Reducing Suicide Potential Among High-Risk Youth: Tests of a School-Based Prevention Program

This study tested the efficacy of a school-based prevention program for reducing suicide potential among high-risk youth. A sample of 105 youth at suicide risk participated in a three-group, repeated-measures, intervention study. Participants in (1) an assessment plus 1-semester experimental program, (2) an assessment plus 2-semester experimental program, and (3) an assessment-only group were compared, using data from preintervention, 5-month, and 10-month follow-up assessments. All groups showed decreased suicide risk behaviors, depression, hopelessness, stress, and anger; all groups also reported increased self-esteem and network social support. Increased personal control was observed only in the experimental groups, and not in the assessment-only control group. The potential efficacy of the experimental school-based prevention program was demonstrated. The necessary and sufficient strategies for suicide prevention, however, need further study as the assessment-only group, who received limited prevention elements, showed improvements similar to those of the experimental groups.     

People Awakening: Collaborative Research to Develop Cultural Strategies for Prevention in Community Intervention

The consequences of alcohol use disorder (AUD) and suicide create immense health disparities among Alaska Native people. The People Awakening project is a long-term collaboration between Alaska Native (AN) communities and university researchers seeking to foster health equity through development of positive solutions to these disparities. These efforts initiated a research relationship that identified individual, family, and community protective factors from AUD and suicide. AN co-researchers next expressed interest in translating these findings into intervention. This led to development of a strengths-based community intervention that is the focus of the special issue. The intervention builds these protective factors to prevent AUD and suicide risk within AN youth, and their families and communities. This review provides a critical examination of existing literature and a brief history of work leading to the intervention research. These work efforts portray a shared commitment of university researchers and community members to function as co-researchers, and to conduct research in accord with local Yup’ik cultural values. This imperative allowed the team to navigate several tensions we locate in a convergence of historical and contemporary ecological contextual factors inherent in AN tribal communities with countervailing constraints imposed by Western science.     

Suicide and African American teenagers: risk factors and coping mechanisms

In this study we investigated whether locus of control, hopelessness, and depression were primary risk factors for suicide ideation and attempts in African American youth, and whether congruency between locus of control and religious coping style reduced suicide risk. The sample consisted of 176 African American high school students (115 females; 61 males). Multiple and logistic regression were used to determine relationships among study variables. Depression was found to mediate the relationship between hopelessness and suicidal behaviors. External locus of control led to greater risk for hopelessness and depression, with a trend in the predicted direction for suicide attempts. Religious coping style alone was not always associated with reduction of risk of suicidal behaviors, yet some evidence suggests that congruency between locus of control and religious coping style reduces risk. Results provide additional support for suicide interventions to target depressive symptoms. Results also highlight the importance of examining the role of culturally salient variables such as fatalism and religious coping style when developing intervention programs for suicide.     

University Students' Perceived Self‐Efficacy in Identifying Suicidal Warning Signs and Helping Suicidal Friends Find Campus Intervention Resources

Currently, suicide is the third leading cause of death among youth 18 to 24 years of age and the second leading cause of death on college campuses. A sample of students (N = 1,019) from three midwestern universities were surveyed regarding their perceived self‐efficacy in identifying suicide warning signs and campus suicide intervention resources. The results indicated that 11% strongly believed they could recognize a friend at suicidal risk, while 17% strongly believed they could ask a friend if he or she was suicidal. Students who had received high school suicide prevention education and who had ever had a family member or friend express suicidal thoughts to them were those most confident in recognizing a friend at risk, asking a friend if he/she is suicidal, and helping a friend to see a counselor. Most (71%) were not aware of on‐campus help resources. These findings underscore the importance of suicide prevention education throughout the high school and college years.     

