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

Linking Suicide-Risk Behaviors, Depression, and Drug Involvement

Direct suicide-risk behaviors are conceptualized as a constellation of self-destructive thoughts and behaviors, including suicidal ideation, communicated threats, and actual suicide attempts (Eggert et al., 1994). These suicidal thoughts and behaviors have been (a) linked with completed suicides (Brent et al., 1993; Gould, Fisher, Parides, Flory, & Shaffer, 1996), (b) included in assessment protocols (Eggert, Thompson, et al., 1994a; Lewinsohn, Garrison, Langhinrichsen, & Marsteller, 1991), and (c) posited to comprise a causal chain in which death by suicide is the final outcome (O`Carroll, German, Maris, & Moscicki, 1996). Further, suicidal thoughts and behaviors in the presence of depression and drug abuse signal greater suicide potential (Brent et al., 1993; Garrison, McKeown, Valois, & Vincent, 1993). Thus defined, suicide-risk behavior is a suitable outcome measure for evaluating prevention programs because there is more variability in suicidal behaviors than in the variable "completed suicides" and a greater propensity to observe changes in this construct longitudinally (Eggert, 1995; Eggert, Thompson, et al., 1995).

Depression, defined broadly herein as depressed affect, hopelessness, and anxiety, has been correlated with or predictive of suicide and suicidal behaviors in several etiologic studies (e.g., Garrison, Addy, Jackson, McKeown, & Waller, 1992; Mazza & Reynolds, 1997). Drug involvement, while not as strong a correlate of suicidal behaviors as depression, has predicted suicide and suicidal behaviors in several tests of etiologic models (Harlow, Newcomb, & Gentler, 1986; Garrison et al., 1993; Kandel, Raveis, & Davies, 1991; Schuckit & Schuckit, 1991; Walsh, 1999). Drug involvement is defined herein as the frequency of alcohol and other drug use, drug-use control problems, and adverse drug-use consequences (Herting, Eggert, & Thompson, 1996). Thus, based on both theoretic premises and empirical evidence, the indicated prevention approaches tested herein were assessed for their immediate efficacy in reducing suicide-risk behaviors, depression, and drug involvement as defined above.

Linking C-CARE and CAST to Reduced Suicide-Risk Behaviors, Depression, and Drug Involvement

As depicted in Figure 1, the posited direct effects of C-CARE and CAST were to increase personal life-skills competencies and social-support resources, thereby influencing the co-occurring outcomes. Thus, of particular importance were interventions that enhanced adolescents' personal and social resources in schools (cf. Bond & Compas, 1989). Five key prevention strategies suggested by Pentz (1993) and evident in efficacious approaches to suicide, depression, and/or drug-abuse prevention (Clarke, Rohde, Lewinsohn, Hops, & Seeley, 1999; Eggert, 1995; Eggert et al., 2001; Schotte & Clum, 1982) were incorporated into the C-CARE and CAST models: (a) information/assessment/feedback strategies, (b) access to help, (c) adult motivation/support, (d) peer support, and (e) social and life skills training.