An Overview of the School-Based Prevention of Adolescent Suicide

This article provides an overview of the options available to school special services personnel in preventing suicide in the secondary schools. A model curriculum based primary prevention program is described, after a discussion of barriers to prevention activities. Secondary prevention activities outlined include direct counseling approaches and peer counseling activities. Counseling strategies include identifying children at risk, and evaluating the suicidal individual. There is little in the literature on the school prevention of suicide but directions for future research are offered.     

Connectedness and Suicide Prevention in Adolescents: Pathways and Implications

Adolescent suicide is a major public health concern. Stressing the need for public health–based solutions, the Centers for Disease Control and Prevention identified “connectedness” as one means of pursuing this agenda. To advance this effort in suicide prevention with adolescents, (1) consistencies and variation in the literature overtly linking connectedness to suicide thoughts and behaviors (STB) are reviewed, (2) three more specific mechanistic pathways are proposed whereby connectedness may influence STB, and (3) several implications related to use of connectedness as a public health framework for adolescent suicide prevention and intervention are outlined.     

A model for the description and interpretation of suicide prevention.

Views about suicide prevention are based on underlying beliefs about the origins of problems and basic concepts about humankind. These implicit theories have an effect on prevention practices. Making these views explicit is one of the keys for the further development of suicide prevention. In this study a paradigm for analyzing suicide prevention of means of a coding frame and interpreting findings by means of theoretical models of prevention was elaborated. The analysis was based on empirical data consisting of definitions of prevention given by psychologists (N = 34) participating in the national suicide prevention project in Finland. The study demonstrates that suicide prevention can be differentiated at the operational level by means of the analysis method generated. Moreover, the findings can be interpreted according to theoretical criteria. Views expressed by the psychologists seemed to correspond largely to central features of current prevention models. Furthermore, the data can be seen to serve as an empirical validation of these models. Suicide prevention proved to be a multifactorial concept manifesting mainly process theory and interactional explanations of suicidality, and prevention practices fell into a simple typology of four categories.     

Perspectives in suicidology: families, mental illness, and suicide

The ways in which the key words "family," "mental illness," and "suicide" are interpreted in the context of research into suicide will influence the formation of theories, the interpretation of results, and the development of suicide prevention strategies. It is argued that there is no general agreement about the meaning of these words.     

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.     

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.     

The Struggle to Prevent and Evaluate: Application of Population Attributable Risk and Preventive Fraction to Suicide Prevention Researach

Population attributable risk (PAR) estimates have been used in suicide research to evaluate the impact of psychosocial and socioeconomic risk factors, including affective disorders, traumatic life events, and unemployment. A parallel concept of preventive fraction (PF), allowing for estimation of the impact of protective factors and effectiveness of preventive interventions, is practically unknown in suicidology. The study authors discuss the application of both concepts to suicide research and prevention, and review literature on the subject. Despite several methodological and conceptual limitations, both PAR and PF are valuable instruments to inform development and evaluation of suicide prevention programs.     

Conceptions of death and suicide in children ages 6-12 and their implications for suicide prevention.

Interviews were conducted with 65 public school children in Grades 1-5 concerning their understanding of and experiences with death and suicide, and investigating the development of the Piagetian concepts of life and age. By third grade, children have an elaborate understanding of suicide, and younger children generally understand "killing oneself," although their understanding of death and living may be immature. Children learn about suicide from television and discussions with other children, but they rarely discuss suicide with adults. The level of development of the concept of suicide is related to maturity rather than specific experiences. Implications for primary prevention are discussed.     

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.     

Suicide across the Life Span: Pathways to Prevention

As reflected in a recent series of highly visible suicide awareness and prevention activities, the call for a comprehensive suicide prevention strategy has never been stronger, nor more unified. Using the framework provided by the transactional model of human development, the author illustrates the central implications that a developmental perspective has for suicide prevention, emphasizing the need to consider multiple pathways to prevention, to place renewed emphasis on prevention strategies that have their impact earlier in the life course and earlier in the course of mental disorder, and to collaborate with prevention specialists and advocates in related fields.     

Preferences for suicide prevention strategies among university students in Japan: a cross-sectional study using full-profile conjoint analysis

In Japan, implementation of suicide prevention policies is mainly supported by public funds. However, it is unclear what kinds of suicide prevention strategies people prefer. We conducted a survey to clarify people’s preferences regarding suicide prevention strategies adopted in Japan. This was a cross-sectional self-administered questionnaire survey. Participants were recruited through a lecture held by the first author at their university. We distributed questionnaires to 324 people present at the lecture; 249 completed questionnaires were included in the final analysis. We estimated suicide prevention strategy preferences using full profile conjoint analysis. For all six prevention strategies, the inclusion of each strategy in the policy profile was statistically significantly related to the positive evaluation of the overall policy profile. Marginal Willingness to Pay (MWTP) for restriction of access to means showed the highest value of the six suicide prevention strategies. MWTP was the lowest for public awareness activities. Preferred suicide prevention strategies in Japan are restriction of access to means and enhancement of psychiatric services. The results of this study indicate the strategies that are preferred have a high level of evidence of suicide prevention and do not directly intervene in a person’s free will to die by suicide.     

