An Analysis of Sucide Prevention Programs, Research Paper Example

Introduction

The word suicide was derived from the Latin language meaning to kill one’s self. Precisely, it is the act of intentionally causing one’s own death. There were many types of self-killing, which are not considered suicide until analysts begin defining suicide based on the preconceived intentions. For example, in some cultures suicide is considered an honor when executed in allegiance to a cult or organization’s beliefs (Aggarwal 2009).  Historically, it was revealed that political leaders killed themselves to honor values of their organization. Notable suicides of this nature still occur in the twentieth and twenty-first centuries including suicide bombers. The 1978 Jones Town massacre in Guyana is one massive suicide event recorded in history.  Studies have proven that in United States of America suicide is the second highest cause of death among adolescents (Meier and Clinard 2008).

The twenty-first century modified definitions and classifications of suicide, and forged interventions due to escalating incidences, especially among teenagers, who seem to have no other reason for taking their lives, but depression (Moutier et.al 2012). Among these interventions are programs geared towards preventing suicide attempts, ultimately lowering suicide incidence rates among all ages.  Unfortunately, the application of several community and health care suicide prevention programs has not adequately addressed the social issue, instead suicides incidences as well as attempts are increasing every year (Moutier et.al 2012).

The purpose of this paper is to review aspects of suicide prevention programs that produced favorable outcomes in the health care environment, community, army, and school settings. This paper will explore a number of primary studies pertaining to development and implementation of suicide prevention programs, ultimately aligning their main features to theories that explain how they function successfully.

In conducting this study the following steps will be taken towards arriving at an appropriate outcomes.  An analysis of existing intervention designs will be made. Next a review of primary, secondary, and tertiary suicide intervention programs will also be undertaken. Subsequently, a comparative analysis rating the effectiveness of each level of mental health initiative, subsequently, developing an efficient prevention and intervention framework in reducing suicide rates will be undertaken.

Further, this literature review will examine how the combination of short-term and long-term intervention, prevention, and post-suicide care can be best utilized. As such, there will be an undertaking review of suicide prevention programs through a literature synthesis. Criteria for selecting literature for the investigation will depend on evidences pertaining towards application of a framework that focuses on collaboration between educators, health care professionals, and social workers (Fountoulakis et.al 2011). More importantly, analysts have predicted that “Suicide cannot be restricted within the boundaries of psychiatry or medicine and reducing suicide rates is a challenge for the whole society” (Fountoulakis et al 2011).

It is the author’s perspective that in reviewing studies measuring the effectiveness of individual programs could be a focal point of understanding the strengths and weaknesses of suicide prevention programs generally. A further examination into the implementation framework strategies encompassing screening, identification of risk factors, predicators of socio-economic factors, and demographic characteristics is expected to be given more in-depth attention. From research that focused on individual suicide prevention programs, and others that focused on risk factors, the following thesis is advanced: Adequate mental health screening of risk factors among vulnerable populations can increase the effectiveness of suicide prevention program.

Background

The significance of this literature review involves finding and listing suicide statisticsrelated to attempts and morbidity rates as well as investigating the extent to which suicide prevention programs have been effective in reducing actual /attempted suicide rates. Miller et al. (2009) in their study confirmed many general and youth suicide statistics, while Nadeem et al. (2011) related that, “there has been an approximately 200% increase in suicide attempts among 11–14 year olds between 1980 and 1999.” Importantly, at-risk populations were identified as young people (Moutier et al. 2012; Robinson et al. 2012). However, universal interventions target elderly people (Lapierre et al. 2011). It was further discovered that while there is a high incidence among military personnel they were neglected regarding appropriate programs, especially those addressing post-traumatic stress disorder (PTSD), which is prevalent among this group of professionals (Knox et al. 2003). As such, rates continue to be extremely high.

Incidence and prevalence of suicide world-wide shows that the highest international suicide incidences are recorded in China and India. Next are Hungary, Japan and Lithuania.  When the suicide rates data by gender and age are accessed studies show where males are more likely to take their lives at a ratio of three to four times more than females. In China more females commit suicide than males and this country has the highest female suicide rates in the world. In most countries the highest suicides and attempts occur among the elderly and middle aged. However, the mean international age range for suicide occurrence is between 15 – 29 years of age (American Association of suicidology 2014).

