarding the most effective prevention strategy. We conducted a systematic review of the empirical literature on school-based suicide prevention programs.

METHOD

Studies were identified through MEDLINE and Scopus searches, using keywords such as "suicide, education, prevention and program evaluation." Additional studies were identified with a manual search of relevant reference lists. Individual studies were rated for level of evidence, and the programs were given a grade of recommendation. Five reviewers rated all studies independently and disagreements were resolved through discussion.

RESULTS

Sixteen programs were identified. Few programs have been evaluated for their effectiveness in reducing suicide attempts. Most studies evaluated the programs' abilities to improve students' and school staffs' knowledge and attitudes toward suicide. Signs of Suicide and the Good Behavior Game were the only programs found to reduce suicide attempts. Several other programs were found to reduce suicidal ideation, improve general life skills, and change gatekeeper behaviors.

CONCLUSIONS

There are few evidence-based, school-based suicide prevention programs, a combination of which may be effective. It would be useful to evaluate the effectiveness of general mental health promotion programs on the outcome of suicide. The grades assigned in this review are reflective of the available literature, demonstrating a lack of randomized controlled trials. Further evaluation of programs examining suicidal behavior outcomes in randomized controlled trials is warranted.

Understanding the effectiveness of school-based interventions to prevent suicide: a realist review

BACKGROUND

Schools appear an obvious place to deliver suicide prevention interventions for children and adolescents. The complexity of suicide interventions lead to a paucity of good quality evidence. An alternate approach of information gathering is needed to identify and collate evidence from existing interventions.

SCOPE

We completed a realist review of school-based suicide interventions. This is a novel method of understanding complex interventions that uses an iterative approach. In this review, we attempt to clarify and lay out what type of suicide intervention programme might be useful in schools, based on the local needs and context.

CONCLUSION

It is possible to develop and implement an evidence-based suicide intervention in schools by understanding the different processes that can contribute to success or failure of these interventions in a real-world setting.

Parents of older at-risk youth: a retention challenge for preventive intervention

We examined data from 162 families who participated in the prevention program Parents and Youth with Schools, which targeted at-risk high school youth and parents, to understand parent retention in the 15-session Parents as Partners program. We obtained reports from youth, parents and parent interventionists, which included both time-invariant and time-varying data regarding demographic factors; parent, youth and family characteristics; and parents' response to intervention. Utilizing event history analysis, we examined data sequentially in order to determine those variables that predicted continued parent attendance. In the model examining all areas simultaneously, the predictors of parent retention across the full program were parent minority status and age, teen anger and parent-teen conflict over school attendance, as well as parents' reports of group support and interventionists' report of parents' commitment. Overall, the analyses indicated that participants' characteristics, as well as their measureable response to the intervention, can alert researchers to potential program disengagement. Monitoring indicators of disengagement will help researchers focus resources early in the intervention process in order to maximize parent attendance and increase the success of prevention programs.

Efficient interventions on suicide prevention: a literature review

AIM

This review focuses on interventions to prevent suicide. It excludes psychotherapy evaluations and pharmaceutical clinical trials. The aim of this article is to provide useful input to the reflection on and the development of actions for professionals who may be concerned by suicide prevention.

METHOD

This research is based on 41 published evaluation studies presenting results on at least one of the three following outcomes: completed suicides, suicide attempts, and suicidal ideations. These studies have been classified into seven categories of preventive action.

RESULTS

According to data from the literature selected for our analysis, the three most efficient categories of intervention seem to be the limitation of access to lethal means, the preservation of contact with the patients hospitalized for a suicide attempt after hospitalization, and the implementation of emergency call centers. The four other categories of intervention examined in this study - the training of general practitioners, the reorganization of care, programs in schools, and information campaigns - have not yet shown sufficient proof of their efficacy. Nevertheless, these interventions, under certain conditions, can also contribute significantly to the prevention of suicide.

CONCLUSION

The majority of effective interventions minister to people already suffering from psychological disorders, but health promotion initiatives prior to situations of psychological disorders also deserve to be considered, in particular the implementation of services for the isolated elderly.

