Principal Investigator: Brooke P. Randell, D.N.Sc., R.N., C.S.
University of Washington, School of Nursing
Abstract:
Suicide remains a leading cause of death among young people—each year 1 in 5 teenagers considers suicide and approximately one million attempt suicide. These rates continue to escalate into young adulthood. Youth suicide-risk behavior is a major public health problem deserving immediate attention to critical intervention factors that promote short-term and maintain long-term behavioral change.
Based on prospective and epidemiological studies, a substantial body of knowledge has developed regarding putative risk and protective factors known to contribute to suicidal behaviors. Theory-based prevention trials are well placed to inform etiologic processes, through the identification and confirmation of risk and protective factors amenable to change. Moreover, these trials can foster understanding factors that account for behavioral change, and for the maintenance of long-term behavioral change.
This proposal examines psychosocial processes associated long-term behavioral change following participation in an indicated suicide prevention program, and responds specifically to RFA OB-03-003 and the Surgeon General’s 1999 Call to Action to Prevent Suicide. The study takes advantage of a recently completed prevention trial, Promoting CARE funded by the National Institute for Nursing Research. The 3 programs tested in Promoting CARE—Counselors-CARE (C-CARE), Parents-CARE (P-CARE) and Counselors & Parents CARE (C- + P-CARE)—integrate a social support/skills training intervention with brief preventive intervention approaches. Their designs involve integrated approaches known to be effective with adolescents, and support and skills training components because these strategies are known to reduce depression and suicide-risk behaviors. Previous research, including growth curve analyses conducted for the Promoting CARE study, speaks to the short-term (9 months post-baseline) efficacy of the intervention and provides preliminary support for the model.
The Promoting CARE study will provide a sample of approximately 550 vulnerable youth, randomly assigned to 1 of 3 experimental conditions, and compared to intervention “as usual.” The study has been rigorously implemented, with extensive measures collected at baseline, post-intervention, 9 and 15 months post-baseline, and, for half the sample, at 30 months post-baseline. These data will be augmented with a 30 month follow-up for the remaining sample, a 52 month follow-up for the total sample, microanalysis of videotaped teen and parent intervention responses, and in-depth interviews with a sub-set of young adults selected at random from the identified change trajectories.
We will 1) test for long-term intervention effects; 2) test the theoretic model, examining for mediational intervention effects on both short- and long-term behavioral outcomes; and 3) identify trajectories of change across time. Advanced statistical procedures (latent growth models, SEM) will be used to examine behavioral change and to test hypothesized mediating intervention effects. The influence of intervention processes and life course factors on patterns of change will be examined using multi-method approaches and exploratory analytic strategies. The proposed study is innovative and significant; it has implications for theory testing and prevention science. This research should markedly increase our understanding of ways in which youth and family-focused preventive interventions for suicide-vulnerable youth work to curb depression, anger and suicide-risk behaviors.
Specific Aims: