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Reducing Suicide-Related Stigma through Peer-to-Peer School-Based Suicide Prevention Programming
Abstract
Youth suicide rates have consistently risen over the past decade, and stigma related to mental health may create a barrier to young people seeking help. Schools are a common intercept point for mental health and suicide prevention programming. Hope Squad, a school-based, peer-to-peer, suicide prevention program, uses trained and mentored students nominated by their peers to perform intentional outreach with fellow students. When a Hope Squad member detects a mental health or suicide crisis in a peer, they alert a trusted adult. We employed a cohort, wait-list–control, cross-sectional survey design. We recruited more than 3,400 students from nine schools—five with Hope Squads and four without—to observe differences in student-body suicide-related stigma. At the end of the academic year, there was significantly lower stigma in Hope Squad schools versus those without the program. Findings suggest that a peer-to-peer, school-based, suicide prevention program may reduce stigmatizing attitudes related to suicide. Next steps include a randomized controlled trial to identify changes in help-seeking and similar protective factors.
Introduction
Suicide is the second leading cause of death in the 15 to 29 age group worldwide, and is a severe public health problem. Adolescent and young adult individuals attend educational institutions which can play an essential role in detecting and preventing suicide. For this reason, the purpose of this research is to identify what educational institutions and agents are called into action in suicide prevention, intervention, and postvention.
Methods
The method of systematic review of the literature based on the PRISMA protocol was used. The review protocol was registered in PROSPERO (PROSPERO 2020 CRD42020189127). The systematic review yielded 66 articles published between 1990 and February 2023.
Results
The results show that a wide variety of educational stakeholders are required to intervene for suicide prevention, interventions and postvention between primary education and college. The study describes the different programs that have been provided, the countries in which they have been implemented and the agents who have been targeted. It also identifies gaps in the research on suicide in the educational field.
Discussion
Overall, educational suicide initiatives report positive effects on participants’ understanding, attitudes, and beliefs regarding suicide and suicide prevention, although some studies have expressed some caution.
Dear editors,
Suicide is a deliberate act of ending one’s own life. Several factors can influence adolescent suicidal tendencies, including social pressure, stigmatization, psychiatric disorders, identity issues and negative physical image. A negative physical image can have a significant impact on one’s mental and personal health, even triggering suicidal thoughts. This is according to the claims of a recent article ‘Body weight perception and suicidal behaviours among Chinese adolescents: a gender-specific study?’.¹ Suicide has become a serious issue in many countries such as Asia, Europe, the USA and Australia.²
The impact of teenage suicide is not only felt by the directly affected individuals and families, but also has far-reaching effects on society as a whole. The trauma, grief and guilt resulting from suicide can have long-lasting effects on the mental and emotional well-being of those closest to them.³ Suicide causes potential losses to society, including the loss of adolescents’ potential contribution to social, economic and cultural development, and also there could be potential increase in violence or serial suicides due to the effects of imitation or contamination of ideas. It is therefore imperative that effective suicide prevention efforts are realized.
It is vital to better understand and effectively treat suicide, as it remains a leading cause of death for youth. The present article discusses the epidemiology of suicidal outcomes for youth and provides an overview of existing treatments. The “Collaborative Assessment and Management of Suicidality” (CAMS) – an evidence-based suicide-specific treatment – is presented, followed by a discussion of the potential benefits of adapting it to youth. Patient-defined “suicidal drivers,” which are identified and targeted within CAMS-guided treatment, may be especially pertinent to suicidal youth who are in the beginning stages of grappling with their experience related to suicide. Current efforts to adapt CAMS for suicidal adolescents and children are described. Crucially, with further development and rigorous clinical research, adaptations of CAMS may one day provide an empirically-proven and reliable approach to reducing suicide risk in adolescents and children.
