Does Practice Make Perfect? A Randomized Control Trial of Behavioral Rehearsal on Suicide Prevention Gatekeeper Skills

Suicide is the third leading cause of death among 10-24-year-olds and the target of school-based prevention efforts. Gatekeeper training, a broadly disseminated prevention strategy, has been found to enhance participant knowledge and attitudes about intervening with distressed youth. Although the goal of training is the development of gatekeeper skills to intervene with at-risk youth, the impact on skills and use of training is less known. Brief gatekeeper training programs are largely educational and do not employ active learning strategies such as behavioral rehearsal through role play practice to assist skill development. In this study, we compare gatekeeper training as usual with training plus brief behavioral rehearsal (i.e., role play practice) on a variety of learning outcomes after training and at follow-up for 91 school staff and 56 parents in a school community. We found few differences between school staff and parent participants. Both training conditions resulted in enhanced knowledge and attitudes, and almost all participants spread gatekeeper training information to others in their network. Rigorous standardized patient and observational methods showed behavioral rehearsal with role play practice resulted in higher total gatekeeper skill scores immediately after training and at follow-up. Both conditions, however, showed decrements at follow-up. Strategies to strengthen and maintain gatekeeper skills over time are discussed

Diffusion of a Peer-Led Suicide Preventive Intervention Through School-Based Student Peer and Adult Networks

Background: Peer-led interventions have been applied to prevent various health behavior problems and may be an important complement to individual-level suicide prevention approaches. Sources of Strength trains student “peer leaders” in secondary schools to conduct prevention activities that encourage other students to build healthy social bonds and strengthen help-seeking norms. Prior work examining diffusion of peer-led programs has focused on youths' closeness to peer leaders but minimally on other factors such as connections to adults and suicidal behavior.Methods: We examined implementation and dissemination of Sources of Strength in 20 schools. Over 1 year 533 students were trained as peer leaders and 3,730 9th−12th graders completed baseline surveys assessing friendships and adults at school, and suicidal thoughts/behaviors; and end-of-year surveys reporting intervention exposure: viewed poster/video, attended presentation, direct peer communication, and activity participation. Chi-square tests compared exposure rates by student and network characteristics. Multi-level logistic regression models tested predictors of exposure across individual and school-level characteristics.Results: Exposure to the intervention varied greatly by school and by individual student characteristics and network position. Training more peer leaders increased school-wide exposure for all modalities except presentation (Bs 0.06–0.10, p's < 0.05). In multivariate models, exposure was consistently higher for students closer to peer leaders in the friendship network (ORs 1.13–1.54, p's < 0.05) and students who named more trusted adults (ORs 1.08–1.16, p's < 0.001); and lower for males (ORs 0.56–0.83, p's < 0.05). In multivariate models, training more students as peer leaders predicted exposure to poster-video and direct peer communication in larger schools (OR = 3.34 and 2.87, respectively). Network characteristics influenced exposure similarly for students with suicidal thoughts and behaviors.Discussion: Our findings confirm prior work showing the importance of personal affiliations to peer leaders and natural networks as a medium for diffusion of peer-led prevention efforts. We build on that work by showing independent effects of closeness to adults at school and number of peer leaders trained. There is a need to strategically select peer leaders to maximize closeness to students school-wide, particularly in larger schools. Additional work is required for Sources of Strength to devise messaging strategies to engage males and students isolated from adults at school

A Longitudinal Analysis of Stress in African American Youth: Predictors and Outcomes of Stress Trajectories

Few researchers have studied trajectories of stress over time in relation to psychosocial outcomes and behaviors among adolescents. A sample of African American adolescents were assessed longitudinally on perceived stress, psychological well-being, support, antisocial behaviors, and academic success. Patterns of stress over 4 time points were developed using a cluster-analytic approach. Differences among the trajectory clusters were examined using psychosocial outcomes and behaviors. Adolescents with chronic levels of stress reported more anxiety and depression, engaged in antisocial behaviors, and reported less active coping than youth in other trajectories. Adolescents with low levels of stress over time reported fewer psychological problems, perceived more social support, and were more likely to graduate from high school than those with higher stress levels over time. We also found that an increase in stress coincided with a lack of support and more psychological problems over time.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45295/1/10964_2004_Article_465298.pd

Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff.

