Research References
Suicide prevention/intervention
Aseltine, R. H., James, A., Schilling, E. A., & Glanovsky, J.
(2007). Evaluating the SOS suicide prevention program: A
replication and extension. BMC Public Health, 7(161).
Retrieved from
https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-7-161
From the abstract: “Methods: 4133 students in 9 high
schools in Columbus, Georgia, western Massachusetts, and
Hartford, Connecticut were randomly assigned to intervention
and control groups during the 2001–02 and 2002–03 school
years. Self-administered questionnaires were completed by
students in both groups approximately 3 months after program
implementation.
Results: Significantly lower rates of suicide attempts and
greater knowledge and more adaptive attitudes about depression
and suicide were observed among students in the intervention
group. Students’ race/ethnicity, grade, and gender did not
alter the impact of the intervention on any of the outcomes
assessed in this analysis.
Conclusion: This study has confirmed preliminary analysis of
Year 1 data with a larger and more racially and
socio-economically diverse sample. SOS continues to be the
only universal school-based suicide prevention program to
demonstrate significant effects of self-reported suicide
attempts in a study utilizing a randomized experimental
design. Moreover, the beneficial effects of SOS were observed
among high school-aged youth from diverse racial/ethnic
backgrounds, highlighting the program's utility as a universal
prevention program.”
Ciffone, J. (2007). Suicide prevention: An analysis and
replication of a curriculum-based high school program.
Social Work, 52(1), 41–49.
https://eric.ed.gov/?id=EJ756258. Retrieved from
https://static1.squarespace.com/static/547a2f62e4b0ab191e978ace/t/59f7441dd6839ac415f9d693/1509377053316/NASW+article.pdf
From the ERIC abstract: “This article highlights some
of the concerns about and benefits of curriculum-based suicide
prevention programs delivered to students in a high school
setting. In addition, it presents information about a specific
curriculum-based prevention program and provides evidence that
the program changed unwanted attitudes about suicide in all
the areas targeted for change and reduced adolescents’
reluctance to seek mental health treatment for themselves and
their peers. The positive results were much like those found
in a similar study by Ciffone (1993). Furthermore, multiple
presenters in two separate schools all obtained similar
positive results.”
Cross, W. F., Seaburn, D., Gibbs, D., Schmeelk-Cone, K.,
White, A. M., & Caine, E. D. (2011). Does practice make
perfect? A randomized control trial of behavioral rehearsal on
suicide prevention gatekeeper skills.
Journal of Primary Prevention, 32(3-4), 195–211.
https://eric.ed.gov/?id=EJ938194. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249637/
From the ERIC abstract: “Suicide is the third leading
cause of death among 10–24-year-olds and the target of
school-based prevention efforts. Gatekeeper training, a
broadly disseminated prevention strategy, has been found to
enhance participant knowledge and attitudes about intervening
with distressed youth. Although the goal of training is the
development of gatekeeper skills to intervene with at-risk
youth, the impact on skills and use of training is less known.
Brief gatekeeper training programs are largely educational and
do not employ active learning strategies such as behavioral
rehearsal through role play practice to assist skill
development. In this study, we compare gatekeeper training as
usual with training plus brief behavioral rehearsal (i.e.,
role play practice) on a variety of learning outcomes after
training and at follow-up for 91 school staff and 56 parents
in a school community. We found few differences between school
staff and parent participants. Both training conditions
resulted in enhanced knowledge and attitudes, and almost all
participants spread gatekeeper training information to others
in their network. Rigorous standardized patient and
observational methods showed behavioral rehearsal with role
play practice resulted in higher total gatekeeper skill scores
immediately after training and at follow-up. Both conditions,
however, showed decrements at follow-up. Strategies to
strengthen and maintain gatekeeper skills over time are
discussed.”
Freedenthal, S. (2010). Adolescent help-seeking and the yellow
ribbon suicide prevention program: An evaluation.