Among western nations suicide is no longer a crime. However, in India it is illegal and surviving families could face prosecution for a family member committing suicide. In the United States of America while suicide is not illegal, significant others and family members are still investigated in cases of suicide. Canadians who have attempted suicide could be denied entry into the US. There are many religious and philosophical perspectives on suicide. In Christianity for example, suicide is considered a sin. Subsequent research have shown where Suicide methods also vary across nations. Some consistency has been established regarding hanging, pesticide ingestion and firearms infliction being the most used methods (American Association of Sucidology. 2014).

Current Prevention

Community Programs

Ghoncheh et al. (2014) reported concerning the effectiveness of adolescent suicide prevention e-learning modules that aim to improve knowledge and self-confidence in persons at risk of committing suicide. Researchers emphasized that community-based intervention learning modules could be useful in suicide prevention programs. The assumption was tested through randomized controlled trails. Pre and post testing of modules were conducted at 4 week intervals. The study was intended to recruit 154 gatekeepers. They were provided knowledge and suicide awareness symptoms through the e-learning strategy. The program allowed them to learn at their own pace while seeking clarification from facilitators (Ghoncheh et al. 2014).

The Alaska community suicide prevention program has been cited by authorities as being very useful to community youths. It is called the Postvention program responding to suicide attempts by minimizing the risk for future attempts, ultimately helping communities and families to heal from actual suicide incidences. Authorities executing the program say it functions similar to a disaster preparedness model. There are three important steps in accessing this program.  First here is a step-by-step guide facilitating the healing process.  Communities must prepare ahead in case of a suicide. Schools, families, funeral authorities and clergy are all integrated in the planning post invention community program. The second phase encompasses gate keeper training teaching the public or anyone in the community to recognize suicide intentions and report them immediately. Thirdly, there is the mental health first aid training evaluating suicide attempts (Division of Behavioral Health 2014).The American Foundation for Suicide prevention has established comprehensive community-based interventions. They embrace families in LGBT Youth Suicide Prevention, depression and Bipolar Awareness, and from Diagnosis to Remission Living with Bipolar Disorder. Also the Billboard Program, promotes and advertises awareness about the serious consequences of depression and encourages anyone experiencing depression to seek help from their doctors, which as a result offers help to anyone contemplating suicide. All of these programs claim to intercede in suicide attempts or facilitate families coping after suicide has been committed, but studies regarding their effectiveness have not been published recently. It is the intention of this literature review project that some studies proven to have established a strong  evidence  towards the efficacy of community based suicide prevention/intervention programs, will be explored (American Foundation for Suicide Prevention 2014).\

School Based Programs

Miller et al. (2009) conducted studies pertaining to suicide prevention programs in schools; the review was done from a public health perspective. The authors contended that while they were not assigned public health status programs, suicide among school-aged children is a public problem. Consequently, the studies reviewed were required to contain data pertaining to implementation of these programs and their outcome achievement. Thirteen studies were retrieved (Miller et al 2009).

It was discovered that only two of the studies out of the thirteen showed statistical evidence that the implementation and functions of the program were effective in reducing incidences of suicide and preventing attempts, generally. Further, the central characteristics of a public health model school suicide prevention program according to these authors should encompass application of scientific evidence. If the supporting data on this issue is limited then the study lacks validity. Besides, they have to strength positive behavior, collaborate with other community prevention programs and apply appropriate research strategies in the evaluation process (Miller et al. 2009).

Currently, credible agencies have outlined strategies. They include designing a conceptual basis for prevention programs, outlining requirements for effective suicide prevention program implementation, specifying the rules for institutionalization and sustainability of suicide prevention programs and disclosing components of comprehensive school-based suicide prevention programs (Suicide Prevention Resource Center 2014). The aim of the program ought to embrace delivery of practical, safe, and effective implementation of school-based suicide prevention programs (Suicide Prevention Resource Center 2014).

Further studies conducted by Victoria Hatton (2014) revealed that teachers’ approach as gate keepers in any suicide prevention program could benefit from additional training in their capacity as role models of students, especially teenagers. The author advanced that many suicide prevention school programs lack full teacher participation. While counselors are trained to deal with these social issues teachers interact with students on a daily basis and are capable of assessing changes in behavior. Counselors see them only if they are refereed. At this time it might be too late for a resolution (Hatton 2014).