Nominating primary confidants (i.e., safety plan nominees) is central to safety planning for suicide but there is a dearth of research about such confidants—a serious oversight given their high-leverage position to affect pathways into clinical care. Informed by advance care planning (ACP) work, this study examined differences between social network members who were and were not identified as primary confidants on attributes that could impact their effectiveness in a helping role. Using social network methodology, information was collected from 41 individuals with affective disorders about the 332 people and relationships in their networks. Logistic regression analysis revealed that being perceived as capable of managing stress and prioritizing the participant’s best interests over one’s own increased the odds of being a primary confidant. Clinicians working with suicidal individuals may benefit from integrating ACP principles—which recognize the thoughtful selection of nominees based on specific attributes—into their safety planning procedures. View the full text version of this article for free at https://rdcu.be/bQUMM.
Given the recent rise in adolescent mental health issues, many researchers have turned to school-based mental health programs as a way to reduce stress, anxiety, and depressive symptoms among large groups of adolescents. The purpose of the current systematic review and meta-analysis is to identify and evaluate the efficacy of school-based programming aimed at reducing internalizing mental health problems of adolescents. A total of 42 articles, including a total of 7310 adolescents, ages 11–18, met inclusion for the meta-analyses. Meta-analyses were completed for each of the three mental health outcomes (stress, depression, and anxiety) and meta-regression was used to determine the influence of type of program, program dose, sex, race, and age on program effectiveness. Overall, stress interventions did not reduce stress symptoms, although targeted interventions showed greater reductions in stress than universal programs. Overall, anxiety interventions significantly reduced anxiety symptoms, however higher doses may be necessary for universal programs. Lastly, depression interventions significantly reduced depressive symptoms, but this reduction was moderated by a combination of program type, dose, race, and age group. Although, school-based programs aimed at decreasing anxiety and depression were effective, these effects are not long-lasting. Interventions aimed at reducing stress were not effective, however very few programs targeted or included stress as an outcome variable. Implications for practice, policy and research are discussed.
Considered a public health issue, the prevalence and severity of poor mental well-being on college campuses has continued to rise. While many college campuses offer mental health counseling services, and utilization rates are increasing, their proportional usage is low especially among males, who often deal with poor mental well-being by adopting unhealthy coping strategies. The purpose of this study was to use the Information-Motivation-Behavioral Skills (IMB) model to assess the relationship between the determinants as factors that may impact help-seeking behaviors in a large sample (n = 1,242) of male college students. Employing a cross-sectional study design, a 71-item online survey assessed information via total mental health literacy (MHL), motivation via attitudes toward mental health and subjective norms regarding mental health, and behavioral skills via intentions regarding help-seeking behaviors, and stigma. Results revealed correlations between information and motivation (r = .363, p < .01), information and behavioral skills (r = .166, p < .01), and motivation and behavioral skills (r = .399, p < .01). Multiple regression was used to determine stigma is a mediator for all relationships. These findings represent an opportunity to take a public health approach to male mental health through developing multilayered interventions that address information, motivation, behavioral skills, and stigma.
Youth suicide is a significant public health problem. A systematic review was conducted to examine the effectiveness of school, community and healthcare-based interventions in reducing and preventing suicidal ideation, suicide attempts and deliberate self-harm in young people aged 12-25 years. PsycInfo, PubMed and Cochrane databases were searched to the end of December 2014 to identify randomised controlled trials evaluating the effectiveness of psychosocial interventions for youth suicide. In total, 13,747 abstracts were identified and screened for inclusion in a larger database. Of these, 29 papers describing 28 trials fulfilled the inclusion criteria for the current review. The results of the review indicated that just over half of the programs identified had a significant effect on suicidal ideation (Cohen's d = 0.16-3.01), suicide attempts (phi = 0.04-0.38) or deliberate self-harm (phi = 0.29-0.33; d = 0.42). The current review provides preliminary support for the implementation of universal and targeted interventions in all settings, using a diverse range of psychosocial approaches. Further quality research is needed to strengthen the evidence-base for suicide prevention programs in this population. In particular, the development of universal school-based interventions is promising given the potential reach of such an approach.
