Preventing adolescent suicide: A systematic review of the effectiveness and change mechanisms of suicide prevention gatekeeping training programs for teachers and parents

Exploring Religion as a Path to Meaning: The Role of "Pastrotherapy" in Supporting Young People's Quest for a Good Life in Nigeria

This paper examines suicide prevalence among Nigerian youth struggling to find meaning in life. Frustrated by unattainable ideals, they experience despair. The study explores religion's role in providing support for meaning-seeking individuals. Utilizing an explorative approach, the paper highlights how religion can play a role in offering solidarity, morality, and hope as vital resources for creating a meaningful life. It introduces "Pastrotherapy" as a pastoral care approach to addressing existential questions. Findings emphasize the importance of religious communities and leaders in promoting resilience and addressing underlying causes of despair. This study reveals how religious beliefs and practices support Nigerian youth facing existential challenges, shedding light on the intersection of religion, meaning-making, and mental health.

Effectiveness of a school-based Life Gatekeeper Training Program on suicide prevention in China: protocol for a randomized controlled trial

BACKGROUND

With suicide as a leading cause of death, the issue of children and adolescent suicide risks is in the spotlight today. To empower teachers in primary and secondary schools to serve as gatekeepers and to ensure the safety of children and adolescents, the systematically tailored and localized Life Gatekeeper suicide prevention program was designed for Chinese schools.

OBJECTIVE

With the ultimate goal of preventing child and adolescent suicide, we aim to outline a research protocol for examining outcomes of the recently created standardized school-based Life Gatekeeper program in reducing teachers' stigma, increasing their knowledge, willingness to intervene, and perceived competence.

METHODS

Participants will be recruited from eligible primary and secondary schools. Cluster sampling will be used to randomly assign each school to either the intervention group or the control group. The primary outcomes are stigma against suicide, suicide literacy, perceived competence, and willingness to intervene with suicidal individuals, which will be measured using the Stigma of Suicide Scale, the Literacy of Suicide Scale, and the Willingness to Intervene Against Suicide Questionnaire, respectively. Measurements will be taken at four time points, including pre-intervention, immediately after the intervention, 6-month follow-up, and 1-year follow-up.

CONCLUSIONS

The current study features innovative implementation in the real world, by using a randomized controlled trial design to examine the effectiveness of a school-based gatekeeper program among primary and secondary school teachers, following a sequence of defined and refined steps. The research will also investigate the viability of a school-based gatekeeper program for primary and secondary school teachers that could be quickly and inexpensively implemented in a large number of schools.

Development and Evaluation of Online Suicide Preventive Tool iAlive to Increase Competences in Engaging With a Suicidal Person

Background: Online implementation of suicide prevention interventions offers many advantages, facilitating the dissemination of large-scale suicide prevention interventions. An online tool iAlive aimed at raising awareness and increasing suicide prevention competences in lay people was developed and implemented in Slovenia. Aims: To develop, implement, and evaluate the iAlive tool. Method: Following the development and implementation of the tool, a nonrandomized controlled study with 310 participants was conducted. One hundred fifty-six of them fully completed the study [intervention group (used the iAlive tool): N = 85, control group (did not use the tool): N = 71]. Perceived competences in engaging with a suicidal person were assessed in both groups at baseline and at follow-up (3-4 weeks apart), which also represents the time of the intervention. Results: A significant effect of time and condition [F(1,149) = 6.62, p = .011, ηp2 = .043] showed that the intervention group assessed their perceived competences on intervention exposure more positively compared to the control group. Limitations: Additional data on different populations and people's engagement with the tool in relation to perceived competences are needed. Conclusion: The study suggests that the interactive online tool iAlive effectively increases perceived competences in engaging with a suicidal person. These results provide a background for further dissemination of the tool.

Online versus in-person gatekeeper suicide prevention training: comparison in a community sample

BACKGROUND

Suicide prevention gatekeeper Training (GKT) is a frequently used suicide prevention intervention, however, there is still limited information about its long-term impact and effectiveness of online delivery.

AIMS

The current study aimed to test the effectiveness of online GKT compared to in-person GKT in improving participant training outcomes.

METHODS

A non-randomised comparison of pre-, post- and six-month follow-up data was conducted. In total 545 people participated in GKT, 317 in SafeTALK in-person sessions and 228 in online "Start" GKT by LivingWorks. Main outcome measures included: perceived knowledge; perceived preparedness; gatekeeper efficacy; and gatekeeper reluctance to intervene.

RESULTS

Linear mixed model analysis demonstrated a significant effect for time for both modes of delivery for all four outcome measures. Post-hoc testing revealed that significant improvement in all outcomes were maintained above baseline at six-months following online and in-person training.

CONCLUSIONS

Online training performed as good, or better than in-person GKT, on measured outcomes demonstrating utility and effectiveness of the modality for use in suicide prevention training practices. Findings additionally indicate that online training may reach participants that in-person programs do not. This study provides evidence that Online GKT has significant utility in addressing a crucial need for online alternatives to evidence-based suicide prevention training.

Using Virtual Reality to Increase Nurses' Knowledge of Adolescent Suicide Precautions

BACKGROUND

Adolescents are disproportionately impacted by suicide, making it imperative nurses know how to identify those at high risk of suicide and provide safe care in the hospital setting. The purpose of this pilot study was to determine the efficacy of a virtual escape room as a learning strategy to increase nursing knowledge of suicide precautions for adolescent patients.

METHOD

A 360-degree virtual escape room was developed to increase nursing knowledge of hospital policy related to suicide. Small groups of participants navigated through two virtual hospital rooms with embedded clues and questions related to suicide screening and precautions. Pretest-posttest questionnaires were used to measure changes in knowledge.

RESULTS

Nurses demonstrated improved knowledge of hospital policy following completion of the activity. Participants also expressed a high level of satisfaction with this form of learning.

CONCLUSION

The use of a virtual escape room was an effective method for educating nurses on standards related to suicide prevention. [J Contin Educ Nurs. 2024;55(4):165-168.].

