Schilling, E. A., Aseltine, R. H., Jr., & James, A. (2016). The SOS suicide prevention program: Further evidence of efficacy and effectiveness. Prevention Science, 17(2), 157–166.
This study evaluated the Signs of Suicide (SOS) prevention program in reducing suicide attempts among the youth using a rigorous design.
The proposed article first notes that adolescent suicide is a leading risk of high mortality among teenagers and suicidal behavior later in life. The authors claim that SOS is a useful school-based intervention for identifying depressive symptoms and abnormal responses to stress. Consequently, the program can help teach students how to recognize suicide risk and receive help if the self-assessment score is high. Previous SOS assessments have involved post-tests only with no comparison to baseline. As a result, this study included a pre-test in order to compare the intervention and control before and after the program.
Basically, the research approach of the study is as follows:
- 1,575 ethnically diverse students (ninth grade) in 17 Connecticut high schools implementing the SOS program (Schilling et al., 2016).
- A pre-test assessment and a post-test survey was administered on the students after completing a 3-month SOS program.
- The intervention and control group were randomly assigned four schools each in the 2008-2009 academic year.
- The duration and number of sessions are not reported in the study.
- Data analysis involved a regression model to determine how SOS affected suicide outcomes.
The authors covered many topics, including:
- Goals and implementation of SOS programs in a school setup.
- Self-assessment procedures and individual scores for which help is indicated.
- The methodological rigor required and standards for evaluating the efficacy of SOS.
- Effectiveness of pre-tests and post-tests in comparing intervention and control groups.
Comparing the pre-intervention and post-intervention scores, the researchers conclude that SOS decreases suicide attempts in high-risk students. It also enhances their understanding and detection of depressive symptoms and promotes help-seeking behavior in depressed individuals or on behalf of their friends. Additionally, the rate of suicide attempts is significantly lower in SOS participants three months after the program than those who do not receive the intervention.
Thorn, P., Hill, N. T. M, Lamblin, M., Teh, Z., Battersby-Coulter, R., Rice, S., Bendall, S., Gibson, K. L., Finlay, S. M., Blandon, R., de Souza, L., West, A., Cooksey, A., Sciglitano, J., Goodrich, S., & Robinson, J. (2020). Developing a suicide prevention social media campaign with young people (the #chatsafe project): Co-design approach. JMIR Mental Health, 7(5), e17520.
This study assessed young people’s experiences of an inclusive suicide prevention intervention delivered through an accessible platform – #chatsafe.
This second article first discusses the efficacy of communication in preventing suicidal ideation and attempt. It highlights the benefits of social media in promoting help-seeking behavior because of the nonjudgmental conditions provided. The authors observe that suicide prevention programs that resonate with adolescents enhance awareness and attitudes towards suicidal behavior. Therefore, the article emphasizes the usefulness of co-design and delivery of the psycho-educational intervention (safe communication about suicide risk) in improving youth engagement.
The design of the study includes the following elements:
- 11 co-design workshops were held in four Australian territories (Thorn et al., 2020).
- 6-16 students attended each workshop that lasted 2.5-6 hours and completed a survey (Thorn et al., 2020).
- The study was conducted in the 2017-2019 period and involved youth (16-25 years) recruited via social media.
- Data analysis employed descriptive statistics and identification of themes to inform the next workshop agenda.
The authors covered a range of topics such as:
- Co-design of suicide prevention programs and their effect on suicide-related literacy and rates.
- Social media is a safe environment for sharing suicidal thoughts and seeking peer support.
- Offline and online suicide literacy interventions for high-risk youth.
The authors also note that suicide prevention campaigns that promote peer-to-peer communication (online) strategy can achieve better outcomes than traditional approaches. Further, the co-design process offers safe, youth-friendly conditions and tailored information on seeking help, including useful resources and support pathways. The authors conclude that such activities improve suicide literacy and equip young people with skills to communicate safely about suicidal thoughts.
Bailey, E., Spittal, M. J., Pirkis, J., Gould, M., & Robinson, J. (2017). Universal suicide prevention in young people: An evaluation of the safeTALK program in Australian high schools. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 38(5), 300–308.
The study examines the effects of universal suicide programs on suicidal ideation.
The third proposed article is slightly different from the other two studies reviewed in that it evaluates the iatrogenic effects arising from school-based suicide prevention initiatives. It begins by providing worrying statistics of high suicide rates – suicidal ideation and attempt in Australia. While psychological outcomes of psycho-educational activities is mostly a subject of research inquiry, potentially negative effects, such as distress and depressive symptoms, are rarely investigated. Consequently, this study examines the efficacy of such interventions and possible iatrogenic effects associated with them.
The basic approach of this study entails:
- 129 students drawn from three Australian high schools were involved in an educational intervention (safeTALK training) (Bailey et al., 2017).
