Selected Suicide Prevention Strategies for Youth: Targeting High Risk Groups

In public health prevention models, selected prevention strategies focus on recognizing and intervening with youth at elevated risk for suicide behavior. The goal is to positively alter the youth’s developmental trajectory and reduce suicide risk. This presentation presents findings from two studies of selective intervention strategies that each began with the identification of youth at elevated risk for suicide in an emergency department serving an urban, underserved population. The first study examined the effectiveness of Teen Options for Change (TOC). Participants were 49 adolescents, ages 14 to 19 years, seeking services for non-psychiatric emergencies who screened positive for suicide risk because of recent suicidal ideation, suicide attempt, or depression plus substance abuse. Youths were randomly assigned to the TOC intervention (adapted motivational interview focused on personal growth goals) or to enhanced treatment as usual. Depression, hopelessness, and suicidal ideation were assessed at baseline and two months later. Adolescents assigned to TOC showed greater reductions in depression than adolescents assigned to the comparison group (Cohen’s d=1.07, a large effect size). Hopelessness, suicidal ideation, and substance abuse outcomes trended positively, with small to moderate effect sizes. The second study is examining the effectiveness of LET’s CONNECT, a screening/recognition and community mentorship intervention for adolescents, ages 12 to 15 years, who report bully victimization, bully perpetration and/or low social connectedness. Participants (n = 219) were randomly assigned to LET’s CONNECT or enhanced treatment as usual. In this sample of youth, all of whom screened positive for problematic peer relationships, baseline data indicate that family connectedness is negatively associated with depression, suicidal ideation, non-suicidal self-injury, and conduct problems, and positively associated with self-esteem and adaptive use of free time. Similarly, school connectedness is negatively associated with depressive symptoms, suicidal ideation, social anxiety, and sexual activity, and positively connected with self-esteem and more adaptive use of free time. These data suggest that it is possible to identify youth in emergency departments who are at elevated risk for suicide and that connectedness interventions may be warranted for these at risk youth.  In conclusion, the emergency department setting is well suited to identifying at risk youth. Moreover, selected prevention strategies have promise for reducing suicide risk.