Preliminary effects of brief school-based prevention approaches for reducing youth suicide-risk behaviors, depression, and drug involvement

Journal of Child and Adolescent Psychiatric Nursing, Apr-Jun 2002 by Eggert, Leona L, Thompson, Elaine A, Randell, Brooke P, Pike, Kenneth C

PROBLEM. Few empirically tested, school-based, suicide-prevention programs exist, The purpose of this study was to evaluate the postintervention efficacy of Counselors-CARE (C-CAST) and Coping and Support Training (CAST) vs. "usual care" controls for reducing suicide risk.

METHODS. A randomized prevention trial; 341 potential dropouts, 14 to 19 years old, from seven high schools (52% female, 56% minorities) participated. Trend analyses using data from three time points assessed over time changes.

FINDINGS. Significant decreases occurred for all youth in suicide-risk behaviors, depression, and drug involvement. Intervention-specific effects occurred for decreases in depression.

CONCLUSIONS. School-based prevention approaches are feasible and show promise for reducing suicidal behaviors and related depression.

Search terms: Depression, high-risk youth, school-based prevention, reducing adolescents" suicide risk

A major problem among high-risk youth in our schools is the co-occurrence of several health-related problem behaviors. For example, our studies of potential high school dropouts demonstrate three co-occurring health risks: drug involvement, depression, and suicidal behaviors (Thompson, Moody, & Eggert, 1994). On average, when surveyed, 38% of these high-risk youth screen is at suicide risk (Eggert, Thompson, & Herting, 1994a; Thompson & Eggert, 2000). Moreover, these youth evidence significantly more drug involvement than typical high school students (Eggert & Herting, 1993; Eggert, Thompson, Herring, & Randell, 2001).

Reducing health-related problem behaviors among potential high school dropouts presents special challenges for health and school professionals. Specifically, to address these problems requires indicated prevention approaches targeting these high-risk youth (Institute of Medicine [IOM], 1994). Challenges associated with preventive intervention include (a) being able to identify these youth within a school's population, (b) designing theory-based prevention approaches that address multiple health-risk behaviors that can be implemented effectively in schools, and (c) testing the efficacy of such prevention approaches within a school setting (Eggert et al., 2001). This last point is particularly important because, for these potential dropouts, the focus of life is still the school setting. This is where they want to belong, where their friends are, and where we expect them to make a healthy transition into young adulthood (Eggert & Nicholas, 1992).

Despite the growing need to address these prevention challenges with high-risk youth, few indicated school-based prevention programs exist; moreover, most school-based suicide-prevention efforts have not been rigorously evaluated (could & Kramer, 2001; Mazza, 1997; National Institute on Drug Abuse, 1997; Randell, Eggert, & Pike, 2001). Our prior studies demonstrated the efficacy of a school-based, semester-long program (Eggert, Nicholas, & Owen, 1995) for decreasing suicidal behaviors, emotional distress, and drug involvement. An individual assessment/crisis intervention (CounselorsCARE [C-CARE]) program, administered to all youth in experimental and control groups, was also effective in reducing suicidal behaviors and depression (Eggert, Thompson, Herting, & Nicholas, 1995).

The purpose of this article is to report the immediate postintervention efficacy of two promising programs: C-CARE, an individual assessment/crisis-intervention approach (Eggert, Thompson, Herting, Seyl, & Randell, 1994, 2002), and Coping and Support Training (CAST), a 12-session coping and skills training program (Eggert & Nicholas, 1996, 2002). The central hypotheses were that the relative effects of C-CARE and CAST would be greater than a "usual care" control condition for decreasing levels of (a) suicide-risk behaviors, (b) depression, and (c) drug involvement among potential high school dropouts at suicide risk.

The expected significance of this prevention trial was to add to our knowledge of what works to reduce youth suicide risk. If supported, the hypotheses will be among the first to test the efficacy of brief suicide-prevention programs for stemming youth suicide-risk behaviors and depressed affect among suicide-risk youth (could & Kramer, 2001). The study findings also will increase our understanding of the intervention "dose" needed to reduce drug involvement among potential high school dropouts at suicide risk.

Theoretic Framework

Figure 1 depicts the heuristic model guiding this study Reading from left to right, the C-CARE and CAST experimental interventions are portrayed as influencing the posited mediating variables (i.e., personal life skills competencies, social support resources). These mediators are key protective factors that preventive interventions are designed specifically to enhance (Eggert, 1995; Eggert et al., 2001; Eggert, Thompson, et al., 1995; Thompson, Mazza, Herting, & Eggert, 2002). Co-occurring outcomes are suicide-risk behaviors, depression, and drug involvement.