- Participants were consenting students aged 16-18 years in secondary schools.
- SafeTALK was delivered through a workshop, though the duration of the session was not measured.
- Each student attended one safeTALK workshop (a group of 30) that encompassed lectures, videos, and role-plays (Bailey et al., 2017).
- Pre- and post-test design with help-seeking behavior, suicide literacy, and suicidal ideation measured using a questionnaire.
The topics the study examined included:
- The problem of suicidal ideation and attempt among people aged 15-24 years.
- Types of suicide prevention measures, including those appropriate to a school environment.
- Evaluation of educational suicide prevention programs, especially multi-modal ones.
No evidence was found linking the psycho-educational program with negative outcomes, such as suicidal ideation. On the contrary, the training appeared to decrease distress and increase the probability of seeking help. The study concluded that universal suicide prevention programs in school settings increase awareness of risks, promote help-seeking behaviors, and have no negative effects.
Robinson, J., Hetrick, S., Cox, G., Bendall, S., Yuen, H. P., Yung, A., & Pirkis, J. (2016). Can an internet‐based intervention reduce suicidal ideation, depression and hopelessness among secondary school students: Results from a pilot study. Early Intervention in Psychiatry, 10(1), 28–35.
The study evaluates the efficacy of online psychoeducational interventions in preventing adolescent suicide.
The fourth proposed article delves into the potential use of cognitive-behavioral therapy (CBT) delivered via the internet in modifying suicidal behavior among adolescents. Since schools are optimal environments for implementing suicide prevention interventions, the study included an internet-based CBT program tailored to high-risk learners. The setting is appropriate because students seek help for mental health issues from their teachers, thus the training can be a less-stigmatizing alternative to traditional psychotherapy.
The methodology adopted for this study includes:
- 11 secondary schools from Melbourne participated in the research (Robinson et al., 2016).
- 34 students completed the baseline survey but only 27 received the intervention (Reframe IT) – no control group.
- 21 finished all the eight modules of the program, each lasting 15-20 minutes (Robinson et al., 2016).
- Three post-intervention outcomes measured using a pre-test/post-test design: suicidal ideation, depression, and hopelessness.
The specific topics addressed in the research were:
- Depressive symptoms and hopelessness as risk factors for suicide in youth.
- Most effective and promising interventions for preventing suicide in school settings.
- CBT use with depressed adolescents in clinical contexts and adherence levels.
- CBT delivery over the internet is cost-effective and ensures better treatment outcomes.
In this study, the intensity of suicidal ideation, depression, and hopelessness declined significantly during the program. The authors establish that internet-based CBT is a safe and effective tool for reducing suicide-related behaviors in adolescents. They conclude that a significant reduction in suicide risk can be achieved with psycho-educational programs delivered through the internet. Further, this delivery approach is less costly and more accessible than traditional, face-to-face interventions.
Hill, R. M., & Pettit, J. W. (2019). Pilot randomized controlled trial of LEAP: A selective prevention intervention to reduce adolescents’ perceived burdensomeness. Journal of Clinical Child & Adolescent Psychology, 48(1), 45–56.
The study investigated levels of perceived burdensomeness towards family or friends after an internet-based psychoeducational intervention.
The final proposed article is unique in the sense that it examines how a selective web-based program (LEAP) can be used to modify perceptions of burdensomeness that are associated with elevated suicide risk among adolescents. The authors claim that unlike universal approaches that involve broad-based, population-level interventions, selective ones are more effective, as they focus on specific risk factors (Hill & Pettit, 2019). As a result, a CBT-based intervention delivered via the internet to target perceived burdensomeness can reduce suicidal behavior in the adolescent population.
The methodology used in this study included the following components:
- 708 adolescents aged 13-19 years were recruited from United States schools (Hill & Pettit, 2019).
- 100 met the inclusion criteria but only 80 provided parental consent.
- The LEAP intervention was delivered in four modules based on CBT principles – the duration of each session is not mentioned.
- Four post-test measures were used: perceived burdensomeness, depression, suicidal ideation, and participant satisfaction.
- Data analysis involved correlations and t-tests comparing intervention and control groups.
Some of the topics that were the focus of this study include:
- The benefits of selective suicide prevention methods over universal interventions for the youth.
- The specific risk factors for suicide-related behaviors in adolescent learners.
- The advantages of web-based programs over one-on-one delivery – overcoming barriers to health access.
In this study, post-LEAP perceived burdensomeness was lower than baseline scores. Additionally, depressive symptoms declined significantly in the intervention group compared to the control arm after the program but the levels of suicidal ideation were not any different between conditions. The selective intervention appeared to modify risks associated with high suicide-related behavior in adolescents. The authors conclude that factors that increase suicide risk such as depression can be addressed through a web-based psycho-educational intervention.