Suicide-Related Stigma and Social Responsibility Moderate the Effects of an Online Suicide Prevention Gatekeeper Training Program

AIM

Gatekeeper interventions are universal programs designed for use by the general public that provide brief training sessions in responding to suicidal risk. To date, the evidence base for the efficacy of gatekeeper intervention training programs has been mixed. However, little attention has been paid to potential psychological moderators of the efficacy of suicide gatekeeper interventions. We explore the potential moderating effects of suicide-related stigma and social responsibility on the efficacy of a suicide prevention gatekeeper training program.

METHODS

Participants were 179 college students with a mean age of 19.05 years (SD = 1.82, range 18-31). Participants were 71.5% women, 48.6% Hispanic, and 19.6% non-Hispanic White.

RESULTS

Results indicated that higher scores on suicide-related stigma were associated with smaller intervention effects on gatekeeper self-efficacy. In contrast, higher scores on social responsibility were associated with greater intervention effects with regard to gatekeeper preparedness and gatekeeper likelihood.

CONCLUSION

An improved understanding of the factors associated with efficacy of gatekeeper intervention programs may lead to the development of improved gatekeeper interventions. These findings may also contribute to the development of targeted gatekeeper interventions for specific cultural or occupational groups.

Randomized Controlled Trial of an Online Suicide Prevention Gatekeeper Training Program

Background: Suicide prevention gatekeeper training programs offer a unique opportunity to increase knowledge about suicide prevention, enhance risk identification, and reduce suicide-related stigma. Aims: This study evaluated the efficacy of an online suicide prevention gatekeeper training program in a randomized trial. Method: Participants were US college students (N = 388). Participants (69.3% women) had a mean age of 19.01 years and identified primarily as Hispanic/Latinx (52.1%) and non-Hispanic White (22.4%). Participants completed pre- and posttest surveys and were randomly assigned to either the ASK About Suicide to Save a Life (AS + K?) suicide prevention gatekeeper training program or an information-only comparison intervention. Results: Participants in the AS + K? condition reported significantly greater gatekeeper preparedness and self-efficacy, and lower stigmatized attitudes at posttraining, as compared with those in the comparison condition. There were no significant differences in likelihood of using gatekeeper skills or suicide-related knowledge across groups. Limitations: This short-term study was not able to assess behavioral change resulting in use of gatekeeper skills over time. Conclusions: Completion of gatekeeper training resulted in increases in preparedness and self-efficacy for engaging in gatekeeper behaviors, as well as a reduction in suicide-related stigma. Despite small intervention effects, the online AS + K? training appears to be a promising program.

A survey of suicide literacy in Japanese school teachers

School teachers are in a unique position to recognize suicide-related problems in their students and to appropriately support them; teachers may need high levels of suicide literacy. However, few studies have examined current levels of suicide literacy in teachers. This study aimed to investigate suicide literacy in school teachers. Teachers (n = 857) from 48 Japanese schools (primary and junior-/senior-high) answered a self-administered questionnaire assessing (a) knowledge about suicide, (b) intention to ask about students' suicidal thoughts/plans, and (c) attitudes towards talking to students with mental health problems. The average proportion of correct answers to the knowledge questions (10 items) was 55.2%. Over half of the teachers knew that suicide is a leading cause of death in adolescents (55.0%), and that asking about suicidality is needed (56.2%). Half of the teachers intended to ask students about their suicidal thoughts (50.2%) and fewer intended to ask about experiences of planning suicide (38.8%). Most of the teachers (90.4%) agreed with the idea that talking to students with mental health problems was a teacher's responsibility. Intention to ask about students' suicidal thoughts/plans were higher in teachers in their 20s (vs. 40s-60s) and working at junior-/senior-high schools (vs. primary schools). Suicide literacy in Japanese school teachers was observed to be limited. However, teachers felt responsibility for helping students with mental health problems. The development and implementation of education programs may help improve teachers' suicide literacy, which, in turn, could encourage effective helping behaviors of teachers for students struggling with suicidality.

Evaluating the Effectiveness of Suicide Prevention Gatekeeper Trainings as Part of an American Indian/Alaska Native Youth Suicide Prevention Program

According to the Centers for Disease Control suicide rates in 2022 for American Indian/Alaska Native youth are 2.5 times higher than the national average. An Urban Indian Health Organization's response to this crisis was to provide community and State-wide Gatekeeper trainings between 2012 and 2019 to teach trainees (N = 810) to respond appropriately to youth at-risk of suicide. We report data on pre-, post-, and six-month follow-up surveys with trainees. Data were analyzed using generalized linear models repeated measures to test within-subject, and between-subject mean score changes on suicide prevention-related measures "knowledge," "ask directly," "respond," "comfort," and "preparedness." Results indicated improved capacity to be prepared to address suicide in the short term and that having a graduate degree enhanced baseline suicide prevention knowledge. Over time those with less education benefited the most and better retained content. Future Trainings should engage young people and those with less education to realize the largest benefit.

Effectiveness of a localised and systematically developed gatekeeper training program in preventing suicide among Chinese adolescents

To combat the pressing issue of contemporary suicide rates, an effective Life Gatekeeper training program was developed to educate school teachers in identifying and intervening with at-risk students. Two single-arm sequential studies evaluated the program's effectiveness, spanning implementation science stages from design to refinement. The initial study employed face-to-face training (FTF), followed by a standardized video-based 'Train-the-trainer' (TTT) approach. In Study 1, post-intervention and one-month follow-up results showed improved suicide literacy, reduced stigma, and increased willingness to intervene among gatekeepers. The revised TTT program (study 2) also yielded reduced stigmatization and improved intervention competence. In addition, six out of twenty teachers exhibited gatekeeper behaviors. In conclusion, both delivery methods proved effective, particularly the practical application of the TTT version, although further research is warranted to examine long-term effectiveness of the program.

