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_Final_Presentation_Adolescents__Suicide_Ali_Rochelle_Madeline_7_3_18_FINAL_rev1.pptxEffect of Sources of Strength Suicide Prevention Program on Suicide Rates of Rural High School Students in Illinois
Ali Daggett,
7/3/18
Introduction & Statement of the Problem
Problem: Suicide is the second leading cause of death for HS age youth ages 14-18.
Between 2006-2016, overall suicide rate in this group went from 5.41 to 8.49 = 57% increase.
Introduction & Statement of the Problem
Overview
In a recent survey, data showed that 17% of high school students have seriously considered suicide
10.6% of high school females reported one or more attempts contrasted to 5.4% of high school males
Although the rate of suicide attempts is higher in females, completion in males is four times the rate in females
Adolescents are going through rapid physical and emotional with changes in their pre-frontal cortex and hypothalamic/ pituitary/gonadal axis during a sensitive time of development in self-worth
They are having painful struggles of self-acceptance and acceptance from others.
Decrease in self-worth during this time may lead to substance abuse, risky sexual behaviors, depression, and suicidal thoughts
In particular, using the Youth Risk Behavior Survey, studies have shown that the highest predictors have been determined to be adolescents who are:
Potential Causes
Gay, lesbian, bisexual, or questioning
Students who feel unsafe in their schools
Sexual intercourse against their will
Smoking
Not speaking English at home
Low self-esteem
In our literature review we researched youth suicide intervention programs, as well as the differences between youth suicide in rural vs. urban areas. This literature helped give context to our research question and gave a clear idea as to why this type of intervention needs to be done.
Introduction & Statement of the Problem
Overview
Causes
Previous Focus
Rural vs. Urban Suicide Rates.
The suicide rate for youth aged 10-24 has previously been documented as twice as high as in urban areas. Several possible explanations exist:
1.) Limited availability and accessibility of mental health services. Of the 1669 areas federally designated as experiencing a shortage of mental health professionals, more than 85% are in rural areas
2.) Cost of mental health care. In rural areas, many residents must travel further to find care, and therefore wait until more serious symptoms arise. By this time, they may need more intensive and expensive treatments than urban residents.
3.) The stigma associated with mental illness. Even when mental health care professionals are available, because there can be a lack of anonymity in rural areas for seeking treatment, they do not go because they don’t want to be judged for their issues.
4.) Social and geographic isolation. There is a lower population density and wider geographic spread of people, often causing less face-to-face interaction with support systems.
In our literature review we researched youth suicide intervention programs, as well as the differences between youth suicide in rural vs. urban areas. This literature helped give context to our research question and gave a clear idea as to why this type of intervention needs to be done.
Between 2006 and 2016, suicide rates for rural or “non-metro” high-school students averaged 56% higher than for youth living in urban areas.
Urban/Rural Differences in Rates, Ages 14-18
Overall (US)
Rate*: 8.49 (1781 suicides)
Urban
* Rate = out of every 100,000
Rate: 8.17 (1472 suicides)
Rural
Rate: 10.41 (309 suicides)
(28% difference)
However, the newest 2016 national data does not support this trend.
2016 Suicide Rates For Ages 14-18
* Rate = out of every 100,000
Illinois 2016 Suicide Rates For Ages 14-18
ILLINOIS
Rate*: 6.85 (58 suicides)
Urban
Rate: 6.23 (47 suicides)
Rural
Rate: 11.98 (11 suicides)
That said, in 2016 in Illinois, the suicide rate for youth ages 14-18 living in rural areas was nearly TWO TIMES as high as for those living in urban areas, or specifically 92% higher.
Sources of Strength Suicide Prevention Program
Implemented in high school by peer leaders
Previous research studies have shown this program has shown success decreasing the number of vulnerable high school students from becoming suicidal
Effective in increasing 8 known preventative factors (sources of strength):
Mental Health
Family Support
Positive Friends
Mentors
Healthy Activities
Generosity
Spirituality
Medical Access
Research Hypothesis
Employing the Sources of Strength Suicide Prevention Program with peer leaders in high schools in select counties of Illinois will decrease the youth suicide rate in these counties compared to counties with rural high schools where this program has not been utilized.
