Self-determination and persistence in a real-life setting: toward a motivational model of high school dropout

The purpose of this study was to propose and test a motivational model of high school dropout. The model posits that teachers, parents, and the school administration's behaviors towards students influence students' perceptions of competence and autonomy. The less autonomy supportive the social agents' behaviors are, the less positive the students' perceptions of competence and autonomy. In turn, the less positive students' perceptions are, the lower their level of self-determined school motivation are. Finally, low levels of self-determined motivation lead students to develop intentions to drop out of high school, which are later implemented, leading to actual dropout behavior. This model was tested with high school students (N = 4,537) by means of a prospective design. Results from analyses of variance and a structural equation modeling analysis (with LISREL) were found to support the model for all participants and for each gender separately.

Burnout and serious thoughts of dropping out of medical school: a multi-institutional study

PURPOSE

Little is known about students who seriously consider dropping out of medical school. The authors assessed the severity of thoughts of dropping out and explored the relationship of such thoughts with burnout and other indicators of distress.

METHOD

The authors surveyed medical students attending five medical schools in 2006 and 2007 (prospective cohort) and included two additional medical schools in 2007 (cross-sectional cohort). The survey included questions about thoughts of dropping out, life events in the previous 12 months, and validated instruments evaluating burnout, depression symptoms, and quality of life (QOL).

RESULTS

Data were provided by 858 (65%) students in the prospective cohort and 2,248 (52%) in the cross-sectional cohort. Of 2,222 respondents, 243 (11%) indicated having serious thoughts of dropping out within the last year. Burnout (P < .0001), QOL (P < .003 each domain), and depressive symptoms (P < .0001) at baseline predicted serious thoughts of dropping out during the following year. Each one-point increase in emotional exhaustion and depersonalization score and one-point decrease in personal accomplishment score at baseline was associated with a 7% increase in the odds of serious thoughts of dropping out during the following year. On subsequent confirmatory multivariable analysis, low scores for personal accomplishment, lower mental and physical QOL, and having children were independent predictors of students having serious thoughts of dropping out during the following year.

CONCLUSIONS

Approximately 11% of students have serious thoughts of dropping out of medical school each year. Burnout seems to be associated with increased likelihood of serious thoughts of dropping out.

The impact of anxiety disorders on educational achievement

Anxiety disorders typically have an age of onset in childhood and adolescence, resulting in significant disability in social and occupational functioning. Epidemiological evidence suggests that persons with psychiatric disorders and perhaps especially social phobia are at increased risk for premature withdrawal from school [Am. J. Psychiatry 157 (2000) 1606]. In order to further determine the impact of anxiety disorders on school functioning and/or premature withdrawal from school, 201 patients meeting DSM-IV criteria for a primary anxiety disorder completed a school leaving questionnaire as well as self-report measures of anxiety, depression, and social adjustment. About 49% (n = 98) reported leaving school prematurely and 24% of those indicated that anxiety was the primary reason for this decision. Patients who had left school prematurely were significantly more likely to have a lifetime diagnosis of generalized social phobia, a past history of alcohol abuse/dependence and a greater number of lifetime diagnoses than those who completed their desired level of education. This study suggests that anxiety disorders, and perhaps especially generalized social phobia, are associated with premature withdrawal from school. Further studies are required to determine methods for early identification and treatment of anxiety disorders in school aged children to enable these students to reach their full potential.

School refusal and psychiatric disorders: a community study

OBJECTIVE

To examine the association between anxious school refusal and truancy and psychiatric disorders in a community sample of children and adolescents using a descriptive rather than etiological definition of school refusal.

METHOD

Data from eight annual waves of structured psychiatric interviews with 9- to 16-year-olds and their parents from the Great Smoky Mountains Study were analyzed.

RESULTS

Pure anxious school refusal was associated with depression (odds ratio [OR] = 13, 95% confidence interval [CI] 3.4, 42) and separation anxiety disorder (OR = 8.7, 95% CI 4.1, 19). Pure truancy was associated with oppositional defiant disorder (OR = 2.2, 95% CI 1.2, 4.2), conduct disorder (OR = 7.4, 95% CI 3.9, 14), and depression (OR = 2.6, 95% CI 1.2, 56). Of mixed school refusers (children with both anxious school refusal and truancy), 88.2% had a psychiatric disorder. They had increased rates of both emotional and behavior disorders. Specific fears, sleep difficulties, somatic complaints, difficulties in peer relationships, and adverse psychosocial variables had different associations with the three types of school refusal.