Development of the Life Gatekeeper suicide prevention training programme in China: a Delphi study

Background

Youth suicide has been a pressing public mental health concern in China, yet there is a lack of gatekeeper intervention programmes developed locally to prevent suicide among Chinese adolescents.

Aims

The current Delphi study was the first step in the systematic development of the Life Gatekeeper programme, the first gatekeeper programme to be developed locally in China that aims to equip teachers and parents with the knowledge, skills and ability to identify and intervene with students at high risk of suicide.

Methods

The Delphi method was used to elicit a consensus of experts who were invited to evaluate the importance of training content, the feasibility of the training delivery method, the possibility of achieving the training goals and, finally, the appropriateness of the training materials. Two Delphi rounds were conducted among local experts with diversified professional backgrounds in suicide research and practice. Statements were accepted for inclusion in the adjusted training programme if they were endorsed by at least 80% of the panel.

Results

Consensus was achieved on 201 out of 207 statements for inclusion into the adapted guidelines for the gatekeeper programme, with 151 from the original questionnaire and 50 generated from comments of the panel members. These endorsed statements were synthesised to develop the content of the Life Gatekeeper training programme.

Conclusions

This Delphi study provided an evidence base for developing the first gatekeeper training programme systematically and locally in China. We hope that the current study can pave the way for more evidence-based suicide prevention programmes in China. Further study is warranted to evaluate the effectiveness of the Life Gatekeeper training programme.

Vulnerability to Suicide Ideation: Comparative Study between Adolescents with and without Psychosocial Risk

Adolescents are characterized as a risk group for suicide, being the fourth leading cause of death in young people. The main aim was to compare vulnerability to suicidal ideation in a sample of young people with and without psychosocial risk. The total sample consisted of 137 adolescents, aged between 10 and 19 years (M = 14.76; SD = 1.40), and it was composed of two groups-the psychosocial risk group (n = 60) and general population group (n = 77). In both groups, suicidal ideation correlated positively with negative events and negatively with self-esteem and social support satisfaction. When comparing the two groups, the psychosocial risk group presented significantly higher mean values of negative life events (mainly separations/losses and physical and sexual abuse) and significantly lower mean values of satisfaction with social support (particularly with family and social activities). It was also found that, in the psychosocial risk group, negative life events were the only significant predictors of suicidal ideation. This study allowed identifying the role of risk and protective factors in suicidal ideation, according to the psychosocial risk of adolescents. The practical implications of the findings on adolescents' mental health and the promotion of their well-being are discussed.

Educational agents and institutions called into action in suicide prevention, intervention, and postvention

Introduction

Suicide is the second leading cause of death in the 15 to 29 age group worldwide, and is a severe public health problem. Adolescent and young adult individuals attend educational institutions which can play an essential role in detecting and preventing suicide. For this reason, the purpose of this research is to identify what educational institutions and agents are called into action in suicide prevention, intervention, and postvention.

Methods

The method of systematic review of the literature based on the PRISMA protocol was used. The review protocol was registered in PROSPERO (PROSPERO 2020 CRD42020189127). The systematic review yielded 66 articles published between 1990 and February 2023.

Results

The results show that a wide variety of educational stakeholders are required to intervene for suicide prevention, interventions and postvention between primary education and college. The study describes the different programs that have been provided, the countries in which they have been implemented and the agents who have been targeted. It also identifies gaps in the research on suicide in the educational field.

Discussion

Overall, educational suicide initiatives report positive effects on participants' understanding, attitudes, and beliefs regarding suicide and suicide prevention, although some studies have expressed some caution.

Beyond human expertise: the promise and limitations of ChatGPT in suicide risk assessment

ChatGPT, an artificial intelligence language model developed by OpenAI, holds the potential for contributing to the field of mental health. Nevertheless, although ChatGPT theoretically shows promise, its clinical abilities in suicide prevention, a significant mental health concern, have yet to be demonstrated. To address this knowledge gap, this study aims to compare ChatGPT's assessments of mental health indicators to those of mental health professionals in a hypothetical case study that focuses on suicide risk assessment. Specifically, ChatGPT was asked to evaluate a text vignette describing a hypothetical patient with varying levels of perceived burdensomeness and thwarted belongingness. The ChatGPT assessments were compared to the norms of mental health professionals. The results indicated that ChatGPT rated the risk of suicide attempts lower than did the mental health professionals in all conditions. Furthermore, ChatGPT rated mental resilience lower than the norms in most conditions. These results imply that gatekeepers, patients or even mental health professionals who rely on ChatGPT for evaluating suicidal risk or as a complementary tool to improve decision-making may receive an inaccurate assessment that underestimates the actual suicide risk.

Outcomes of professional development activities for selected Texas school personnel helping students cope with behavioral and mental health issues

School personnel help youth cope with life and school stressors. However, help may depend on each person's confidence or knowledge of such issues. In 2019 and 2020, more than 13,800 Texas educators participated in Emotional Backpack Project (EBP) training to support youth coping with behavioral and mental health issues. Post-intervention results revealed significant gains in self-perceived understanding of students' behavioral and mental health issues, improved confidence in approaching students, parents, or other school staff to discuss students' harmful behaviors, understanding of mindfulness activities, and increased knowledge of trauma informed schools and trauma informed educators. Teachers and other school personnel were less confident in approaching parents or guardians to discuss youth mental health issues than in approaching students, counselors, and other staff. School personnel's knowledge, perceptions, and confidence to help students cope with behavioral and mental health issues was significantly better after EBP interventions. EBP training should be adopted widely and occur more than once annually.

Suicide in young people: screening, risk assessment, and intervention

Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. This review outlines the epidemiology of suicide and suicidal behavior in young people. It discusses intersectionality as an emerging framework to guide research on prevention of suicide in young people and highlights several clinical and community settings that are prime targets for implementation of effective treatment programs and interventions aimed at rapidly reducing the suicide rate in young people. It provides an overview of current approaches to screening and assessment of suicide risk in young people and the commonly used screening tools and assessment measures. It discusses universal, selective, and indicated evidence based suicide focused interventions and highlights components of psychosocial interventions with the strongest evidence for reducing risk. Finally, the review discusses suicide prevention strategies in community settings and considers future research directions and questions challenging the field.

