Suicide Prevention Messaging Delivered by High School Peer Leaders: Proximal Impact On Classmates' Help-Seeking Norms and Perceptions of Adult Help

Introduction: Health behavior campaigns based on social marketing principles are widely used in efforts to reduce risky behaviors and increase healthy practices. Many of these efforts derive from the health belief model and highlight the costs of risk behaviors.  Although a number of initiatives have been effective in reducing problems such as tobacco use, others have been ineffective or possibly harmful, particularly campaigns that employ fear messages. Suicide prevention campaigns have increasingly employed social marketing strategies as means of modifying attitudes about seeking help for mental health problems.  There is minimal data about the impact of these messages for adolescents.  Recent evidence that PSAs emphasizing the costs of untreated depression have minimal impact and may, in fact, decrease positive help-seeking attitudes in depressed and suicidal adolescents points to the need for more research. Sources of Strength (SoS) trains teen peer leaders to conduct strength-based messaging campaigns to enhance positive coping norms and practices. A first RCT found positive impact on school-wide help-seeking norms, but did not ascertain which aspects of peer messaging were effective. This study tested the impact of two alternative classroom-messaging activities delivered by SoS peer leaders. Actively engaging classmates to apply the strength-based concepts was expected to have added positive effect beyond peer leader modeling, consistent with the elaboration likelihood model.   

Methods: 36 classrooms in four high schools were randomly assigned (blocked by school) to: (a) Peer Leader positive coping modeling; (b) modeling plus interactive component, or (c) no message.  The interactive component consisted of inviting students to identify a trusted adult.  Measures of help-seeking acceptability, coping attitudes, and perceptions of adult support were collected from 706 students immediately after messaging.  Differences by condition were tested using HLM, with classroom as a nesting factor. Secondary models examined: Suicide Risk (SR), Sex, and Condition, and interactions of condition with SR and sex.

 

Results: Students exposed to either of the presentations (modeling and interactive components) reported more positive help-seeking norms and identification of capable adults.  Among students reporting suicidal ideation, the presentation that added an interactive component increased impact above and beyond the peer leader modeling condition. 

Conclusion: This brief study demonstrated short-term positive impact of student peer leader presentations using positive modeling and direct engagement of audience techniques.  The additional impact of engaging students for higher-risk youth suggests that approach may be promising for suicide prevention.