Piloting a culturally adapted multilevel suicide prevention intervention in schools for Black youth and their families

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Project Summary/Abstract The goal of this proposed study is to pilot test and evaluate the preliminary effectiveness of a school-based suicide prevention intervention tailored specifically for Black youth and those connected to Black youth (e.g., families and school personnel). Suicide was recognized in 2018 as the 2nd leading cause of death for 10 to 14- year-old Black adolescents in the U.S., yet there are few evidence-based suicide prevention interventions designed to account for the cultural factors that influence Black youth's risks for suicidality. Further – although universal school-based suicide prevention programs have great potential to alleviate disparities in access to mental health resources – most school-based suicide prevention interventions are administered to high school students. Some researchers have begun to implement prevention interventions among middle school-aged youth, but we know little about the effect universal school-based suicide prevention interventions could have for Black students residing in underserved communities. To redress this gap, we propose modifying an existing intervention with culturally adapted content by conducting a pilot RCT to assess preliminary effectiveness, tolerability, and feasibility. The Signs of Suicide (SOS) program is a school-based intervention that has demonstrated reductions in suicide attempts among middle and high school students by identifying knowledge and attitudes towards depression and suicide as key mechanisms that mediate the relation between intervention participation and a significant reduction in suicide attempts. Thus, it is important to consider how prioritizing these two mechanisms – knowledge and attitudes towards depression and suicide – may differ for Black youth whose perceptions of knowledge and attitudes of suicide may be culturally bound and influenced by stigmatized beliefs regarding help-seeing for mental health concerns. Parents views about stigma and school personnel's familiarity with suicide prevention resources may also influence Black youth's knowledge and attitudes, thus affirming the necessity of a multilevel suicide prevention intervention. We therefore propose a cultural adaptation of the SOS program that aims to: 1) Tailor the SOS intervention videos to include culturally adapted strategies for navigating stigma of receiving mental health treatment; (2) Develop culturally adapted curricula that trains parents and school personnel to (a) recognize suicide risk factors for Black youth; and (b) refer students to local mental health treatment services; and (3) Conduct a pilot randomized controlled trial (n=300) to assess feasibility, tolerability, and acceptability of reducing suicidality among Black youth across three intervention conditions (standard SOS condition; culturally adapted SOS condition; culturally adapted SOS + parent and school personnel training condition). Pre-test scores will be compared at post-test, 3-month, and 1-year follow up. Results from this study will advance our understanding of factors that contribute to and protect against suicidality in Black youth, while also providing a foundation to test and refine study procedures to implement the intervention in a larger cohort of students.