Cultural Adaptation of the teen Mental Health First Aid (tMHFA) Program from Australia to the USA

teen Mental Health First Aid (tMHFA) is an evidence-based program developed in Australia that teaches young people in grades 10-12 how to identify and respond to signs of mental health challenges and crises among peers. Recognizing the growing adolescent mental health crisis in the USA, the National Council for Mental Wellbeing, in partnership with a Johns Hopkins University research team, used a multimethod research approach to adapt the program culturally and contextually from Australia to the USA. The goals of the study were to engage adolescents, MHFA instructors, and content area experts (N = 171) in a process to determine: how to retain the elements of the course that were evidence-based and effective while adapting the program for US students, what topics to add so US students have the essential information and skills teens needed to help a friend experiencing a mental health challenge or crisis, what changes to make to curriculum materials to ensure the style and delivery resonate with US students, and what tools to include so the program is implemented safely and with fidelity in diverse US schools. This paper outlines the adaptation process, including engaging participants, identifying key recommendations for modification, and making changes to the tMHFA program. The findings demonstrate the types of adaptations that may be needed to facilitate implementation and maintenance of program effectiveness when introducing tMHFA to new populations of students in the USA. In addition, the process outlined can be replicated toward this purpose as the program continues to expand both in the USA and in other countries.

Vaping and Sleep as Predictors of Adolescent Suicidality

PURPOSE

To investigate sleep quantity as a moderator of vaping and self-reported suicidality among adolescents.

DESIGN

Cross-sectional. Setting: United States high schools.

SAMPLE

10,520 high-school students with complete data on the primary outcome of suicide attempt in the past year (76.9% response rate).

MEASURES

2019 Youth Risk Behaviors Survey.

ANALYSIS

Logistic regression to examine main effects and potential moderation.

RESULTS

Students with under seven sleep hours on school nights (OR = 2.6; 95% CI = 2.1-3.3) and who vaped in the past month (OR = 3.0; 95% CI = 2.1-3.9) had higher odds of attempting suicide in the last year. Sleep quantity moderated the relationship between vaping and suicidal thoughts in the past year (P = .01) but did not moderate the relationship between vaping and a suicide plan (P = .15) or suicide attempts (P = .06). Specifically, vaping had a smaller effect on suicidal thoughts among students who slept under seven hours on school nights (OR = 1.8) compared to the descriptively larger effect among participants with more sleep (OR = 2.5).

CONCLUSIONS

Students who vape or report low sleep quantity would be ideal participants in suicide prevention interventions as they may be at higher risk for suicidality. Organizations implementing sleep or vaping interventions should incorporate information regarding the higher odds of suicide among students with low sleep quantity or vaping habits.

The Role of Mindfulness in Mitigating the Detrimental Effects of Harsh Parenting among Chinese Adolescents: Testing a Moderated Mediation Model in a Three-Wave Study

Based on the conservation of resources theory, this study aimed to investigate the mediating role of depressive symptoms and the moderating role of mindfulness in the association between harsh parenting and adolescent suicidal ideation in the Chinese cultural context. Using a three-wave (i.e., three months apart) data collection among 371 Chinese adolescents, this study found that depressive symptoms mediated the relationship between harsh parenting and adolescent suicidal ideation. Moreover, adolescent mindfulness mitigated the effects of harsh parenting on suicidal ideation, as well as the indirect effect of harsh parenting on suicidal ideation via depressive symptoms. The theoretical and practical implications are discussed.

Posttraining Outcomes, Acceptability, and Technology-Based Delivery of the STAC Bystander Bullying Intervention Teacher Module: Mixed Methods Study

Background

Bullying is a significant problem for youth associated with wide-ranging negative consequences. Providing students who witness bullying with intervention strategies to act as defenders can reduce bullying and negative associated outcomes for both targets and bystanders. Educating teachers about bullying and training them to support students to intervene as defenders may increase the efficacy of bystander programs as teachers’ attitudes and responses to bullying relate to bystander behavior. This is particularly important in middle school, when bullying peaks and rates of reporting bullying to teachers begin to decline. Reducing implementation barriers, including limited time and resources, must also be considered, particularly for schools in low-income and rural areas. Technology-based programs can increase access and scalability but require participant buy-in for adoption.

Objective

We used a mixed methods design to inform the development of the STAC teacher module, a companion training to a brief bullying bystander intervention. STAC stands for the four bystander intervention strategies: Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion. Objectives included examining the effectiveness of the STAC teacher module and informing the translation of the training into a technology-based format that can be used as a companion to the technology-based STAC.

Methods

A sample of 17 teachers recruited from 1 middle school in a rural, low-income community completed pre- and posttraining surveys assessing immediate outcomes (ie, knowledge, confidence, comfort, and self-efficacy), intention to use program strategies, and program acceptability and relevance, followed by a qualitative focus group obtaining feedback regarding program appropriateness, feasibility, content, perception of need, and desire for web-based training. Descriptive statistics, 2-tailed independent-sample t tests, and thematic analyses were used to analyze the data.

Results

Assessment of pre- and posttraining surveys indicated that teachers reported an increase in knowledge and confidence to support defenders, confidence and comfort in managing bullying, and bullying self-efficacy. Furthermore, most participants reported that they were likely or very likely to use STAC strategies to support students who intervene in bullying. Quantitative and qualitative data revealed that participants found the training easy to use, useful, relevant, and appropriate. Qualitative data provided feedback on ways of improving the program, including revising role-plays and guidance on understanding student behavior. Participants shared positive perceptions regarding program feasibility and need for bullying-specific prevention, the most significant barriers being cost and parent buy-in, suggesting the importance of including parents in the prevention process. Finally, participants shared the strengths of a web-based program, including ease of implementation and time efficiency, while indicating the importance of participant engagement and administration buy-in.

