Teachers' knowledge of facts and myths about suicide

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

Mobilizing Schools for Suicide Prevention

ABSTRACT: Experience in providing consultation and survivor counseling to school personnel following student suicides led to the development of a program of prevention through training school personnel. The goal of the program was to increase the ability of resource persons available to adolescents—teachers, counselors and school nurses—to recognize signs of suicidal depression and to respond effectively to suicidal students. This report describes that program, the reaction of the participants and the observations of the project staff, and comments on the feasibility of this approach as a means of helping to prevent suicide among adolescents.     

Activity involvement among suicidal and nonsuicidal high-risk and typical adolescents

The purpose of this study was to compare weekly activities among four groups of randomly selected high-risk and typical high school students: (1) potential dropouts at suicide risk, (2) typical youth at suicide risk, (3) potential dropouts not at suicide risk, and (4) typical youth not at suicide risk. Of the 1,286 participants, 39.4% of the high-risk and 30.1% of typical high school students screened in at suicide risk. Weekly activity comparisons across the four groups showed that suicide-risk adolescents, regardless of potential dropout status, engaged in more solitary activities on weekdays and weekends than did their nonsuicide risk peers. High-risk potential dropout youth engaged in less homework and more social activities during weekdays and weekends than did the typical high school students. These results provide important insight into the weekly activity involvement of at-risk youth while helping to gain a better understanding of suicide-risk adolescents. Implications of these findings are discussed for identifying youth at risk for suicidal behavior and for prevention programming.     

“Hey,let me hold your guns for a while”: A qualitative study of messaging for firearm suicide prevention

A recommended component of suicide prevention is encouraging at‐risk individuals to voluntarily and temporarily reduce access to firearms and other lethal methods. Yet delivering counseling on the topic can be difficult, given the political sensitivity of firearm discussions. To support such counseling, we sought to identify recommended framing and content of messages about reducing firearm access for suicide prevention. Through qualitative interviews with firearm owners and enthusiasts, we identified key points for use in framing (identity as a gun owner, trust, voluntary and temporary storage, and context and motivation) and specific content (preference for “firearm” over “gun,” and legal issues such as background checks for transfers). These findings build on prior work and should enhance efforts to develop and deliver effective, acceptable counseling and—ultimately—prevent firearm suicide.     

“Signs of Suicide” Shows Promise as a Middle School Suicide Prevention Program

Although the Signs of Suicide (SOS) suicide prevention program has been implemented at both the middle and high school levels, its efficacy has been demonstrated previously only among high school students. The current study evaluated SOS implemented in high military impact middle schools. Compared to controls, SOS participants demonstrated improved knowledge about suicide and suicide prevention, and participants with pretest ideation reported fewer suicidal behaviors at posttest than controls with pretest ideation. These results provide preliminary evidence for SOS's efficacy as a suicide prevention program for middle school students.     

An Evidence-Based Approach to Managing Suicidal Patients in the Patient-Centered Medical Home

Primary care is a critical setting for suicide prevention because it is often the first and only source of mental health care for the U.S. general population. It is also important because suicidal patients report a greater number of somatic complaints and make more frequent medical visits compared to nonsuicidal patients. Models for managing suicide within primary care have recently arisen, yet no models have been proposed for use within the patient-centered medical home (PCMH), a primary care model that integrates behavioral health into its practice. The authors suggest a chronic disease model for the management of suicide risk in the PCMH along with collaborative strategies that may include suicide screening and targeted assessment, warm hand-offs, cognitive-behavioral interventions, routine collaborative medication management, and means restriction counseling. The current paper advises how those within the PCMH can adapt and implement evidence-based practices to manage suicide. Finally, the authors discuss a case example illustrating these evidence-based and collaborative methods.     

Evaluation of a youth suicide prevention school program

Adolescent suicide is a subject of increasing national concern. In California, this problem was addressed through the implementation of a three-year youth suicide prevention school program established by legislative mandate in 1983. Findings for the first two years of the program indicate significant gains in understanding of youth suicide prevention techniques for those high school students who completed a four-hour training course. School staff and parents completing 90-minute youth suicide awareness seminars indicated that they most appreciated receiving practical advice and resources they could use in responding to a potentially suicidal young person.     

Elementary School Counseling with Unstructured Play Media

The need for utilizing unstructured play media in counseling with elementary school children is discussed. The suggestion is made that through play activities the child learns ways of operating in social situations, tests various roles, and expresses his frustrations and concerns. Limiting the child to verbal expression in counseling is seen as being as inappropriate as limiting an adult to the use of puppets. The elementary school counselor's use of play in counseling is designed to facilitate the expression and communication of the normal child rather than to provide data for analytical purposes. Responses to verbal and nonverbal clues, therefore, include reflection and summarization more often than interpretation. Advantages of unstructured over structured materials are discussed; illustrations show the need children feel for amorphous materials in communicating feelings.     