There is no relationship between utilizing the Sources of Strength Suicide Prevention Program in high schools in select counties of Illinois with youth suicide rates in these counties.
Null Hypothesis
Rationale & Objectives
Overview
Focus
RATIONALE
The fact that suicide is such a pervasive problem in adolescents, particularly in rural areas, makes this issue extremely important and imperative to address by identifying possible ways to reduce the high suicide rates among youth
School systems have been identified as ideal settings for the implementation of suicide prevention programs.
Strong evidence for peer-led interventions with a social connectedness approach to improve help-seeking for suicide prevention.
RESEARCH OBJECTIVES
To determine whether implementation of the Sources of Strength suicide prevention program in rural high schools in Illinois results in a reduction of suicide rates in rural areas of Illinois
In our literature review we researched youth suicide intervention programs, as well as the differences between youth suicide in rural vs. urban areas. This literature helped give context to our research question and gave a clear idea as to why this type of intervention needs to be done.
Literature Review
Findings:
As adolescents undergo major physical and emotional changes during puberty, they are in a vulnerable time to develop self-esteem issues
One of the major risks for suicide is having low self-esteem during this time of change
Studies have shown that in certain schools, 17.0% of high school students seriously considered suicide, with nearly twice as many females (22.4%) reporting they seriously considered suicide contrasted to 11.6% of males.
Literature Review
Suicide, puberty, and a changing body
Suicide patterns and association with predictors among Rhode Island public high school students: a latent
class analysis
Findings:
In the groups of students identified as the highest risk for suicide, the most common predictors were associated with speaking a language other than English at home, being gay/lesbian/bisexual/unsure, feeling unsafe at school, and forced sexual intercourse,
Interventions for adolescents who have been determined the highest-risk for committing suicides may help prevent suicides
In our literature review we researched youth suicide intervention programs, as well as the differences between youth suicide in rural vs. urban areas. This literature helped give context to our research question and gave a clear idea as to why this type of intervention needs to be done.
Urban–Rural Differences in Suicide in the State of Maryland: The Role of Firearms
Evaluation of the Better Todays/Better Tomorrows Youth Suicide Prevention Program: Increasing Mental Health Literacy in Rural Communities
Findings:
As there are large increases in suicide rates for rural areas, this study aims to find out if prevalence of firearms are the reason
The increase in suicide rates in rural areas were from firearm suicides, and non-firearm suicide rates were not significantly higher in rural settings
It was not conclusive if firearm prevalence increases suicide rates, but there were higher rates of firearm suicides with men in rural areas
Findings:
The Better Todays/Better Tomorrows Youth Suicide Prevention Program was put to test to see if there was an increase in mental health literacy among participants
Specifically, this training was given to those who interact with youth in rural areas such as school personnel, police, justice system personnel, community volunteers, clergy, mayors, tribal social workers, and parents
After the program mental health literacy did improve
Literature Review
In our literature review we researched youth suicide intervention programs, as well as the differences between youth suicide in rural vs. urban areas. This literature helped give context to our research question and gave a clear idea as to why this type of intervention needs to be done.
Findings:
Rural youth suicides are almost double that of urban youth suicides. In addition, the rural vs urban youth suicide gap is growing for young men. This study aims to examine trends in this disparity.
In regards to this growing gap, the study looked at how to approach this disparity. Three of the most promising approaches for remedying the urban-rural disparity in services were: integrated care services, the use of telemedicine, and school-based intervention.
Literature Review
Widening rural-urban disparities in youth suicides, United States, 1996-2010.
An outcome evaluation of the Sources of Strength suicide prevention program delivered by adolescent peer leaders in high schools.
Findings:
This study examines the Sources of Strength suicide prevention program. This program is delivered by adolescent peer leaders in high schools, and focuses on enhancing protective factors associated with reducing suicide.
The program evaluation occurred fourth months post-implementation. It was found that the program decreased suicidal ideation and increased protective factors among students.
In our literature review we researched youth suicide intervention programs, as well as the differences between youth suicide in rural vs. urban areas. This literature helped give context to our research question and gave a clear idea as to why this type of intervention needs to be done.