CONCLUSIONS

Anxious school refusal and truancy are distinct but not mutually exclusive and are significantly associated with psychopathology, as well as adverse experiences at home and school. Implications of these findings for assessment, identification, and intervention for school refusal are discussed.

The development of heavy drinking and alcohol-related problems from ages 18 to 37 in a U.S. national sample

OBJECTIVE

The purpose of this study is to add to the understanding of the development of heavy alcohol use and alcohol-related problems by examining data from the National Longitudinal Survey of Youth (NLSY), a general population sample that contains information on alcohol use for the ages 18-37. A key question in this study is how background characteristics of the individual influence this development and whether the influence of these background characteristics changes over time.

METHOD

The data used in this study are a general population sample (N = 7,859) from the National Longitudinal Survey of Youth (NLSY). This study uses a multivariate outcome approach that focuses on individual variation in trajectories over age. The statistical analysis uses random coefficients in a latent variable framework. Across-age changes in the importance of the influence of background variables on the outcomes are modeled using varying centering points.

RESULTS

A key finding is that dropping out of high school has no effect on alcohol-related problems for individuals in their mid-twenties, but is associated with significantly increased levels of alcohol-related problems for individuals in their mid-thirties. In contrast, going on to college is associated with lower levels of heavy drinking when individuals reach their late twenties and their thirties. Strong gender and ethnicity effects seen in the twenties diminish when individuals reach their thirties.

CONCLUSIONS

The trajectory analysis expands the knowledge of problematic alcohol development for individuals in their late twenties and thirties. The increasing detrimental effect of dropping out of high school up to the age 37 endpoint of the study raises questions about the effects in later life of dropping out of high school.

Academic success among students at risk for school failure

A sample of 1,803 minority students from low-income homes was classified into 3 groups on the basis of grades, test scores, and persistence from grade 8 through Grade 12; the classifications were academically successfully school completers ("resilient" students), school completers with poorer academic performance (nonresilient completers), and noncompleters (dropouts). Groups were compared in terms of psychological characteristics and measures of "school engagement." Large, significant differences were found among groups on engagement behaviors, even after background and psychological characteristics were controlled statistically. The findings support the hypothesis that student engagement is an important component of academic resilience. Furthermore, they provide information for designing interventions to improve the educational prognoses of students at risk.

A longitudinal cohort study of burnout and attrition in nursing students

BACKGROUND

It is well-established that stress is likely to contribute to attrition in nursing students. Attrition from nursing programmes and retention of nurses in the profession are international concerns and steps are currently being taken in the United Kingdom to tackle these issues.

AIM

The aim of this study was to investigate prospectively the determinants of, and relationships among, stress, burnout and attrition in nursing students.

METHOD

A longitudinal design involving a complete cohort of nursing students was employed, using a battery of instruments to measure personality, intelligence, psychological morbidity, stress, coping and burnout. Data were gathered on entry, at 12 and 24 months, and at the end of the nursing programme.

FINDINGS

Students experienced increasing levels of stress and use of negative coping mechanisms as the programme progressed and psychological morbidity increased. Positive aspects of personality were more likely to lead to aspects of burnout, and personality was a more important indicator of attrition than cognitive ability.

CONCLUSIONS

Stress, burnout and attrition may not be directly linked. Personality factors at course entry contributed significantly to the prediction of burnout and programme completion, but the relationships were not strong enough to be practically useful.

School disengagement as a predictor of dropout, delinquency, and problem substance use during adolescence and early adulthood

Over the past 5 years, a great deal of attention has been paid to the development of early warning systems for dropout prevention. These warning systems use a set of indicators based on official school records to identify youth at risk for dropout and then appropriately target intervention. The current study builds on this work by assessing the extent to which a school disengagement warning index predicts not only dropout but also other problem behaviors during middle adolescence, late adolescence, and early adulthood. Data from the Rochester Youth Development Study (N = 911, 73% male, 68% African American, and 17% Latino) were used to examine the effects of a school disengagement warning index based on official 8th and 9th grade school records on subsequent dropout, as well as serious delinquency, official offending, and problem substance use during middle adolescence, late adolescence, and early adulthood. Results indicate that the school disengagement warning index is robustly related to dropout as well as serious problem behaviors across the three developmental stages, even after controlling for important potential confounders. High school dropout mediates the effect of the warning index on serious problem behaviors in early adulthood.