Youth Suicide Prevention: A Survey and Analysis of Policies and Efforts in the 50 States

State-level initiatives directed at youth suicide prevention since 1980 were analyzed. During 1992 and 1996, each governor was surveyed regarding his or her state's efforts in youth suicide prevention. Questions pertained to legislation, a mandated or recommended school-based suicide prevention curriculum, funding, a special advisory council, a state plan, the development and dissemination of materials, and assessment. Several states sent examples of their prevention activities, which were reviewed to determine the extent to which they represent conceptually and/or empirically grounded preventive intervention strategies. The number of suicides, suicide rates, and percentage change in rate for youth 15–19 years old were reported by state for the periods 1979–1981 and 1992–1994. The results of a repeated measures 2 × 5 ANOVA revealed that while changes in suicide rates over time were statistically significant, there was no relation between these changes and any of the variables studied. Suggestions for future research on state-level initiatives are presented.     

A Systematic Review of Mass Media Campaigns for Suicide Prevention: Understanding Their Efficacy and the Mechanisms Needed for Successful Behavioral and Literacy Change

Mass media campaigns are increasingly seen as an important part of suicide prevention; however, despite their popularity, their efficacy is not well understood. The current review aimed to address key knowledge gaps regarding how mass media campaigns can be optimized to prevent suicide, by looking at their global efficacy, and mechanisms related to successful outcomes. A systematic review of the international literature examined studies which evaluated mass media campaigns targeted at suicide prevention, where suicide behaviors (mortality, attempts) or suicide literacy (knowledge, attitudes, help‐seeking) was identified as a primary outcome. Thirteen articles describing 12 unique campaigns met eligibility criteria. For behavioral outcomes, mass media campaigns appear to be most effective when delivered as part of a multicomponent suicide prevention strategy, while “standalone campaigns” were modestly useful for increasing suicide literacy. Level of exposure, repeat exposure, and community engagement appeared to be fundamental to the success of these campaigns; however, these constructs were poorly adhered to in the development and implementation of campaigns. Overall, the mixed quality of the included studies highlights a need for increased quantity, consistency, and quality of evaluations to advance the evidence base.     

The Art of Dying as an Art of Living: Historical Contemplations on the Paradoxes of Suicide and the Possibilities of Reflexive Suicide Prevention

The main aim of this paper is to reconstruct different aspects of the history of ideas of suicide, from antiquity to late modernity, and contemplate their dialectical tension. Reflexive suicide prevention, drawing on the ancient wisdom that the art of living is inseparable from the art of dying, takes advantage, it is argued, of the contradictory nature of suicide, and hence embraces, rather than trying to overcome, death, pain, grief, fear, hopelessness and milder depressions. This approach might facilitate the transformation of inner shame to inter-personal guilt, which is the precondition for coping with losses through grieving that is shared with others. The traditional projection of suicide on the ‘Other’, reinforced by modernity’s bio-political suppression of death, has inhibited development of good suicide prevention. Awareness of the ambiguity and ambivalence found in suicide may work as a resource when measures are taken to address as many causal mechanisms as possible, and bringing special emphasis to external factors.     

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.     

Evidence-based practices project for suicide prevention

Suicide continues to be a serious public health problem. In response to this problem, a myriad of suicide prevention programs have been developed and employed across the United States. Unfortunately, the effectiveness of many of these programs is unknown because they have not been evaluated using rigorous methods. The Evidence-Based Practices Project (EBPP) for suicide prevention was created in 2002 to identify and promote evidence-based suicide prevention programs. In this paper the process and outcomes of the initial EBPP project within the context of the broader evidence-based movement are described, and the EBPPs creation of a best practice registry for suicide prevention is previewed.     

5 Social Suicide

At first blush suicide seems like the ultimate private action. However, it is argued that social forces and social pathologies figure prominently in the dynamics of suicide interacting with more individual characteristics. Several examples of “social suicide” (intentional cotemporaneous self-murder of two or more persons) are considered, including mass suicide, organizational self-destruction, social analogues to individual suicide, and military suicide. Suicide prevention requires social, economic, and cultural transformations at the primary prevention level, not just individual psychotherapy and dispensing of the latest antidepressants.     

A general systems approach to suicide prevention: lessons from cardiac prevention and control

The pathology of cardiac disease includes genetic, physical, biochemical, psychological, social, and environmental vectors. Factors contributing to suicide have been identified in these same areas. Survival from an acute cardiac event requires a systematized and multisectoral response. Communities that do not have systematized response capabilities to acute cardiac events have poorer survival outcomes. Suicide prevention and control may also be responsive to an integrated community response system. This paper examines the development of a community cardiac care model, explores potential parallels for a community suicide prevention and control model, and outlines a general systems theory framework for a suicide prevention and control system.     

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.