Youth suicide is a growing public health concern. As schools are becoming a key entry point for preventing and addressing
youth suicide, the integration of suicide prevention efforts into existing school mental health (SMH) systems is becoming
even more important. Unfortunately, as schools expand and adapt their existing SMH systems to meet this need, little guidance
is available to them regarding how to do this. This article shares a case study documenting one rural school district's efforts
to initiate, implement, and evaluate a suicide prevention program (Yellow Ribbon Ask 4 Help) through integration into the
district's existing SMH system. Data were collected from 5,949 sixth- to 12th-grade students over four academic years, and
changes were tracked in relationship to students' knowledge and help-seeking behaviors to support peers with suicidal thoughts.
Data also capture the reasons students gave for experiencing suicidal thoughts, and the prevalence of these reasons. This
case study suggests the feasibility of integrating a suicide prevention program into an existing SMH system and offers strategies
for other schools to consider in their efforts. Implications for school social workers developing programs to prevent and
address suicide among students through connections to SMH systems also are discussed.
No published studies have explored school social workers (SSWs) experiences with, or beliefs and attitudes about, working
with suicidal youths at the elementary, middle, and high school levels. The authors surveyed SSWs (N = 399) who were members of the 11-state Midwest Council on School Social Workers. Results indicated significant SSW involvement
with suicidal youths: 88 percent of SSWs worked with suicidal youths in the past two years, and rates for SSWs at the high
school level approached 100 percent. Most SSWs felt very confident and prepared to work with suicidal youths, were responsible
for suicide assessments, expressed confidence identifying suicide risk factors and making appropriate referrals, and were
highly knowledgeable on school suicide policy. Multivariate analysis of variance indicated no reported differences on perceived
suicide knowledge and preparation among SSWs working in elementary, middle, and high schools. Consistent with recent research,
SSWs reported low levels of receiving graduate-level training in working with suicidal youths. Implications include the need
to address a perceived lack of suicide training in SSW graduate education and to further research on the experiences and preparation
of SSWs at each school level. This exploratory study provides a baseline of information on SSWs and suicide.
Purpose
The present study examined the relative contributions of perceptions of social support from parents, close friends, and school on current suicidal ideation (SI) and suicide attempt history (SA) in a clinical sample of adolescents.
Methods
Participants were 143 adolescents (64% female, 81% white, range = 12-18 years, M = 15.38, SD = 1.43) admitted to a partial hospitalization program. Data were collected with well-validated assessments and a structured clinical interview. Main and interactive effects of perceptions of social support on SI were tested with linear regression. Main and interactive effects of social support on the odds of SA were tested with logistic regression.
Results
Results from the linear regression analysis revealed that perceptions of lower school support independently predicted greater severity of SI, accounting for parent and close friend support. Further, the relationship between lower perceived school support and SI was strongest among those who perceived lower vs. higher parental support. Results from the logistic regression analysis revealed that perceptions of lower parental support independently predicted SA history, accounting for school and close friend support. Further, those who perceived lower support from school and close friends reported the greatest odds of a SA history.
Conclusion
Results address a significant gap in the social support and suicide literatures by demonstrating that perceptions of parent and school support are relatively more important than peer support in understanding suicidal thoughts and history of suicidal behavior. Results suggest that improving social support across these domains may be important in suicide prevention efforts.
This paper summarises an ambitious research agenda aiming to uncover the factors that affect help-seeking among young people for mental health problems. The research set out to consider why young people, and particularly young males, do not seek help when they are in psychological distress or suicidal; how professional services be made more accessible and attractive to young people; the factors that inhibit and facilitate help-seeking; and how community gatekeepers can support young people to access services to help with personal and emotional problems. A range of studies was undertaken in New South Wales, Queensland and the ACT, using both qualitative and quantitative approaches. Data from a total of 2721 young people aged 14-24 years were gathered, as well as information from some of the community gatekeepers to young people's mental health care. Help-seeking was measured in all the studies using the General Help Seeking Questionnaire (Wilson, Deane, Ciarrochi & Rickwood, 2005), which measures future help-seeking intentions and, through supplementary questions, can also assess prior help-seeking experience. Many of the studies also measured recent help-seeking behaviour using the Actual Help Seeking Questionnaire. The types of mental health problems examined varied across the studies and included depressive symptoms, personal-emotional problems, and suicidal thoughts.