Resilience among abused and neglected children grown up

Although an extensive literature has accumulated documenting the maladaptive outcomes associated with childhood victimization, a limited body of knowledge addresses resilience. This paper sought to operationalize the construct of resilience across a number of domains of functioning and time periods and to determine the extent to which abused and neglected children grown up demonstrate resilience. Substantiated cases of child abuse and neglect from 1967 to 1971 were matched on gender, age, race, and approximate family social class with nonabused and nonneglected children and followed prospectively into young adulthood. Between 1989 and 1995. 1,196 participants (676 abused and neglected and 520 controls) were administered a 2-hr in-person interview, including a psychiatric assessment. Resilience requires meeting the criteria for success across six of eight domains of functioning: employment, homelessness, education, social activity, psychiatric disorder, substance abuse, and two domains assessing criminal behavior (official arrest and self-reports of violence). Results indicate that 22% of abused and neglected individuals meet the criteria for resilience. More females met the criteria for resilience and females were successful across a greater number of domains than males. We speculate on the meaning of these findings and discuss implications for the child maltreatment field. Limitations of the study are also acknowledged.

Multidimensional properties of the General Health Questionnaire

This analysis re-examines the factor structure of the 12-item GHQ for a large Australian sample of young people. It shows that oblique factor rotation better approaches the criterion of simple structure, and allows separate components of the GHQ to be identified and measured using factor scores. When the performance of these separate factors is compared with composite Likert scores, it is found that they do not behave uniformly in response to outside variables, both in cross-sectional and longitudinal analyses. These results suggest that there are advantages to be gained by using the multidimensional properties of the GHQ as well as a single severity score. The additional information this yields can provide new insights into the nature of psychiatric impairment within and between samples.

Cognitive functioning in children and adolescents with multiple sclerosis

OBJECTIVE

To examine cognitive functioning in children with multiple sclerosis (MS).

METHODS

The authors examined the neuropsychological profile of 37 children with a diagnosis of clinically definite MS and assessed the associations between cognitive function and clinical features.

RESULTS

Of 37 children and adolescents evaluated, 35% demonstrated significant cognitive impairment. Cognitive functioning was strongly related to several clinical variables, including current Expanded Disability Status Scale, total number of relapses, and total disease length. The consequences of MS adversely affected academic functioning in over a third of the children.

CONCLUSIONS

Cognitive deficits occur in children with multiple sclerosis. Comprehensive treatment planning should involve recognition that they may require academic accommodations for their education.

Risk Factors for School Absenteeism and Dropout: A Meta-Analytic Review

School absenteeism and dropout are associated with many different life-course problems. To reduce the risk for these problems it is important to gain insight into risk factors for both school absenteeism and permanent school dropout. Until now, no quantitative overview of these risk factors and their effects was available. Therefore, this study was aimed at synthesizing the available evidence on risk factors for school absenteeism and dropout. In total, 75 studies were included that reported on 781 potential risk factors for school absenteeism and 635 potential risk factors for dropout. The risk factors were classified into 44 risk domains for school absenteeism and 42 risk domains for dropout. The results of a series of three-level meta-analyses yielded a significant mean effect for 28 school absenteeism risk domains and 23 dropout risk domains. For school absenteeism, 12 risk domains were found with large effects, including having a negative attitude towards school, substance abuse, externalizing and internalizing problems of the juvenile, and a low parent-school involvement. For dropout, the risk domains having a history of grade retention, having a low IQ or experiencing learning difficulties, and a low academic achievement showed large effects. The findings of the current study contribute to the fundamental knowledge of the etiology of school absenteeism and dropout which in turn contributes to a better understanding of the problematic development of adolescents. Further, more insight into the strength of effects of risk factors on school absenteeism and dropout is important for the development and improvement of both assessment, prevention and intervention strategies.

The role of father involvement in children's later mental health

Data on 8441 cohort members of the National Child Development Study were used to explore links between father involvement at age 7 and emotional and behavioural problems at age 16, and between father involvement at age 16 and psychological distress at age 33, controlling for mother involvement and known confounds. Father involvement at age 7 protected against psychological maladjustment in adolescents from non-intact families, and father involvement at age 16 protected against adult psychological distress in women. There was no evidence suggesting that the impact of father involvement in adolescence on children's later mental health in adult life varies with the level of mother involvement.