Conclusions

This study demonstrates the effectiveness of the STAC teacher module in increasing knowledge and bullying self-efficacy and provides support for developing the module, including key information regarding considerations for web-based translation.

Correlates of suicidality in young people with depressive disorders: A systematic review

OBJECTIVE

Depression is one of the most prevalent and disabling mental health conditions among young people worldwide. The health and economic burdens associated with depressive illness are substantial. Suicide and depression are closely intertwined, yet a diagnosis of depression itself lacks predictive specificity for suicidal behaviour. To better inform suicide prevention and early intervention strategies for young people, improved identification of modifiable intervention targets is needed. The objective of this review was to identify clinical, psychosocial and biological correlates of suicidality in young people diagnosed with a broad range of unipolar and bipolar depressive disorders.

METHOD

Systematic searches were conducted across MEDLINE, Embase and PsycINFO to identify studies of young people aged 15-25 years diagnosed with unipolar or bipolar depressive disorders. An assessment of suicidality was required for inclusion. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Synthesis Without Meta-analysis guidelines.

RESULTS

We integrated findings from 71 studies including approximately 24,670 young people with clinically diagnosed depression. We identified 26 clinical, psychosocial and biological correlates of suicidality. Depression characteristics (type and severity), psychiatric comorbidity (particularly anxiety and substance use disorders) and neurological characteristics emerged as having the most evidence for being associated with suicidal outcomes. Our ability to pool data and conduct meaningful quantitative synthesis was hampered by substantial heterogeneity across studies and incomplete reporting; thus, meta-analysis was not possible.

CONCLUSION

Findings of this review reinforce the notion that suicidality is a complex phenomenon arising from the interplay of multiple contributing factors. Our findings question the utility of considering a diagnosis of depression as a specific risk factor for suicidality in young people. Suicidality itself is transdiagnostic; adoption of a transdiagnostic approach to investigating its aetiology and treatment is perhaps warranted. Future research investigating specific symptoms, or symptom networks, might help to further our understanding of suicidality among young people experiencing mental illness.

Teachers as Youth Suicide Prevention Gatekeepers: An Examination of Suicide Prevention Training and Exposure to Students at Risk of Suicide

Background

Teachers are important gatekeepers in suicide prevention for children and youth, yet little is known about factors that contribute to suicide prevention training effectiveness and the influence of student suicidality on teachers' role as gatekeepers.

Objective

This study examined teachers' attitudes and self-efficacy in suicide prevention including an examination of suicide prevention training and exposure to student suicidality. Researchers examined incremental prediction of the relationship between teachers' self-efficacy, outcome expectations, and outcome values following prevention training.

Methods

Participants included teachers in PreK-12th grade schools in the United States (N = 505). Researchers used non-parametric statistics to examine group level differences and a structural equation model (SEM) to test the proposed theoretical model.

Results

Teachers who experienced a student death by suicide reported significantly higher levels of gatekeeper reluctance than teachers who had not experienced a student death by suicide (p < 0.01). Similarly, teachers who encountered students with suicidal thoughts reported greater levels of gatekeeper reluctance (p < 0.01) and higher self-efficacy to engage in suicide prevention (p < 0.05) compared to teachers who had not had this exposure. Results of the SEM indicated an adequate goodness of fit and fit statistics [χ2 (87) = 194.420, p = 0.000; CFI = 0.95; RMSEA = 0.05]. The model remained in-tact when exposure to student suicide was added.

Conclusions

Findings support the importance of supporting teachers continued engagement in youth suicide prevention and prevention training that targets specific outcomes in teachers' attitudes and efficacy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10566-022-09699-5.

Suicidal behaviour in adolescents: Educational interventions in Mexico

Suicide in adolescents constitutes a public health problem throughout the world. The objective of this study was to identify the prevalence of suicidal behaviour in a public middle school in Mexico and to implement appropriate educational interventions in the school and community contexts. Our work took place from September 2017 to July 2018. We conducted a quasi-experimental, mixed-methodology study with 12-year-old students in first year of middle school (n = 29), using an educational intervention approach within the frame of the Life Skills Education methodology. We included family members and academic staff in the study with the view of sensitising them to suicidal behaviour. At the community level, we worked with the adolescent and adult populations to form 'gatekeepers' (guardians). We administered a questionnaire on psychosocial indicators of depression and suicide risk to 383 students in their first-to-third years of middle school. Other questionnaires were applied, and life skills focus groups (FGs) were organised with the educational intervention participants. The questionnaires addressed suicidal behaviour in adolescents, alcohol consumption, life skills and prosociality. Prevalence of attempted suicide cases came to 14.1% (95 CI% 10.7-17.9), the average age of those who reported having hurt themselves with the purpose of taking their lives was 12.9 years, 75% of those who had attempted suicide were female and 64.8% had consumed alcohol. The educational intervention with students achieved a statistically significant increase in the life skills of participants, specifically as regards self-awareness and overall scores. The family members in the FGs developed greater awareness of suicidal behaviour, and the adolescents engaged at the community level significantly broadened (p < .05) their knowledge of depression. In developing countries such as Mexico, it is essential not only to increase the number of interventions for preventing suicidal behaviour in adolescents, but also to improve instruments for measuring the extent of the problem.

Mental Health and Positive Development Prevention Interventions: Overview of Systematic Reviews

CONTEXT

Previous reviews of mental health interventions have focused on adolescents (10-19 years), with a paucity of comprehensive evidence syntheses on preventive interventions for school-aged children (5-10 years).

OBJECTIVE

To summarize and synthesize the available evidence from systematic reviews of mental health and positive development interventions for children aged 5-14.9 years in both high-income (HIC) and low- and middle-income countries (LMIC), with a focus on preventive and promotive strategies.

DATA SOURCES

This overview includes all relevant reviews from OVID Medline, The Cochrane Library, and Campbell Systematic Reviews through December 2020.

STUDY SELECTION

We included systematic reviews that synthesized empirical studies using experimental or quasi-experimental designs to evaluate the effectiveness of interventions in children aged 5-14.9 years.

