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

Author:

Wyman PeterORCID,Cero Ian,Brown Charles Hendricks,Espelage Dorothy,Pisani Anthony,Kuehl Tomei,Schmeelk-Cone KarenORCID

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 ofSources 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.

Funder

New York State Office of Mental Health

NIH Clinical Center

National Center for Injury Prevention and Control

National Center for Advancing Translational Sciences

Center for Mental Health Services

Publisher

BMJ

Subject

Public Health, Environmental and Occupational Health

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