Culturally grounded strategies for suicide and alcohol risk prevention delivered by rural Alaska Native communities: A dynamic wait-listed design evaluation of the Qungasvik intervention

We examined the effectiveness of the Qungasvik (Tools for Life) intervention in enhancing protective factors as a universal suicide and alcohol prevention strategy for young people ages 12−18 living in highly affected rural Alaska Native communities. Four communities were assigned to immediate intervention or to a dynamic wait list. Outcomes were analyzed for 239 young people at four time points over two years of community intervention. Outcomes assessed two ultimate variable protective factors buffering suicide and alcohol risk, and three intermediate variable protective factors at the individual, family, and community level. Dose dependent intervention effects were associated with growth in ultimate but not intermediate variables. This evaluation of the Qungasvik intervention provides support for the effectiveness of its Indigenous strategies for suicide and alcohol misuse prevention in this rural Alaska Native setting. Though findings did not provide support for a theory of change where growth in ultimate variables is occasioned through effects on intermediate variables, research designs focused on young people who enter intervention at lower levels of preexisting protection hold promise for better understanding of intervention change processes. The Qungasvik intervention is responsive to an acute public health need for effective rural Alaska Native suicide and alcohol risk prevention strategies.     

Written Exposure Therapy for Suicide in a Psychiatric Inpatient Unit: A Case Series

Patients with posttraumatic stress disorder (PTSD) are at an elevated risk of suicide. For patients hospitalized for suicide risk, psychosocial treatment and stabilization are routinely offered; however, the availability of evidence-based, manualized therapeutic interventions for PTSD is sparse. Typically, the short duration of hospitalization makes it difficult to accommodate evidence-based, trauma-focused treatments. This article presents the clinical course of four active-duty service members with PTSD who were hospitalized in a psychiatric inpatient unit for acute suicide risk and treated with Written Exposure Therapy for Suicide (WET-S). WET-S is a brief, five-session therapy based upon Written Exposure Therapy and augmented with Crisis Response Planning for Suicide Prevention. Both posttraumatic stress symptoms and suicidal ideation were reduced from pre- to posttreatment for three of the four patients treated. WET-S shows promise as a manualized therapeutic intervention that can be delivered on an inpatient psychiatric unit.     

Family Factors Predicting Categories of Suicide Risk

We compared family risk and protective factors among potential high school dropouts with and without suicide-risk behaviors (SRB) and examined the extent to which these factors predict categories of SRB. Subjects were randomly selected from among potential dropouts in 14 high schools. Based upon suicide-risk status, 1,083 potential high school dropouts were defined as belonging to one of four groups; 573 non-suicide risk, 242 low suicide risk, 137 moderate suicide risk and 131 high suicide risk. Results showed significant group differences in all youth self-reported family risk and protective factors. Increased levels of suicide risk were associated with perceived conflict with parents, unmet family goals, and family depression; decreased levels of risk were associated with perceived parental involvement and family support for school. Perceived conflict with parents, family depression, family support satisfaction, and availability of family support for school were the strongest predictors of adolescent SRB. Our findings suggest that suicide vulnerable youth differ from their non-suicidal peers along the dimensions of family risk and protective factors.     

Parenting and Chinese Adolescent Suicidal Ideation and Suicide Attempts: The Mediating Role of Hopelessness

Various family factors are risk factors for adolescent suicidality (suicidal ideation and suicide attempts). However, little is known about the role of parenting in adolescent suicidality. The present study examined the unique relations between three parenting dimensions (parental warmth, behavioral control, and psychological control) and adolescent suicidality, as well as the mediating role of adolescent hopelessness among these relations. A total of 1529 Chinese adolescents (52 % male; mean age = 14.74 years, SD = 1.48) completed anonymous questionnaires designed to assess three parenting dimensions, hopelessness, suicidal ideation and suicide attempts. After controlling for gender, age, family structure, and socioeconomic status, it was found that parental warmth negatively predicted adolescent suicidality, whereas psychological control positively predicted adolescent suicidality. In addition, parental warmth negatively predicted adolescent hopelessness, whereas psychological control positively predicated adolescent hopelessness, which in turn enhanced adolescent suicidality. Although behavioral control did not predict adolescent suicidality, it did negatively predict adolescent hopelessness, which in turn promoted adolescent suicidality. These findings revealed the differential roles of different parenting dimensions in adolescent suicidality, and the mediation effect of adolescent hopelessness between parenting and adolescent suicidality. Future practices would benefit from incorporating both parenting and hopelessness for optimal intervention effect.     

