Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff.

Gatekeeper-training programs, designed to increase identification and referral of suicidal individuals, are widespread but largely untested. A group-based randomized trial with 32 schools examined impact of Question, Persuade, Refer (QPR) training on a stratified random sample of 249 staff with 1-year average follow-up. To test QPR impact, the authors introduced and contrasted 2 models of gatekeeper-training effects in a population: gatekeeper surveillance and gatekeeper communication. Intent-to-treat analyses showed that training increased self-reported knowledge (effect size [ES] = 0.41), appraisals of efficacy (ES = 1.22), and service access (ES = 1.07). Training effects varied dramatically. Appraisals increased most for staff with lowest baseline appraisals, and suicide identification behaviors increased most for staff already communicating with students about suicide and distress. Consistent with the communication model, increased knowledge and appraisals were not sufficient to increase suicide identification behaviors. Also consistent with the communication model were results from 2,059 8th and 10th graders surveyed showing that fewer students with prior suicide attempts endorsed talking to adults about distress. Skill training for staff serving as "natural gatekeepers" plus interventions that modify students' help-seeking behaviors are recommended to supplement universal gatekeeper training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural considerations in adolescent suicide prevention and psychosocial treatment.

Ethnic groups differ in rates of suicidal behaviors among youths, the context within which suicidal behavior occurs (e.g., different precipitants, vulnerability and protective factors, and reactions to suicidal behaviors), and patterns of help-seeking. In this article, the authors discuss the cultural context of suicidal behavior among African American, American Indian and Alaska Native, Asian American and Pacific Islander, and Latino adolescents, and the implications of these contexts for suicide prevention and treatment. Several cross-cutting issues are discussed, including acculturative stress and protective factors within cultures; the roles of religion and spirituality and the family in culturally sensitive interventions; different manifestations and interpretations of distress in different cultures; and the impact of stigma and cultural distrust on help-seeking. The needs for culturally sensitive and community- based interventions are discussed, along with future opportunities for research in intervention development and evaluation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing adolescent depression: An evaluation of the Problem Solving For Life program.

This study evaluated the effectiveness of the Problem Solving For Life program as a universal approach to the prevention of adolescent depression. Short-term results indicated that participants with initially elevated depressions scores (high risk) who received the intervention showed a significantly greater decrease in depressive symptoms and increase in life problem-solving scores from pre- to postintervention compared with a high-risk control group. Low-risk participants who received the intervention reported a small but significant decrease in depression scores over the intervention period, whereas the low-risk controls reported an increase in depression scores. The low-risk group reported a significantly greater increase in problem-solving scores over the intervention period compared with low-risk controls. These results were not maintained, however, at 12-month follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Initial behavior outcomes for the PeaceBuilders universal school-based violence prevention program.

PeaceBuilders is a universal, elementary-school-based violence prevention program that attempts to alter the climate of a school by teaching students and staff simple rules and activities aimed at improving child social competence and reducing aggressive behavior. Eight matched schools (N > 4,000 students in Grades K-5) were randomly assigned to either immediate postbaseline intervention (PBI) or to a delayed intervention 1 year later (PBD). Hierarchical linear modeling was used to analyze results from assessments in the fall and spring of 2 consecutive school years. In Year 1, significant gains in teacher-reported social competence for students in Grades K-2, in child self-reported peace-building behavior in Grades K-5, and reductions in aggressive behavior in Grades 3-5 were found for PBI but not PBD schools. Differential effects in Year 1 were also observed for aggression and prosocial behavior. Most effects were maintained in Year 2 for PBI schools, including increases in child prosocial behavior in Grades K-2. Implications for early universal school-based prevention and challenges related to evaluating large-scale prevention trials are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does marriage and relationship education work? A meta-analytic study.

In this meta-analytic study, the authors examined the efficacy of marriage and relationship education (MRE) on 2 common outcomes: relationship quality and communication skills. A thorough search produced 86 codable reports that yielded 117 studies and more than 500 effect sizes. The effect sizes for relationship quality for experimental studies ranged from d = .30 to .36, while the communication skills effect sizes ranged from d = .43 to .45. Quasi-experimental studies generated smaller effect sizes, but these appeared to be due to pretest group differences. Moderate-dosage programs produced larger effect sizes than did low-dosage programs. For communication skills, published studies had larger effects than those of unpublished studies at follow-up; there were no publication differences for relationship quality. There was no evidence of a gender difference. Unfortunately, a lack of racial/ethnic and economic diversity in the samples prevented reliable conclusions about the effectiveness of MRE for disadvantaged couples, a crucial deficit in the body of research. In addition, intervention outcomes important to policy makers, such as relationship stability and aggression, rarely have been addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Consultation as a means of veteran suicide prevention.

