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Book Title: Treating and Preventing Adolescent Mental Health Disorders
> pp. [445]-[449]
UNDEFINED: AUTHORS
Treating and Preventing Adolescent Mental Health Disorders
Print ISBN 9780195173642, 2005
pp. [445]-[449]
CHAPTER 22 Universal Approaches to Youth Suicide Prevention
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PRINTED FROM Treating and Preventing Adolescent Mental Health Disorders (www.oup.com/amhi-treatingpreventing)
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In this chapter, we focus on suicide prevention programs that have taken a universal approach, targeting youth in specific settings regardless of individual risk factors. One particularly widespread approach targets youth where they are most accessible—in the schools. Although the ultimate goal of all suicide prevention programs is to reduce death by suicide, school-based programs typically focus on more proximal outcomes. Two broad types of universal prevention programs have been especially common. The first includes educational programs that aim to increase students' knowledge and awareness about suicidal behavior, encourage troubled students to seek help, and improve recognition of at-risk students by teachers, counselors, and other “gatekeepers” within the school or community settings. In the second category are screen-ing programs that seek to identify and refer to treatment youth who are at risk for suicidal behavior. In each category, suicide prevention efforts have been separately designed for high school and college students. In the following pages, we summarize these universal programs, identifying for each broad type the underlying assumptions and specific program examples, and providing a summary critique of the approach.
SUICIDE AWARENESS AND EDUCATION PROGRAMS
A wide range of suicide education and awareness programs have been developed; these are summarized in Table 22.1 The key assumptions underlying such programs are that the conditions that contribute to suicide risk in adolescents and young adults often go unrecognized, undiagnosed, and untreated, and that educating students and gatekeepers about the warning signs for suicide and appropriate responses will result in better identification of at-risk youth, and an increase in help seeking and referrals for treatment.
Most suicide awareness and education programs described in the literature have been implemented at the high school level and share a core of common programmatic features, centering on a suicide education curriculum, supplemented in some cases with training directed toward teachers and other gatekeepers. Such programs are exemplified by those developed by Kalafat and colleagues (Kalafat & Elias, 1992, 1994; Kalafat & Gagliano, 1996; Kalafat & Ryerson, 1999), which incorporate education about the warning signs of suicide and appropriate help-seeking behaviors into the regular physical education or related curricula. Such education has been reported by the program developers to result in students' increased knowledge about suicidal behavior, more positive attitudes about talking to friends they believe to be suicidal, and seeking of help from adults. In its most fully developed form, the Adolescent Suicide Awareness Program (ASAP) includes education for teachers, school staff, and parents, as well as students. Although no controlled evaluations have been reported, the developers cited anecdotal reports of increased referrals of at-risk youth, following implementation of ASAP in a number of schools (Kalafat & Ryerson, 1999). Another widely applied curriculum-based prevention effort is the Signs of Suicide (SOS) program, developed by Jacobs and colleagues. The SOS program delivers the core message that suicidal behavior is directly related to mental illness, particularly depression, and needs to be responded to as a mental health emergency. The instructional component, which occurs over one to two class periods, may be augmented with screening and parent-awareness activities. Schools in which the program has been implemented have reported substantial increases in students' help-seeking behavior and high satisfaction with the program among school officials (Aseltine, Jacobs, Kopans, & Bloom, 2003). In a recent posttest-only evaluation involving five high schools in Columbus, Georgia, and Hartford, Connecticut, 2,100 students were randomly assigned to intervention and control groups. In self-administered questionnaires 3
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PRINTED FROM Treating and Preventing Adolescent Mental Health Disorders (www.oup.com/amhi-treatingpreventing)
© Copyright Oxford University Press, 2006. All Rights Reserved
Table 22.1
Suicide Education ProgramsReference | Intervention | Study Design | Program Length | Sample Size | Comments | Spirito et al., 1988 | Samaritan-based program | Nonrandom pre–postcontrol group design | 8 hr | Experimental: 291 high school students Control: 182 high school students | Program-exposed group demonstrated increase in knowledge Females increased knowledge more than males | Overholser et al., 1989 | Samaritan-based program with didactics, handouts, discussion, and role-playing | Nonrandom pre–postcontrol group design | 5 health classes | Experimental: 215 ninth-grade students from two schools Control: 256 ninth-grade students from one school 53% male from suburban middle class | Gender and personal experience related to students' knowledge and attitudes at baseline and after the program More positive effect of program for females and slightly negative in some aspects for males Students who knew suicidal peer were more likely to increase knowledge All students except males with personal experience with suicidal behavior had decreased negative attitudes No comparisons with controls presented | Shaffer et al., 1990 | Didactics and discussion led by trained, regular education classroom teachers | Nonequivalent control group with 2×2 (attempt yes/no×program yes/no) pre–post design | 1–3 hr, depending on school | Initial sample: N = 1,551 ninth graders Final sample:
