Given the finite resources allocated to suicide prevention, it is necessary to direct resources into interventions that are most likely to have an impact. This article tests for possible impacts on youth suicides of a cost-intensive Australian policy change (increased firearms restriction) that limited access to a means of suicide. Suicide rates by different age groups and methods were examined for structural breaks, using Zivot-Andrews and Quandt tests. No breakpoint was found in firearm suicide among Australian youth around the time of the 1996 legislative changes. Method restriction in the form of firearms legislation could not be tied to a corresponding impact on youth suicide.
OBJECTIVE: Suicide is the third leading cause of death among adolescents. Many suicidal youths treated in emergency departments do not receive follow-up treatment as advocated by the National Strategy for Suicide Prevention. Two strategies for improving rates of follow-up treatment were compared. METHODS: In a randomized controlled trial, suicidal youths at two emergency departments (N = 181; ages ten to 18) were individually assigned between April 2003 and August 2005 to one of two conditions: an enhanced mental health intervention involving a family-based cognitive-behavioral therapy session designed to increase motivation for follow-up treatment and safety, supplemented by care linkage telephone contacts after emergency department discharge, or usual emergency department care enhanced by provider education. Assessments were conducted at baseline and approximately two months after discharge from the emergency department or hospital. The primary outcome measure was rates of outpatient mental health treatment after discharge. RESULTS: Intervention patients were significantly more likely than usual care patients to attend outpatient treatment (92% versus 76%; p = .004). The intervention group also had significantly higher rates of psychotherapy (76% versus 49%; p = .001), combined psychotherapy and medication (58% versus 37%; p = .003), and psychotherapy visits (mean 5.3 versus 3.1; p = .003). Neither the emergency department intervention nor community outpatient treatment (in exploratory analyses) was significantly associated with improved clinical or functioning outcomes. CONCLUSIONS: Results support efficacy of the enhanced emergency department intervention for improving linkage to outpatient mental health treatment but underscore the need for improved community outpatient treatment to prevent suicide, suicide attempts, and poor clinical and functioning outcomes for suicidal youths treated in emergency departments. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
BACKGROUND: Individuals who have attempted suicide are at increased risk of subsequent suicidal behavior. Since 1983, a community-based suicide prevention team has been operating in the municipality of Bærum, Norway. This study aimed to test the effectiveness of the team's interventions in preventing repeated suicide attempts and suicide deaths, as part of a chain of care model for all general hospital treated suicide attempters.
METHODS: Data has been collected consecutively since 1984 and a follow-up was conducted on all individuals admitted to the general hospital after a suicide attempt. The risk of repeated suicide attempt and suicide were comparatively examined in subjects who received assistance from the suicide prevention team in addition to treatment as usual versus those who received treatment as usual only. Logistic regression and Cox regression were used to analyze the data.
RESULTS: Between January 1984 and December 2007, 1,616 subjects were registered as having attempted suicide; 197 of them (12%) made another attempt within 12 months. Compared to subjects who did not receive assistance from the suicide prevention team, individuals involved in the prevention program did not have a significantly different risk of repeated attempt within 6 months (adjusted OR = 1.08; 95% CI = 0.66-1.74), 12 months (adjusted OR = 0.86; 95% CI = 0.57-1.30), or 5 years (adjusted RR = 0.90; 95% CI = 0.67-1.22) after their first recorded attempt. There was also no difference in risk of suicide (adjusted RR = 0.85; 95% CI = 0.46-1.57). Previous suicide attempts, marital status, and employment status were significantly associated with a repeated suicide attempt within 6 and 12 months (p < 0.05). Alcohol misuse, employment status, and previous suicide attempts were significantly associated with a repeated attempt within 5 years (p < 0.05) while marital status became non-significant (p > 0.05). With each year of age, the risk of suicide increased by 3% (p < 0.05).
CONCLUSIONS: The present study did not find any differences in the risk of fatal and non-fatal suicidal behavior between subjects who received treatment as usual combined with community assistance versus subjects who received only treatment as usual. However, assistance from the community team was mainly offered to attempters who were not receiving sufficient support from treatment as usual and was accepted by 50-60% of those deemed eligible. Thus, obtaining similar outcomes for individuals, all of whom were clinically judged to have different needs, could in itself be considered a desirable result.
BACKGROUND: Systematic screening to identify adolescents at risk for suicidal behavior is crucial to suicide prevention.
AIMS: The current practice of screening and follow-up actions taken by school nurses in schools for secondary education in Rotterdam, the Netherlands, was studied.
METHODS: In Rotterdam, an approach was developed in which, as a standard routine, students are invited to an interview with a school nurse after filling out a youth health survey in classroom setting. This health survey comprised, among other subjects, the Strengths and Difficulties Questionnaire (SDQ) and questions about suicidal thoughts and behaviors. The results from the interviews and the self-report questionnaires of nearly 4000 first-grade students in secondary education were analyzed.
RESULTS: The vast majority of invitations were not followed by any action from the school nurse. Also, the majority of students whose self-report led to an "Attention Subject" for the nurse were not considered to be at risk by the nurse. The self-report of recent suicidal thoughts added to the predictive value of emotional distress as measured by the SDQ and other self-report conclusions.
CONCLUSIONS: This study demonstrates the additional value of self-reported suicidal thoughts for Dutch preventive practices in youth health care.
BACKGROUND: Suicide ranks as the third leading cause of death among youth aged 15-24 years. Schools provide ideal opportunities for suicide prevention efforts. However, research is needed to identify programs that effectively impact youth suicidal ideation and behavior. This study examined the immediate and 3-month effect of Surviving the Teens® Suicide Prevention and Depression Awareness Program on students' suicidality and perceived self-efficacy in performing help-seeking behaviors.