DATA EXTRACTION

Data extraction and quality assessment were completed independently and in duplicate by two review authors. The AMSTAR2 tool was used to assess methodological quality.

RESULTS

We included 162 reviews. The greatest evidence was found in support of school-based universal and anti-bullying interventions in predominantly HIC. Moderate evidence was found for the use of substance abuse prevention, and early learning and positive development interventions in mixed settings. In LMIC-only contexts, the most promising evidence was found for positive youth development programs.

LIMITATIONS

The review was primarily limited by paucity of high-quality research due to methodological issues and high heterogeneity.

CONCLUSIONS

This overview of reviews highlights the need for further research to consolidate findings and understand the specific criteria involved in creating positive mental health and development outcomes from the various interventions considered.

Parent Education for Responding to and Supporting Youth with Suicidal Thoughts (PERSYST): An Evaluation of an Online Gatekeeper Training Program with Australian Parents

The gatekeeper training of parents is a promising approach for suicide prevention in young people, but little research has addressed the effectiveness of such training, especially using online delivery. This study aimed to evaluate the efficacy and acceptability of the delivery of an online suicide prevention training program, LivingWorks Start, to improve the capacity of parents to support young people at risk of suicide. The participants were 127 parents of young people aged 12-25 who completed the LivingWorks Start training and consented to participate in the evaluation. The participants completed online surveys before, after, and 3 months after training. The participants showed increases in perceived self-efficacy and formal help-seeking intentions but no change in suicide stigma. Suicide literacy also increased, but only at the three-month follow-up. Most parents found the training acceptable, and did not find it upsetting. Prior mental health, suicide-related experiences, and pre-participation vulnerability were not predictive of finding the training distressing. Overall, the findings show that online gatekeeper training for parents can be beneficial, and is rarely associated with distress.

Greater Minority Stress is Associated with Lower Intentions to Disclose Suicidal Thoughts among LGBTQ + Youth

OBJECTIVE

The current study examined suicide-related disclosure intentions in LGBTQ + youth, and the associations between reporting of lifetime experiences of minority stress and intentions to disclose suicidal thoughts.

METHOD

A sample of 592 LGBTQ + youth ages 12-24 (22.3% cisgender men, 33.1% cisgender women, 44.6% gender diverse, 75.3% white) who contacted an LGBTQ-specific crisis service, completed a survey.

RESULTS

Youth reported highest intentions to disclose future suicidal ideation to LGBTQ-specific crisis services, a mental health professional, and someone they know who also identifies as LGBTQ. They reported lowest suicide-related disclosure intentions to family, spiritual counselors, and emergency room personnel. Greater lifetime minority stress was significantly associated with lower suicide-related disclosure intentions. When specific domains of minority stress were examined separately, five domains were significantly associated with lower suicide-related disclosure intentions: identity management, family rejection, homonegative communication, negative expectancies, and internalized homonegativity. However, only internalized homonegativity remained significant when they were examined simultaneously. In addition, greater lifetime minority stress was significantly associated with lower suicide-related disclosure intentions to some groups (e.g., family, friends), but not others (e.g., others who have thought about or attempted suicide, others who identify as LGBT).

CONCLUSIONS

Minority stress may play an important role in LGBTQ + youth's suicide-related disclosure intentions. As such, reducing minority stress and its effects may be an important target to promote disclosure of suicidal thoughts and access to treatment among LGBTQ + youth.HIGHLIGHTSMinority stress was associated with lower suicide-related disclosure intentions.Internalized homonegativity was uniquely associated with disclosure intentions.Reducing minority stress may promote disclosure of suicidal thoughts.

Wer profitiert von einem Workshop zur Suizidprävention an Schulen?

Zusammenfassung. Um die Suizidprävention an Schulen zu verbessern, wurden psychoedukative Workshops für Schüler_innen implementiert und angeboten. N=200 Schüler_innen der 8.–10. Jahrgangsstufe wurden zufällig einer Experimental- oder Kontrollgruppe zugewiesen. Vor und nach dem Training sowie nach drei Monaten wurden sie zu ihrem hilfesuchenden und hilfegebendem Verhalten sowie ihrer depressiven Symptomatik befragt. Die Ergebnisse weisen darauf hin, dass besonders die als stärker suizidgefährdet eingestuften Jugendlichen von dem Training durch eine Abnahme ihrer depressiven Symptomatik profitierten. Schüler_innen der Kontrollgruppe verbesserten sich demgegenüber nicht signifikant in ihrer depressiven Symptomatik. Für das hilfesuchende ebenso wie das hilfegebende Verhalten zeigten sich positive Trends, die jedoch nicht statistisch signifikant wurden. Diese Ergebnisse zeigen – wenn auch mit Limitationen aufgrund von Ausfällen durch die Coronapandemie 2020 und durch ein restriktives Vor-Screening – die Wirksamkeit einer aufwändigen außerschulischen Suizidprävention auf Befinden und Verhalten.

Mental Health Literacy Programs for Parents of Adolescents: A Systematic Review

INTRODUCTION

Many mental illnesses begin during adolescence. Parents of adolescents need to have sufficient mental health literacy (MHL) to recognize mental health problems in their children and to assist them with help-seeking. Although several educational programs have been developed to enhance parental MHL, their effectiveness has not been established. This study provides a systematic review for the effectiveness of MHL programs in parents of adolescents.

METHODS

PubMed, PsycINFO, CINAHL, ERIC and Web of Science were searched from the earliest date possible until February 2022; references of studies which met eligibility criteria were also screened. Studies that assessed quantitative change in at least one of the following components of parental MHL were included: knowledge of mental health/illnesses; stigma toward people with mental health problems; confidence in helping children with mental health problems, and intention, knowledge or behavior of helping children with mental health problems. Risk of bias (ROB) for each outcome within the included studies was rated using the revised Cochrane risk-of-bias tool for randomized trials for randomized controlled trials (RCTs), and the Risk of Bias Assessment Tool for Nonrandomized Studies for nonrandomized studies.

