The Impact of Universal Suicide-Prevention Programs on the Help-Seeking Attitudes and Behaviors of Youths
Abstract
Background: While the ultimate goal of adolescent suicide-prevention efforts is to decrease the incidence of death by suicide, a critical intermediary goal is directing youths toward effective sources of assistance. Aim: To comprehensively review the universal prevention literature and examine the effects of universal prevention programs on student’s attitudes and behaviors related to help-seeking. Method: We systematically reviewed studies that assessed help-seeking outcomes including prevention efforts utilizing (1) psychoeducational curricula, (2) gatekeeper training, and (3) public service messaging directed at youths. Of the studies reviewed, 17 studies evaluated the help-seeking outcomes. These studies were identified through a range of sources (e.g., searching online databases, examining references of published articles on suicide prevention). Results: The results of this review suggest that suicide-prevention programming has a limited impact on help-seeking behavior. Although there was some evidence that suicide-prevention programs had a positive impact on students’ help-seeking attitudes and behaviors, there was also evidence of no effects or iatrogenic effects. Sex and risk status were moderators of program effects on students help-seeking. Conclusions: Caution is warranted when considering which suicidal prevention interventions best optimize the intended goals. The impact on adolescents’ help-seeking behavior is a key concern for educators and mental-health professionals.
References
1980). Attitudes, personality, and behavior. Chicago, IL: Dorsey Press.
(1999). Suicide within 12 months of contact with mental health services: National clinical survey. British Journal of Medicine, 318, 1235–1239.
(2003). An evaluation of a school based suicide prevention program. Adolescent and Family Health, 3, 81–88.
(2004). An outcome evaluation of the SOS suicide prevention program. American Journal of Public Health, 94, 446–451.
(2007). Evaluating the SOS suicide prevention program: A replication and extension. BMC Public Health, 7, 161–168.
(2007). Emotional support and suicide prevention through the Internet: A field project report. Computers in Human Behavior, 23, 971–984.
(2001). Help-seeking behavior prior to nearly lethal suicide attempts. Suicide and Life-Threatening Behavior, 32, 68–75.
(2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47, 372–394.
(2007). The role of randomized trials in testing interventions for the prevention of youth suicide. International Review of Psychiatry, 19, 617–631.
(2000). Impact of attitudes and suicidal ideation on adolescents’ intentions to seek professional psychological help. Journal of Adolescence, 23, 35–45.
(2007). Postcards from the Edge project: Randomized controlled trial of an intervention using postcars to reduce repetition of hospital treated deliberate self-poisoning. British Medical Journal, 331, 805–807.
(2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youths. Journal of Consulting and Clinical Psychology, 70(1), 44–55.
(1992). Youth suicide prevention programs: A resource guide. Atlanta, GA: Author.
. (2009). National suicide statistics at a glance: Percentage of U. S. high school students reporting considering, planning, or attempting suicide in the past 12 months, by sex, United States, 2007. Retrieved from www.cdc.gov/ViolencePrevention/suicide/statistics/youth_risk.html
. (2007). Control-group study of an intervention training program for youth suicide prevention. Suicide and Life-Threatening Behavior, 37, 135–144.
(1993). Suicide prevention: A classroom presentation to adolescents. Social Work, 38, 197–203.
(2007). Suicide prevention: An analysis and replication of a curriculum-based high school program. Social Work, 52, 41–49.
(2008). What prevents adolescents from seeking help after a suicide education program? Suicide and Life-Threatening Behavior, 38, 74–86.
(1992). An empirical investigation of adolescent suicidal ideation. Adolescence, 27, 813–818.
(1997). Adolescents voice their needs: Implications for health promotion and suicide prevention. Canadian Journal of Counseling, 31, 53–66.
(1995). Differences in young adolescents’ coping strategies based on gender and ethnicity. Journal of Early Adolescence, 15, 203–219.
S. (2010). Youth perceptions of suicide and help-seeking: They’d think I was weak or “mental.” Journal of Youth Studies, 13, 699–715.
(2011). The effectiveness of middle and high school-based suicide prevention programs for adolescents: A systematic review. Injury Prevention, 17, 43–49.
(1988). Strategies for the primary prevention of adolescent suicide. School Psychology Review, 17, 559–569.
(2001). Suicidal ideation and help-negation: Not just hopelessness or prior help. Journal of Clinical Psychology, 57, 1–14.
