Prevention Strategies 1
Working Prevention Strategies for Adolescent Suicide
Hallie R. Hemmingsen
Western Washington University
HSP 385
Prevention Strategies 2
Adolescent suicide is a topic individuals often avoid talking about or even
acknowledging. The fear of glorifying self inflicted death has become so strong that too
many people sit in silence following suicides, too scared to say the wrong thing. The
reality is that adolescent suicide is “the third leading cause of death among 15-24 year
olds in the United States, [and] is now recognized as an important public health issue”
(Baber & Bean, 2009, p. 365). In addition to being the third leading cause, “it is
estimated that for every completed suicide there are as many as 50 to 150 attempts”
(Ayyash-Abdo, 2002, p. 459). There are several important trends to recognize as we
attempt to understand this complex topic. National Adolescent Health Information Center
(2006, p. 2) highlights the longest standing trend among teen suicide, which is:
Adolescent and young adult males aged 10-24 have a consistently higher
suicide rate than their female peers, averaging more than five times the
rate of same-age females…From 1981-2003, 84.1% of 10- to 24 year olds
who committed suicide were male.
While it is clear that males commit suicide substantially more than females, it is
interesting to note that studies show a different statistic among suicide attempts. The Add
Health Project was a two-year study conducted by the Carolina Population Center,
University of North Carolina Chapel Hill, which surveyed approximately 19,000
individuals including adolescents, their parents and school administrators. While the
study was targeted mostly to find race differences among adolescent suicide they also
found that of the 16,000 adolescents surveyed, “suicide attempts for females are
significantly higher than for males for both Blacks and Whites” (Watt & Sharp, 2002, pp.
240-243). While the sample size of whites surveyed (11,559) was much higher than
Prevention Strategies 3
blacks (4,232), there was little difference between white females (5,864) and white males
(5,695) in attempted suicides. However, in looking at differences between suicide
attempts just between white males and females, the females attempt suicide over twice as
often.
In addition to the clear gap among suicides between male and females, another
common trend among suicide deaths is based on differences in cultural, racial and ethnic
backgrounds. For example, David Goldston et al. (2009), authors of Cultural
Considerations in Adolescent Suicide Prevention and Psycholosocial Treatment, states
that “the rate of suicide deaths among adolescents differs by a factor of 20 between the
highest risk group (American Indian/Alaska Native males) and the lowest risk group
(African American females).” The ‘factor of 20’ they were referring to was a
measurement referring to the number of suicide deaths per 100,000 people. In order to
pinpoint successful prevention strategies to successfully combat adolescent suicide, it is
necessary to first fully understand common causes that can lead to adolescent suicide.
Common Causes
It is important to understand that most suicides do not result from one particular
cause, but rather they “are a consequence of several factors, beginning with a psychiatric
illness that is generally not receiving any treatment together with its consequent
psychosocial crisis” (Haas, Hendin, & Mann, 2003, p. 1230). Huda Ayyash-Abdo, author
of Adolescent Suicide: An Ecological Approach, talks about a similar idea when she says
that it’s important to “move beyond individualistic explanations, and take into
consideration the complex relationships between personal, interpersonal, and
Prevention Strategies 4
sociocultural factors influencing adolescent suicide” (2002, p. 459). These studies argue
that adolescent suicide stems from a variety of different struggles including, cultural
differences touched on earlier, feelings of depression and hopelessness, substance abuse,
family history, dealing with peers and poor school performance, and the media can all
influence suicidal ideation (Ayyash-Abdo, pp. 461-465). To be clear when talking about
media influences, I am speaking of “newspaper articles, television reports, and fictional
stories’ and how those correlate with increased suicide rates. (Ayyash-Abdo, pp. 465.)
Adolescents tend to give clues including, “…changes in sleeping or eating patterns,
dysthymia or onset of depression, drug or alcohol abuse, suicidal ideation, a previous
suicide attempt, social isolation, withdrawal, or marked changes in the established
behaviors of the adolescent” (Roswarski & Dunn, 2009, p. 34). It is not often that
adolescents are completely alone, and by recognizing these behavioral clues people
around them will be able to better identify at risk youth and then direct them to proper
services.
Authors Watt and Sharp (2002) pinpoint family strain as particularly important
when it comes to risk factors for adolescent suicide: “A family history of suicide, family
conflict, broken homes, parental illness, parental psychopathology, parental rejection and
sexual abuse are associated with suicidality among adolescents” (p. 235). Specifically,
adolescents who have had a family member either attempt or commit suicide are at a
particularly high risk for suicidal tendencies themselves (Roswarski & Dunn, 2009, p.
36). It is important to note that previous suicide attempts are the biggest and most reliable
predictor of a completed suicide and the first attempt should be means enough to
investigate (Watt & Sharp, 2002, p. 251).
