Youth Suicide Prevention: Maintaining Long Term Change

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DESCRIPTION (provided by applicant): Suicide remains a leading cause of death among young people--each year 1 in 5 teenagers considers suicide and approximately one million attempt suicide. These rates continue to escalate into young adulthood. Youth suicide-risk behavior is a major public health problem deserving immediate attention to critical intervention factors that promote short-term and maintain long-term behavioral change. This proposal examines psychosocial processes associated long-term behavioral change following participation in an indicated suicide prevention program, and responds specifically to RFA OB-03-003. The proposal takes advantage of a nearly completed prevention trial, Promoting CARE funded by the National Institute for Nursing Research. The program has demonstrated short-term outcome effects for suicide-vulnerable high school youth. The Promoting CARE study will provide a sample of approximately 550 vulnerable youth, randomly assigned to 1 of 3 experimental conditions, and compared to intervention "as usual." The study has been rigorously implemented, with extensive measures collected at baseline, post-intervention, 9 and 15 months post-baseline, and, for half the sample, at 30 months. With an extended follow-up to 48 months, we will 1) test for long-term intervention effects; 2) test the theoretic model, examining for mediational intervention effects on both short- and long-term behavioral outcomes; and 3) identify trajectories of change across time. Advanced statistical procedures (latent growth models, SEM) will be used to examine behavioral change and to test hypothesized mediating intervention effects. The influence of intervention processes and life course factors on patterns of change will be examined using multi-method approaches and exploratory analytic strategies. The proposed study is innovative and significant; it has implications for theory testing and prevention science. This research should markedly increase our understanding of ways in which youth and family-focused preventive interventions for suicide-vulnerable youth work to curb depression, anger and suicide-risk behaviors.