METHODS: High school students in Greater Cincinnati schools were administered a 3-page survey at pretest, immediate posttest, and 3-month follow-up. A total of 1030 students participated in the program, with 919 completing matched pretests and posttests (89.2%) and 416 completing matched pretests and 3-month follow-ups (40.4%).
RESULTS: Students were significantly less likely at 3-month follow-up than at pretest to be currently considering suicide, to have made a suicidal plan or attempted suicide during the past 3 months, and to have stopped performing usual activities due to feeling sad and hopeless. Students' self-efficacy and behavioral intentions toward help-seeking behaviors increased from pretest to posttest and were maintained at 3-month follow-up. Students were also more likely at 3-month follow-up than at pretest to know an adult in school with whom they felt comfortable discussing their problems. Nine in 10 (87.3%) felt the program should be offered to all high school students.
CONCLUSIONS: The findings of this study lend support for suicide prevention education in schools. The results may be useful to school professionals interested in implementing effective suicide prevention programming to their students.
OBJECTIVE: Despite increased interest in screening adolescents for mental health problems and suicide risk, little is known regarding the extent to which youth are identified and connected with appropriate services.
METHOD: Between 2005 and 2009, a total of 4,509 ninth-grade students were offered screening. We reviewed the records of the 2,488 students who were screened. Students identified as being at risk were provided with a referral. Data were collected on screening results, mental health referrals, and completion of recommended treatment over approximately 90 days.
RESULTS: Among students screened, 19.6% were identified as being at risk, 73.6% of whom were not currently receiving any treatment. Students referred for school services tended to be less severely ill than those referred for community services, with lower rates of suicidal ideation, prior suicide attempts, and self-injury. Among at-risk students not currently in treatment, 76.3% of students referred received at least one mental health visit during the follow-up period. Overall, 74.0% of students were referred to school and 57.3% to community services. A great majority of school referrals (80.2%) successfully accessed services, although a smaller proportion of community services referrals successfully accessed treatment (41.9%).
CONCLUSIONS: Systematic voluntary school-based mental health screening and referral offers a feasible means of identifying and connecting high-risk adolescents to school- and community-based mental health services, although linkages to community-based services may require considerable coordination.
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.
OBJETIVO: Para replicar un estudio que encontró que la terapia de grupo superior a la atención de rutina para prevenir la recurrencia de la auto-daño comportamiento en los adolescentes que habían hecho daño deliberadamente a sí mismos al menos en dos ocasiones.
MÉTODO: Estudio individual ciego con grupos paralelos aleatorios realizados en tres sitios en Australia. La medida de resultado primaria fue la repetición de la autoagresión, evaluada en promedio a los 6 y 12 meses. Las medidas de resultado secundarias incluyeron ideación suicida, trastornos psiquiátricos y uso de servicios.
RESULTADOS: Setenta y dos adolescentes de 12 a 16 años (91% de los sujetos femeninos) fueron asignados al azar a la terapia de grupo o la atención habitual. Estaban disponibles para 68 de los 72 participantes asignados al azar datos de los resultados primarios. Más adolescentes asignados al azar a la terapia de grupo de los asignados al azar a la atención de rutina tenían auto-daño a los 6 meses (30/34 frente a 23/34, chi = 4,19, p = 0,04), y hubo una tendencia estadísticamente no significativa para este patrón a ser repetido en el intervalo de 6 a 12 meses (30/34 frente a 24/34, chi = 3,24, p = 0,07). Hubo pocas diferencias entre los grupos de tratamiento en las medidas de resultado secundarias, excepto una tendencia a una mayor mejoría en el tiempo de las calificaciones globales de síntomas entre el grupo experimental en comparación con el grupo control.
CONCLUSIONES: Nuestros resultados contradicen los del estudio original. Algunas diferencias en las características de los participantes entre los estudios, junto con menos experiencia en los sitios de Australia en la entrega de la intervención, pueden haber representado los diferentes resultados. El beneficio de la terapia de grupo para la autoagresión deliberada no está comprobada fuera del entorno en el que se desarrolló originalmente.
OBJECTIVE: We sought to examine follow-up service use by students identified at risk for suicidal behavior in a school-based screening program and assess barriers to seeking services as perceived by youths and parents.
METHOD: We conducted a longitudinal study of 317 at-risk youths identified by a school-based suicide screening in six high schools in New York State. The at-risk teenagers and their parents were interviewed approximately 2 years after the initial screen to assess service use during the intervening period and identify barriers that may have interfered with seeking treatment.
RESULTS: At the time of the screening, 72% of the at-risk students were not receiving any type of mental health service. Of these students, 51% were deemed in need of services and subsequently referred by us to a mental health professional. Nearly 70% followed through with the screening's referral recommendations. The youths and their parents reported perceptions about mental health problems, specifically relating to the need for treatment, as the primary reasons for not seeking service.
CONCLUSIONS: Screening seems to be effective in enhancing the likelihood that students at risk for suicidal behavior will get into treatment. Well-developed and systematic planning is needed to ensure that screening and referral services are coordinated so as to facilitate access for youths into timely treatment.
Given the finite resources allocated to suicide prevention, it is necessary to direct resources into interventions that are most likely to have an impact. This article tests for possible impacts on youth suicides of a cost-intensive Australian policy change (increased firearms restriction) that limited access to a means of suicide. Suicide rates by different age groups and methods were examined for structural breaks, using Zivot-Andrews and Quandt tests. No breakpoint was found in firearm suicide among Australian youth around the time of the 1996 legislative changes. Method restriction in the form of firearms legislation could not be tied to a corresponding impact on youth suicide.