Gatekeeper-training programs, designed to increase identification and referral of suicidal individuals, are widespread but largely untested. A group-based randomized trial with 32 schools examined impact of Question, Persuade, Refer (QPR) training on a stratified random sample of 249 staff with 1-year average follow-up. To test QPR impact, the authors introduced and contrasted 2 models of gatekeeper-training effects in a population: gatekeeper surveillance and gatekeeper communication. Intent-to-treat analyses showed that training increased self-reported knowledge (effect size [ES] 0.41), appraisals of efficacy (ES 1.22), and service access (ES 1.07). Training effects varied dramatically. Appraisals increased most for staff with lowest baseline appraisals, and suicide identification behaviors increased most for staff already communicating with students about suicide and distress. Consistent with the communication model, increased knowledge and appraisals were not sufficient to increase suicide identification behav-iors. Also consistent with the communication model were results from 2,059 8th and 10th graders surveyed showing that fewer students with prior suicide attempts endorsed talking to adults about distress. Skill training for staff serving as “natural gatekeepers ” plus interventions that modify students’ help-seeking behaviors are recommended to supplement universal gatekeeper training

Coping Strategies of High School Students in an International Baccalaureate Program

Students who are enrolled in academically challenging curricula face a multitude of stressors related to increased academic demands in addition to the developmental and biological challenges that are normative to adolescence. This article presents results of a qualitative study conducted to uncover the coping styles of students in a rigorous curriculum and determine which strategies are associated with varying levels of psychopathology (specifically, low and above‐average anxiety). Forty‐eight students from an International Baccalaureate (IB) diploma program participated in eight focus groups, in which participants were grouped by level of anxiety. Following transcription analysis using grounded theory methodology, researchers identified coping strategies and the frequency of these approaches; active problem‐solving and avoidance of demands were reported most often among all IB students in this investigation. Students with above‐average levels of anxiety discussed seeking social support more often, whereas students with low anxiety more frequently discussed avoiding demands, reducing one\u27s workload, and seeking positive emotions

Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training

Importance: Suicide has been a leading manner of death for US Air Force personnel in recent years. Universal prevention programs that reduce suicidal thoughts and behaviors in military populations have not been identified. Objectives: To determine whether the Wingman-Connect program for Airmen-in-training reduces suicidal ideation, depression, and occupational problems compared with a stress management program and to test the underlying network health model positing that cohesive, healthy units are protective against suicidal ideation. Design, Setting, and Participants: This cluster randomized clinical trial was conducted from October 2017 to October 2019 and compared classes of personnel followed up for 6 months. The setting was a US Air Force technical training school, with participants studied to their first base assignment, whether US or international. Participants in 216 classes were randomized, with an 84% retention rate. Data analysis was performed from November 2019 to May 2020. Interventions: The Wingman-Connect program used group skill building for cohesion, shared purpose, and managing career and personal stressors (3 blocks of 2 hours each). Stress management training covered cognitive and behavioral strategies (2 hours). Both conditions had a 1-hour booster session, plus text messages. Main Outcomes and Measures: The primary outcomes were scores on the suicidal ideation and depression scales of the Computerized Adaptive Test for Mental Health and self-reports of military occupational impairment. Class network protective factors hypothesized to mediate the effect of Wingman-Connect were assessed with 4 measures: cohesion assessed perceptions that classmates cooperate, work well together, and support each other; morale was measured with a single item used in other studies with military samples; healthy class norms assessed perceptions of behaviors supported by classmates; and bonds to classmates were assessed by asking each participant to name classmates whom they respect and would choose to spend time with. Results: A total of 215 classes including 1485 individuals (1222 men [82.3%]; mean [SD] age, 20.9 [3.1] years) participated; 748 individuals were enrolled in the Wingman-Connect program and 737 individuals were enrolled in the stress management program. At 1 month, the Wingman-Connect group reported lower suicidal ideation severity (effect size [ES], −0.23; 95% CI, −0.39 to −0.09; P = .001) and depression symptoms (ES, −0.24; 95% CI, −0.41 to −0.08; P = .002) and fewer occupational problems (ES, −0.14; 95% CI, −0.31 to −0.02; P = .02). At 6 months, the Wingman-Connect group reported lower depression symptoms (ES, −0.16; 95% CI, −0.34 to −0.02; P = .03), whereas the difference in suicidal ideation severity was not significant (ES, −0.13; 95% CI, −0.29 to 0.01; P = .06). The number needed to treat to produce 1 fewer participant with elevated depression at either follow-up point was 21. The benefits of the training on occupational problems did not extend past 1 month. The Wingman-Connect program strengthened cohesive, healthy class units, which helped reduce suicidal ideation severity (estimate, −0.035; 95% CI, −0.07 to −0.01; P = .02) and depression symptom scores (estimate, −0.039; 95% CI, −0.07 to −0.01; P = .02) at 1 month. Conclusions and Relevance: Wingman-Connect is the first universal prevention program to reduce suicidal ideation and depression symptoms in a general Air Force population. Group training that builds cohesive, healthy military units is promising for upstream suicide prevention and may be essential for ecological validity. Extension of the program to the operational Air Force is recommended for maintaining continuity and testing the prevention impact on suicidal behavior. Trial Registration: ClinicalTrials.gov Identifier: NCT04067401</p