School refusal in children and adolescents: a review of the past 10 years

OBJECTIVE

To critically review the past 10 years of research on school refusal in children and adolescents.

METHOD

Literature on school refusal published from 1990 onward was reviewed following a systematic search of PsycINFO. The review focuses on definitional issues, epidemiology and school refusal identification, diagnostic considerations, family functioning, assessment, treatment, and follow-up studies.

RESULTS

While definitional and conceptual issues are still evident, promising developments have occurred in relation to assessment and treatment practices and understanding of the family context of school refusal.

CONCLUSIONS

From a clinical viewpoint, school refusal cases require comprehensive assessment and treatment. Advances have been made in the treatment of school refusal. However, additional controlled studies evaluating interventions for school refusal are needed.

Mental disorders and termination of education in high-income and low- and middle-income countries: epidemiological study

BACKGROUND

Studies of the impact of mental disorders on educational attainment are rare in both high-income and low- and middle-income (LAMI) countries.

AIMS

To examine the association between early-onset mental disorder and subsequent termination of education.

METHOD

Sixteen countries taking part in the World Health Organization World Mental Health Survey Initiative were surveyed with the Composite International Diagnostic Interview (n=41 688). Survival models were used to estimate associations between DSM-IV mental disorders and subsequent non-attainment of educational milestones.

RESULTS

In high-income countries, prior substance use disorders were associated with non-completion at all stages of education (OR 1.4-15.2). Anxiety disorders (OR=1.3), mood disorders (OR=1.4) and impulse control disorders (OR=2.2) were associated with early termination of secondary education. In LAMI countries, impulse control disorders (OR=1.3) and substance use disorders (OR=1.5) were associated with early termination of secondary education.

CONCLUSIONS

Onset of mental disorder and subsequent non-completion of education are consistently associated in both high-income and LAMI countries.

A multi-institutional study exploring the impact of positive mental health on medical students' professionalism in an era of high burnout

PURPOSE

Although burnout is associated with erosion of professionalism and serious personal consequences, whether positive mental health can enhance professionalism and how it shapes personal experience remain poorly understood. The study simultaneously explores the relationship between positive mental health and burnout with professionalism and personal experience.

METHOD

The authors surveyed 4,400 medical students at seven U.S. medical schools in 2009 to assess mental health (categorized as languishing, moderate, and flourishing) and burnout. Additional items explored professional behaviors, beliefs, suicidal ideation, and serious thoughts of dropping out.

RESULTS

A total of 2,682/4,400 (61%) responded. Prevalence of suicidal ideation (55/114 [48.2%], 281/1,128 [24.9%], and 127/1,409 [9.1%]) and serious thoughts of dropping out (15/114 [13.2%], 30/1,128 [2.7%], and 14/1,409 [1.0%]) decreased as mental health improved from languishing, moderate, and flourishing, respectively (all P < .0001); this relationship between personal experience and mental health persisted independent of burnout (all P < .001). As mental health improved, the prevalence of unprofessional behaviors (i.e., cheating and dishonest behaviors) also declined, whereas students' altruistic beliefs regarding physicians' responsibility toward society improved. For example, 33/113 (29.2%), 426/1,120 (38.0%), and 718/1,391 (51.6%) of students with languishing, moderate, and flourishing mental health endorsed all five altruistic professional beliefs (P < .0001). The relationship between professional beliefs and mental health persisted among students with burnout, whereas fewer relationships were found among students without burnout.

CONCLUSIONS

Findings suggest that positive mental health attenuates some adverse consequences of burnout. Medical student wellness programs should aspire to prevent burnout and promote mental health.

Gay, lesbian, and bisexual youth risks for emotional, physical, and social problems: results from a community-based survey

OBJECTIVE

Health problems of gay, lesbian, and bisexual (GLB) youth are reported as differing from those of heterosexual youth. Increased depression, suicide, substance use, homelessness, and school dropout have been reported. Most studies of GLB youth use clinical or convenience samples. The authors conducted a community school-based health survey that included an opportunity to self-identify as GLB.

METHOD

An anonymous self-report health care questionnaire was used during a community-based survey in 2 high schools in an upper middle class district.

RESULTS

Significantly increased health risks for self-identified GLB youth were found in mental health, sexual risk-taking, and general health risks compared with self-identified heterosexuals, but not in health domains associated with substance abuse, homelessness, or truancy.