Similar perceptions pertaining to teachers’ role in suicide prevention programs was cited in a study conducted by Nadeem et al. (2011). These researchers contend that strategies enhancing teachers’ full participation in suicide prevention programs is mandatory for any school based intervention success. Teachers themselves voiced opinions through interviews that, they felt inadequate dealing with suspected suicide cases due to lack of training. Suggestions from the research was that teachers be trained not only in detecting symptoms, but in their daily interactions with them be a resource for resolution in students being able to express their concerns to them (Nadeem et al. 2011).

Public Health Programs

According to the Suicide Prevention Resource Center (2014) there are specific public health approaches to suicide prevention. These encompass defining the problem through surveillance, conducting research to identify causes and prevention risk factors, developing and testing interventions, and implementing and evaluating interventions (SPRC 2014).

In defining the problem through surveillance, program coordinators have the responsibility of first collecting data pertaining to the magnitude of suicide attempts and actual occurrences within the targeted community. The next step in the approach is defining the problem. Research has shown that suicide is defined as a complex human behavior. The third step is developing and testing interventions prior to implementation. The forth process relates to implementing the interventions and finally evaluating outcomes to determine if objectives were met (National Strategy for Suicide Prevention 2001).

Studies conducted by Fountoulakis et al (2010) revealed that the public health model has been very effective. These researchers examined community campaigns developed to address attempted and accrual suicide issues. This evaluation was conducted by reviewing relevant literature. Their conclusions indicated that short interventions have very little effect on suicide prevention rates. Recommendations were that models that have significant components such as the one suggested in the public health protocol were best in addressing suicide and related issues   (Fountoulakis et al. 2011).

In another public health awareness suicide intervention strategy Moutier et al (2012) conducted a study of a suicide prevention program. From one point view the program could be considered  a school- based intervention, but from a wider perspective a public health interface can be identified. The researchers sampled three hundred and seventy four (374) people working at the university. After completing the preliminary evaluation risk factors for these subjects were found eligible for the intervention (Moutier et al. 2012).

Adapting a public health approach model for investigating the phenomenon and program, it was discovered from a preliminary literature search that 300-400 medical students and physicians took their own lives yearly in the United States of America. While depression was perceived as the major cause of suicide, many other environmental and social factors were responsible. A needs assessment was conducted on the sample selected. The problems cited initially by the sample continued over the years during this study. The main objective was developing a relationship between depressions as suicide risk (Moutier et al. 2012).

The study concluded from this trial program intervention that while meeting public health suggested requirements for an effective program, students were reluctant to continue the trial after the first tier assessments/screening. Consequently it was difficult to estimate program outcomes for the 374 people who began the trial program. (Moutier2012).

Evaluation of Suicide Prevention Programs’ Effectiveness

Miller et al. (2008) found that the suicide prevention administrative system in America lacks program implementation integrity and this reduces the effectiveness of school-based programs. Therefore, there is a need for the development/designing of an implementation framework. This allows for standardization of programs when facilitating the evaluation process. In this section of the review the author will highlight some criteria researchers have found very useful in evaluating the efficacy of suicide programs (Miller 2008).

For example, the suicide prevention action network (SPNA) conducted studies regarding suicide prevention evaluation services, and concluded that lack of evaluation research is the single greatest obstacle to improving current efforts towards suicide prevention. Further, the un-named researchers advanced that there is great potential for data collection when effective evaluation is conducted. Essentially, data is the only means of knowing the criteria for successful evaluation is mandatory (SPAN USA, Inc. 2001).

As outlined in this model the authors advocated that sharing knowledge among project managers regarding successful outcomes was the first step in suicide program evaluation. This strategy they contend allows for understanding whether suggested program materials are applicable. Evaluation also measures whether plans implemented are feasible and goals are achievable. Assessment identifies risks that would inhibit success of the program. Unexpected benefits/problems could be cited too during an evaluation procedure. Mangers while examining reports and data retrieved from the experiences become equipped with knowledge to improve suicide prevention intervention program strategies (SPAN USA, Inc. 2001).