N = 63 suicide attempters (35 program/28 control)
N = 910 nonattempters (489 program/421 Control) | Majority felt others should participate in program Changes in knowledge and attitudes tended to be in intended direction Male attempters more likely than nonattempters to feel uncomfortable dealing with friends' problems, to know someone upset by program, and to discourage participation | Shaffer et al., 1991 Vieland et al., 1991 | Didactic instruction and discussion | Pretest–posttest design with comparison group Follow-ups at 1 month and of a subsample at 18 months | 3 different suicide-awareness programs, each lasting 3–4 hr, focusing on symptom identification and help seeking; differences between programs in use of teachers and focus on help seeking, problem solving, or mobilizing networks | 11 schools
n = 758 from 6 program schools (2 for each program)
n = 680 from 5 control schools 9th and 10th graders 5 urban 2 suburban 4 rural/suburban | Reaction to program was good Females and nonwhite ethnic groups rated programs more highly Base knowledge high; exposure increased controversial beliefs supported by the programs Programs increased knowledge about where to get help but did not improve help-seeking behavior | Kalafat & Elias, 1994 | Adolescent Suicide Awareness Program (ASAP) Didactics and discussion program | Solomon four-group design | 3 health class periods | 253 suburban 10th graders | Increased knowledge about warning signs Improved attitudes about help seeking More likely to talk about a friend's suicidal behavior and refer for help | Kalafat & Gagliano, 1996 | ASAP Didactics, discussion, and simulated encounters with suicidal peers | Stratified random sample Pre–post control group | 5 health class periods | 109 eighth graders (whole grade) White
n = 52 experimental
n = 57 controls | Experimental group was more likely to tell an adult about suicidal peers Less likely to report suicidal behavior to an adult when ambiguous | Zenere & Lazarus, 1997 | Didactics and discussion | Epidemiological comparison No control group | One class in 5-year program | Reports from department of crisis management | Decreased rate of suicide completions and suicide attempts No change in suicidal ideation | Aseltine et al., 2003 | Signs of Suicide (SOS) Video, didactics, discussion, school kit with materials for screening and parents | One group posttest only, 1-and 3-month follow-up | 1–2 class periods | 376 high schools postscreen 233/376 schools at 1 month 64% white 12% African American 10% Latino 27% urban 33% suburban 41% rural 21% school lunch eligible 177/376 schools at 3 months | 63% completed program and evaluation Schools reported increased help-seeking behavior of students, increased help-seeking on behalf of friend, low cost 1% of teachers thought program might have had adverse effect | Thompson, 2003a | YSPP Needs assessment and school-based student-led campaign program | Single group(s) qualitative design | Ongoing program | Gatekeepers, crisis teams, community groups, and high school students willing to participate | Increased awareness, knowledge, and number of students advising peers to get help Direct involvement of students in antisuicide campaign development | National Mental Health Association | Booklets and offers of help to develop mental health programs | Not yet evaluated | Booklet | Distributed to college students, administrators, and student leaders, and on Web site | Not yet evaluated | Aseltine & DeMartine, 2004 | SOS Video and discussion guide Columbia Depression Screen (CDS) | Posttest only Stratified random assignment with delayed-treatment comparison group | 2 health or social studies classes |
N = 2,100
n = 1,435 3 classes from Hartford, CT High School grades 9–12, “economically disadvantaged” 47% male 59% Hispanic 20% non-Hispanic black 20% in remedial English or ESL
n = 665 from two Columbus, GA high schools ninth graders 52% male “working class” 39% white 37% African American 15% remedial English or ESL | SOS vs. Comparison 3.6 vs. 5.4 suicide attempts SOS had higher posttest knowledge and more positive attitudes than comparison No difference in suicidal ideation or treatment seeking Combined schools without comparing Don't know about pretest differences |
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ESL, English as a second language.
end p.447
PRINTED FROM Treating and Preventing Adolescent Mental Health Disorders (www.oup.com/amhi-treatingpreventing)
© Copyright Oxford University Press, 2006. All Rights Reserved
end p.448
PRINTED FROM Treating and Preventing Adolescent Mental Health Disorders (www.oup.com/amhi-treatingpreventing)
© Copyright Oxford University Press, 2006. All Rights Reserved
end p.449
doi:10.1093/9780195173642.003.0023
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