Establishing standards for the assessment of suicide risk among callers to the national suicide prevention lifeline

The National Suicide Prevention Lifeline was launched in January 2005. Lifeline, supported by a federal grant from the Substance Abuse and Mental Health Services Administration, consists of a network of more than 120 crisis centers located in communities across the country that are committed to suicide prevention. Lifeline's Certification and Training Subcommittee conducted an extensive review of research and field practices that yielded the Lifeline's Suicide Risk Assessment Standards. The authors of the current paper provide the background on the need for these standards; describe the process that produced them; summarize the research and rationale supporting the standards; review how these standard assessment principles and their subcomponents can be weighted in relation to one another so as to effectively guide crisis hotline workers in their everyday assessments of callers to Lifeline; and discuss the implementation process that will be provided by Lifeline.     

Evaluation of the effectiveness of suicide prevention programs: a methodological perspective

Many studies that attempt to evaluate the effectiveness of treatment programs for suicidal patients are methodologically deficient in one or more areas. This paper outlines six criteria that should be met in designing such investigations: Patients should be randomly assigned to groups; at least 80% of the subjects who were initially enrolled should be followed up; the results should be both statistically significant and clinically important; all clinically relevant outcomes should be reported; the patients must be adequately described; and the new intervention should be feasible in other settings. It is shown that these criteria are both necessary and achievable.     

Efficacy of brief telephone psychotherapy with callers to a suicide hotline

The efficacy of two types of theapy conducted exclusively over the telephone was studied. Clients (N=55) were recruited from a pool of callers to a suicide hotline and were randomly assigned to a waiting list control (WC) or Solution Focused Brief Therapy (SFBT) or Common Factors Therapy (CFT). It was hypothesized that improvements would be significantly higher in the two therapy conditions compared to the waitlist control and SFBT would be significantly more efficacious than CFT. Results confirmed that improvement was significantly higher in the two treatment conditions compared to the waitlist control, but no difference in improvement was found between SFBT and CFT. The implications of these findings for suicide hotlines are discussed.     

Alberta's suicide prevention training programs: a retrospective comparison with Rothman's developmental research model

Developmental research is used to transform existing knowledge into applied programs. A social research and development (R&D) method, developed by Rothman for the human service professions, is compared with the method used to develop the Suicide Prevention Training Programs in Alberta, Canada. A retrospective review compares the development of these programs, which have since been implemented both nationally and internationally, with Rothman's model; discusses social R&D as a transformation methodology; and draws conclusions about the probable success of using developmental research methods in the human services. The review finds that the Alberta method closely paralleled the phases of Rothman's model. Results show that the transformation of knowledge about suicide into widely disseminated suicide prevention training programs can be attributed to the application of social R&D principles. The study concludes that the use of developmental research methods to establish human service programs should increase the probability of their success.     

Starting a therapy group in a suicide prevention and crisis center.

This report outlines the experience of one center in establishing a group therapy program, discussing the "readiness" of the center, reservations of the governing board, qualifications and number of group leaders, composition of the group, time-place-duration of meetings, "open" versus "closed" structure, vagaries of obtaining participants, integration with the 24-hour telephone crisis service, problems of confidentiality, and dealing with the suicide of a group member.     

Helpline: suicide prevention at a suicide site

In an effort to reduce the number of suicides from the Mid-Hutson Bridge in Poughkeepsie, New York, the Dutchess County Department of Mental Hygiene and the New York State Bridge Authority jointly established a suicide prevention phone on the bridge, which is directly connected to a 24-hour psychiatric emergency service. This program is the first known one in which a dedicated suicide prevention helpline has been installed at a site of known suicides and linked with a mental health service. After 2 years of operation, the phone has been used 30 times; the data suggest that most would-be jumpers are ambivalent enough about dying that they will reach out for help/contact if the opportunity exists, and, as a consequence, can be saved.     

Community responses to a suicidal crisis: implications for suicide prevention

We conducted a cross‐sectional, random‐digit‐dial survey to evaluate public responses to a hypothetical question: “If someone you knew was suicidal, what would you do first?” Younger people were more likely to call a suicide hotline, and less likely to go to an emergency room (ER) or call 911; immigrants (in the U.S. <15 years) were more likely to call 911, and less likely to call a suicide hotline; African Americans were more likely to go to the ER and call 911; Hispanics were more likely to call 911 but less likely to call a suicide hotline. These results suggest that public messages about hotlines and emergency options for suicidal patients need to be tailored to relevant population characteristics including age, education, ethnicity, and language preferences.     

Development and evaluation of school-based violence prevention programs

Discusses key issues in developing and evaluating school-based violence prevention interventions. Schools provide a natural setting for implementing programs directed at teaching youth attitudes, knowledge, and skills to reduce their involvement in violence. Although multitudes of these programs exist, few have been rigorously evaluated. Developers of violence prevention programs need to pay particular attention to the type of violence being addressed, the target population, relevant risk and protective factors, and the target of the intervention. Conducting sound evaluations of such programs requires careful attention to the unit of randomization, treatment conditions, outcome measures, timing of data collection, and potential moderator variables. Efforts to develop effective prevention programs can be greatly facilitated by adopting an action-research strategy in which evaluation findings provide a basis for continual program refinement.     