RESULTS

Nine studies (four RCTs, three controlled before-and-after studies, and two case series), reported in 10 articles, were included. Mental health knowledge and/or confidence was significantly improved in several studies, while no studies observed significant improvement in stigma and/or intention/behavior of helping children. ROB was high in five out of nine studies (10 out of 18 outcomes) and unclear in the others.

CONCLUSIONS

A limited number of studies have evaluated effects of MHL program in parents and inconsistent quality contributes to difficulty in establishing their overall effectiveness. More studies with appropriate methods of recruitment, measurement and analysis, and transparent reporting are needed.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193072, Identifier: CRD42020193072.

Positive Relationships with Adults and Resilience to Suicide Attempt among New Mexico Hispanic Adolescents

Suicide is a leading cause of adolescent death and has increased in recent years. The purpose of this study was to examine the effect that relationships with adults at home and in the community had on the probability of suicide attempts of Hispanic teenagers in New Mexico. Data from the 2019 New Mexico Youth Risk and Resiliency Survey were analyzed to identify the ways in which relationships with adults influenced suicide attempts among Hispanic adolescent students. The examined factors included: relationships with adults in the home and in the community and with same-age friends, and participation in hobbies or organizations outside of school. The resiliency factors were similar for male and female Hispanic students. As positive relationships with adults at home or in the community increased, the probability of suicide attempts decreased by 37–54%. Positive relationships with same-age friends were also associated with reduced suicide attempts. Community organization involvement and hobbies affected males and females differently. Adults at home and in the community can decrease the risk of suicide for Hispanic teenagers through supportive relationships. Hybrid programs focusing on adolescent health, positive communication, and academic support, which integrate adults from home and community environments, show promise in reducing suicidal thoughts and other risk behaviors.

Youth Mental Health First Aid: Examining the Influence of Pre-Existing Attitudes and Knowledge on Training Effectiveness

Youth Mental Health First Aid (YMHFA) is a gatekeeper training designed to assist professionals in their identification and response to youth mental illness. Despite widespread implementation, few studies have examined how individual-level trainee characteristics may impact the effectiveness of this training. In this study, we examined how pre-existing knowledge and attitudes about youth mental illness (measured prior to participation in the program) influenced training outcomes. We used a sample of 987 child-serving professionals who completed the YMHFA training program to identify demographic and work-related factors that predicted pre-existing attitudes and knowledge. The sample was then divided into two groups based on pre-existing attitudes and knowledge. We examined training effectiveness across four constructs: knowledge, confidence, intentions to intervene, and stigma. Findings indicate that gender and work-related characteristics were associated with pre-existing knowledge and attitudes about youth mental illness. The magnitude of training effectiveness varied across pre-existing attitudes and knowledge. Those participants with above average attitudes and knowledge benefited little from the program, suggesting that universal implementation of YMHFA may not be an efficient use of resources. Suggestions for a tiered implementation plan that prioritizes professionals most in need of the training are discussed.

Effectiveness of a Continuity-of-Care Model to Reduce Youth Suicidality

Background: Suicidal ideation and recent suicide attempts greatly increase the risk of suicide among youth. Many youth experiencing suicidality are not adequately connected to in-person treatment. Aims: This study aimed to determine the efficacy of a continuity-of-care approach in reducing suicide attempts, ideation, and related hospital and emergency department (ED) visits among youth at high risk for suicide. Method: Data on suicidal ideation, attempts, and related hospital and ED visits were collected over a 6-month period for youth under age 25 (n = 376). One-way repeated measures ANOVA and Cochran's Q tests assessed change from intake at the 3- and 6-month follow-up. Results: Youth had significantly fewer suicide attempts and related hospital and ED visits at both 3- and 6-month timepoints. Suicidal ideation decreased to 52% from intake to 6-month follow-up. Limitations: This study lacked a comparison population to examine continuity-of-care versus treatment-as-usual. Furthermore, the study did not extend beyond 6 months, limiting the ability to assess the intervention's long-term effectiveness. Conclusion: This youth-focused continuity-of-care model reduced suicidal ideation and related behaviors. Further studies should utilize control groups to confirm the validity of these results.

Exposure to Self-Directed Violence: Understanding Intention to Help and Helping Behaviors among Adolescents and Emerging Adults

Exposure to self-directed violence (SDV) is a public health issue. Prevention trains third parties to identify SDV risk and provide help. However, we know little about the range of help provided to those who engage in SDV. The current study used a cross-sectional online survey of 1031 adolescents and emerging adults to learn about their SDV exposure, intent and attempts to help, and barriers to helping. Most participants reported SDV exposure, commonly by a peer, and provided help. Regression analyses showed that intent to help was predicted by social norms and having knowledge of resources, and such knowledge (but not social norms) was also related to actual helping behaviors. Qualitative analysis of short open-ended questions on the survey documented a range of barriers to helping. Findings support but also encourage revision of theoretical models of helping upon which prevention programs are based.

Gatekeeper training for friends and family of individuals at risk of suicide: A systematic review

AIMS

Gatekeeper training (GKT) is an important suicide prevention strategy. Studies have evaluated the effectiveness of GKT in different populations, often neglecting family and friends who play a vital role in caring for people with suicide risk. This review evaluated GKT programs targeting family and friends to determine their effectiveness in this specific population.

METHODS

Academic databases were searched for studies on GKT programs. Programs involving family and friends caring for people with suicide risk were assessed for any impact on knowledge, self-efficacy, attitudes, and suicide prevention skills.

RESULTS

Seventeen studies were reviewed. GKT showed significant gains on outcomes of interest. Three studies targeted family and friends, with one involving them in program creation and conduction and another adjusting the program after their input.

CONCLUSIONS

GKT programs have potentially positive effects on family and friends caring for people with suicide risk. Few programs address the specific needs of this group, and programs adapted specifically for them are scarce. Future program development recommendations are discussed.