We examined the effectiveness of the Sources of Strength suicide prevention program in enhancing protective factors among peer leaders trained to conduct schoolwide messaging and among the full population of high school students.
Eighteen high schools--6 metropolitan and 12 rural--were randomly assigned to immediate intervention or the wait-list control. Surveys were administered at baseline and 4 months after program implementation to 453 peer leaders in all schools and to 2675 students selected as representative of the 12 rural schools.
Training improved the peer leaders' adaptive norms regarding suicide, their connectedness to adults, and their school engagement, with the largest gains for those entering with the least adaptive norms. Trained peer leaders in larger schools were 4 times as likely as were untrained peer leaders to refer a suicidal friend to an adult. Among students, the intervention increased perceptions of adult support for suicidal youths and the acceptability of seeking help. Perception of adult support increased most in students with a history of suicidal ideation.
Sources of Strength is the first suicide prevention program involving peer leaders to enhance protective factors associated with reducing suicide at the school population level.
• Despite the high prevalence of mental health problems and disorders that develop in adolescence and early adulthood, young people tend to not seek professional help. Young men and young people from Indigenous and ethnic minority groups tend to be those most reluctant to seek help.
• Young people are more inclined to seek help for mental health problems if they:
• have some knowledge about mental health issues and sources of help;
• feel emotionally competent to express their feelings; and
• have established and trusted relationships with potential help providers.
• Young people are less likely to seek help if they:
• are experiencing suicidal thoughts and depressive symptoms;
• hold negative attitudes toward seeking help or have had negative past experiences with sources of help; or
• hold beliefs that they should be able to sort out their own mental health problems on their own.
• Young people may seek help through talking to their family and friends, with family being more important for younger adolescents, and friends and partners becoming more influential later on.
• The professionals most likely to act as gatekeepers to mental health services for young people are school counsellors, general practitioners, and youth workers.
• Increasingly, Internet‐based information and interventions are being used to engage young people in the help‐seeking process.
Perceived barriers to help-seeking among adolescents attending a suicide education program were examined. A total of 854 high school students in Colorado completed one of two questionnaires, measuring barriers to help-seeking for self or friend. The most prominent barriers for self were: inability to discuss problems with adults, self-overconfidence, fear of hospitalization, and lack of closeness to school adults. The most prominent barriers for troubled friends were: friendship concerns, unapproachability of school adults, fear of friend's hospitalization, and underestimating friend's problems. Results reveal multiple constraints limiting the program's utilization, supporting the need for comprehensive system approaches to suicide prevention.
We show that immigrant managers are substantially more likely to hire immigrants than are native managers. The finding holds when comparing establishments in the same 5-digit industry and location, when comparing different establishments within the same firm, when analyzing establishments that change management over time, and when accounting for within-establishment trends in recruitment patterns. The effects are largest for small and owner-managed establishments in the for-profit sector. Separations are more frequent when workers and managers have dissimilar origin, but only before workers become protected by EPL. We also find that native managers are unbiased in their recruitments of former co-workers, suggesting that information deficiencies are important. We find no effects on entry wages. Our findings suggest that a low frequency of immigrant managers may contribute to the observed disadvantages of immigrant workers.
Background:
School-based mental health services have been advocated to increase access to psychological support for children and adolescents. However, concerns have been raised about the potential stigma associated with selection of students and the visibility of school-based service contact.
Methods:
This review assessed findings from qualitative studies to identify potential stigmatising effects of participation in targeted school-based mental health interventions for students attending primary- or secondary-level education. Eight articles (reflecting seven studies) were identified through electronic database searches (PsycInfo, EMBASE, Medline, CINAHL, ERIC), supplemented by citation and reference searches and expert consultations. Data were synthesised according to established guidelines for thematic synthesis.
Results:
Three overarching themes were identified: "anticipated and experienced stigma", "consequences of stigma" and "mitigating strategies". These findings illustrate how pervasively stigma can compromise efforts to increase access to mental health care through targeted school-based provision, while also outlining strategies endorsed by students for alleviating the risk and/or impact of stigma.