Suicide and Life-Threatening Behavior, 40(6),
628–639.
https://eric.ed.gov/?id=EJ966096. Retrieved from
https://guilfordjournals.com/doi/pdf/10.1521/suli.2010.40.6.628
From the ERIC abstract: “The Yellow Ribbon Suicide
Prevention Program has gained national and international
recognition for its school- and community-based activities.
After the introduction of Yellow Ribbon to a Denver-area high
school, staff and adolescents were surveyed to determine if
help-seeking behavior had increased. Using a pre-post
intervention design, staff at an experimental school and
comparison school were surveyed about their experiences with
student help-seeking. Additionally, 146 students at the
experimental high school were surveyed. Staff did not report
any increase in student help-seeking, and students' reports of
help-seeking from 11 of 12 different types of helpers did not
increase; the exception was help-seeking from a crisis
hotline, which increased from 2.1% to 6.9%. Further research
with larger, more inclusive samples is needed to determine
whether Yellow Ribbon is effective in other locations.”
Hooven, C., Herting, J. R., & Snedker, K. A. (2010). Long-term
outcomes for the promoting CARE suicide prevention program.
American Journal of Health Behavior, 34(6), 721–736.
https://eric.ed.gov/?id=EJ955331. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119363/
From the ERIC abstract: “Objectives: To provide a
long-term look at suicide risk from adolescence to young
adulthood for former participants in Promoting CARE, an
indicated suicide prevention program. Methods: Five hundred
ninety-three suicide-vulnerable high school youth were
involved in a long-term follow-up study. Latent class growth
models identify patterns of change in suicide risk over this
period. Results: Three distinct trajectories are determined,
all showing a maintenance of decreased suicide risk from
postintervention in adolescence into young adulthood for
direct suicide-risk behaviors, depression and anger.
Intervention conditions as well as key risk/protective factors
are identified that predict to the long-term trajectories.
Conclusion: Early intervention is successful in promoting and
maintaining lower-risk status from adolescence to young
adulthood, with the caveat that some high-risk behaviors may
indicate a need for additional intervention to establish
earlier effects.”
Schilling, E. A., Lawless, M., Buchanan L., & Aseltine, R. H.
Jr. (2014). “Signs of Suicide” shows promise as a middle
school suicide prevention program.
Suicide and Life-Threatening Behavior, 44(6),
653–667. Retrieved from
http://mssaa.org/gen/mssaa_generated_bin/documents/basic_module/2014_MS_Research.pdf
From the abstract: “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.”
Singer, J. B., Erbacher, T. A., & Rosen, P. (2018).
School-based suicide prevention: A framework for
evidence-based practice. School Mental Health, 11(1),
54–71.
https://eric.ed.gov/?id=EJ1229683. Retrieved from
https://www.researchgate.net/publication/322436333
From the ERIC abstract: “Suicide is the second leading
cause of death among youth aged 10–25 years, and approximately
one in six adolescents reported serious suicidal ideation in
the past year (Centers for Disease Control and Prevention
[CDC] in Web-based Injury Statistics Query and Reporting
System (WISQARS). http://webappa.cdc.gov/cgi-bin/broker.exe,
2017). Schools are a unique environment in which to identify
and respond to youth suicide risk, yet the research base for
school-based suicide prevention programs is limited due to
challenges with implementation and evaluation. The purpose of
this article is to review best practice approaches and
existing empirical support for school-based suicide prevention
and to present a framework for how these efforts can be
embedded within multi-tiered systems of support (MTSS). In
line with the Substance Abuse and Mental Health Services
Administration [SAMHSA] (Preventing suicide: a toolkit for
high schools.
https://store.samhsa.gov/shin/content//SMA12-4669/SMA12-4669.pdf,
2012) framework for suicide prevention in schools, the article
overviews existing programs for student education, staff
training, and screening, noting where these programs may be
situated across tiers of intervention. This is followed by a
review of school-related outcomes of existing suicide
prevention programs, which highlights the limitations of
existing research. Because there are only two school-based
prevention programs with evidence for reducing suicide risk in
students, the authors encourage school staff to implement best
practice recommendations in collaboration with school mental
health professionals who can provide ongoing evaluation of
program effectiveness, as well as with researchers who are
able to design and conduct outcome studies addressing the
limitations of current research. Findings also underscore the
need for greater integration of suicide prevention programming
with existing school initiatives such as MTSS, which aligns
with a growing focus in the field of suicide prevention on
‘upstream approaches.’”