CONCLUSIONS

Self-identified GLB youth in community settings are at greater risk for mental health, sexual risk-taking, and poorer general health maintenance than their heterosexual peers.

Exploring factors affecting attrition of male students from an undergraduate nursing course: a qualitative study

This article reports the findings of a qualitative study that investigated the factors influencing both the academic and clinical practice performance of undergraduate male nursing students at a regional Australian university. The impetus for the study evolved from the recognition that, despite increasing numbers of males choosing to undertake nursing as a career, attrition by males from nursing courses continues to be problematic. In a profession that is hallmarked by critical staff shortages, it was viewed as important to investigate reasons contributing to the attrition of male nursing students enrolled in undergraduate nursing courses. The informants for the research were eight male nursing students enrolled internally in the Bachelor of Nursing course at a regional university in Australia. Data were collected using in-depth interviews and written narratives in the form of a diary. Data were analysed using thematic analysis, the findings revealing that male nursing students face particular challenges from an academic and clinical practice perspective during their university experience. For example, themes identified from interviews and narratives highlighted the fact that there is a tendency for male nursing students to feel isolated and excluded from an academic and clinical perspective. As well as this, the informants in this study clearly highlighted their preference for engaging in the technical aspects of nursing. The implications for nurse educators are emphasized and from this, educational strategies are suggested to facilitate the retention of male nursing students in undergraduate nursing courses.

Unemployment, underemployment, and mental health: conceptualizing employment status as a continuum

The economy is one of the most important social environments that affect well-being, and community psychologists have long studied the social costs of one key economic stressor--job loss. But economically inadequate employment has received much less research attention than unemployment in regard to mental health effects. This paper contrasts these two literatures and considers factors that might account for their differential growth including actual rates of unemployment and underemployment. Recent panel studies offer no support for another possible basis for this differential growth--the assumption that inadequate employment is more like adequate employment than unemployment. Implications of a paradigm shift from a dichotomous perspective (employment vs. unemployment) to a continuum perspective with variations of both unemployment and employment are discussed for research and prevention. Another implication is the need to expand standard labor force statistics to reflect better the degree of underemployment.

Childhood trauma and psychiatric disorders as correlates of school dropout in a national sample of young adults

The effect of childhood trauma, psychiatric diagnoses, and mental health services on school dropout among U.S.-born and immigrant youth is examined using data from the Collaborative Psychiatric Epidemiology Surveys, a nationally representative probability sample of African Americans, Afro-Caribbeans, Asians, Latinos, and non-Latino Whites, including 2,532 young adults, aged 21-29. The dropout prevalence rate was 16% overall, with variation by childhood trauma, childhood psychiatric diagnosis, race/ethnicity, and nativity. Childhood substance and conduct disorders mediated the relation between trauma and school dropout. Likelihood of dropout was decreased for Asians, and increased for African Americans and Latinos, compared to non-Latino Whites as a function of psychiatric disorders and trauma. Timing of U.S. immigration during adolescence increased risk of dropout.

Gender, gender roles and completion of nursing education: a longitudinal study

The current worldwide nursing shortage and high attrition of nursing students remain a challenge for the nursing profession. The aim of this paper was to investigate how key psychological attributes and constructions differentiate between completers and non-completers of nursing education. A questionnaire including measures of gender role identity and perceived gender appropriateness of careers was administered to 384 students early in the first year of the course. At the end of the programme attrition rates were obtained. The findings indicate that males were more likely to leave the course than females. Furthermore, those who completed the course tended to view nursing as more appropriate for women, in contrast to the non-completers who had less gender typed views. The female-dominated nature of nursing, prevalent stereotypes and gender bias inherent in nursing education seem to make this an uncomfortable place for males and those with less gendered typed views. Whilst it is acknowledged that attrition is undoubtedly a complex issue with many contributing factors, the nursing profession need to take steps to address this bias to ensure their profession is open equally to both female and male recruits.

Factors associated with dropout in medical education: a literature review

CONTEXT

Medical school dropout may have negative consequences for society, patients, the profession, schools and dropouts. To our knowledge, the literature dealing with dropout from medical school has never been systematically and critically appraised.

OBJECTIVES

This review aimed to systematically and critically review studies dealing with factors found to be associated with dropping out of medical school.

