Suicide is the third leading cause of death for 15- 19-year-olds and exceeds all natural causes of death for youth in this age group (National Center for Health Statistics, 2007). Each year, countless adolescents require medical attention for self-inflicted injuries (CDC, 2006). The impact of these deaths and potential years of life lost led to the Garrett Lee Smith Memorial Act to develop, implement, and evaluate prevention programs for youth (Youth Suicide Early Intervention and Prevention Act of 2004). Given added resources, suicide prevention has become an important focus for children, adolescents, and college students. Nevertheless, suicide risk assessment is a daunting task that is sometimes considered to be unachievable (Hallfors et al., 2006).
In prevention studies, measurement of suicidal behaviors can be challenging due to low base rates for suicide deaths. Rodgers, Sudak, Silverman, and Litts (2007) characterized the conflicting need for outcomes studies as a "measurement conundrum" in which programming effectiveness should be determined by decrease in deaths, but unattainable in the absence of vast sample sizes. As a result, intermediate factors in prevention such as increased knowledge and perceived efficacy are potential mediating factors in primary prevention and important constructs for measurement in prevention studies.
Mental health problems that are detected later in life often begin in youth (age 12-24 years) (Patel, Flisher, Hetrick, & McGorry, 2007). Thus, primary prevention efforts that minimize the burden of depression, anxiety, and other possible precipitates (e.g., poor impulse control, maladaptive problem-solving) to self-harm behavior are critical. Here, we briefly outline the status of youth suicide risk and prevention and the necessity for non-metropolitan and rural efforts. Finally, we provide evaluative data for the LifeSavers' peer support, suicide, and crisis prevention program.
Though the path to a suicide attempt varies, studies have suggested that low self-esteem and hopelessness are key factors in youth suicide risk (Overholser, Adams, Lehnert, & Brinkman, 1995; Roberts, Roberts, & Chen, 1998). Other factors include negative life events (Rudd, Joiner, Jobes, & King, 1999; Shaffer et al., 2001), psychopathology (Apter et al., 1998), and impulsivity (Apter et al., 1995) in addition to disrupted familial environment, low economic status, sense of isolation, presence of mood disorder, interpersonal conflict, and availability of drugs/alcohol and lethal means (Maris, Berman, & Silverman, 2000). These are all important targets for prevention efforts. Untreated problems may escalate in college settings where suicide has been identified as the second leading cause of death (CDC, 1997). One objective outlined in the National Strategy for Suicide Prevention was to "increase the proportion of school districts and private school associations with evidence-based programs ... designed to prevent suicide" (U.S. Department of Health and Human Services, 2001, p. 64). Unfortunately, investigations of youth suicide prevention programs are either nonexistent or are plagued by methodological problems (see Lewis & Lewis, 1996) yielding very few evidence-based programs for any age group (see Rodgers, Sudak, Silverman, & Litts, 2007 for review).
Though available studies typically omit theoretical mechanisms for youth suicide prevention programs, peer gatekeeper programs are said to be successful because peers are more "in touch" (Konet, 1990; Lewis & Lewis, 1996). Social ties, interdependence, and trust occur more readily among similar, in-group others and foster an environment that is more prepared to intervene in the event of emerging crisis. According to youth who participated in the Signs of Suicide (SOS) training, participants' fear of reporting concerns to adults was a primary complaint of the program (Aseltine & DeMartino, 2004). …