Prevention Strategies 5
Prevention Strategies
Baber and Bean (2009) introduce the idea of “gatekeeper programs” which,
“prepare community and professional individuals (including physicians, first responders,
educators, parents, faith leaders, etc.) to understand risk and protective factors, to identify
youth at risk, to be aware of available resources, and make referrals when necessary” (p.
685) By training individuals across all community outlets, it gives more resources for atrisk youth to turn to if they feel inclined to talk to someone about their suicidal ideation.
Roswarski and Dunn (2009) support the idea of gatekeeping and underline the fact that,
“trusted gatekeepers can both serve as initial contacts for adolescents seeking help, and
then mediate and encourage adolescents to seek out counseling” (p. 41). It is most
important to recognize that gatekeepers are educated in effectively communicating with
potentially suicidal adolescents and then give them support in seeking further advice from
more trained individuals.
School based prevention programs are another important factor to successfully
combat adolescent suicide. Peer assistance programs are one prevention strategy that like
‘gatekeeper programs,’ train peers to be better equipped to deal with dealing with
potentially suicidal teens. It is most likely the case that teenagers contemplating suicide
will most likely turn to friends or peers before turning to teachers or counselors. The idea
behind peer assistance programs is that they would educate students on how to identify
peers that are at risk and then make sure they get the proper help they may need (King,
2000, p. 9). Baber and Bean (2009) focus their article around the Frameworks project.
The idea was to increase community effectiveness in responding to suicides, and one of
the community outlets being through other youth. They collected information through
Prevention Strategies 6
interviews either face-to-face, by telephone, or both with 131 ninth-grade high school
students who had participated in the Frameworks training. What they found was that due
to the training:
These youth were more likely to turn to an adult for assistance if they were
concerned about a peer, rather than trying to deal with the situation on
their own. They also indicated a greater belief in the usefulness of mental
health care. In addiction…training increased their sense of responsibility
that they should do something to help a peer about whom they may be
concerned (pp. 688, 693).
Another school based prevention program is one that is incorporated directly into the
curriculum programs presented to all students, rather then just the ones considered at-risk.
Ayyash-Abdo (2002) makes the major goals of such a program very clear: “1) increase
students’ awareness of suicidal behavior, 2) help students identify warning signs of
suicide, and 3) provide students with information about mental health resources and how
to access them” (p. 469). Unlike the first two school based programs, this one has had
mixed feelings regarding it’s implementation in the fear that “exposure to such programs
may increase the risk of some students to actually try to kill themselves” (p. 469).
Through their studies Roswarski and Dunn (2009) continually emphasized the
effectiveness of ‘help’ and ‘hope’ working together to create successful early intervention
strategies. One of the most successful prevention strategies was called the Local Outreach
to Suicide Survivors (LOSS) Program, which sends:
Mental health and paraprofessional volunteers immediately to the scene of
the suicide. Team members made themselves available to children and
Prevention Strategies 7
other survivors and recommended help-seeking behaviors. The program
successfully reduced the average time it took for a survivor to seek
professional help from 880 days to 39 days (pp. 36-37).
The program was successful due to the idea that making the ‘help’ there and available to
them during the earliest time of distress it will “drastically improve future help-seeking
behavior by vulnerable families…[and] has a significant impact on the development of
suicidal ideation and suicidal intent” (Roswarski & Dunn, 2009, 37). Haas, Herbert and
Hendin (2003) authors of Suicide in College Students supported the idea of the need of
providing readily available help for those in need of it. Their study researched the
effectiveness of outreach towards the vulnerable population, because often time’s
depression holds these people in doors not allowing them to go seek out the help they
need. The students were contacted by email asking to fill out a questionnaire, and based
on their answers they would be contacted by a follow up email urging them to seek
further provided help on campus (pp. 1231-1232). From 2002 to 2005 8,000 students
were invited to participate, and of that 8,000, 729 of them completed the questionnaire.
Kathy Baker (2008), author of Depressed College Students Benefit From Study reports
that:
Study data showed that 91 percent of the students who filled out the
questionnaire viewed the counselor's assessment; 34 percent engaged in
dialogues and 20 percent came in for an evaluation. More than 80 students
characterized as high-risk entered psychotherapy after the in-person
evaluation (para. 8).
Prevention Strategies 8
By having adolescents understand that help is available to them, these authors argue that
this alone instills hope for their future.
Conclusion
Adolescent suicide is not usually the result of only one influence but rather a
combination of a variety of different causes. It is important to understand that any
suicidal outcome is “a complex, multidomain, interactive effect of many factors over
fairly long periods of time” (Ayyash-Abdo, 2002, p. 470). Causes such as school
performance, peer acceptance, family history, gender, cultural background, previous
attempts, and ethnicity are only a few of common causes that my lead to suicide. The
National Conference of State Legislatures (2005) points out that a range of factors
usually causes suicidal tendencies, and because of that it’s important to combat suicide
with a diverse set of strategies.