Adolescent Suicidal Risk: Psychological,Problem Solving,and Environmental Factors

This study examined the life stress and problem-solving interactional model of suicide proposed by Clum, Patsiokas, and Luscomb (1979) . Thirty-three hospitalized suicidal adolescents were compared with 21 adolescents hospitalized for other psychiatric problems and with 89 controls. The assessment battery was composed of psychological measures, problem-solving measures, and environmental and family measures. The discriminant analyses revealed that the suicide group could be discriminated from the psychiatric control group but not from the high school control group. Unexpectedly, life stresses did not contribute to the identification of current suicide risk. The results suggest the importance of assessing suicide risk at the time of admission to minimize any subsequent changes in the risk group.     

Mediating effects of an indicated prevention program for reducing youth depression and suicide risk behaviors

This study explored the intervention processes of an indicated prevention program for high-risk youth. It was hypothesized that intervention effects would be influenced by the direct and mediating effects of teacher social support on both peer group support and perceived personal control. In turn, personal control was hypothesized to mediate between teacher and peer group support, contributing to reductions in depression and suicide risk behaviors. The hypotheses were tested using a three-wave, longitudinal design incorporating data from preintervention, 5-month follow-up, and 10-month follow-up assessments of 106 high-risk youth divided into three comparison groups: two experimental, one control. For the two intervention groups, there were direct and/or indirect effects of teacher and peer group support on personal control, depression, and suicide risk behaviors. The general hypothesis that personal control mediates between support resources and reductions in depression and suicide risk behaviors received partial support across the study groups.     

The effects of baby bath and massage by fathers on the family system: The sunraysia australia intervention project

Instruction in baby massage and the Burleigh Relaxation Bath technique was given to one-half of our sample of 32 couples who had just had their first child. This brief intervention, given at 4 weeks post-partum, led to beneficial behavioural and psychological effects for the family system when assessed at 12 weeks postpartum. Depression and marital satisfaction were assessed with mothers and fathers at 4 weeks and 12 weeks after the birth of their child, and self-esteem was measured at 12 weeks only. The mothers and fathers who were shown baby bathing and massage techniques showed higher degrees of marital satisfaction and self-esteem, as well as lower levels of depression at 12 weeks post-partum, than parents who did not receive instruction. It seems likely that brief interventions which educate new parents concerning functional techniques of baby care may favourably affect their feelings of competence and be of benefit to the entire family system.     

Long‐Term Effects of the Family Check‐Up in Early Adolescence on Risk of Suicide in Early Adulthood

The impact of the Family Check‐Up (FCU), a school‐based prevention program, as delivered in public secondary schools on suicide risk across adolescence, was examined. Students were randomly assigned to a family‐centered intervention (N = 998) in the sixth grade and offered a multilevel intervention that included (1) a universal classroom‐based intervention, (2) the FCU (Dishion, Stormshak, & Kavanagh, 2011), and (3) family management treatment. Engagement with the FCU predicted significant reductions in suicide risk across adolescence and early adulthood.     

Use of case vignettes in suicide risk assessment

Thirty-three brief case histories of suicidal patients were given to 19 experienced crisis workers for 7-point ratings of short- and long-term suicide risk. The ratings revealed considerable variability, raising questions about the reliability of such global assessments of suicidality. The most consistently rated cases were selected to operationally define "mild," "moderate," and "high" risk. Thus, each level was "anchored" by several vignettes. It was hoped that these anchor points would lead to more uniform future ratings among crisis workers. The correlation between short- and long-term risk ranged from near zero for some vignettes to as high as .82 (median = .46), demonstrating the need to rate both separately. Long-term risk was more difficult to rate, as demonstrated by a larger number of cases judged to be unrateable because of "insufficient information" (94 vs. 53 rater-case combinations). When the anchor vignettes were provided as a guide to the same sample of crisis workers, their ratings of suicide risk, as expected, showed significantly improved consistency.     

Is Suicide Ideation a Surrogate Endpoint for Geriatric Suicide?

