The Garrett Lee Smith Memorial Suicide Prevention Program

In response to calls for greater efforts to reduce youth suicide, the Garrett Lee Smith (GLS) Memorial Act has provided funding for 68 state, territory, and tribal community grants, and 74 college campus grants for suicide prevention efforts. Suicide prevention activities supported by GLS grantees have included education, training programs (including gatekeeper training), screening activities, infrastructure for improved linkages to services, crisis hotlines, and community partnerships. Through participation in both local‐ and cross‐site evaluations, GLS grantees are generating data regarding the local context, proximal outcomes, and implementation of programs, as well as opportunities for improvement of suicide prevention efforts.     

Suicide surveillance in the U.S. Military--reporting and classification biases in rate calculations

The military has a well-defined population with suicide prevention programs that have been recognized as possible models for civilian suicide prevention efforts. Monitoring prevention programs requires accurate reporting. In civilian settings, several studies have confirmed problems in the reporting and classification of suicides. This analysis evaluated whether suicides were underreported or misclassified under accident or undetermined manner of death in the military system. We reviewed all 1998 and 1999 military deaths using official death reports and compared these data with additional sources, most importantly the DoD Medical Mortality Registry. We assessed for evidence of expressed suicidal intent and past psychiatric history among deaths classified as undetermined and accidents due to gunshot, overdose, drowning, falls, or asphyxia. Using sources other than official records, we found 17% more suicides than were reported, and an additional 4% of deaths that were suspicious for suicide. This study suggests that reporting and classification errors may account for 21% additional suicides in the military. These findings are comparable to rates seen in civilian studies and add to the literature regarding the problems inherent in using administrative death classification data for medical surveillance purposes.     

Does a Gatekeeper Suicide Prevention Program Work in a School Setting? Evaluating Training Outcome and Moderators of Effectiveness

The suicide prevention gatekeeper training program QPR (Question, Persuade, and Refer) was evaluated among school personnel using a nonequivalent control group design. Substantial gains were demonstrated from pre- to post-test for attitudes, knowledge, and beliefs regarding suicide and suicide prevention. Exploratory analyses revealed the possible moderating effects of age, professional role, prior training, and recent contact with suicidal youth on QPR participants' general knowledge, questioning, attitudes toward suicide and suicide prevention, QPR quiz scores, and self-efficacy. The need for replication using a more rigorous experimental design in the context of strong community collaboration is discussed.     

Does a Gatekeeper Suicide Prevention Program Work in a School Setting? Evaluating Training Outcome and Moderators of Effectiveness

The current study sought to evaluate the suicide prevention gatekeeper training program QPR (Question, Persuade, and Refer) among school personnel using a non‐equivalent control group design. Substantial gains were demonstrated from pre‐ to post‐test for attitudes, knowledge, and beliefs regarding suicide and suicide prevention. Exploratory analyses revealed the possible moderating effects of age, professional role, prior training, and recent contact with suicidal youth on QPR participants' general knowledge, questioning, attitudes toward suicide and suicide prevention, QPR quiz scores, and self‐efficacy. The need for replication using a more rigorous experimental design in the context of strong community collaboration is discussed.     

Good Samaritans, Good Humanitarians

abstract   Duties of beneficence are not well understood. Peter Singer has argued that the scope of beneficence should not be restricted to those who are, in some sense, near us. According to Singer, refusing to contribute to humanitarian relief efforts is just as wrong as refusing to rescue a child drowning before you. Most people do not seem convinced by Singer's arguments, yet no one has offered a plausible justification for restricting the scope of beneficence that doesn't produce counterintuitive results elsewhere. I offer a defence of this restricted scope by introducing the notion of unique dependence, a notion that is both intuitively attractive and theoretically grounded. It explains why your reason to rescue the drowning child is more stringent than your reason to contribute to humanitarian relief, while blocking the conclusion that we have no reason at all to aid distant sufferers.     

Undergraduate education majors' knowledge about suicide

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

Attitudes toward suicide prevention in front-line health staff

A questionnaire assessing attitudes toward suicide prevention was constructed and shown to have satisfactory reliability and internal consistency. The determinants and distribution of these attitudes were investigated in four groups of health professionals who are in contact with suicidal patients: general practitioners, accident and emergency nurses, psychiatrists in training, and community psychiatric nurses. Attitudes toward suicide prevention were shown to differ significantly between professional groups. More positive attitudes were associated with mental health professionals, working in the community, and previous training in suicide risk assessment. Negative attitudes should be assessed and targeted in training designed to improve the management of suicide risk.     

Perceived Coaching Behaviors and College Athletes' Intrinsic Motivation: A Test of Self-Determination Theory

We investigated whether a shared mental model is present in elite ice hockey and handball teams. In total, 231 male players participated in the study. Shared mental models were found to exist. Relationships between shared mental models and coaching efforts to develop a general training shared mental model and an opponent-specific model were explored. The relationship between role clarity and shared mental model, general training shared mental model, and opponent-specific model was positive. The shared mental model is a useful construct for analyzing elite team practice and coaching behavior. Coaches and sport psychologists should be aware that establishing a shared mental model in elite teams is essential in facilitating performance.     

The legacy of Emile Durkheim

The development of the suicide prevention movement since the 1897 publication of Emile Dukheim's book Suicide is briefly traced. Durkheim's theory of suicide is outlined, and implications for contemporary suicide prevention efforts are identified and discussed. Future trends in the development of suicide prevention centers and in the national organization of suicidology are outlined.     

Suicide in America--moving up the public health agenda

Despite improvements in the health of Americans over the last 30 years, the problem of suicide, and its disturbing rise in the last three decades, remains a major American health riddle. Recognizing suicide as a public health concern is essential to discovering strategies to prevent suicide. Such strategies and prevention efforts must be multifaceted, incorporating a number of public health principles and approaches. These approaches include the refinement of epidemiological methods in the study of suicide; development of health education, information, and intervention programs dealing with suicide; and increased community awareness of and participation in all suicide prevention efforts.     