Research Methodology
The Sources of Strength (SOS) Suicide Prevention Program
Previous research has shown that SOS leads to an increase in coping skills, understanding indicators of suicide and referring depressed and suicidal friends for help
Taking that research the next step, determining whether SOS actually leads to a decrease in the suicide rates
Secondarily, we will examine qualitative data from a pre and post test to help understand the mechanism by which SOS decreases suicide.
Program Structure
2-5 adult advisors who have contact with students are recruited at each school to receive SOS training (one day, 4-6 hours)
10-50 students are recruited through staff and student nominations to form a team of peer leaders, who are mentored by adult advisors.
Program Structure Continued
Certified Sources of Strength trainers provide the peer leaders with an initial 4-hour interactive training, which the adult advisors also must attend.
Adult advisors facilitate peer leader meetings over 3 months to plan, design, and practice tailored messaging activities, including individual messaging, classroom presentations, and media messaging, that reflect local cultural adaptations.
The peer leaders have one-on-one conversations within their network of friends; develop posters and public service announcements with local faces and voices; give peer-to-peer presentations; and develop messages to be delivered via video, instant messaging, text message, and social media such as Facebook, Instagram, Snapchat, etc.
Youths are taught to recognize signs of suicide and depression in themselves and others, and the specific steps to take.
The program is usually a 3- to 6-month project. Adult advisors receive monthly teleconference support meetings with Sources of Strength staff.
Costs approximately $5,000 per school/per year.
The Sources of Strength (SOS) Suicide Prevention Program
Seek a full board review and approval from NYU Institutional Review Board
Obtain informed consents from parents, school staff and students
Population being studied is all high school students in rural Illinois counties, as designated by CDC
The high schools (clusters) will be randomly assigned to an experimental group (SOS) and a control group (No SOS)
Independent variable = SOS suicide prevention program
Dependent variable = Suicide rate for high school students (14-18) in rural Illinois counties in the experimental group
Post-test:
Suicide rates for counties in the experimental group and control group will be compared
SOS program includes pre-intervention and post-intervention surveys to assess student knowledge about depression and suicide, as well as sources of strength. These surveys will be analyzed to measure differences pre and post intervention
Research Design: Experimental, with Randomized Clusters
Sampling
63 counties in Illinois have been designated as rural by the Centers for Disease Control (CDC)
600,000 high school students in these rural counties
Clusters = 206 high schools in these rural counties
These 206 rural high schools will be randomly assigned to one of two groups:
The Experimental Group—103 high schools, approximately 300,000 students
Will receive the Sources of Strength suicide prevention program
The Control Group—103 high schools, approximately 300,000 students
Will not receive the Sources of Strength program
Data Collection and Statistical Tools
Pre-intervention
1. Obtain suicide rates for Illinois high school youth (ages 14-18) in rural counties prior to intervention
2. All students in the Experimental Group will take a survey to determine baseline assessments of their knowledge about depression, suicide, risk factors, protective factors and coping strategies.
Post-intervention Measurements
1. Three months after SOS program ceases, a post-intervention survey will be administered, and the results compared to the pre-intervention baseline survey
2. Annual suicide rates after SOS program for the Experimental Group and Control Group will be obtained. We will expect to see that the suicide rate for the Experimental Group declined. The Control Group may decline, go up, or stay the same as before.
3. The suicide rate for the Experimental Group will be compared to the suicide rate for the Control Group, using the t-test to determine if they are statistically different at the p < .05 level. If p < .05, the null hypothesis (that SOS had no effect on the Intervention Group) will be rejected and we will conclude that the SOS program is effective for decreasing suicide for high school students in rural Illinois.
4. We would like to see and effect size of r > .6
Challenges & Limitations
Peer Volunteers & Staff Advisors: The Sources of Strength program relies on peer volunteers and staff advisors. This is a limitation in that the volunteers would need to be qualified and committed the program.
Peer Volunteer Activity: The SOS Peer Volunteers are in charge of delivering messaging around the intervention curriculum. This includes spreading the word via social media, posters etc. This is a limitation in that not all students would be able to access the social media messaging, frequent see the posters etc.