Emotion regulation difficulties, youth-adult relationships, and suicide attempts among high school students in underserved communities

To develop and refine interventions to prevent youth suicide, knowledge is needed about specific processes that reduce risk at a population level. Using a cross-sectional design, the present study tested hypotheses regarding associations between self-reported suicide attempts, emotion regulation difficulties, and positive youth-adult relationships among 7,978 high-school students (48.6% male, 49.9% female) in 30 high schools from predominantly rural, low-income communities. 683 students (8.6%) reported a past-year suicide attempt. Emotion regulation difficulties and a lack of trusted adults at home and school were associated with increased risk for making a past-year suicide attempt, above and beyond the effects of depressive symptoms and demographic factors. The association between emotion regulation difficulties and suicide attempts was modestly lower among students who perceived themselves as having higher levels of trusted adults in the family, consistent with a protective effect. Having a trusted adult in the community (outside of school and family) was associated with fewer suicide attempts in models that controlled only for demographic covariates, but not when taking symptoms of depression into account. These findings point to adolescent emotion regulation and relationships with trusted adults as complementary targets for suicide prevention that merit further intervention studies. Reaching these targets in a broad population of adolescents will require new delivery systems and "option rich" (OR) intervention designs.

A Systematic Review of School-Based Interventions Aimed at Preventing, Treating, and Responding to Suicide- Related Behavior in Young People

Background: Suicide, in particular among young people, is a major public health problem, although little is known regarding effective interventions for managing and preventing suicide-related behavior. Aims: To review the empirical literature pertaining to suicide postvention, prevention, and early intervention, specifically in school settings. Method: MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials (CCRCT) as well as citation lists of relevant articles using terms related to suicide and schools were searched in July 2011. School-based programs targeting suicide, attempted suicide, suicidal ideation, and self-harm where intent is not specified were included. No exclusion was placed on trial design. All studies had to include a suicide-related outcome. Results: A total of 412 potentially relevant studies were identified, 43 of which met the inclusion criteria, as well as three secondary publications: 15 universal awareness programs, 23 selective interventions, 3 targeted interventions, and 2 postvention trials. Limitations: Overall, the evidence was limited and hampered by methodological concerns, particularly a lack of RCTs. Conclusions: The most promising interventions for schools appear to be gatekeeper training and screening programs. However, more research is needed.

Suicide risk protocols: addressing the needs of high risk youths identified through suicide prevention efforts and in clinical settings

Several agencies have emphasized the importance of establishing clear protocols or procedures to address the needs of youths who are identified as suicidal through suicide prevention programs or in emergency department settings. What constitutes optimal guidelines for developing and implementing such protocols, however, is unclear. At the request of the Substance Abuse and Mental Health Services Administration, we provide an overview of recommendations, as well as steps taken in conjunction with selected prevention programs and in emergency department settings to address the needs and improve the care of these youths.

The effect of training problem-solving skills on coping skills of depressed nursing and midwifery students

INTRODUCTION

Nurses have a considerable role in caring and health promotion. Depressed nurses are deficient in their coping skills that are important in mental health. This study evaluated the effectiveness of training problem-solving skills on coping skills of depressed nursing and midwifery students.

METHODS

The Beck Depression Scale and coping skills questionnaire were administered in Tabriz and Urmia nursing and midwifery schools. 92 students, who had achieved a score above 10 on the Beck Depression Scale, were selected. 46 students as study group and 46 students as control group were selected randomly. The intervention group received six sessions of problem-solving training within three weeks. Finally, after the end of sessions, coping skills and depression scales were administered and analyzed for both groups.

RESULTS

Comparing the mean coping skills showed that before the intervention there were no significant differences between the control and study groups. However, after the intervention, a significant difference was observed between the control group and the study group. By comparing the mean coping skills before and after the intervention, a significant difference was observed in the study group.

CONCLUSION

Training problem-solving skills increased the coping skills of depressed students. According to the role of coping skills in people's mental health, increasing coping skills can promote mental health, provide the basis for caring skills, and improve the quality of nurses' caring skills.

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.