Wyman, P. A., Brown, C. H., Inman, J., Cross, W.,
Schmeelk-Cone, K., Guo, J., et. al. (2008). Randomized trial
of a gatekeeper program for suicide prevention: 1-year impact
on secondary school staff.
Journal of Consulting and Clinical Psychology, 76(1),
104–115.
https://eric.ed.gov/?id=EJ784049. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771576/
From the ERIC abstract: “Gatekeeper-training programs,
designed to increase identification and referral of suicidal
individuals, are widespread but largely untested. A
group-based randomized trial with 32 schools examined impact
of Question, Persuade, Refer (QPR) training on a stratified
random sample of 249 staff with 1-year average follow-up. To
test QPR impact, the authors introduced and contrasted 2
models of gatekeeper-training effects in a population:
gatekeeper surveillance and gatekeeper communication.
Intent-to-treat analyses showed that training increased
self-reported knowledge (effect size [ES] = 0.41), appraisals
of efficacy (ES = 1.22), and service access (ES = 1.07).
Training effects varied dramatically. Appraisals increased
most for staff with lowest baseline appraisals, and suicide
identification behaviors increased most for staff already
communicating with students about suicide and distress.
Consistent with the communication model, increased knowledge
and appraisals were not sufficient to increase suicide
identification behaviors. Also consistent with the
communication model were results from 2,059 8th and 10th
graders surveyed showing that fewer students with prior
suicide attempts endorsed talking to adults about distress.
Skill training for staff serving as “natural gatekeepers” plus
interventions that modify students’ help-seeking behaviors are
recommended to supplement universal gatekeeper training.”
Depression prevention/intervention
Benas, J. S., McCarthy, A. E., Haimm, C. A., Huang, M.,
Gallop, R., & Young, J. F. (2016). The depression prevention
initiative: Impact on adolescent internalizing and
externalizing symptoms in a randomized trial.
Journal of Clinical Child and Adolescent Psychology 48(sup1), 57–71. Retrieved from
https://europepmc.org/article/PMC/5493504#R23
From the abstract: “This randomized controlled trial
examined the longitudinal effects of two school-based
indicated depression prevention programs on adolescents’
internalizing and externalizing symptoms, as measured by
adolescents, their parents, and their teachers. One hundred
eighty-six adolescents participated in this study. The average
age was 14.01 (SD = 1.22) years, and the sample was 66.7%
female. One third of the sample belonged to a racial minority.
Youth received either Interpersonal Psychotherapy–Adolescent
Skills Training or group counseling. Symptoms were assessed
using adolescent, parent, and teacher reports on the Achenbach
System of Empirically Based Assessment at baseline,
postintervention, and 6-month follow-up. Adolescents reported
the most robust effects in favor of Interpersonal
Psychotherapy–Adolescent Skills Training. Adolescents in
Interpersonal Psychotherapy–Adolescent Skills Training
reported significantly greater reductions in internalizing
symptoms through the 6-month follow-up and significantly
greater reductions in externalizing symptoms during the
intervention as compared to group counseling. Less robust
effects were found when examining parent and teacher reports,
although there was evidence of significant within-group change
in parent- and teacher-reported internalizing symptoms for
both interventions and significant between-group differences
in teacher-reported externalizing symptoms. This study
provides additional evidence supporting the efficacy of
Interpersonal Psychotherapy–Adolescent Skills Training as a
depression prevention program for adolescents. Interpersonal
Psychotherapy– Adolescent Skills Training appears to have
fast-acting effects on broadband internalizing and
externalizing symptoms as reported by adolescents. This
suggests that Interpersonal Psychotherapy–Adolescent Skills
Training may serve as a transdiagnostic preventive
intervention. Moreover, given the disparate reports of
adolescents, parents, and teachers, this study demonstrates
the significance of collecting information from multiple
sources when possible.”
