Academic journal article Social Work

Suicide Prevention: An Analysis and Replication of a Curriculum-Based High School Program

Academic journal article Social Work

Suicide Prevention: An Analysis and Replication of a Curriculum-Based High School Program

Article excerpt

There appears to have been a clear and persistent decline in the number (and rate) of suicides among 15- to 19-year-olds in the United States from 1988 through 2003 (the last year for which data are available from the Centers for Disease Control and Prevention [CDC], n.d.). Two possible explanations for this decline are (1) greater awareness of behaviors associated with suicide and (2) greater help-seeking activities by and for those who are at risk of suicide. The most prevalent strategy for increasing awareness and help-seeking behavior has been curriculum-based presentations given to students in schools. However, a 2003 report prepared by the University of California, Los Angeles, Center for Mental Health in Schools stated: "For instance, many studies have found that while general education programs may increase students' general knowledge about suicide and warning signs, they do little to change students' attitudes about suicide and help-seeking behaviors" (p. 30).

CURRICULUM-BASED PRESENTATIONS

Shaffer and other researchers (Shaffer, Garland, Gould, Fisher, & Trautman, 1988; Shaffer, Garland, Vieland, Underwood, & Busner, 1991; Shaffer & Greenberg, 2002) have been critical of curriculum-based suicide prevention programs, particularly those who subscribe to the view that suicide is most often the consequence of stress as opposed to a consequence of a mental illness. Shaffer and his colleagues (1991) have asserted that an emphasis on presenting suicide "as an understandable response to common adolescent problems could inadvertently facilitate the expression of suicidal ideas" (p. 588). Suicide is not a common consideration following common problems, nor do the majority of stressed teenagers share a potential vulnerability to suicide (Clark, 1990). There is abundant research showing that suicide is most often the consequence of a mental illness (U.S. Public Health Service, 1999).

Wilcox and Shaffer (1996) have argued that the primary strategy for preventing teenage suicide should be the use of a screening tool as a mechanism to identify and intervene with at-risk students. However, to more clearly identify some of the advantages of using curriculum-based presentations, the disadvantages of using screening tools alone must first be discussed. For example, Shaffer and associates (2004) reported on the sensitivity and specificity of the Columbia SuicideScreen (Columbia University, 2003). According to that report, the SuicideScreen has a sensitivity of .75 and a specificity of .83. A sensitivity of .75 means that of those students who are at risk of suicide, 75 percent will score positively on the SuicideScreen. One obvious disadvantage is that the screeners cannot be sure that those who are not identified as at risk when screened may not actually become at risk at another juncture (CDC, 1992). Clark (1990) stated:

   A student's risk status can change silently at a
   moment's notice. A student who was screened
   and found healthy in November can develop
   a major depressive disorder or make a suicide
   attempt in the following February, and thus
   move from a low- to a high-risk category. Unless
   screening is instituted on a biweekly or monthly
   basis, how can these changes be detected? How
   can risk status changes be monitored over long
   summer vacations? (p. 2)

Although the Columbia SuicideScreen has a specificity of .83, its use could indicate that as many as 17 percent of those classified as not at risk are false negatives--actually at risk but missed by the screening (Shaffer et al., 2004, p. 77). Shaffer and associates concluded that a second-stage screening is necessary to assess the risk status of those who were not identified in the first screening and to also address the time and resource "burden of low specificity" on school personnel (p. 71). However, the CDC (1992) warned of the "potentially adverse consequences of referring false positives" (those thought to be at risk but actually not at risk) for more intensive screening or counseling (p. …

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