(2002). Why are we not getting any closer to preventing suicide? British Journal of Psychiatry, 181, 372–374.
(1990). Demographic differences in adolescents’ health concerns and perceptions of helping agents. Journal of Clinical Child Psychology, 19, 44–54.
(2006). Adolescent suicide prevention: Gender differences in students’ perceptions of the acceptability and intrusiveness of school-based screening programs. Journal of School Psychology, 44, 271–285.
(2010). Adolescent help-seeking and the yellow ribbon suicide prevention program: An evaluation. Suicide and Life-Threatening Behavior, 40, 628–639.
(1993). Adolescent suicide prevention: Current research and social policy implications. American Psychologist, 48, 169–181.
(1983). An operational classification of disease prevention. Public Health Reports, 98, 107–109.
(2003). Youth suicide risk and preventative interventions: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 386–405.
(2003). Media contagion and suicide among the young. American Behavioral Scientist, 46, 1269–1284.
(2001). Youth suicide prevention. Suicide and Life-Threatening Behavior, 29, 353–364.
(2002). Seeking help from the internet during adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1182–1189.
(2004). Teenagers’ attitudes about coping strategies and help-seeking behavior for suicidality. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1124–1133.
(1994). Beyond coping: An empowerment perspective on stressful life events. Journal of Sociology and Social Welfare, 21, 201–219.
(1998). Prevention and early intervention for depression in adolescence and early adult life. European Archives of Psychiatry and Clinical Neuroscience, 248, 32–45.
(2009). Gatekeeper training as a preventative intervention for suicide: A systematic review. Canadian Journal of Psychiatry, 54, 260–268.
. (2003). School approaches to youth suicide prevention. American Behavioral Scientist, 46, 1211–1223.
(1992). Adolescents’ experience with and response to suicidal peers. Suicide and Life-Threatening Behavior, 22, 315–321.
(1994). An evaluation of adolescent suicide intervention classes. Suicide and Life-Threatening Behavior, 24, 224–233.
(1995). Suicide prevention in an educational context: Broad and narrow foci. Suicide and Life-Threatening Behavior, 25, 123–133.
(1993). The relationship of bystander intervention variables to adolescents’ responses to suicidal peers. Journal of Primary Prevention, 13, 231–244.
(1996). The use of simulations to assess the impact of an adolescent suicide response curriculum. Suicide and Life-Threatening Behavior, 26, 359–364.
(1989). Lifelines: A school based adolescent suicide response program. Dubuque, IA: Kendall/Hung.
(2007). Who gets care? Mental health service use following a school-based suicide prevention program. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1341–1348.
(2002). Unmet need for mental health care among U. S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159, 1548–1555.
(2009). Tennessee lives count: Statewide gatekeeper training for youth suicide prevention. Professional Psychology: Research and Practice, 40, 126–133.
(2007, September). Suicide prevention public messaging: Differences in adolescent boy’s and girl’s perceptions of suicidal risk. Paper presented at the Women’s Health Research Conference, University of Minnesota, Minneapolis.
(2009). Suicide prevention with adolescents: Considering potential benefits and untoward effects of public service announcements. Crisis, 30, 128–135.
(1993). Coping with distress and self harm: The impact of a primary prevention program among adolescents. Journal of Adolescence, 16, 121–140.
(2003). Risk of suicide and related adverse outcomes after exposure to a suicide prevention program in the US Air Force: Cohort study. British Journal of Medicine, 327, 1376–1378.
(1996). Strategic marketing for nonprofit organizations management. Upper Saddle River, NJ: Prentice Hall.
(1997). Measuring barriers to help-seeking behavior in adolescents. Journal of Youth and Adolescence, 26, 637–649.
(2005). Suicide prevention strategies: A systematic review. Journal of the American Medical Association, 294, 2064–2074.
(2000). Comprehensive textbook of suicidology. New York, NY: Guilford.
(1997). School-based suicide prevention programs. Are they effective? School Psychology Review, 26, 383–396.
(1996). School-based prevention of adolescent suicide: Issues, obstacles, and recommendations for practice. Journal of Emotional and Behavioral Disorders, 4, 221–230.
(2009). Suicide prevention programs in the schools: A review and public health perspective. School Psychology Review, 38, 168–188.
(2003). What works in prevention. Principles of effective prevention programs. American Psychologist, 58, 449–456.