Cardemil, E. V., Reivich, K. J., Beevers, C. G., Seligman, M.
E. P., & James, J. (2007). The prevention of depressive
symptoms in low-income, minority children: Two-year follow-up.
Behaviour Research and Therapy, 45(2), 313–327.
Retrieved from
https://wordpress.clarku.edu/ecardemil/files/2013/02/The-Prevention-of-Depressive-Symptoms-2-yr-followup-final-2007.pdf
From the abstract: “We present 2-year follow-up data on
the efficacy of the Penn Resiliency Program (PRP), a
school-based depression prevention program, with low-income,
racial/ethnic minority children. This program taught cognitive
and social problem-solving skills to 168 Latino and African
American middle school children who were at-risk for
developing depressive symptoms by virtue of their low-income
status. We had previously reported beneficial effects of the
PRP up to 6 months after the conclusion of the program for the
Latino children, but no clear effect for the African American
children. In this paper, we extend the analyses to 24 months
after the conclusion of the PRP. We continue to find some
beneficial effects for the Latino children and no
differentially beneficial effect for the African American
children. Implications of findings and future research
directions are discussed.”
Connell, A. M., & Dishion, T. J. (2008). Reducing depression
among at-risk early adolescents: Three-year effects of a
family-centered intervention embedded within schools.
Journal of Family Psychology, 22(3), 574–585.
Retrieved from
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.584.5623&rep=rep1&type=pdf
From the abstract: “The Adolescent Transitions Program
(ATP) is a family-focused multilevel prevention program
designed for delivery within public middle schools to target
parenting factors related to the development of behavior
problems in early adolescence. The current study examines the
effects of the ATP on the development of youth depressive
symptoms across early adolescence in a sample of 106 high-risk
youths. Youths were recruited in 6th grade, and selected as
high risk based on teacher and parent reports of behavioral or
emotional problems. Depression symptoms were based on youth
and mother reports in 7th, 8th, and 9th grades. Receipt of the
family-centered intervention inhibited growth in depressive
symptoms in high-risk youths over the 3 yearly assessments
compared with symptoms in high-risk youths in the control
group. Results support the notion that parental engagement in
a program designed to improve parent management practices and
parent–adolescent relationships can result in collateral
benefits to the youths’ depressive symptoms at a critical
transition period of social and emotional development.”
Cutuli, J. J., Gillham, J. E., Chaplin, T. M., Reivich, K. J.,
Seligman, M. E. P., Gallop, R. J., et al. (2013). Preventing
adolescents’ externalizing and internalizing symptoms: Effects
of the Penn Resiliency Program.
International Journal of Emotional Education, 5(2),
67–79.
https://eric.ed.gov/?id=EJ1085607
From the ERIC abstract: “This study reports secondary
outcome analyses from a past study of the Penn Resiliency
Program (PRP), a cognitive-behavioral depression prevention
program for middle-school aged children. Middle school
students (N = 697) were randomly assigned to PRP, PEP (an
alternate intervention), or control conditions. Gillham et
al., (2007) reported analyses examining PRP’s effects on
average and clinical levels of depression symptoms. We examine
PRP’s effects on parent-, teacher-, and self-reports of
adolescents' externalizing and broader internalizing
(depression/anxiety, somatic complaints, and social
withdrawal) symptoms over three years of follow-up. Relative
to no intervention control, PRP reduced parent-reports of
adolescents’ internalizing symptoms beginning at the first
assessment after the intervention and persisting for most of
the follow-up assessments. PRP also reduced parent-reported
conduct problems relative to no-intervention. There was no
evidence that the PRP program produced an effect on teacher-
or self-report of adolescents' symptoms. Overall, PRP did not
reduce symptoms relative to the alternate intervention,
although there is a suggestion of a delayed effect for conduct
problems. These findings are discussed with attention to
developmental trajectories and the importance of interventions
that address common risk factors for diverse forms of negative
outcomes.”