Limitations:
The findings need to be considered in view of the relative scarcity of surveyed evidence. Furthermore, as all evidence came from high-income and Western countries, the applicability to other contexts is unclear.
Conclusions:
This synthesis reflects the first overview of qualitative evidence regarding stigmatising experiences and concerns associated with students' engagement with targeted school-based mental health interventions. The findings should inform efforts for mitigating stigma-related barriers to students' engagement in targeted mental health support, and serve to guide future research in this area.
This study aimed to determine predictors of help-seeking intentions for symptoms of depression/anxiety and self-harm in adolescents. It focused on personal and perceived public stigma to gather data of value for the design of anti-stigma interventions. Participants (n = 722; 368 girls) were recruited from three cohorts of secondary school students in Ireland (mean ages: 1st = 12.9 years; 3rd = 14.9 years; 5th = 16.6 years). Hierarchical regression models indicated that perceived public stigma is a significant unique predictor of help-seeking intentions for depression [F(4, 717) = 13.4, p < .001] and self-harm [F(4, 717) = 13.5, p < .001]. This indicates that young people's beliefs about other people's stigma towards mental health problems was a stronger predictor of help-seeking intentions than their own stigma beliefs. These findings highlight the importance of looking separately at different types of stigma when investigating the role of stigma in predicting help-seeking intentions.
Background:
Suicide is a leading cause of death and a complex clinical outcome. Here, we summarize the current state of research pertaining to suicidal thoughts and behaviors in youth. We review their definitions/measurement and phenomenology, epidemiology, potential etiological mechanisms, and psychological treatment and prevention efforts.
Results:
We identify key patterns and gaps in knowledge that should guide future work. Regarding epidemiology, the prevalence of suicidal thoughts and behaviors among youth varies across countries and sociodemographic populations. Despite this, studies are rarely conducted cross-nationally and do not uniformly account for high-risk populations. Regarding etiology, the majority of risk factors have been identified within the realm of environmental and psychological factors (notably negative affect-related processes), and most frequently using self-report measures. Little research has spanned across additional units of analyses including behavior, physiology, molecules, cells, and genes. Finally, there has been growing evidence in support of select psychotherapeutic treatment and prevention strategies, and preliminary evidence for technology-based interventions.
Conclusions:
There is much work to be done to better understand suicidal thoughts and behaviors among youth. We strongly encourage future research to: (1) continue improving the conceptualization and operationalization of suicidal thoughts and behaviors; (2) improve etiological understanding by focusing on individual (preferably malleable) mechanisms; (3) improve etiological understanding also by integrating findings across multiple units of analyses and developing short-term prediction models; (4) demonstrate greater developmental sensitivity overall; and (5) account for diverse high-risk populations via sampling and reporting of sample characteristics. These serve as initial steps to improve the scientific approach, knowledge base, and ultimately prevention of suicidal thoughts and behaviors among youth.
The last 20 years has seen an uptick in research on missing data problems, and most software applications now implement one or more sophisticated missing data handling routines (e.g., multiple imputation or maximum likelihood estimation). Despite their superior statistical properties (e.g., less stringent assumptions, greater accuracy and power), the adoption of these modern analytic approaches is not uniform in psychology and related disciplines. Thus, the primary goal of this manuscript is to describe and illustrate the application of multiple imputation. Although maximum likelihood estimation is perhaps the easiest method to use in practice, psychological data sets often feature complexities that are currently difficult to handle appropriately in the likelihood framework (e.g., mixtures of categorical and continuous variables), but relatively simple to treat with imputation. The paper describes a number of practical issues that clinical researchers are likely to encounter when applying multiple imputation, including mixtures of categorical and continuous variables, item-level missing data in questionnaires, significance testing, interaction effects, and multilevel missing data. Analysis examples illustrate imputation with software packages that are freely available on the internet.
