Gender and the Primary Prevention of Suicide Mortality

Primary prevention aims at reducing the incidence of a disorder. The first step in primary prevention involves documenting the magnitude of the problem and identifying risk factors. Consistent with primary prevention practices, we review the national and international epidemiological data on suicide mortality and then discuss the implications these data hold for primary prevention. Our approach is novel because we systematically examine the suicide epidemiology data by gender and culture. Suicide mortality appears to be highest among individuals (e.g., young adult married females in some Papua New Guinea regions; older adult, isolated, White males in the United States) for whom such behavior is culturally sanctioned. Thus, an important target for primary prevention may be local cultures of gender and suicide.     

Prevention ethics: explicating the context of prevention activities

Research and intervention involving primary prevention [related to mental health and psychology] have grown dramatically in the past 10 years. However, little attention has been paid to ethical issues in primary prevention. This article proposes a framework for increasing awareness of such issues. The framework centers on explicating the contexts where prevention activities occur and the roles adopted by interventionists engaging in these activities. Several assumptions underlying primary prevention are stated, and ways of clarifying ethical issues are proposed.     

Counselling and primary prevention

Counsellors and counselling services are frequently involved in primary prevention work. Increasingly these services are required to help immediately after major disasters, an implicit assumption being made that normal social support networks will be unable to cope. A review of the literature suggests extensive participation of counsellors in primary prevention activities despite difficulties in definition, training and funding, and evidence that some interventions may be ineffective or harmful. It is suggested that counsellors providing primary prevention services should be aware of the complex practice and philosophy issues surrounding such efforts, and should be rigorous in assessing the real effects of primary prevention activity.     

Two Critical Issues in Primary Prevention: What It Is and How To Do It

Definition of primary prevention and of end-state and stressful life variable models are presented to guide the design and conduct of primary prevention activities.     

A School-Based Multilevel Preventive Intervention: Issues in Program Development and Evaluation

This article describes conceptual, methodological, and practical issues of prevention research generally and specifically relevant to a school-based primary and secondary prevention effort to reduce the prevalence of learning and emotional disorders in primary grade children.     

Two pathways to prevention

Health promotion and disease prevention programs are becoming important components of contemporary health care. There are at least 2 pathways to the enhancement of population health status through disease prevention. The first pathway requires the early diagnosis and treatment of disease. The second pathway promotes healthy lifestyles and disregards the requirement that a condition must be diagnosed before intervention is recommended. Data from several evaluations suggest that prevention efforts that rely on diagnosis have produced somewhat limited benefits, whereas primary prevention efforts may have substantial benefits. Current health policy places greater emphasis on secondary prevention. The objectives of improved population health might be better achieved by devoting relatively more resources to primary prevention through the promotion of healthy behaviors.     

Barriers to primary prevention efforts in the schools: Are we the biggest obstacle to the transfer of knowledge?

Dialogue and debate regarding the definition of prevention has subsided and has been replaced by research and information regarding pathways to dysfunction and effective primary prevention strategies. In spite of the solid research base and the strong desire of practitioners to apply prevention strategies, there continues to be sporadic implementation in schools. Barriers to the implementation of primary prevention programs include traditional professional practice within psychology, lack of communicating pertinent information between professions and policymakers, commitment of resources, and limited understanding of the pathways to successful and widespread implementation. Recommendations to address these barriers are discussed.     

Applying Primary Prevention Precepts to Campus Substance Abuse Programs

The authors identify five primary prevention programming precepts dealing with perspective, targets, methods, intentionality, and ethic. They describe how the United States Department of Education's Fund for the Improvement of Post Secondary Education (FIPSE) sponsored University of Cincinnati substance abuse prevention project was developed by following these precepts. They hope that this information will aid others in their development of primary prevention programs in college substance abuse (i.e., alcohol and other drug abuse) or in other areas.     

On the Semantics and Operations of Primary Prevention and Wellness Enhancement (Or Will the Real Primary Prevention Please Stand Up?)

Compared two recent, major reviews of primary prevention program evaluation research (i.e., Durlak and Wells' meta-analysis of 177 such studies and the Institute of Medicine (IOM) Report's summary of research studies of preventive intervention programs) with respect to specific studies included and input sources used. Whereas the IOM Report defined the goal of primary prevention as reducing the occurrence of new cases of mental disorder, Durlak and Wells' broader definition included both that goal and the promotion of psychological wellness. Overlap in journal sources used by the two reviews was modest and overlap in the actual primary prevention program evaluation studies included was minimal (7%). These findings bespeak somewhat different views of primary prevention and suggest a need for the complementary development of both the above approaches as alternatives, individually and collectively, to mental health's past established restorative ways.     

The Primary Prevention of Illness: Social Systems and Personal Power

There is evidence to be inferred from statistics about health status and mortality rates that a large proportion of illness and premature death is preventable. Primary prevention programmes appear to have had only limited success when individuals need to take responsibility for preserving their own health. This paper examines the concept of primary prevention and its assumptions, including the need to increase the sense of personal power of individuals. It also deals with some of the problems for primary prevention policies and their implementation. Other primary prevention issues such as ethical and legal considerations. cost-benefits, foci of programmes, and the specification of goals and objectives, are considered. We propose public (government) policies to broaden the concept of health sciences for research and practice, and to give a high priority for resource allocation to prevention of illness and promotion of health, including funding of interdisciplinary research teams. We advocate taking a general systems theory approach to prevention, while enhancing and developing the sense of personal power of individual members of social systems.     