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.     

Minnesota clergy’s attitudes on suicide prevention and likelihood to inquire about suicidal thoughts and intent

Clergy are a recognised profession for suicide prevention and intervention in the United States. The current objective was to determine if clergy’s suicide prevention training, perceived roles in suicide prevention, and suicide prevention self-efficacy predicted likelihood to inquire about suicidal thoughts and intent. Among 367 Minnesota clergy surveyed, 30% reported a suicide in their congregation in the past year, and about one-third reported adequate training in suicide intervention strategies. The majority (85%) reported it was their role to provide education on suicide and mental health to their congregations, although 32% reported no or low ability to do so. Most (70%) stated, if concerned about a parishioner’s mental health, they would inquire about suicidal thoughts, but fewer (59%) stated they would inquire about suicidal intent. Significant, but weak, predictors of likelihood to inquire about suicide included self-efficacy and perceived role. Clergy could benefit from suicide prevention education, training, and support.     

Resolving Ethical Dilemmas in Suicide Prevention: The Case of Telephone Helpline Rescue Policies

The ethical basis of suicide prevention is illustrated by contrasting helpline emergency rescue policies of the Samaritans and the AAS and the U.S. National Suicide Prevention Lifeline network. We contrast moralist, relativist, and libertarian ethical premises and question whether suicide can be rational. Samaritans respect a caller's right to decide to die by suicide; U.S. helplines oblige emergency intervention during an attempt even against the caller's will. We analyze the effect of emergency rescue when there is high suicide risk but an attempt has not been initiated. We examine links between values and actions, needs for empirical evidence to guide practice, and propose vigorous dialogue about values in the gray zone of moral practice.     

Changing the Direction of Suicide Prevention in the United States

It is axiomatic that the goal of suicide prevention is the prevention of suicide. Yet in spite of significant efforts to this end since the middle of the last century, and most notably in the last decade, the rate of suicide in the U.S. has not declined; rather, it has increased. To address this issue, Suicide Awareness Voices of Education (SAVE) brought together leading prevention specialists from other public health problems where successes have been achieved, representatives from countries where suicide rates have declined, and U.S. based suicide prevention researchers and program directors, to “think outside the box” and propose innovative, scalable approaches that might better drive success in achieving desired results from U.S. suicide prevention efforts. The recommendations should challenge our preconceptions and force us outside our own mental constraints to broaden our perspectives and suggest catalysts for real change in suicide prevention.     

Epidemiology of Suicidal Behavior

This paper presents the epidemiology of suicide and discusses the known risk factors for suicide within a framework designed to encourage a systematic approach to theory testing and prevention. Mental and addictive disorders are the most powerful of the multiple risk factors for suicide in all age groups. Since risk factors for suicide rarely occur in isolation, prevention efforts are more likely to succeed if multiple risk factors are targeted.     

Risk and protective factors for suicide among Guyanese youth: Youth and stakeholder perspectives

Guyana, a low-to-middle-income country (LMIC) in South America, leads the world in youth suicide. As an understanding of risk and protective factors is critical to the development of culturally informed suicide prevention efforts, research exploring these factors among youth in Guyana is needed. The current study expands on current research on adolescent suicide in Guyana and LMICs broadly by using qualitative focus groups and interviews to explore adult stakeholders' and youth's perspectives. Participants included 17 adult stakeholders and 40 adolescents in Guyana. Data were analysed using a grounded theory approach. Themes related to participants' perceptions of risk factors for suicide included demographic characteristics, pressure and expectations, adults' responses to youth, limited coping with stressful life events and exposure to suicide. Themes related to protective factors for suicide included positive social support and involvement in community activities. Findings have implications for the development and tailoring of suicide prevention efforts for Guyanese youth.     

An aggregate analysis of professional sports,suicide, and homicide rates: 30 U.s. metropolitan areas, 1971–1990

Research on fan behavior in the sociology of sport has discussed the issue of fan behavior at or shortly after the sporting event in detail. Less prevalent in the sociology of sport literature, however, are how successes and failures of sports teams are related to the general public. In this article, suicide and homicide rates are compared to the successes and failures of professional sports teams in 30 metropolitan areas from 1971–1990. Using Gabennesch's (1988) theory of broken promises as a theoretical framework, statistical analyses reveal that making the playoffs is significantly related to a decline in suicide and homicide rates, while winning championships is significantly related to a decline only for suicide rates. Explanations for these associations are offered.     

Suicide assessment and evaluation strategies: a primer for counselling psychologists

Suicide is a recognized national health risk in many countries. In order to effectively intervene in suicidal crises, it is important for mental health professionals to understand facts about suicidal behaviour, procedures for assessing an individual's risk of self-harm, and the evaluation of the lethality of a client's suicidal gestures. With updated knowledge and proper training, counselling psychologists can play a vital role in suicide prevention. This paper summarizes for counselling psychologists current statistics about suicide, general and specific risk factors for suicidality, and assessment tools used to evaluate suicidal risk.     

Bridging the Gap: Connecting Resident Assistants and Suicidal Residents Through Gatekeeper Training

One hundred sixty‐two resident assistants (RA s) at a large southeastern university were randomly assigned to attend either a specialized 1‐hr training program in suicide prevention (intervention group) or a stress and time management skills training program (control group). The results failed to show the suicide prevention training program had any impact on RA intervention behaviors, resident help‐seeking behaviors, or RA perceptions of resident distress and suicidality 4 months following training. Results are interpreted and discussed in relation to strengthening suicide prevention training programs on college campuses.