Post-Test Accuracy: Due to the long evaluation period (occurring annually) there are other factors at play that may affect the suicide rate. Ex) School counseling, media, peers, external influences
Challenges & Limitations
Challenges & Limitations
Consent: The program requires informed consent from parents, staff and students. This is a limitation in that we would need the buy-in from the stakeholders to be most effective. We could be challenged by lack of support from staff and school, thus affecting the effectiveness.
Cost: The program would cost ~$5,000 per school/per year, this is a limitation due to funding. We could be challenged by lack of funding or other programs presenting more cost-effective.
Impact Evaluation: Long time to evaluate (annual evaluation) and SOS often has a multiyear evaluation method due to nature of intervention topic.
Challenges & Limitations
Suicide Rates: Suicide rates are reliant on mortality data, and suicides may be misclassified as accidental or undetermined deaths. This could lead to an inaccurate suicide rate.
Student Surveys: The student surveys that are occurring pre and post test are reliant on self-reported measures, thus reliant on honesty from the Experimental Group
Control Group: As we are not interacting with the control group, we cannot determine if this cluster of schools will have a suicide prevention intervention during our testing period.
References
References
Overview
Focus
Aseltine, R.H., Jr., James, A., et al. (2007). Evaluating the SOS suicide prevention program: a replication and extension.
Biomedical Central Public Health, 7, 161-167.
Aseltin, R.H., Jr. & DeMartino, R. (2004). An outcome evaluation of the SOS suicide prevention program. American Journal
of Public Health, 94(3), 446-451.
Berzoff, J. (2016). Chapter 5: Psychosocial ego development: The theory of Erik Erikson. Inside out and outside in:
Psychodynamic clinical theory and practice in contemporary multicultural contexts (4th, ed., pp. 100-122). Lantham,
MD: Rowman & Littlefield.
Fatal Injury Reports, National, Regional and State, 1981 – 2016. Centers for Disease Control and Preventation.
https://webappa.cdc.gov/sasweb/ncipc/mortrate.html
Fontanella, C.A., Hiance-Steelesmith, D.L., et al. (2015). Widening rural-urban disparities in youth suicides, United States,
1996-2010. JAMA Pediatrics, 169 (5) 466-473.
Jiang, Y., Perry, D.K., & Hesser J.E. (2010). Suicide patterns and association with predictors among Rhode Island public high
school students: a latent class analysis. American Journal Of Public Health, 100(9),1701-1707.
NYU Institutional Review Board. (2018-2022). https://www.nyu.edu/research/resources-and-support-offices/getting-started-
withyourresearch/human-subjects-research.html
In our literature review we researched youth suicide intervention programs, as well as the differences between youth suicide in rural vs. urban areas. This literature helped give context to our research question and gave a clear idea as to why this type of intervention needs to be done.
Nestadt, P. S., Triplett, P., Fowler, D. R., & Mojtabai, R. (2017). Urban–Rural Differences in Suicide in the State of Maryland: The Role of Firearms. American Journal of Public Health, 107(10), 1548-1553. doi:10.2105/ajph.2017.303865 Rahmandar, M.H. & Biro, F.M. (2017). Suicide, puberty, and a changing body. International Journal of Child Health & Human Development, 10(4), 299-304. Sources of Strength Suicide Prevention Program. (2018). https://sourcesofstrength.org Suicidal Behavior Among Illinois Youth. (n.d.) http://www.dph.illinois.gov/sites/default/files/publications/publicationsowhfsyouth- suicide-fact-sheet.pdf Story, C. R., Kirkwood, D., Parker, S., & Weller, B. E. (2016). Evaluation of the Better Todays/Better Tomorrows Youth Suicide Prevention Program: Increasing Mental Health Literacy in Rural Communities. Best Practice In Mental Health, 12(1), 14-25. Social Science. 8 (1). Substance Abuse and Mental Health Services Administration. (2018). National Registry of Evidence-Based Programs and Practices: Sources of Strength Program. https://nrepp.samhsa.gov/legacy/viewintervention.aspx?id=248 Wyman, P.A., Brown, C.H., et al. (2010). An outcome evaluation of the Sources of Strength Suicide Prevention Program delivered by adolescent peer leaders in high schools. American Journal of Public Health, 100(9), 1653-1661.