Duong, M. T., Cruz, R. A., King, K. M., Violette, H. D., &
McCarty, C. A. (2015). Twelve-month outcomes of a randomized
trial of the Positive Thoughts and Action program for
depression among early adolescents.
Prevention Science, (17)3, 295–305. Retrieved from
https://www.researchgate.net/publication/283214605
From the abstract: “This study was conducted to examine
the 12-month effects on depression and depressive symptoms of
a group-based cognitive-behavioral preventive intervention for
middle school students (Positive Thoughts and Actions, or
PTA), relative to a brief, individually administered
supportive intervention (Individual Support Program, or ISP).
A randomized clinical trial was conducted with 120 early
adolescents (73 girls and 47 boys; age 12–14 years) drawn from
a school-based population who had elevated depressive
symptoms. Youths completed measures of depressive symptoms at
baseline, post-intervention, and 6 and 12 months into the
follow-up phase. Measures of internalizing problems,
externalizing problems, school adjustment, interpersonal
relationships, and health behavior were obtained from parents
and/or youth. Multilevel models indicated that the effect of
PTA on youth-reported depressive symptoms persisted until
12-month follow-up; d = 0.36 at post-intervention, d = 0.24 at
6-month follow-up, and d = 0.21 at 12-month follow-up. PTA
youths also reported lower internalizing symptoms at
post-intervention, d = 0.44, and at 12-month follow-up, d =
0.39. Time-limited effects were found for parent-reported
internalizing symptoms and health behavior. Onset of new
depressive episodes did not differ based on intervention group
(21% ISP; 17% PTA). Results demonstrate support for the
long-term efficacy of PTA, a cognitive-behavioral preventive
intervention in which youths engage in personal goal-setting
and practice social-emotional skills.”
Michael, K. D., George, M. W., Splett, J. W., Jameson, J. P.,
Sale, R., Bode, et al. (2016). Preliminary outcomes of a
multi-site, school-based modular intervention for adolescents
experiencing mood difficulties.
Journal of Child and Family Studies, 25(2),
1903–1915. Retrieved from
https://libres.uncg.edu/ir/asu/f/Michael_Kurt_SEED%20Pilot%20Michael%20George%20Splett%20Jameson%20et%20al%202016.pdf
From the abstract: “Many evidence-based programs to
address the emotional needs of youth experiencing mood
difficulties are based on implementing “manualized”
interventions. This approach often presents feasibility
challenges in the school setting. In contrast, modular
strategies, which involve implementing the most effective
practices for specific emotional/behavioral problems, may be
more feasible. Research, however, on the feasibility,
acceptability, and effectiveness of modular approaches in
schools to address youth experiencing mood difficulties is
lacking. The multi-site current study tested the
effectiveness, feasibility, and acceptability of a modular
intervention approach delivered in schools for youth
presenting with mood disorder symptoms. The pilot study
included 20 participants (ages 12–16) and parents/caregivers
for each student. Data were collected at baseline, throughout
treatment, and following intervention or end of school year.
The intervention, called the Student Emotional and Educational
Development (SEED) project, included a modularized manual of
efficacious and common practice elements for the treatment of
mood disorders among adolescents. Decision making protocols
guided provision of specific modules based on baseline and
treatment data. Statistically significant differences were
found between pretest and posttest assessments with modest to
large effect sizes for youth and/or parents’ report of
mood-related symptoms, including reduced symptoms of
depression, anxiety and inattention. Clinically significant
findings were also detected with more than 50% of participants
demonstrating reliable improvement on a global assessment of
mental health symptoms. With regards to feasibility, these
results were achieved with an average of nine, 45-min sessions
across 2–3 months, and a subsample of participants
overwhelmingly supported the acceptability of SEED. Although
limited by the lack of a controlled comparison and small
sample size, findings from this pilot study suggest this
modular intervention focused on internalizing symptoms in
students can be feasibly implemented in the school setting, is
acceptable to students, and holds promise for improving their
psychosocial functioning.”
