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

Logically, the mechanisms by which factual information/assessment, personally relevant feedback, access to help, and adult social support work were expected to apply to C-CARE, CAST, and the control condition. This is because each strategy is present in all three approaches, albeit the "doses" in CAST are greatest.

First, empirical support reveals that providing factual information/assessment and personally relevant feedback increases motivation (Miller & Rollnick, 1991; Miller & Sanchez, 1994), reduces uncertainty and skills deficits, and functions to enhance personal control and decrease negative health outcomes in tests of social influence and empowerment models (Dorn, 1984; Eggert & Herting, 1991; Igoe, 1991; Vorrath & Brendtro, 1985).

For youth, access to help in youths' normal settings typically reduces barriers to getting assistance and fosters increased self-efficacy skills (Pentz, 1993; Stone & Perry, 1990). Social support, in the form of expressed empathy and caring, meets basic human needs for acceptance and belonging, providing a propitious environment for adaptive growth and greater emotional well-being (Eggert, 1987; Sarason, Pierce, & Sarason, 1990; Wills, 1982). Social support has been shown to enhance personal control directly, thereby indirectly reducing depression and suicide-risk behaviors among potential dropouts (Thompson, Eggert, & Herting, 2000). Hence, we hypothesized that C-CARE and "usual care" would work to decrease suicidal behaviors, depression, and drug involvement for all youth in the study, given that each of the three conditions had a social support intervention component.

Second, the rationale for positing that the CAST coping and skills training group would have greater effects than C-CARE or "usual care" was based on expected larger doses of adult support, added peer support, and skills training. Theoretically, peer support and positive peer relationships are pivotal in social influence models and healthy adolescent development (Cauce & Srebnik, & Srebnik, 1989; Dorn, 1984; Dryfoos, 1991). Moreover, peer support and pleasant activities with peers are empirically linked with less depression (Clarke et al., 1999; Dryden, 1981; Gotlib & Whiffen, 1991; LaGaipa & Wood, 1981) and/or suicidal behaviors (Thompson et al., 2000).

Third, skills training should provide greater reinforcements and differential opportunities for learning important social and life skills within a supportive, interpersonal, and valued peer-group context (Bandura, 1977; Eggert, Nicholas, et al., 1995; Schinke & Gilchrist, 1984). Empirically, C-CARE and CAST increased the posited mediators in a preliminary test (i.e., personal control, problem solving, coping, and perceived family support) (Randell et al., 2001). Hence, we anticipated that the intervention effects of CAST would be greater than that of C-CARE and "usual care" for reducing suicide-risk behaviors, depression, and drug involvement.

Specific Hypotheses

This study examined three hypotheses:

H^sub 1^. Youth in CAST, C-CARE, and the "usual care" control condition will experience reductions in suicide-risk behaviors (H^sub 1a^), depression (H^sub 1b^), and drug involvement (H^sub 1c^) over time.