METHODS

A systematic critical literature review of the international peer-reviewed research literature on medical education was performed. A primary search was conducted and subsequently supplemented with ancestry and descendancy searches. The population of interest was medical students and the outcome was dropout. Abstract/title screening and quality assessment were performed by two independent researchers. Studies were assessed on six domains of quality: study participation; study attrition; predictor measurement; measurement of and accounting for confounders; outcome measurement, and analysis. Only studies that accounted for confounding were included in the final analysis.

RESULTS

Of 625 studies found, 48 were quality-assessed and 13 of these were eventually included based on their fulfilment of our quality-related criteria. A range of entry qualifications seemed to be associated with greater chances of a student dropping out (odds ratio [OR] = 1.65-4.00). Struggling academically in medical school may be strongly associated with dropout. By contrast, no specific pattern of demographic variables was particularly important in relation to dropout. The effects of socio-economic, psychological and educational variables on dropout were not well investigated.

CONCLUSIONS

More research into causal models and theory testing, which considers the effects of education, organisation and institution, is necessary if we are to learn more about how we can actively prevent medical student withdrawal.

Perceptions of nursing: confirmation, change and the student experience

Research has identified a number of negative societal perceptions of nursing related to gendered stereotyping, subordination to doctors, low academic standards, limited career opportunities and poor pay and conditions, and importantly how these perceptions may affect levels of recruitment into nursing. Focusing specifically on nurses, research has also considered the extent to which these societal perceptions are realities in their workplaces, and the direct experiences that contribute to attrition from both nursing courses and jobs. However, to date, few research has actually bridged the above approaches and considered the perceptions that nursing students hold as they first enter their education and how these change, or are confirmed, as a result of their experiences. In this context, the current study uses a combined questionnaire (n = 650), interview (n = 30) and focus group (n = 7) methodology to investigate the experiences of students based at two British Universities. The findings suggest that many students were surprised, yet not overwhelmed, by the high academic standards required of them and came to recognize and value the tremendous knowledge, skills set and responsibilities of nurses as they acquired them. However, their experiences reinforced both society's and their own image of an underpaid, overworked profession that lacks respect and has low morale. The findings support media initiatives that emphasize nurses' skills in order to influence public opinion. They also support a range of subtle changes in nurse education at the institutional level to make student life easier. Nevertheless, it is acknowledged that these may have a limited impact unless pay and conditions are adequately addressed at the national level.

Effect of underemployment on school-leavers' self-esteem

This study explores whether self-esteem is adversely affected by economic underemployment as defined by unemployment, involuntary part-time employment, intermittent unemployment, and poverty income in a group of recent school-leavers. Results indicate that self-esteem was significantly lower in each of the economically underemployed groups relative to the adequately employed after controlling for early self-esteem, socio-economic status, gender, ethnicity, aptitude, age, and education. There were no differences in self-esteem among the economically underemployed groups after adjusting for the control variables. Economic underemployment proved to be a distinct concept relative to self-reported job satisfaction. Underemployment was negatively related to self-esteem after controlling for perceived job satisfaction and the other control variables. Our findings suggest a need for societal attention to the levels of underemployment on par with the attention given to monitoring traditional unemployment levels.

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

OBJECTIVES

This study evaluated the efficacy of 2 indicated preventive interventions, postintervention and at 9-month follow-up.

METHODS

Drawn from a pool of potential high school dropouts, 460 youths were identified as being at risk for suicide and participated in 1 of 3 conditions randomly assigned by school: (1) Counselors CARE (C-CARE) (n = 150), a brief one-to-one assessment and crisis intervention; (2) Coping and Support Training (CAST) (n = 155), a small-group skills-building and social support intervention delivered with C-CARE; and (3) usual-care control (n = 155). Survey instruments were administered pre-intervention, following C-CARE (4 weeks), following CAST (10 weeks), and at a 9-month follow-up.

RESULTS

Growth curve analyses showed significant rates of decline in attitude toward suicide and suicidal ideation associated with the experimental interventions. C-CARE and CAST, compared with usual care, also were effective in reducing depression and hopelessness. Among females, reductions in anxiety and anger were greater in response to the experimental programs. CAST was most effective in enhancing and sustaining personal control and problem-solving coping for males and females.

CONCLUSIONS

School-based, indicated prevention approaches are feasible and effective for reducing suicidal behaviors and related emotional distress and for enhancing protective factors.