The present study explored the validity of treating suicide ideation as a surrogate endpoint that can serve as a proxy for suicide in clinical intervention research with suicidal seniors. Two criteria; that suicide ideation is modulated by the proposed intervention and that modulation of suicide ideation leads to a quantitative reduction in suicide rates, were the focus of this review. A series of literature searches of the PsychINFO and Medline databases were conducted on the terms geriatric, elderly, seniors, suicide, self-destruction, clinical, randomized, trial, treatment, intervention , and ideation . Articles were analyzed if they provided sufficient information to examine whether an intervention effectively led to a reduction in suicide ideation among seniors. Two hundred and eight articles were considered for potential inclusion in this study, with 19 articles meeting final inclusion criteria. The articles reviewed were divided into three broad categories: articles supporting suicide ideation as a surrogate endpoint for geriatric suicide ( n = 6); those not supporting this hypothesis ( n = 1); and those providing insufficient information to test the hypothesis ( n = 12). The present analysis provided modest evidence for suicide ideation as a surrogate endpoint for geriatric suicide, due, in part, to a paucity of randomized controlled trials of treatment interventions for suicidal seniors, thus demonstrating a clear need for research in this area. Implications of utilizing surrogate endpoints in suicide research are discussed.     

Risk Factors of a Suicide Reattempt by Seasonality and the Method of a Previous Suicide Attempt: A Cohort Study in a Japanese Primary Care Hospital

Suicide has a great impact on the individual whose life is lost and the bereaved family members. The risk of a suicide reattempt is particularly high during the first 12 months after a suicide attempt. In this cohort study, risk factors for a suicide reattempt were explored among 291 patients at suicide risk. Clinical and demographic data were collected from a Japanese primary care hospital. Past psychiatric history and multiple diagnoses were associated with suicide reattempts in both genders. Drug overdose, past psychiatric history, and the summer season were linked to suicide reattempts among males. Past psychiatric history and multiple diagnoses were linked to suicide reattempts among females. Appropriate assessment of past psychiatric history, season and method of suicide attempt, gender, and diagnosis may play a role in preventing suicide.     

Nonlinear Change Processes During Psychotherapy Characterize Patients Who Have Made Multiple Suicide Attempts

Research suggests that multiple suicide attempters experience considerable variability in suicide ideation and longer‐duration suicidal crises, which suggests the possibility of two states of stability (one low risk and one high risk). To date, however, few studies have examined nonlinear change processes in suicide ideation among patients. In a sample of 76 active duty U.S. Army soldiers receiving brief cognitive behavioral therapy for acute suicide risk, we examined differences in the ebb and flow of suicide ideation among multiple attempters, first‐time attempters, and ideators. Results indicated that multiple attempters were characterized by two states of stability corresponding to low and high intensity suicide ideation; these states were separated by a region of instability corresponding to moderate intensity suicide ideation. In contrast, ideators and first‐time attempters were characterized by only a single state of stability corresponding to low intensity suicide ideation. Among patients who have made multiple suicide attempts, suicide ideation may function as a bimodal rather than a continuous construct.     

Psychosocial risk assessment among families receiving assistance from the social services

This study analyses the psychosocial risk profiles that better discriminate between three levels of risk: low, middle and high. We also examine to what extent the assessments of the level of risk made by professionals of social services are consistent with their decision of initiate a "risk declaration" expedient. For this purpose, 468 cases of families (245 two-parents and 223 one-parent) were examined through the Psychosocial Risk Profile of the Family. Discriminant analysis showed that social exclusion and family violence profiles discriminate between high and middle-low levels of risk in two-parent families. Negligence and family violence plus maternal inadequacy and children maladjustment discriminate between high and middle-low levels of risk in one-parent families. There is a high consistence between the assessment of psychosocial risk and the decision to initate a procedure of a "risk declaration" in both families, with a tendency to overestimate the middle risk in one-parent families.     

Risk for Suicidal Ideation and Attempt among a Primary Care Sample of Adolescents Engaging in Nonsuicidal Self‐Injury

One in five adolescents in the United States has engaged in nonsuicidal self‐injury (NSSI), one in eight have had serious thoughts of suicide, and one in 25 have attempted suicide. Research suggests that NSSI may increase risk for suicide attempt, yet little is known about the relationship between NSSI and suicidal ideation or attempts. In a primary care setting, 1,561 youth aged 14–24 years completed a brief, comprehensive, mental health screen as part of a routine well visit to determine which factors were most likely to predict suicidal ideation and attempt among youth engaging in NSSI. Results of recursive partitioning revealed that current depression and history of alcohol use best differentiated youth engaging in NSSI with low versus high risk for suicidal ideation and attempts. This simple algorithm is presented as a clinical screening tool that might aid medical providers in determining which youth would benefit from more intensive assessment and intervention.