Given the range of risk factors associated with suicide, prevention efforts
must be multifaceted. Successful prevention efforts seek to minimize risk
factors and maximize protective factors (i.e., effective clinical care for
mental, physical and substance abuse disorders; family and community
support; and promoting skills in problem solving, conflict resolution and
nonviolent handling of disputes) (para. 4).
Suicide is due to a multitude of factors, and prevention strategies have been developed
based around these causes. Yet, for the most part, we don’t know what aspects of
prevention programs really work because it is nearly an impossible thing to measure due
to fact that most of the people that can tell us what could have helped them have lost their
lives to suicide. After reading this literature I am interested in understanding, what do
Prevention Strategies 9
adolescent suicide survivors see as successful prevention strategies? As well as,
understand what are the systems they feel failed them and may have influenced their
attempt? Further research needs to be done to understand the key ingredients to a
successful intervention program, as well as how to expand these programs nationwide so
that this suicidal trend among adolescents can be battled successfully. While the gaps are
difficult to fill in research on this complex topic, I propose further research specifically
with adolescent suicide survivors. Through this qualitative interview style of research, we
will gather information on what these adolescents found to be especially helpful in the
months following their suicide attempt. Because the most predictive factor to a suicide is
a previous attempt, we need to understand what the adolescents themselves feel they
need, in order to keep them away from suicidal ideation.
Research Proposal
Data
In this study participants will be adolescent suicide survivors between the ages of
thirteen and eighteen living in six major cities throughout the United States. In order to
get a somewhat diverse sampling I will gather data from Seattle, Boston, Los Angeles,
Denver, Kansas City, and Austin, Texas. My sampling frame would be to obtain
permission to administer anonymous surveys pertaining to topics regarding adolescent
suicide in five randomly selected high schools in each of the selected cities. If I am
unable to do this due to confidentiality purposes I will instead post fliers around town
near public high schools and sites where suicide survivors meet for their support groups
in the hopes to ideally compile a list of names willing to participate. From there my
sample would be narrowed down to those adolescents that do indeed take the survey. In
Prevention Strategies 10
order to move forward with the research I would first require informed consent from the
parents or legal guardians of the adolescents. The weaknesses of this sample are going to
be the strength in number of people surveyed, because of the uncertainty on how I will be
able to collect my data. If I am able to administer the survey than I will be able to get
more results, but at the same time might be forced to do the fliers instead. The weakness
regarding the fliers is that they require the adolescents to contact me rather than me
seeking them out. Due to the confidentiality circumstances, both of these strategies are
the best approaches because they give a random sampling of our age group that will give
us our data regarding adolescent suicide.
Through these surveys I am looking to see how my independent variables, pre
existing prevention strategies, have affected survivors since their suicide attempt or if
they received any support from them before their attempt. I am also curious to know if
there are any services, or lack thereof, that may have helped to lead the adolescents to
their suicide attempt. By getting a glimpse of what services survivors wish they could
have received or found helpful in their time of vulnerability, will give us a better idea of
what programs need to be better developed.
Method
If granted permission I will administer anonymous surveys given to all students at
the randomly selected five high schools throughout the chosen cities. I will select the
schools by compiling a list of all the schools in each of the cities, and pick five of them
out of a hat to ensure that the selections were random. As I mentioned before I will give
this anonymous survey to all students at the school, but my sample will only be those that
respond ‘yes’ to having ever had suicidal thoughts or a previous suicide attempt. At the
Prevention Strategies 11
end of each survey there will be an opportunity for the students to give their name and
choose to attend a focus group at a later date.
Through my research I have pinpointed a few different prevention strategies that
have been implemented throughout the United States. I am curious as to if any of these
students that I will survey could have benefited from these pre existing strategies, and if
not what kind of support would have benefited them at the time of their suicidal thoughts.
The survey will entail a mixture of Likert Scaling questions as well as qualitative openended questions that will allow for us to get a better understanding of why students
answered the way they did. The weaknesses of this survey will be that there is always a
chance of adolescents not taking it seriously and skewing the data with answers just to
get the survey over with. Also there is the possibility that the students may not know
what they could have benefited from at their time of need, nor be in a place of mind
where they want to fill out a survey to tell a stranger what they are feeling. Yet given the
weaknesses, this is still the best way to approach the situation because it takes a sample
from a large demographic and gives us a lens to see what this vulnerable population feels
they would benefit from. Some of my initial questions that I will ask them are:

In my time of suicidal vulnerability I would have found the following
programs helpful…
1)
The Gatekeeper program trains community members to understand and be
equipped to help youth with suicidal thoughts and tendencies. By training
individuals across all community outlets, it gives more resources for at-risk
youth to turn to if they feel inclined to talk to someone about their suicidal
ideation. This program would have been or was helpful for me
Prevention Strategies 12
Strongly Disagree
Disagree
Neutral
Agree
Strongly Disagree
Why do you feel it would, or would not have been helpful?