The development and implementation of a suicide consultation service being run by an interdisciplinary team in a metropolitan Veteran’s Administration (VA) medical center is described. This service is grounded in a collaborative theoretical framework. An overview of the consultation process and theoretical and empirical literature to support the framework used by the service are provided. Some of the interventions commonly recommended to referring clinicians to reduce client suicide risk are reviewed. Although there are many challenges to running a service such as this, the authors conclude that the model presented is flexible enough to be applied in a variety of settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating a prevention program for teenagers on sexual coercion: A differential effectiveness approach.

The authors evaluated a coeducational program for teenagers on preventing sexual coercion in dating situations. Students examined individual and social attitudes underlying coercive sexual behavior and learned communication skills aimed at preventing or dealing with unwanted sexual advances. Instruction was enhanced by video and an interactive video "virtual date." Outcomes were assessed using sexual attitude scales with a sample of 458 high school students. Student health education classes were randomly assigned to either a treatment or a control condition. Findings, based on a latent variable model of differential effectiveness, showed that students in the treatment group with initial coercive attitude scores at or above the mean benefited significantly more than students with the same range of scores in the control group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls.

Efficacy trials indicate that an eating disorder prevention program involving dissonance-inducing activities that decrease thin-ideal internalization reduces risk for current and future eating pathology, yet it is unclear whether this program produces effects under real-world conditions. The present effectiveness trial tested whether this program produced effects when school staff recruit participants and deliver the intervention. Adolescent girls with body image concerns (N = 306; M age = 15.7, SD = 1.1) randomized to the dissonance intervention showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, dieting attempts, and eating disorder symptoms from pretest to posttest than did those assigned to a psychoeducational brochure control condition, with the effects for body dissatisfaction, dieting, and eating disorder symptoms persisting through 1-year follow-up. Effects were slightly smaller than those observed in a prior efficacy trial, suggesting that this program is effective under real-world conditions, but that facilitator selection, training, and supervision could be improved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Show versus no show: A comparison of referral calls to a suicide prevention and crisis service.

Conducted an exploratory content analysis of 20 pairs of taped telephone calls to a suicide prevention and crisis service. Variables that might differentiate between referrals resulting in "show" and those resulting in "no show," were studied. A show and a no show call for each of 20 telephone therapists were coded. It is concluded that a scale based on 6 indexes would differentiate between the 2 groups. Motivation of the caller for getting help and the concreteness of the therapist emerged as most important factors in the 6-item scale. The relationship between this research and a crisis intervention model is discussed. (28 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An effectiveness trial of a selected dissonance-based eating disorder prevention program for female high school students: Long-term effects.

Objective: Efficacy trials found that a dissonance-based eating disorder prevention program in which female high school and college students with body image concerns critique the thin ideal reduced eating disorder risk factors, eating disorder symptoms, and future eating disorder onset. The present effectiveness trial tested whether this program produces effects through long-term follow-up when high school clinicians recruit students and deliver the intervention under real-world conditions. Method: Female high school students with body image concerns (N = 306; M age = 15.7 years, SD = 1.1) were randomized to the dissonance intervention or an educational brochure control condition and completed assessments through 3-year follow-up. Results: Dissonance participants showed significantly greater decreases in body dissatisfaction at 2-year follow-up and eating disorder symptoms at 3-year follow-up than controls; effects on other risk factors, risk for eating disorder onset, and other outcomes (e.g., body mass) were marginal or nonsignificant. Conclusions: Although it was encouraging that some key effects persisted over long-term follow-up, effects were on average smaller in this effectiveness trial than previous efficacy trials, which could be due to (a) facilitator selection, training, and supervision; (b) the lower risk status of participants; or (c) the use of a control condition that produces some effects. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predictors of suicide attempts: State and trait components.