Implementing Theme-Focused Prevention: Challenge for the 1980s

This article describes theme-focused prevention as a specific type of active primary prevention programming, offers principles to guide program design, and outlines an actual program.     

Research,policy, and the federal role in prevention initiatives for children

With the ability and the funds to implement programs on a national level, federal policy is a potentially potent tool in primary prevention. Despite the U.S. government's history of ambivalence toward intervening in child rearing and limited national support for primary prevention, several initiatives have been implemented for children and families with some measure of success. The successes, however, are mitigated by limitations of the initiatives themselves and by the inconclusive nature of much of the evaluation data. This review of 5 federal policy-based initiatives for children and families provides the backdrop for discussing aspects of federal prevention program design, implementation, policy, and research.     

The role of primary prevention in mental health services: A review and critique

Community psychology in the West has had a growing impact on mental health service provision. One facet of this development has been the advocacy of an increased focus on the primary prevention of mental illness. This paper reviews both theoretical and practical work in this area in order to assess the current role and relevance of primary preventive interventions. There is a discussion of primary prevention's historical and theoretical contexts, of its conceptualisations and definitions, of criticisms of its relevance and efficacy, and of examples of its practice. It is argued that primary prevention is inappropriately marginalised in current service provision and that there is a need to engage in the long-term planning and evaluation of primary preventive interventions in order to facilitate their fuller incorporation into national and local policies on mental health.     

Primary Prevention: A Road Paved with a Plethora of Promises and Procrastinations

Long associated with the primary preventive tactic of deliberate psychological education, Norm Sprinthall discusses some of the reasons why primary prevention is so important even in secondary schools.     

Primary Prevention Mental Health Programs for Children and Adolescents: A Meta-Analytic Review

Used meta-analysis to review 177 primary prevention programs designed to prevent behavioral and social problems in children and adolescents. Findings provide empirical support for further research and practice in primary prevention. Most categories of programs produced outcomes similar to or higher in magnitude than those obtained by many other established preventive and treatment interventions in the social sciences and medicine. Programs modifying the school environment, individually focused mental health promotion efforts, and attempts to help children negotiate stressful transitions yield significant mean effects ranging from 0.24 to 0.93. In practical terms, the average participant in a primary prevention program surpasses the performance of between 59% to 82% of those in a control group, and outcomes reflect an 8% to 46% difference in success rates favoring prevention groups. Most categories of programs had the dual benefit of significantly reducing problems and significantly increasing competencies. Priorities for future research include clearer specification of intervention procedures and program goals, assessment of program implementation, more follow-up studies, and determining how characteristics of the intervention and participants relate to different outcomes.     

A brief history of primary prevention in the twentieth century: 1908 to 1980

While primary prevention is a much talked about and debated topic in contemporary psychology, it has a considerable history. This paper critically traces primary prevention, philosophy and practice, in the 20th century. Beginning with the mental hygiene movement (1908-1960), the paper progresses to examine the child guidance movement (1920-1955), the eugenics movement (1860-1955), the initial era of federal involvement (1930s, 1940s) as well as significant research, events, and legislation in the decades between 1950 and 1980. The paper concludes with a synopsis of the major themes revealed by the review and suggestions for future efforts in prevention.     

A Process Model for Prevention Program Research

Interventions attempted before the onset of a counseling problem are primary prevention efforts. A process model for prevention program research is the focus of this paper. The process model features four essential steps: assessment, goal setting, strategy implementation, and evaluation. The likely problems encountered by a prevention researcher at each step of the model are discussed.     

Prevention of depression with primary care patients: A randomized controlled trial

The prevention of major depression is an important research goal which deserves increased attention. Depressive symptoms and disorders are particularly common in primary care patients and have a negative impact on functioning and well-being comparable with other major chronic medical conditions. The San Francisco Depression Prevention Research project conducted a randomized, controlled, prevention trial to demonstrate the feasibility of implementing such research in a public sector setting serving low-income, predominantly minority individuals: 150 primary care patients free from depression or other major mental disorders were randomized to an experimental cognitive-behavioral intervention or to a control condition. The experimental intervention group reported a significantly greater reduction in depressive levels. Decline in depressive levels was significantly mediated by decline in the frequency of negative conditions. Group differences in the number of new episodes (incidence) of major depression did not reach significance during the 1-year trial. We conclude that depression prevention trials in public sector primary care settings are feasbile, and that depressive symptoms can be reduced even in low-income, minority populations. To conduct randomized prevention trials that can test effects on incidence with sufficient statistical power, subgroups at greater imminent risk have to be identified.     

Assessing the Impact of a Prejudice Prevention Project

This article reports on the effectiveness of a prejudice prevention intervention that was used among a culturally diverse group of students in Hawaii. Implications of the results of this primary prevention effort for counseling practice and interculturally adaptive social development are discussed.     

Primary prevention of behavior problems in mexican-american children

A primary prevention program, the Houston Parent-Child Development Center, directed towards infants and their parents, has effectively reduced the frequency of behavior problems for these children 5 to 8 years after the program's completion. Teacher ratings showed significantly fewer acting-out, aggressive behaviors for program children. Ratings of classroom behaviors found program children significantly less hostile and more considerate than control boys. This appears to be the first primary prevention program to have demonstrated effectiveness in reducing behavior problems over such a long time.