Adaptation and Pilot Test of a Universal School-Based Suicide Prevention Program

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The Centers for Disease Control and Prevention reported that the suicide rate for females aged 10 –14 has had the largest percent increase (200%) of any other demographic group between 1999 and 2014, tripling from 0.5 per 100,000 in 1999 to 1.5 in 2014. Although the rates of suicide are relatively rare in these ages, as compared to older ages, the sharp increase in suicide among young people is alarming. Data from the 2016 Youth Risk Behavior Surveillance System showed that 27% of Baltimore City middle school students (ages 11- 14) reported having ever thought about killing themselves and 14% had ever attempted suicide. With suicide being the second leading cause of death for persons ages 10-14, it is important to target prevention efforts early. Almost all of the existing suicide prevention programs target suicide risk in high school, which is too late to meet the needs of middle school students. The primary aim of this R34 pilot effectiveness trial is to establish the feasibility, acceptability, preliminary impact, and potential for future uptake of the Youth Aware of Mental Health (YAM) program. YAM is an evidence-based mental health promotion program administered in schools that has been shown to be effective among primarily white European high school students ages 14 to 16 years old. In a large randomized trial involving 11,110 students from 168 schools in ten European Union countries, students randomized to YAM reported 55% lower incidence of suicide attempts and 50% lower incidence of severe suicidal ideation over one year. YAM was chosen for the proposed study not just because of these outcome data, but because it aligns with U.S. National Health Education Standards, and because it was created with the heterogeneity of youth in mind. Our adaptation and implementation of YAM will include five sessions delivered in middle school health education class by trained health education teachers. Given its flexibility, YAM was designed with an eye toward community implementation, sustainment and scalability. YAM’s proposed target mechanisms of action involve enhancing problem-solving and coping skills to manage acute stressors. This pilot study will examine feasibility and acceptability of the proposed recruitment methods, research design, intervention, assessment methods and training program in a school system with a majority African American population by matching 7th and 8th grade classrooms by school and randomizing classrooms to YAM or to the wait-list control condition. The primary outcomes will be suicidal ideation and mood symptoms in the 3 months after YAM implementation. This proposed pilot effectiveness trial will lay the groundwork for a larger clinical trial (R01) to evaluate the effectiveness of YAM on suicidal behaviors in urban middle school students.