2) Peer assistance programs would educate students on how to identify peers that
are at risk and then make sure they get the proper help they may need. This
program would have been or was helpful for me.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Disagree
Why do you feel it would, or would not have been helpful?
3) Early intervention strategies is an outreach program that sends mental health
and paraprofessional volunteers immediately to the scene of any suicide to help
with those left behind. The program was successful due to the idea that making
the ‘help’ there and available to them during the earliest time of distress, would
help them cope. This program would have been or was helpful for me.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Disagree
Why do you feel it would, or would not have been helpful?
4) Before your attempt did you have any sort of support system? Yes/No
Please Explain:
5) What are strategies that helped you after your suicide attempt?
6) Do you have a friend or family member that has committed or attempted
suicide? Yes/No
7) Are there any services or prevention strategies, or lack thereof, that you feel
would have helped before your attempt?
8) Would you be willing to attend a two hour focus group regarding teen suicide
and successful prevention strategies? Yes/No
Prevention Strategies 13
9) If you answered yes, please provide your contact information below.
This survey will serve as two purposes, first to gather youth’s opinions on already
existing programs as well as get a glimpse of what suicide survivors saw to be helpful
during their time of vulnerability.
Analysis
After completing the surveys at the thirty schools throughout the United States I
will gather the data and give each survey an ID. I will then record the responses and
categorize the quantitative data into five categories and log them onto a computer
database. From this information I will look at common tendencies that suicide survivors
say worked for them simply based on the Likert Scale, and will follow up with common
reasons ‘why’ as I continue to analyze. After logging in the quantitative data I will then
begin to code the qualitative data based on common responses. I will look for
commonalities among what suicide survivors said that they feel would have been
effective prevention strategies or services that would have benefited them before their
attempt. I will also look at the particular percentage of suicide survivors who answered
‘no’ to question number four, and see if lacking a support system is correlated to suicide
attempt, as well as if knowing someone who committed suicide is also correlated with
adolescent attempts and to their interest in the “early intervention strategy” of prevention.
Conclusion
Previous data shines light on the tragedy of adolescent suicide, and this study will
shine light on the survivor’s perspective. In order to find a prevention strategy that works
we have to understand the demographic we are working for, and understanding their
opinions is what will help to build a strong and working prevention strategy. Future
Prevention Strategies 14
research on existing strategies as well as development of new prevention programs based
on this study will help to curve the fourth leading cause of death among adolescents, and
ideally give them an outlet other then suicide.
Prevention Strategies 15
Works Cited
Ayyash-Abdo, H. (2002). Adolescent suicide: an ecological approach. Psychology in the
Schools, 39(4), 459-475.
Baber, K., & Bean, G. (2009). Frameworks: a community-based approach to preventing
youth suicide. Journal of Community Based Psychology, 37(6), 684-696.
Baker, K. (September 11, 2008). Depressed college students benefit from study.
Retrieved from http://www.medicalnewstoday.com/articles/120989.php
Goldston, D. B., Molock, S. D., Whitbeck, L. B., Murakami, J.L, Zayas, L.H., Nagayama
Hall, G. C. (January 2008). Cultural considerations in adolescent suicide
prevention and psychosocial treatment, American Psychology, 63(1), 14-31.
Haas, A. P., Hendin, H., & Mann, J. J. (May 2003). Suicide in college students. American
Behavioral Scientist, 6(9), 1224-1240.
King, K. A. (April 2000). Preventing adolescent suicide: do high school counselors know
the risk factors? Professional School Counseling, 3(4).
National Adolescent Heath Information Center. (2006). Fact sheet on suicide:
Adolescents & young adults. San Francisco, CA: University of California, San
Francisco.
Roswarski, T. E. & Dunn, J. P. (January, 2009). The role of help and hope in prevention
and early intervention with suicidal adolescents: implications for mental health
counselors. Journal of Mental Health Counseling, 31(1), 34-36.
National Conference of State Legislatures. (2005). Teen suicide prevention. State health
lawmakers’ digest, 5(5). Retrieved from
http://www.ncsl.org/default.aspx?tabid=14111
Prevention Strategies 16
Watt, T. T., & Sharp, S. F. (December, 2002). Race differences in strains associated with
suicidal behavior among adolescents. Youth & Society, 34(2), 232-252.