Simultaneously, managers become equipped with information whereby they can monitor goals/aspects of the program which are strong and those that need strengthening. These are the favorable features of evaluation, but some disadvantages pertain to the costs of first beginning an evaluation process and maintaining it periodically. Suggestions are that suicide prevention program coordinators should budget at least 15-20% of funding towards research of an evaluation nature. Consequently, when making program proposals to funding agencies and stakeholders evaluation must be a prominent part of the budgeting content (SPAN USA, Inc. 2001).

Money expended on evaluation of suicide prevention programs should never be viewed as money wasted analysts further reiterated.  Instead it should be considered an investment into better outcomes in the future of suicide prevention intervention.  Another strategy mentioned by these experts is that every program must either recruit an evaluating agency or coordinator. A worthwhile recommendation was evaluating the professional competence of agencies conducting program evaluations along with the coordinators who work with them.. From their evaluation reports of these sensitive agencies many of them even lost their funding (SPAN USA, Inc. 2001).

Another general criteria outlined by these experts relate to evaluation routine within the program framework and all staff should be aware of the criteria and become participants in the evaluation process. Importantly, they ought to function as primary stakeholders since their participation could determine the life of the project. Useful methods that have been recommended, include pilot testing, efficient record keeping and purpose evaluation projects (SPAN USA, Inc. 2001).

Ultimately, the experts  devised solid criteria when considering evaluation of suicide prevention programs the encompass pilot-testing  of all the program’s plans, procedures, activities, and materials used in disseminating information about self-esteem, building healthy  relationships and bounding with parents/siblings significant others. Three major criteria were established in the investigation. They pertain to designing strategies for knowing whether the program is compatible with the population it is intended to serve. Also, data collection procedures ought to be carefully designed according to a scientific protocol. Components of the evaluation system form the third important criteria. These include identifying objectives for the evaluation program, description of the target population, and description of what features of the program ought to be evaluated (SPAN USA, Inc. 2001).

Finally, the six steps to evaluation must be practiced for effectiveness. Adequate mental health screening of risk factors among vulnerable populations can increase the effectiveness of suicide prevention programs has been chosen to guide this exposition regarding suicide programs. It would be relevant to note as well that adequate mental health screening could impact the program as a purpose evaluation strategy. Accordingly, the six steps towards effective suicide program evaluations relate to first engaging stake holders, describing the program, completing a focused design, gathering credible evidence, justifying conclusions and sharing lessons learnt from the evaluation project (SPAN USA, Inc. 2001).

Literature Review Summary

Tracking indicators is one of the main prevention methods identified by Knox et al. (2003). Mental well-being programs at schools and workplaces (Moutier et al. 2012) have also proven to be effective in identifying persons who are at risk. Timing is extremely important, and it is crucial that professionals intervene as early as possible, preferably when the first suicidal thoughts arise. Miller et al. (2009) found that three strategies are extremely effective when designing a screening and prevention plan: delivering counseling services, strengthening positive attitudes and behavior, community collaboration, and researching affected populations to successfully determine risk indicators along with more teacher training to intervene at schools were major reasons for ineffectiveness of suicide programs (Nadeem 2014).

Findings

Community involvement is important success factor of public health suicide prevention programs. The importance of research has also been highlighted by several authors. Finally, focusing on “at-risk” populations is an effective strategy.  People who are unable to talk to others about their problems, are isolated, stigmatized, or under mental stress. Military personnel, medical student and physicians are at highest risk.

Specifically, teachers voiced their inadequacies regarding participating in school based programs. While teachers are told to inform counselors when students seem to express that they want to take their lives there was no other way of knowing without any verbal expression. Suicides have not only become prevalent in high school settings, but also murders simultaneously. Intensive teacher training is mandatory for school programs (Miller 2008).

It was also discovered that while a comprehensive public heath model was recommended for designing suicide prevention program which was very effective it was difficult to maintain. Resources mainly to conduct the initial assessments and continuous evaluation was a challenge. For example, in the trial suicide program conducted at the California, San Diego School of Medicine many of the subjects did not continue the program until the end. To this extent the true value of the intervention could not have been estimated (Moutier et al. 2012).

Finally, evaluation of programs is essential to determining the effectiveness of suicide prevention interventions. Research showed that organizations, project managers and stakeholders must budget for evaluation since without this component there may be wasting of scare resources. Essentially the process must follow six distinct steps (SPAN USA, Inc. 2001).