(2004). Help-seeking behavior and the internet: An investigation among Australian adolescents. Advances in Mental Health, 3, 16–23.
(2003). Adolescent suicidality and adult support: The reach for health study of urban youths. American Journal of Health Behavior, 27, 633–644.
(1993). The impact of a suicide prevention program for adolescents on suicidal tendencies, hopelessness, ego identify, and coping. Suicide and Life-Threatening Behavior, 23, 120–129.
(1989). Suicide awareness programs in the schools: Effects of gender and personal experience. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 925–930.
(2011). Challenges in U. S. suicide prevention public awareness programs. In , International handbook of suicide prevention: Research, policy, and practice (pp. 577–590). London, UK: Wiley. doi 10.1002/9781119998556.ch33
(1996). A systematic overview of adolescent programs. Canadian Journal of Public Health, 87, 319–324.
(2006). Suicide prevention in adolescents: A controlled study of the effectiveness of a school-based psycho-educational program. Journal of Child Psychology and Psychiatry, 47, 910–918.
(2007). QPR gatekeeper training for suicide prevention: The model, rational, and theory. Retrieved from qprinstitute.com
(2000). Adolescents’ help-seeking behavior: The difference between self- and other-referral. Journal of Adolescence, 23, 721–740.
(2008). An evaluation of suicide gatekeeper training for school counselors and teachers. Professional School Counseling, 11, 386–394.
(1991). A school-based procedure for the identification of adolescents at-risk for suicidal behaviors. Family and Community Health, 14, 64–75.
(2007). When and how do young people seek professional help for mental health problems. Medical Journal of Australia, 187, S35–S39.
(2006). Internet-based intervention for mental health and substance use problems in disaster-affected populations: A pilot feasibility study. Behavior Therapy, 37, 190–205.
(1993). De Utrechtse Coping Lijst: UCL [
(The Utrecht Coping List ]. Lisse, The Netherlands: Swets and Zeitlinger.1988). Preventing teenage suicide: A critical review. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 675–687.
(1987). An evaluation of three youth suicide prevention programs in New Jersey (final project report). Trenton, NJ: New Jersey State Department of Health and Human Services.
(1991). The impact of curriculum-based suicide prevention programs for teenagers. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 588–596.
(2004). The Columbia Suicide Screen: Validity and reliability of a screen for youth suicide and depression. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 71–79.
(1988). Evaluation of a suicide awareness curriculum for high school students. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 705–711.
(1988). Development of a brief checklist to assess coping in pediatric populations. Journal of Pediatric Psychology, 13, 555–574.
(1996). Help-seeking pathways for children and adolescents. Journal of Emotional and Behavioral Disorders, 4, 210–220.
(2010). Does a gatekeeper suicide prevention program work in a school setting? Evaluating training outcome and moderators of effectiveness. Suicide and Life-Threatening Behavior, 40, 506–515.
(1999). The surgeon general’s call to action to prevent suicide. Washington, DC: Author.
. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575–600. doi 10.1037/a0018697
(1997). Suicide contagion. In , Review of suicidology (pp. 96–137). New York, NY: Guilford.
(1991). The impact of curriculum-based suicide prevention programs for teenagers: An 18-month follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 811–815.
(2005). Promoting and protecting youth mental health through evidence based prevention and treatment. American Psychologist, 60, 628–648.
(2008). The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempt. Drug and Alcohol Dependence, 95(Suppl.), S60–S73.
(2001). Adolescent opinions about reducing help-seeking barriers and increasing appropriate help engagement. Journal of Educational and Psychological Consultation, 12, 354–364.
(2005). Measuring help-seeking intentions: Properties of the general help-seeking questionnaire. Canadian Journal of Counseling, 39, 15–28.
(2008). Suicide statistics: Introduction. Retrieved from www.who.int/mental_healthlprevention/suicided/suicideprevent/en/print.html
. (2010). Toward evidence-based suicide prevention programs. Geneva, Switzerland: Author.
. (2006). Development and evaluation of a youth mental health community awareness campaign – The Compass Strategy. BMC Public Health, 6, 215–228.
(2008). Randomized trail of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. Journal of Consulting and Clinical Psychology, 76, 104–115.
(2010). College students’ intentions to seek help for suicidal ideation: Accounting for the help-negation effect. Suicide and Life-Threatening Behavior, 40, 438–450.
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