Suicide Prevention Programs in the Schools: A Review and Public Health Perspective
Miller, David N., Eckert, Tanya L., Mazza, James J., School Psychology Review
Abstract. The purpose of this article is to provide a comprehensive review of school-based suicide prevention programs from a public health perspective. A literature review of empirical studies examining school-based suicide prevention programs was conducted. Studies were required to contain information pertaining to the implementation and outcomes of a school-based program designed to address suicidal behaviors among children and youth. A total of 13 studies was identified. Most of the studies (77%) were classified as universal suicide prevention programs (n = 10), with the remaining studies classified as selected suicide prevention programs (n = 3). Studies were coded based on key methodological features of the Task Force on Evidence-Based Interventions in School Psychology Procedural and Coding Manual (Kratochwill & Stoiber, 2002). The highest methodology ratings were obtained by two universal suicide prevention programs (Klingman & Hochdorf, 1993; LaFromboise & Howard-Pitney, 1995) and one selected prevention program (Randell, Eggert, & Pike, 2001), although the selected suicide prevention programs demonstrated proportionally more key methodological features than the universal suicide prevention programs. However, only 2 of the 13 studies reviewed demonstrated strong evidence for statistically significant effects on primary outcome measures. Very few studies provided promising evidence of educational/clinical significance (7.6%), identifiable components linked to statistically significant primary outcomes (23.1%), and program implementation integrity (23.1%). Furthermore, no studies provided evidence supporting the replication of program effects. The implications of these results for practice are discussed as well as needs for future research.
Youth suicide continues to be a major leading cause of death among children ages public health problem in the United States. To 5-14 and the third leading cause of death put this problem in context, suicide is the fifth among adolescents and young adults ages 15-24. In recent years, more young people died from suicide than from cancer, heart disease, HIV/AIDS, congenital birth defects, diabetes, and other medical conditions combined (Centers for Disease Control and Prevention, 2007). Suicidal behavior is not conceptualized as being restricted to suicide alone; it also includes suicidal ideation and suicide attempts, and each of these behaviors affects thousands of children, adolescents, and families in the United States each year (Mazza, 2006). As such, youth suicidal behavior is a significant public health issue for individuals as well as entire communities. First, the loss of life that results from suicide is both tragic and preventable. Second, those who attempt suicide and survive may have serious injuries such as broken bones, brain damage, or organ failure. Moreover, individuals who survive a suicide attempt often experience depression and/or other mental health problems. Family and friends of youth who exhibit suicidal behavior may also experience a variety of mental health problems, and the financial, medical, social, psychological, and emotional costs of suicide on members of the community is substantial (Centers for Disease Control and Prevention, 2006).
Because of the seriousness and pervasiveness of this problem, and given that children and youth spend much of their time in schools, school personnel have been asked to take an increasingly prominent role in suicide prevention efforts (Gould & Kramer, 2001; Kalafat, 2003; Mazza, 1997; Miller & DuPaul, 1996). This development has been intensified by calls for school psychologists to become more proactive in the prevention of youth suicide (Lieberman, Poland, & Cassel, 2008) and other mental health problems (Power. 2003), and to shift from an individualized service delivery model to a population-based (Doll & Cummings, 2008), public health approach (Hoagwood & Johnson, 2003; Nastasi, 2004; Power, 2000; Power, DuPaui, Shapiro, & Kazak, 2003; Strein, Hoagwood, & Cohn, 2003). …