Impact of Sources of Strength on adolescent suicide deaths across three randomized trials

Peter Wyman; Ian Cero; Charles Hendricks Brown; Dorothy Espelage; Anthony Pisani; Tomei Kuehl; Karen Schmeelk-Cone

doi:10.1136/ip-2023-044944

Impact of Sources of Strength on adolescent suicide deaths across three randomized trials

Peter Wyman^*, Ian Cero, Charles Hendricks Brown, Dorothy Espelage, Anthony Pisani, Tomei Kuehl, Karen Schmeelk-Cone

^*Corresponding author for this work

Psychiatry and Behavioral Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

Universal interventions are key to reducing youth suicide rates, yet no universal intervention has demonstrated reduction in suicide mortality through an RCT. This study pooled three cluster-RCTs of Sources of Strength (n=78 high schools), a universal social network-informed intervention. In each trial, matched pairs of schools were assigned to immediate intervention or wait-list. Six schools were assigned without a pair due to logistical constraints. During the study period, no suicides occurred in intervention schools vs four in control schools, that is, suicide rates of 0 vs. 20.86/100,000, respectively. Results varied across statistical tests of impact. A state-level exact test pooling all available schools showed fewer suicides in intervention vs. control schools (p=0.047); whereas a stricter test involving only schools with a randomised pair found no difference (p=0.150). Results suggest that identifying mortality-reducing interventions will require commitment to new public-health designs optimised for population-level interventions, including adaptive roll-out trials.

Original language	English (US)
Pages (from-to)	442-445
Number of pages	4
Journal	Injury Prevention
Volume	29
Issue number	5
DOIs	https://doi.org/10.1136/ip-2023-044944
State	Published - Oct 1 2023

Funding

The three RCTs were supported as follows. Trial #1 was supported by the Center for Mental Health Services (SAMHSA; grant 5-UD1-SM57405), the National Institutes of Health (grants P20MH071897, RO1MH40859, and UL1-RR024160), the New York State Office of Mental Health, and the JDS Foundation. Trial #2 was supported by National Institutes of Health grant RO1MH091452. Trial #3 was funded by the National Center for Injury Prevention and Control (U01CE002841). IC’s time was supported by a grant (KL2 TR001999) from National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health (NIH) and by a National Institutes of Health Extramural Loan Repayment Award for Clinical Research (L30 MH120727).

Keywords

Adolescent
Mortality
Program evaluation
School
Suicide/Self?Harm

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1136/ip-2023-044944

Cite this

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title = "Impact of Sources of Strength on adolescent suicide deaths across three randomized trials",

abstract = "Universal interventions are key to reducing youth suicide rates, yet no universal intervention has demonstrated reduction in suicide mortality through an RCT. This study pooled three cluster-RCTs of Sources of Strength (n=78 high schools), a universal social network-informed intervention. In each trial, matched pairs of schools were assigned to immediate intervention or wait-list. Six schools were assigned without a pair due to logistical constraints. During the study period, no suicides occurred in intervention schools vs four in control schools, that is, suicide rates of 0 vs. 20.86/100,000, respectively. Results varied across statistical tests of impact. A state-level exact test pooling all available schools showed fewer suicides in intervention vs. control schools (p=0.047); whereas a stricter test involving only schools with a randomised pair found no difference (p=0.150). Results suggest that identifying mortality-reducing interventions will require commitment to new public-health designs optimised for population-level interventions, including adaptive roll-out trials.",

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AU - Espelage, Dorothy

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AU - Kuehl, Tomei

AU - Schmeelk-Cone, Karen

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N2 - Universal interventions are key to reducing youth suicide rates, yet no universal intervention has demonstrated reduction in suicide mortality through an RCT. This study pooled three cluster-RCTs of Sources of Strength (n=78 high schools), a universal social network-informed intervention. In each trial, matched pairs of schools were assigned to immediate intervention or wait-list. Six schools were assigned without a pair due to logistical constraints. During the study period, no suicides occurred in intervention schools vs four in control schools, that is, suicide rates of 0 vs. 20.86/100,000, respectively. Results varied across statistical tests of impact. A state-level exact test pooling all available schools showed fewer suicides in intervention vs. control schools (p=0.047); whereas a stricter test involving only schools with a randomised pair found no difference (p=0.150). Results suggest that identifying mortality-reducing interventions will require commitment to new public-health designs optimised for population-level interventions, including adaptive roll-out trials.

AB - Universal interventions are key to reducing youth suicide rates, yet no universal intervention has demonstrated reduction in suicide mortality through an RCT. This study pooled three cluster-RCTs of Sources of Strength (n=78 high schools), a universal social network-informed intervention. In each trial, matched pairs of schools were assigned to immediate intervention or wait-list. Six schools were assigned without a pair due to logistical constraints. During the study period, no suicides occurred in intervention schools vs four in control schools, that is, suicide rates of 0 vs. 20.86/100,000, respectively. Results varied across statistical tests of impact. A state-level exact test pooling all available schools showed fewer suicides in intervention vs. control schools (p=0.047); whereas a stricter test involving only schools with a randomised pair found no difference (p=0.150). Results suggest that identifying mortality-reducing interventions will require commitment to new public-health designs optimised for population-level interventions, including adaptive roll-out trials.

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Impact of Sources of Strength on adolescent suicide deaths across three randomized trials

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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