Self-harm and suicide in adolescents

Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage years and suicide being the second most common cause of death in young people worldwide. Important contributors to self-harm and suicide include genetic vulnerability and psychiatric, psychological, familial, social, and cultural factors. The effects of media and contagion are also important, with the internet having an important contemporary role. Prevention of self-harm and suicide needs both universal measures aimed at young people in general and targeted initiatives focused on high-risk groups. There is little evidence of effectiveness of either psychosocial or pharmacological treatment, with particular controversy surrounding the usefulness of antidepressants. Restriction of access to means for suicide is important. Major challenges include the development of greater understanding of the factors that contribute to self-harm and suicide in young people, especially mechanisms underlying contagion and the effect of new media. The identification of successful prevention initiatives aimed at young people and those at especially high risk, and the establishment of effective treatments for those who self-harm, are paramount needs.

Addressing Self-Directed Violence Prevention for Preventive Medicine Practitioners

This article summarizes the field of self-directed violence and its prevention focusing on suicidal behavior. Then it describes ways in which health care practitioners, especially preventive medicine specialists, can play a role in preventing these injuries whether they practice in clinical or community based settings. A review of the importance of suicidal behavior as a public health problem, its epidemiology, and prevention approaches are discussed. Suicidal behavior results from an interaction of risk factors but much is known about these factors and many of the injuries due to this phenomenon are preventable. Prevention of suicidal behavior requires collaboration from many sectors, including health care practitioners. Preventive medicine specialists can address this problem that affects individuals, families, and communities by taking an active part as practitioners, researchers, advocates, and through education.

Suicide prevention programs through community intervention

Broad general community campaigns were developed to reduce suicide rates. The aim of the current paper was to review such studies in the literature. The MEDLINE search using a combination of the keywords 'suicide', 'education'/'psychoeducation' and 'community' updated through January 10th 2010, returned 424 references and relevant for the current review were 48 with 14 papers reporting results. Although suicide prevention programs through community education are widespread, the reporting of their efficacy is limited. It seems that only long term programs that utilize a commitment of the society at multiple levels and succeed in establishing a community support network that can effectively reduce suicidal rates. The success of most interventions in changing the attitudes and improving the knowledge of the public concerning suicide is restricted at the theoretical-intellectual level; when it comes to action there seems to be no change. Very short duration interventions don't seem to have even this slight effect.

Connect: an effective community-based youth suicide prevention program

Youth suicide prevention is an important public health issue. However, few prevention programs are theory driven or systematically evaluated. This study evaluated Connect, a community-based youth suicide prevention program. Analysis of pre and posttraining questionnaires from 648 adults and 204 high school students revealed significant changes in knowledge and attitudes about suicide, increased belief in the usefulness of mental health care, and reduction of stigma associated with seeking help. Adults' preparedness to help also increased significantly as did the likelihood that youth participants would seek adult assistance if they were concerned about a peer. Implications of findings are discussed.

A review and application of suicide prevention programs in high school settings

Teen suicide is a terrible tragedy and is the third leading cause of death among high school children aged 14 to 19. School based intervention programs have been regarded as an effective and essential means of addressing this problem. A comprehensive review of the extant literature provides examination of the risk and protective factors of suicide in this age group, the development of these programs, the current state of the science and recommendations for enhanced assessment and intervention.

Long-term outcomes for the promoting CARE suicide prevention program

OBJECTIVES

To provide a long-term look at suicide risk from adolescence to young adulthood for former participants in Promoting CARE, an indicated suicide prevention program.

METHODS

Five hundred ninety-three suicide-vulnerable high school youth were involved in a long-term follow-up study. Latent class growth models identify patterns of change in suicide risk over this period.

RESULTS

Three distinct trajectories are determined, all showing a maintenance of decreased suicide risk from postintervention in adolescence into young adulthood for direct suicide-risk behaviors, depression and anger. Intervention conditions as well as key risk/protective factors are identified that predict to the long-term trajectories.

CONCLUSION

Early intervention is successful in promoting and maintaining lower-risk status from adolescence to young adulthood, with the caveat that some high-risk behaviors may indicate a need for additional intervention to establish earlier effects.