Additional Organizations to Consult
American Foundation for Suicide Prevention—https://afsp.org/
From the website: “American Foundation for Suicide
Prevention (AFSP) is a voluntary health organization that
gives those affected by suicide a nationwide community
empowered by research, education and advocacy to take action
against this leading cause of death.
AFSP is dedicated to saving lives and bringing hope to those
affected by suicide. AFSP creates a culture that’s smart about
mental health by engaging in the following core strategies:
- Funding scientific research
-
Educating the public about mental health and suicide
prevention
-
Advocating for public policies in mental health and
suicide prevention
-
Supporting survivors of suicide loss and those affected by
suicide in our mission”
National Action Alliance for Suicide Prevention (Action
Alliance)—https://theactionalliance.org/
From the website: “The National Action Alliance for
Suicide Prevention (Action Alliance) is the nation’s
public-private partnership for suicide prevention.
The Action Alliance is dedicated to advancing the National
Strategy for Suicide Prevention, which presents the nation’s
13 goals and 60 objectives for suicide prevention.
Through its unique ability to engage and unify passionate
stakeholders and leaders in all sectors to collaborate toward
a national and comprehensive approach to suicide prevention,
the Action Alliance:
- Champions suicide prevention as a national priority
-
Catalyzes efforts to implement high priority objectives of
the National Strategy
-
Cultivates the resources needed to sustain progress.”
National Institute on Mental Health (NIMH)—https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml
The National Institute on Mental Health website has a section
on suicide prevention that provides information on mental
illness, suicide prevention, treatment options, and risk
factors. NIMH also conducts research on suicide and suicide
prevention.
National Suicide Prevention Lifeline—https://suicidepreventionlifeline.org/
From the website: “The National Suicide Prevention
Lifeline is a leader in suicide prevention and mental health
crisis care. Since its inception, the Lifeline has engaged in
a variety of initiatives to improve crisis services and
advance suicide prevention for all, including innovative
public messaging, best practices in mental health, and
groundbreaking partnerships.
The National Suicide Prevention Lifeline is independently
evaluated by a federally-funded investigation team from
Columbia University’s Research Foundation for Mental Hygiene.
The Lifeline receives ongoing consultation and guidance from
national suicide prevention experts, consumer advocates, and
other stakeholders through the Lifeline’s Steering Committee,
Consumer/Survivor Committee, and Standards, Training and
Practices Committee.”
The Lifeline also provides informational materials, such as
brochures, wallet cards, posters, and booklets.
Society for the Prevention of Teen Suicide (SPTS)—https://sptsusa.org/
From the website: “The mission of the Society for the
Prevention of Teen Suicide is to reduce the number of youth
suicides and attempted suicides by encouraging public
awareness through the development and promotion of educational
training programs.
SPTS expert program staff are available to meet your
educational and professional development needs with a
comprehensive catalog of dynamic workshops and training
programs for schools, community groups, professional
conferences and parents.”
Suicide Prevention Resource Center—https://www.sprc.org/
From the website: “The Suicide Prevention Resource
Center (SPRC) is the only federally supported resource center
devoted to advancing the implementation of the National
Strategy for Suicide Prevention. SPRC is funded by the U.S.
Department of Health and Human Services’ Substance Abuse and
Mental Health Services Administration (SAMHSA).
SPRC advances suicide prevention infrastructure and capacity
building through:
-
Consultation, training, and resources to enhance suicide
prevention efforts in states, Native settings, colleges
and universities, health systems and other settings, and
organizations that serve populations at risk for suicide.
-
Staffing, administrative, and logistical support to the
Secretariat of the National Action Alliance for Suicide
Prevention (Action Alliance), the public-private
partnership dedicated to advancing the National Strategy
for Suicide Prevention.
-
Support for Zero Suicide, an initiative based on the
foundational belief that suicide deaths for individuals
under care within health and behavioral health systems are
preventable. The initiative provides information,
resources, and tools for safer suicide care.”