The Decline of Youth Suicidal Behavior in an Urban,Multicultural Public School System Following the Introduction of a Suicide Prevention and Intervention Program

A 5-year longitudinal study of suicidal behavior of students attending Dade County Public Schools (DCPS) in Miami, Florida, between the 1989–1990 and 1993–1994 school years, is described. As the fourth largest public school system in the United States, DCPS is representative of an urban, multicultural community. The prevalence of suicidal behavior among DCPS students necessitated the development of a districtwide Suicide Prevention and School Crisis Management Program (SPSCMP), including the creation of the “Youth in Crisis Hotline.” A review of eight national school districts' suicide prevention and intervention programs indicates similarities with the DCPS model. Statistical data compiled by the DCPS program are organized into annual, monthly, grade level, and school level classifications, and are analyzed to determine the degree and direction of self-destructive behavior among youth in a culturally and linguistically diverse school population following the introduction of a suicide prevention and intervention program. Evaluative data regarding the effectiveness of the program as well as implications for suicide prevention and intervention are discussed.     

The School-Based Prevention of Childhood Crises

This paper sets forth the research on the school-based prevention of crises reactions to chlidhood stress. Four types of crises are considered: life transitions, traumatic events, developmental crises, and pscyhopathological crises. Each may be prevented by specific programs such as orientation programs for school entrance, informational programs to prevent child abuse, conflict resolution programs, and suicide prevention programs. General programs termed competence enhancement programs may address and ameliorate a variety of stressors. Prevention programs aimed at the entire school system are also discussed, including such activities as creating and supporting crises response teams. Additionally, a number of issues for future study and research are identified.     

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.     

Suicide and Firearm Means Restriction: Can Training Make a Difference?

Along with physician education in depression recognition and treatment, restricting lethal methods is an effective suicide prevention strategy. The present study surveyed a random sample (N = 697) of Ohio licensed social workers regarding client firearm assessment and safety counseling. Analyses sought to determine what independent factors would predict the probability that a social worker would hold positive attitudes regarding firearm risk assessment and counseling. Findings indicated that prior training and reporting from an urban area significantly increased the odds (p < .05) of registering more positive attitudes toward firearm assessment and safety counseling by 91.1% and 44.7%, respectively. Training mental health professionals in firearm assessment and safety counseling is an important aspect in addressing the reduction of suicide by this means.     

Suicide Prevention in Australian Aboriginal Communities: A Review of Past and Present Programs

A review of Aboriginal suicide prevention programs were conducted to highlight promising projects and strategies. A content analysis of gray literature was conducted to identify interventions reported to have an impact in reducing suicidal rates and behaviors. Most programs targeted the whole community and were delivered through workshops, cultural activities, or creative outlets. Curriculums included suicide risk and protective factors, warning signs, and mental health. Many programs were poorly documented and evaluations did not include suicidal outcomes. Most evaluations considered process variables. Results from available outcome evaluations suggest that employing a whole of community approach and focusing on connectedness, belongingness and cultural heritage may be of benefit. Despite the challenges, there is a clear need to evaluate outcomes if prevention is to be progressed.     

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.     

Changing Rates of Suicide Ideation and Attempts Among Inuit Youth: A Gender‐Based Analysis of Risk and Protective Factors

Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15–24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross‐sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long‐term impacts on Inuit youth, as well as exposure to culturally meaningful activities.     

Social and individual risk factors for suicide ideation among Chinese children and adolescents: A multilevel analysis

The objective of this study was to investigate the prevalence and predictors of suicide ideation among primary, middle and high school students. We used multilevel modelling to investigate suicide ideation among 12,733 Chinese children and adolescents aged 9–18 years from wide range of areas across China. Approximately, 32.09% of children and adolescents reported suicide ideation, with females were more likely to report suicide ideation than males (38.09% vs. 29.95%). Our results showed that the risk factors in primary school students were different from middle and high school student groups, whereas significant risk factors for middle and high school students were similar. The city's standard of living as indicated by the Engel coefficient and the city's divorce rate were positively associated with the prevalence of suicide ideation; in contrast, the school's pupil‐to‐teacher ratio was negatively correlated with elevated suicide ideation. Significant risk factors for suicide ideation included study anxiety, self‐accusation tendency, impulsive tendency, terror tendency and physical symptoms. These results have important implications for the prevention of suicide, suggesting that both contextual (city‐level) and compositional (individual‐level) factors could be important targets for prevention and intervention for children and adolescents at risk of suicide ideation.     

A Review of School Counseling Outcome Research: Implications for Practice

In this review, the authors summarize school counseling outcome research published between 1988 and 1995. Gysbers and Henderson's (1994) comprehensive developmental guidance model served as the organizing model through which the status of empirical literature regarding school counseling is examined. Results indicated that research focused more on remediation activities as compared to preventive interventions. This review found tentative support for career planning, group counseling, social skill training activities, and peer counseling. Practical implications and future research direction are drawn from these conclusions.     

SHORES: A Practical Mnemonic for Suicide Protective Factors

Guidelines for addressing and managing client suicide risk include discussing and conceptualizing protective factors. Counselors should be able to recall and discuss suicide protective factors that are applicable across client populations. SHORES, a suicide protective factors mnemonic that is supported by the literature, has applications for risk assessment and crisis intervention across settings, preventative care, strengths‐based management, and counselor training. A case example and discussion serve to illustrate the wide‐ranging application of SHORES in counseling practice.     

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.