An ecological understanding of youth suicide in South Korea

This article reviews risk factors for youth suicide in South Korea (hereafter referred to as Korea), based on the ecological systems theory. Although youth suicide is a major concern for Korean society, understanding of this phenomenon has been limited since most of the empirical studies address personal characteristics without much consideration to larger environmental contexts for Korean adolescents. This review integrates many empirical findings on Korean adolescents’ suicidal ideation or behaviours within the context of micro-, meso-, exo-, macro-, and chrono-systems that surround an individual. Finally, it draws implications on assessment and intervention strategies for youth suicide that school psychologists and other mental health professionals in Korean schools can utilize.

A theoretical model for understanding mental health, substance use, and work performance among Asian immigrants

Mental illness and substance use disorders are prevalent among workers. Each year businesses lose billions of dollars to decreased work performance associated with these issues. This article discusses a theoretical model that depicts relationships between social discrimination, job concerns, and social support and workers' mental health problems and substance use and work performance. The focus is Asian immigrant workers, a population underrepresented in the literature. This model serves to assist occupational health nurses in the practice and research arenas better understand the complexities of mental health problems and substance use among Asian immigrant workers. Occupational health nurses are in a prime position to recognize, identify, and respond to at-risk workers. Examples of areas that might be considered by occupational health nurses when using this model are included.

A Theoretical Model for Understanding Mental Health, Substance Use, and Work Performance among Asian Immigrants

Mental illness and substance use disorders are prevalent among workers. Each year businesses lose billions of dollars to decreased work performance associated with these issues. This article discusses a theoretical model that depicts relationships between social discrimination, job concerns, and social support and workers' mental health problems and substance use and work performance. The focus is Asian immigrant workers, a population underrepresented in the literature. This model serves to assist occupational health nurses in the practice and research arenas better understand the complexities of mental health problems and substance use among Asian immigrant workers. Occupational health nurses are in a prime position to recognize, identify, and respond to at-risk workers. Examples of areas that might be considered by occupational health nurses when using this model are included.

Neighborhood poverty and suicidal thoughts and attempts in late adolescence

BACKGROUND

Suicide tends to concentrate in disadvantaged neighborhoods, and neighborhood disadvantage is associated with many important risk factors for youth suicide. However, no study has directly investigated the link between neighborhood poverty and youth suicidal behaviors, while controlling for pre-existing vulnerabilities. The objective of this study was to determine whether living in a poor neighborhood is associated with suicidal thoughts and attempts in late adolescence over and above background vulnerabilities, and whether this association can be explained by late-adolescence psychosocial risks: depression, social support, negative life events (NLEs), delinquent activities, substance abuse and exposure to suicide. The potential moderating role of neighborhood poverty was also examined.

METHOD

A subset of 2776 participants was selected from the Canadian National Longitudinal Survey of Children and Youth (NLSCY). Late-adolescence suicidal behaviors and risk factors were self-reported. The 2001 Canadian Census was used to characterize neighborhoods during early and middle adolescence. Late-childhood family and individual controls were assessed through parent-report.

RESULTS

At the bivariate level, the odds of reporting suicidal thoughts were about twice as high in poor than non-poor neighborhoods, and the odds of attempting suicide were about four times higher. After controlling for background vulnerabilities, neighborhood poverty remained significantly associated with both suicidal thoughts and attempts. However, these associations were not explained by late-adolescence psychosocial risks. Rather, youth living in poor neighborhoods may be at greater risk through the amplification of other risk factors in disadvantaged neighborhoods.

CONCLUSIONS

Potential explanations for the increased vulnerability of youth living in poor neighborhoods are discussed.

Risk and Protective Profiles Among Never Exposed, Single Form, and Multiple Form Violence Exposed Youth

This investigation integrated violence exposure with critical risk and protective factors linked to healthy adolescent adaptation and transition into early adulthood. A racially diverse sample of 848 adolescents identified as at-risk for school drop-out were assessed for no, single, or multiple forms of violence exposure. MANOVA tests revealed that youth with single form victimization fared more poorly than never-exposed youth, and that multiple-form victimization held the greatest jeopardy to development. Youth with multiple-form victimization reported significantly elevated risk factors (emotional distress, life stress, suicide risk, risky behaviors) and lower protective factors (social support, school engagement, family structure) than both single-form and never-exposed youth. Implications are discussed for preventive and early intervention programming and for examining the transition of at-risk youth into young adulthood.