The authors examined the state and trait components of 3 predictors of suicide attempts (depression, hopelessness, and anxiety), and their relationship to suicidal behavior. Self-report questionnaire and interview data from 180 adolescents enrolled in a prospective naturalistic study were analyzed. Between 23% and 30% of the variance in the predictors was attributable to subjects' trait levels of these variables; the trait, as well as the state, components of the predictor variables were interrelated; and trait levels of these variables were consistently related to suicide attempts. To reduce long-term risk of suicide attempts, clinicians should focus not only on reducing short-term distress but also on reducing individuals' more enduring patterns (trait levels) of negative affectivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing mediating variables in a school-based nutrition intervention program.

This study identified mediators of a school-based nutrition intervention for 4th graders and their parents. Nine variables were tested for satisfying 4 conclusions necessary to establish mediation of intervention effects on changes in fruit and vegetable consumption (FVC) in 4th graders (N=1,676). FVC was measured in children by the use of 24-hr dietary recalls. Mediators were assessed by the use of questionnaires completed by children and parents. All 4 conclusions were met for positive outcome expectancies. Knowledge, self-efficacy, and parent consumption satisfied the first 3 conclusions for mediation but the mediating effects were not statistically significant (Conclusion 4). Future mediational analyses and the creation of a national database of mediators are crucial for increasing strength and efficiency of school-based nutrition programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moving beyond efficacy and effectiveness in child and adolescent intervention research.

This Special Section of the Journal of Consulting and Clinical Psychology focuses on research that extends beyond documenting the efficacy and effectiveness of specific psychological treatments or preventive interventions for children and youths. In the past 30 years, there have been remarkable advances in the development and evaluation of psychological treatments and preventive interventions for a wide range of child and adolescent problems. At the same time, only a small percentage of youths who suffer from emotional and behavioral problems receive psychological services, and many of these services are not evidence-based. This article discusses key features of the Special Section studies, which examine important issues related to (a) disseminating treatments in diverse community settings (i.e., investigating the transportability of treatment), (b) personalizing mental health care (i.e., investigating predictors and moderators of treatment outcome), and (c) developing evidence-based explanations of treatment (i.e., investigating mediators of treatment). Key issues that are raised in the specific studies are discussed, and important considerations for future research are highlighted. Moving the field forward requires innovation, complex research designs, and a willingness to develop treatment models that reach beyond the current body of treatment outcome and prevention research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementation of a school-based prevention program: Effects of counselor and school characteristics.

The authors explore 2 broad categories of factors that could influence the intervention dissemination process: individual interventionist characteristics and school-level characteristics. Counselors from 32 schools received training in the Coping Power youth violence prevention intervention. Interventionist characteristics found to affect the implementation process included counselors’ agreeableness and conscientiousness. Counselor agreeableness was positively associated with completion of session objectives, the number of sessions scheduled, and engagement with parents. Counselor conscientiousness was associated with engagement with children. In terms of school-level characteristics, counselors who were cynical about organizational change had poorer quality of engagement with children and parents if they worked in schools with environments that allowed staff limited autonomy and with greater managerial control. These findings have implications for screening of practitioners for training of evidence-based programs and for providing education during intervention training about practitioner and setting characteristics that are related to optimal intervention implementation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

School-based prevention of depressive symptoms: A randomized controlled study of the effectiveness and specificity of the penn resiliency program.

The authors investigated the effectiveness and specificity of the Penn Resiliency Program (PRP; J. E. Gillham, L. H. Jaycox, K. J. Reivich, M. E. P. Seligman, & T. Silver, 1990), a cognitive-behavioral depression prevention program. Children (N = 697) from 3 middle schools were randomly assigned to PRP, Control (CON), or the Penn Enhancement Program (PEP; K. J. Reivich, 1996; A. J. Shatté, 1997), an alternate intervention that controls for nonspecific intervention ingredients. Children's depressive symptoms were assessed through 3 years of follow-up. There was no intervention effect on average levels of depressive symptoms in the full sample. Findings varied by school. In 2 schools, PRP significantly reduced depressive symptoms across the follow-up relative to both CON and PEP. In the 3rd school, PRP did not prevent depressive symptoms. The authors discuss the findings in relation to previous research on PRP and the dissemination of prevention programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practitioner and site characteristics that relate to fidelity of implementation: The Early Risers prevention program in a going-to-scale intervention trial.