A call to collaboration: the federal commitment to suicide prevention

The federal government, largely through the U.S. Department of Health and Human Services (HHS), sponsors an array of science-based suicide prevention initiatives. This article details the prevention-related agendas and collaborative efforts of five operating divisions within the Department of Health and Human Services: the Substance Abuse and Mental Health Services Administration, National Institutes of Health, Centers for Disease Control and Prevention, Indian Health Service, and Health Resources and Services Administration. The article highlights HHS's activities and their link to the National Strategy for Suicide Prevention, the plan which will guide the nation's suicide prevention efforts for the next decade.     

Adolescent suicide prevention: Gender differences in students' perceptions of the acceptability and intrusiveness of school-based screening programs

Suicidal behavior is a significant problem among adolescents in the United States. Three types of school-based suicide prevention programs have been proposed to address this problem including curriculum programs, staff in-service training, and school-wide screening. The relative acceptability of these three programs among older adolescents was examined. The sample included 662 freshmen (496 females, 161 males) enrolled in a large private university. Respondents rated the degree to which they considered adolescent suicide to be a significant problem, and the acceptability, intrusiveness, and time demands of the three suicide prevention programs. A majority (85.9%) of the sample agreed that adolescent suicide was a significant problem. Significant gender differences were observed in relation to the acceptability ratings of the school-based suicide programs. Female participants rated the curriculum-based program and staff in-service training as more acceptable than male participants. In addition, female participants rated the curriculum-based program as significantly less intrusive and less time demanding than male participants. Implications of these findings for implementation of suicide prevention programs and for future research are discussed.     

An application of the empirical Bayes approach to directly adjusted rates: a note on suicide mapping in California

A simple, reliable, and comparable measure for suicide mapping and other health problems is needed. Because standardized mortality ratios (SMRs) may not indicate the relative meaning of their magnitudes when compared with one another, and statistical significance levels of tests for SMRs overlook the areas that have small populations, neither of these approaches provides a satisfactory index. The results using directly adjusted rates can be ordered directly according to their magnitudes. However, because of the lack of reliable estimates of local age-specific rates, the usefulness of directly adjusted rates in mapping suicide is also limited. To extend the usefulness of directly adjusted rates, an empirical Bayes approach whereby information from other areas is borrowed to improve the precision of the estimates of local age-specific rates in calculating directly adjusted rates--especially in the areas with small population sizes--is proposed. When an empirical Bayes approach was applied to the 1983 suicide data for California counties, a more reasonable conclusion than could be obtained by using directly adjusted rates was reached.     

Eating disorder prevention programs: a meta-analytic review

This meta-analysis of eating disorder prevention programs found that intervention effects ranged from an absence of any effects to reductions in current and future eating pathology. Certain effects persisted as long as 2 years and were superior to minimal-intervention control conditions. Larger effects occurred for selected (vs. universal), interactive (vs. didactic), and multisession (vs. single session) programs; for programs offered solely to females and to participants over age 15; for programs without psychoeducational content; and for trials that used validated measures. The results identify promising prevention programs and delineate sample, format, and design features that are associated with larger effects, but they suggest the need for improved methodological rigor and statistical modeling of trials and enhanced theoretical rationale for interventions.     

Child sexual abuse prevention programs: a meta-analysis

Conducted a meta-analytic evaluation of the effectiveness of school-based child abuse prevention programs. Literature searches identified 27 studies meeting inclusion criteria for use in this meta-analysis. The average effect size for all programs studied was 1.07, indicating that children who participated in prevention programs performed 1.07 SD higher than control group children on the outcome measures used in the studies. Analysis of moderator variables revealed significant effects for age, number of sessions, participant involvement, type of outcome measure, and use of behavioral skills training. Most important, programs presented over 4 or more sessions that allowed children to become physically involved produced the highest effect sizes. Although most often used only with younger children, findings suggest that active, long-term programs may be more effective for children of all ages.     

Advancing prevention research on the role of culture in suicide prevention

Despite evidence of considerable racial/ethnic variation in adolescent suicidal behavior in the United States, research on youth of European American descent accounts for much of what is know about preventing adolescent suicide. In response to the need to advance research on the phenomenology and prevention of suicidal behavior among ethnic minority populations, NIMH co-sponsored the "Pragmatic Considerations of Culture in Preventing Suicide" workshop to elicit through interdisciplinary dialogue how culture can be considered in the design, development, and implementation of suicidal behavior prevention programs. In this discussion paper we consider the three ethnic minority suicide prevention efforts described in the articles appearing in this issue, along with workshop participants' comments, and propose six major areas where issues of culture need to be better integrated into suicidal behavior research.     

Selective attention to specific location cues: the peak and center of a patch are equally accessible as location cues.

Asymmetric patterns have several spatially distinct cues for spatial localization. These cues include the peak of the luminance distribution, the centroid of the contrast distribution, zero-crossings in the second derivative of the luminance profile, and the midpoint of the visible area. If these cues are represented as primitives in the visual system, the observer should be able to access them at will. To examine whether observers can selectively attend to particular cues, we measured perceived alignment for an asymmetric pattern with two distinct instructions: "align the peak", and "align the center". We found that observers could align the patterns in accord with the instructions with identical precision, suggesting that the peak and the center cues were equally accessible by the observer. We conclude that multiple localization cues are represented in and can be selectively accessed by the visual system.