Effectiveness of suicide prevention gatekeeper training for university teachers in Japan

Suicide is a leading cause of death among Japanese college and university students. Our previous study showed that the gatekeeper training (GKT) program significantly improved competence and confidence in the management of suicidal students in university administrative staff. However, we could not determine which component of the program was effective, nor if this program was effective for university teachers as well. In the current study, 81 university teachers were recruited; 63 of them received a general mental health lecture (MHL) and 18 of them received a 2.5 -h GKT program based on the Mental Health First Aid program. Competence and confidence in managing suicide intervention and behavioral intention as a gatekeeper were assessed by a self-report questionnaire before and immediately after the intervention. As a result, we found a significant improvement in competence in the management of suicidal students in the GKT group compared to the MHL group. We also found significant improvements in confidence in the management of suicidal students and behavioral intention as gatekeepers in the GKT group, although the questionnaires for these outcomes were not validated. The program satisfaction score was significantly higher in the GKT group than in the MHL group. To our knowledge, this is the first study to evaluate a GKT program for university teachers in Japan. By comparing the two groups, we explicitly confirmed that active involvement of the participants is crucial for effective suicide prevention training.

Exposure to Suicidal Behavior and Social Support Among Sexual- and Gender-Minority Youth

OBJECTIVES

In this study, we examine reports of exposure to suicidal behavior by youth sexual and gender identity. We explore how exposure is related to depressed mood in the context of high social support while accounting for cumulative adversity.

METHODS

Data from a large national sample of youth aged 14 to 15 years in the United States (N = 3979) were collected online in 2018-2019.

RESULTS

Sexual- and gender-minority youth were more likely to know someone close to them who attempted suicide, relative to cisgender heterosexual youth. Cisgender heterosexual youth were buffered from recent depressed mood when they endorsed having high social support in the context of exposure to suicidal behavior; less social support did not provide such a buffer. For cisgender sexual-minority male and female youth, exposure to suicidal behavior was related to recent depressed mood regardless of the level of social support. For gender-minority youth assigned female at birth, the combination of exposure and high social support was significantly associated with elevated depressed mood. Cumulative adversity accounted for some but not all of these relationships, indicating the influential role of exposure to suicidal behavior on depressed mood for some youth.

CONCLUSIONS

These findings illustrate the complexities of social support and raise questions about its potential to magnify stress rather than serve as a buffer for some youth. Although findings need to be replicated, suicide prevention efforts should carefully consider how to promote resilience among these suicide-exposed sexual- and gender-minority youth who may themselves be at risk for suicidal ideation and behavior.

The Effectiveness of Active Learning Strategies in Gatekeeper Training on Behavioral Outcomes

Background: Studies of suicide prevention gatekeeper trainings (GKT) show temporary enhancements in short-term behavioral outcomes and limited enhancements in intermediate behavioral outcomes. Aims: We aimed to examine the impact of two training enhancements (role-play and booster) on intermediate GKT outcomes. Method: The study used a factorial randomized controlled design to assign participants to one of four groups. Three indicators of gatekeeper behavior at 6-month follow-up were the primary outcomes of interest. We used propensity score-based techniques to address observed imbalances. Results: At 6 months, among participants assigned to role-play, a significantly larger proportion of those assigned to booster performed identifications and referrals followed by a notification to the referral source, and followed by escorting the youth to the resource. Limitations: While observed imbalances were addressed, unobserved differences may persist. The validity of self-reported indicators to measure actual behavior remains unknown. Conclusion: Results suggest that active learning strategies can, in combination, enhance the effectiveness of trainings. The strategies seem to increase the comprehensiveness of gatekeeper behaviors.

The Teacher Expectations and Values for Suicide Prevention Scale

Background: Teachers play a critical role in youth suicide prevention, yet few psychometrically sound instruments exist to measure teachers' expectations and values regarding suicide prevention. Aims: This study examined the factor structure and psychometric properties of the Teacher Expectations and Values for Suicide Prevention (TEVSP) Scale. Method: The TEVSP was administered to 500 teachers in the United States. Confirmatory factor analysis was used to determine the factor structure and bivariate correlations were used to investigate convergent and discriminant validity. Mann-Whitney U tests investigated group differences in TEVSP scores between participants who had received suicide training and those who had not. Results: Results support a three-factor hierarchical model with strong internal consistency and evidence of validity. Significant differences were found in TEVSP scores between groups. Limitations: There is a need to further explore the psychometric properties of the scale across samples and face-to-face methods. Conclusion: The TEVSP is a sound instrument that can be used to measure teachers' expectations and values for suicide prevention.

Taking Youth Suicide Prevention to the Schools: Pilot Evaluation of School-Based Clinician Outcomes and Perspectives of a Multi-Modal Program Including Post-Training Online Consultations for Management of Ongoing Suicide Risk

School-based youth-specific suicide prevention and early intervention initiatives are presently underdeveloped. The current study conducted a pilot evaluation of a multi-modal suicide prevention training program for school-based social workers, ‘Management of Youth Suicidality Training for Schools’ (MYSTS). The program comprised a two-day workshop and six fortnightly post-workshop webinar online consultations. Participants were 36 social workers (years’ experience M = 11.23, SD = 8.29) employed by the Department of Education in Tasmania, Australia. Outcomes were self-rated confidence, competence, and knowledge of self-harm in young people, and attitudes toward suicide prevention and suicide-related behaviors. Exploratory quantitative results indicated significant improvements with large effect sizes for participants’ self-reported competence (d = 1.33), and confidence (d = 1.29) to identify and respond therapeutically to youth suicidality following the workshop. Confidence remained significantly higher than baseline following the online consultations (d = 0.90). Qualitative analysis of online supervision consultations indicated key themes of accessibility, communication and information sharing, and clinical management. Participants endorsed the MYSTS package as well-presented, with relevant topics, and effective learning activities. This study highlights the need for continued supervisory or implementation support to practitioners following suicide prevention training initiatives and suggests web-based teleconference technology as a feasible strategy for this. Further evaluation of the MYSTS package, including a suitable comparison or control condition, is indicated.