Despite the increased availability of evidence-based prevention programs targeting serious mental health problems, an ongoing challenge within the field of prevention science is transporting prevention programs into real-world settings where their health impact can be fully realized. As part of a going-to-scale study, we examined how context, namely the characteristics of the practitioners and organizations, promotes or impedes fidelity of implementation of prevention efforts. Practitioners delivered Early Risers, an intensive, multicomponent, indicated prevention program across 27 geographically dispersed elementary schools and recorded 3 indexes of fidelity\Mexposure, adherence, and quality of implementation. As predicted, practitioner characteristics, including personality traits (low neuroticism, high extraversion, openness, and conscientiousness), beliefs (pre-implementation beliefs about program success), and use of flexible coping strategies (reappraisal coping) were related to various fidelity indexes. Contrary to predictions, teachers’ negative perceptions of the organizational structure were positively related to fidelity. Follow-up regression analyses suggested that practitioner characteristics differentially predict fidelity for child and family programming. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of suicide ideation and attempts among adolescents using a brief performance-based test.

Suicide is a leading cause of death that is difficult to predict because clinical assessment has relied almost exclusively on individuals' self-report of suicidal thoughts. This is problematic because there often is motivation to conceal such thoughts. The authors tested the ability of the Self-Injury Implicit Association Test (SI-IAT), a reaction-time measure of implicit associations between self-injury and oneself, to detect and predict suicide ideation and attempts. Participants were adolescents who were nonsuicidal (n = 38), suicide ideators (n = 37), or recent suicide attempters (n = 14). Analyses revealed large between-group differences on the SI-IAT, with nonsuicidal adolescents showing large negative associations between self-injury and themselves, suicide ideators showing small positive associations, and suicide attempters showing large positive associations on this performance-based test. The SI-IAT accurately predicted current suicide ideation and attempt status as well as future suicide ideation, and it incrementally improved prediction of these outcomes above and beyond the use of known risk factors. Future research is needed to refine this assessment method and to further develop and examine performance-based assessment of suicide risk in clinical settings (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tennessee Lives Count: Statewide gatekeeper training for youth suicide prevention.

Youth suicide remains a significant public health problem in the United States. In 2004, the Garrett Lee Smith Memorial Act provided states and tribes with funding to implement and evaluate youth suicide prevention programs. The Tennessee Lives Count project was developed through a collaborative model at the state level and delivers an enhanced version of the Question, Persuade, Refer gatekeeper training program to individuals working with youth across the state. This article describes the development of the project and preliminary outcomes of 416 participants in child welfare, juvenile justice, health, and education systems at pretest, posttest, and 6-month follow-up. The findings suggest the training has an immediate and long-term impact on perceived knowledge of suicide prevention, self-efficacy, and attitudes about the inevitability of suicide. Policy and practice implications are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term prediction of marital quality following a relationship education program: Being positive in a constructive way.

Relationship education programs such as Ehevorbereitung--Ein Partnerschaftliches Lernprogramm (Premarital Preparation--A Couples' Learning Program) and the Relationship Education and Relationship Enhancement Program (PREP) can help prevent marital distress among newlyweds. Thus, it is important to understand which couples respond best to the intervention and which couples respond less well. E. A. Schilling, D. H. Baucom, C. K. Burnett, E. A. Allen, and L. Ragland (2003) unexpectedly found that the more women increased positive communication in response to PREP, the more likely they were to become distressed in the subsequent 5 years. The current study explores similar issues, investigating a relationship education program in Germany. The current results indicate that couples are susceptible to future relationship distress if women demonstrate extreme increases in positive and decreases in negative communication after intervention. Implications are provided for adapting these relationship education programs in the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of suicide risk in a psychiatric hospital.

Assessment of suicide risk is a serious responsibility of psychologists. Best practice instructs use of a standardized instrument and clinical interview to evaluate suicide risk. Six instruments used to assess suicide behavior and symptoms of anxiety and depression were examined. The sample was adults receiving acute psychiatric treatment in a public hospital. The study consisted of 2 groups: 25 patients admitted for suicidal behavior and 42 patients admitted for other reasons. Analyses were conducted to discriminate between the 2 groups on study instruments. No single instrument predicted suicide risk without significant error. Standardized assessments must be used as part of a structured clinical interview. Suicide risk should be assessed with all people admitted to the hospital regardless of admissions criteria. (PsycINFO Database Record (c) 2010 APA, all rights reserved)