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Programs for the Prevention of Suicide Among Adolescents and Young Adults
The following CDC staff members prepared this report:
Patrick W. O'Carroll, M.D., M.P.H.
Office of the Director Office of Program Support
Lloyd B. Potter, Ph.D., M.P.H.
James A. Mercy, Ph.D. National Center for Injury Prevention and Control
Incidence rates of suicide and attempted suicide among adolescents and young adults aged 15-24 years continue to remain at high levels. In 1992, to aid communities in developing new or augmenting existing suicide prevention programs directed toward this age group, CDC's National Center for Injury Prevention and Control published Youth Suicide Prevention Programs: A Resource Guide. The Resource Guide describes the rationale and evidence for the effectiveness of various suicide prevention strategies, and it identifies model programs that incorporate these strategies. This summary of the Resource Guide describes eight suicide prevention strategies and provides general recommendations for the development, implementation, and evaluation of suicide prevention programs targeted toward this age group.
The continued high rates of suicide among adolescents (i.e., persons aged 15-19 years) and young adults (persons aged 20-24 years) (Table_1) have heightened the need for allocation of prevention resources. To better focus these resources, CDC's National Center for Injury Prevention and Control recently published Youth Suicide Prevention Programs: A Resource Guide (1). The guide describes the rationale and evidence for the effectiveness of various suicide prevention strategies and identifies model programs that incorporate these strategies. It is intended as an aid for communities interested in developing or augmenting suicide prevention programs targeted toward adolescents and young adults. This report summarizes the eight prevention strategies described in the Resource Guide.
Suicide prevention programs were identified by contacting suicide prevention experts in the United States and Canada and asking them to name and describe suicide prevention programs for adolescents and young adults that, based on their experience and assessment, were likely to be effective in preventing suicide. After compiling an initial list, program represen- tatives were contacted and asked to describe the number of persons exposed to the intervention, the number of years the program had been operating, the nature and intensity of the intervention, and the availability of data to facilitate evaluation. Program representatives were also asked to identify other programs that they considered exemplary. Representatives from these programs were contacted and asked to describe their programs. The list of programs was further supplemented by contacting program representatives who participated in the 1990 national meeting of the American Association of Suicidology and by soliciting program contacts through Newslink, the association's newsletter.
Suicide prevention programs on the list were then categorized according to the nature of the prevention strategy using a framework of eight suicide prevention strategies:
After categorizing suicide prevention efforts according to this framework, an expert group at CDC reviewed the list to identify recurrent themes across the different categories and to suggest directions for future research and intervention.
The following conclusions were derived from information published in the Resource Guide:
Suicide prevention efforts targeted for young adults are rare. With a few important exceptions, most programs have been targeted toward adolescents in high school, and these programs generally do not extend to include young adults. Although the reasons for this phenomenon are not clear, the focus of prevention efforts on adolescents may be because they are relatively easy to access in comparison with young adults, who may be working or in college. In addition, persons who design and implement such efforts may not realize that the suicide rate for young adults is substantially higher than the rate for adolescents (Table_1).
Links between suicide prevention programs and existing community mental health resources are frequently inadequate. In many instances, suicide prevention programs directed toward adolescents and young adults have not established close working ties with traditional community mental health resources. Inadequate communication with local mental health service agencies obviously reduces the potential effectiveness of programs that seek to identify and refer suicidal adolescents and young adults for mental health care.
Some potentially successful strategies are applied infrequently, yet other strategies are applied commonly. Despite evidence that restricting access to lethal means of suicide (e.g., firearms and lethal dosages of drugs) can help to prevent suicide among adolescents and young adults, this strategy was not a major focus of any of the programs identified. Other promising strategies, such as peer support programs for those who have attempted suicide or others at high risk, are rarely incorporated into current programs.
In contrast, school-based education on suicide is a common strategy. This approach is relatively simple to implement, and it is a cost-effective way to reach a large proportion of adolescents. However, evidence to indicate the effectiveness of school-based suicide education is sparse. Educational interventions often consist of a brief, one-time lecture on the warning signs of suicide -- a method that is unlikely to have substantial or sustained impact and that may not reach high-risk students (e.g., those who have considered or attempted suicide). Further, students who have attempted suicide previously may react more negatively to such curricula than students who have not. The relative balance of the positive and the potentially negative effects of these general educational approaches is unclear.
Because current scientific information about the efficacy of suicide prevention strategies is insufficient, the Resource Guide does not recommend one strategy over another. However, the following general recommendations should be considered:
For a copy of the full report, Youth Suicide Prevention Programs: A Resource Guide, write to Lloyd Potter, Ph.D., M.P.H., at the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, Mailstop K-60, Atlanta, GA 30341-3724. Single copies are available free of charge.
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TABLE 1. Suicide rates * for persons 15-24 years of age, by age group and sex -- United States, 1950, 1960, 1970, 1980, and 1990 ========================================================================================= Year ---------------------------------------- Age group (yrs)/Sex 1950 1960 1970 1980 1990 ----------------------------------------------------------------------- 15-19 Male 3.5 5.6 8.8 13.8 18.1 Female 1.8 1.6 2.9 3.0 3.7 Total 2.7 3.6 5.9 8.5 11.1 20-24 Male 9.3 11.5 19.2 26.8 25.7 Female 3.3 2.9 5.6 5.5 4.1 Total 6.2 7.1 12.2 16.1 15.1 15-24 Male 6.5 8.2 13.5 20.2 22.0 Female 2.6 2.2 4.2 4.3 3.9 Total 4.5 5.2 8.8 12.3 13.2 ----------------------------------------------------------------------- * Per 100,000 persons. Source: National Center for Health Statistics, CDC. =========================================================================================
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