Researchers to study suicide prevention program in high schools

University of Rochester Medical CenterSep 8 2010

With students returning to classes, University of Rochester Medical Center researchers are beginning a large, long-term study of the effectiveness of a unique suicide prevention program in high schools across New York and North Dakota.

The study of the program called Sources of Strength, led by Peter Wyman, Ph.D., associate professor of Psychiatry at the Medical Center, is supported by a five-year, $3-million grant awarded by the National Institute of Mental Health.

"Most school-based programs are oriented by a medical model designed to identify students who already are suicidal or highly distresses and refer them to treatment," Wyman said. "That approach has several limitations. The traditional approach assumes that mental health services are available and acceptable to most teens, which is frequently not the case. The tradition model does not change school culture and teen socialization in ways that prevent new instances of suicidal problems."

Sources of Strength aims to "strengthen how teens handle depression, stress and other problems by training influential teen 'peer leaders' who work to change coping practices in their friendship networks," he said.

Wyman's study will include 36 high schools, two-thirds of which will be in New York State. Schools in Chemung, Franklin, Onondaga, Schuyler, Tioga and Wyoming counties already have agreed to participate. As many as 14,000 students will be involved.

"We're focusing on rural and underserved areas where the traditional suicide prevention models are not a reasonable sole solution," Wyman said.

Suicide accounts for more deaths among those aged 10 to 24 in the United States than do all natural causes combined. Each year, 5 to 8 percent of adolescents attempt suicide. Up to one-third of these attempts result in an injury requiring medical intervention.

"This study is a real opportunity to determine how influential peer leaders in high school can change the culture of their schools and peer groups and determine whether this intervention leads to a decrease in suicide attempts," Wyman said.

The New York State Office of Mental Health Suicide Prevention Initiatives already has backed the program and the study.

"This office is proud to help support the expansion of the evidence-based Sources of Strength project," said Melanie Puorto, director of the Suicide Prevention Initiatives. "This school-based program promotes resiliency and helps increase positive help-seeking behaviors. This is an important effort to help prevent youth suicide."

Sources of Strength was developed in the late 1990s by Mark LoMurray with tribal and rural suicide prevention workers in North Dakota. Youth opinion leaders from diverse social cliques, including at-risk adolescents, are trained to change the typical beliefs and behaviors of their peers by conducting well-defined messaging activities with adult mentoring. The purpose is to modify the beliefs propagated through communication within peer groups and to alter perceptions of what is typical behavior for handling emotional crises and of the social consequences for positive coping behaviors.

Peer leaders encourage friends to name and engage ''trusted adults'' to increase youth-adult communication ties. They also reinforce the idea that friends should ask adults for help for suicidal friends, thereby reducing implicit suicide acceptability and stigma for seeking help. Peer leaders develop videos and other messages showing how positive coping strategies or "sources of strength" can help in getting through tough times and challenging emotions. Changing these factors is designed to connect suicidal youths with capable adults and to reduce the likelihood that lower risk youths will develop behavior that includes suicidal thinking.

In a study of the Sources of Strength program in 18 schools in Georgia, New York and North Dakota that was published in July in the American Journal of Public Health, Wyman and his colleagues found that trained peer leaders in larger schools were four times as likely as were untrained peer leaders to refer a suicidal friend to an adult. Among students across the school population, the intervention increased perceptions of adult support for suicidal youths and the acceptability of seeking help. Perception of adult support increased most in students with a history of suicidal ideation.

"Sources of Strength is an innovative and promising program," Wyman said.