Implications

The review of related research and literature has revealed that it is possible to identify “at-risk” individuals at an early stage, using scientific research and statistical data.  However, enhancing the evaluation process of the current programs by establishing a standard framework of prevention and intervention can be beneficial.

Conclusion and Future Research.

Integrating suicide prevention into community programs, employee and management training, as well as health care, can improve intervention outcomes. A framework needs to be developed for all professionals and community support workers. This would enable gatekeepers to identify persons who are at risk.

In my opinion, while efforts have been made through public health intervention models, community action groups, many research studies, evaluation systems and reforms suicide rates have not been reducing over the years.  However, with reference to Moutier et al. (2012) whereby medical students and physicians’ suicide potential was researched and found to be at a very high risk, questions regarding the real causes must be further researched.

Is there a genetic predisposition to suicide? When a comparison of counties’ suicide rates was performed, China and India topped the averages. Does this mean that environmental factors other than social factors affect suicide risks?  If this is the case that suicide could be caused by sources other than social and environmental, then more in-depth studies pertaining to causes ought to be undertaken.

Reference

Aggarwal, N. 2009. Rethinking suicide bombing. Crisis. 30 (2): 94–7.

American Association of Sucidology (AAS). 2014. Facts and statistics. Retrieved on November 2nd, 2014 from. http://www.suicidology.org/resources/facts-statistics

American Foundation for Suicide prevention. 2014. Our education and prevention programs. Retrieved on November 2nd, 2014 from http://www.afsp.org/preventing-suicide/our-education-and-prevention-programs

Aseltine  R, James A, Schilling E, Glanowsky J. 2007. Evaluating the SOS suicide prevention   program: a replication and extension BMC Public Health. 161 (7): 1-7.

Division of Behavioral Health. 2014. Alaska suicide prevention. Retrieved on November 2nd, 2014 from http://dhss.alaska.gov/dbh/Pages/Prevention/programs/suicideprevention/default.aspx

.Fountoulakis K, Gonda X, Rihmer, Z. 2010. Suicide prevention programs through community intervention. Elsevier. Journal of Affective Disorders.130 (2): 6 – 10.

Ghoncheh R, Kerkhof A, Koot H. 2014. Effectiveness of adolescent suicide prevention e-learning modules that aim to improve knowledge and self-confidence of gatekeepers: study protocol for a randomized controlled trial. Trials Journal. 15 (52): 1-7.

Hatton, Victoria R. 2014. Secondary teachers’ perceived role in suicide prevention and intervening with suicidal students. [Dissertations]. Provo (UT): Brigham Young University.

Knox K, Litts D, Talcott W, Caine E. 2003. Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: cohort study. BMJ 327 (13): 1-5.

Lapierre S, Erlangsen A, Waern M, De Leo D, Oyama H, Scoccio P, Szanto K, Conwell Y, Draper B, Quinnett. 2011. A systematic review of elderly suicide prevention programs. Crisis. 32(2): 88–98.

Miller D, Eckert D, Mazza J. 2009. Suicide prevention programs in schools: a review and public health perspective. School Psychology Review. 38 (2): 168-188.

Moutier C, Norcross W, Jong P, Norman M, Kirby B, McGuire T, Zisook S. 2012. The suicide prevention and depression awareness program at the University of California, San Diego School of Medicine. Academic Medicine. 87 (3): 320-326.

Nadeem E, Kataoka S, Chang V, Vona P, Wong M, Stein B. 2011. The role of teachers in school-based suicide prevention: A qualitative study of school staff perspectives. School Mental Health. 3: 209–221.

National Strategy for Suicide Prevention: Goals and objectives for action. 2001 Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service.

Prevention of Suicide. 2006. Guidelines for the formulation and implementation of National Strategies.  United Nations.

Robinson J, Cox G, Malone A, Williamson M, Baldwin G, Fletcher K. O’Brien M. 2013. School based interventions and suicide-related behavior. Crisis 34 (3): 164-182.

SPAN USA, Inc. 2001. Suicide prevention: prevention effectiveness and evaluation. SPAN USA. 43 (6): 1-32.

Suicide Prevention Resource Center (SPRC). 2014. Guidelines for school based suicide prevention programs. Retrieved on November 3rd, 2014 from http://www.sprc.org/bpr/section-II/guidelines-school-based-suicide-prevention-programs