Increasing help-seeking and referrals for at-risk individuals by decreasing stigma has been defined as Aspirational Goal 10 in the National Action Alliance for Suicide Prevention’s Research Prioritization Task Force’s 2014 prioritized research agenda. This article reviews the research evidence on the impact of mass media awareness campaigns on reducing stigma and increasing help-seeking. The review will focus on both beneficial and iatrogenic effects of suicide preventive interventions using media campaigns to target the broad public. A further focus is on collaboration between public health professionals and news media in order to reduce the risk of copycat behavior and enhance help-seeking behavior. Examples of multilevel approaches that include both mass media interventions and individual-level approaches to reduce stigma and increase referrals are provided as well.
Multilevel suicide prevention programs that combine various approaches seem to provide the most promising results, but much more needs to be learned about the best possible composition of these programs. Major research and practice challenges include the identification of optimal ways to reach vulnerable populations who likely do not benefit from current awareness strategies. Caution is needed in all efforts that aim to reduce the stigma of suicidal ideation, mental illness, and mental health treatment in order to avoid iatrogenic effects. The article concludes with specific suggestions for research questions to help move this line of suicide research and practice forward.
Crisis hotlines have been central to suicide prevention efforts; however, utilization among youth remains low. A sample of at-risk youth was surveyed about their awareness, utilization, and attitudes toward local and national crisis hotlines. Youth reported low rates of awareness and utilization, yet expressed a strong interest in phone hotlines (41% vs. 59% for new media categories combined). Youth reported stigma, but that help-seeking could be positively influenced by peers and adults in their support system. Implications include making crisis services available across several mediums and the importance of engaging trusted others in youth suicide awareness campaigns and prevention efforts.
Little is known about the factors that increase the risk for enacted mental illness stigma (i.e. rejection, devaluation and exclusion) as perceived by the stigmatized person. This is particularly true for the population of adolescents diagnosed with a mental illness. The aim of this study was to address this question and examine select social and clinical factors that predict enacted stigma (self-reported) with research that follows eighty American adolescents for 6 months following a first psychiatric hospitalization. Drawing on social identity theory, and research on stigma-threatening environments, social group identification and social support, this study tested four hypotheses: affiliation or identification with higher status and lower status peers predicts more and less stigma respectively (H1); a greater and more supportive social network, and more perceived family support predict less stigma (H2); greater severity of internalizing and externalizing symptoms predicts more stigma (H3); and poorer school functioning predicts more stigma (H4). Results indicated that about 70% of adolescents reported experiencing enacted stigma (at 6 months); disrespect or devaluation was more common than outright social rejection. Using OLS regression analyses, the results provided partial support for H1, H3 and H4, while H2 was not supported. The baseline factors found to be most predictive of enacted stigma ratings at 6-months were: affiliating with more friends with mental health problems, identifying with the ‘populars’ peer group, higher internalizing symptom ratings, and self-reported disciplinary problems at school. These four factors remained significant when controlling for initial enacted stigma ratings, pointing to their importance in determining changes in social stigma experiences in the follow-up period. They also remained significant when controlling for perceived public stigma ratings at follow-up, indicating that the findings were not due to generalized perceptions of stigma of youth with mental illness.
The purpose of this study was to measure levels of suicide literacy and stigma amongst Australian medical students in comparison to a general university population, and to assess medical students' help-seeking intentions.
A cross-sectional survey was administered to 165 currently-enrolled Australian National University (ANU) postgraduate medical students and 54 final year undergraduate medical students at the University of Adelaide. These samples were compared to another sample of 676 general members of the ANU, undertaken six months earlier.
Final year postgraduate and undergraduate students had significantly higher levels of mental health literacy (measured using the Literacy of Suicide Scale) than other medical students or general university staff and students. Suicide stigma (measured using the Stigma of Suicide Scale) was comparable across the samples. Less exposure to suicide was associated with greater stigma and increased intentions of informal help seeking. Students who normalised suicide had significantly lower intentions of seeking help for thoughts of suicide.
The findings indicate that exposure to suicidal people through clinical experience may improve knowledge about suicide but may lead to more negative attitudes toward informal help-seeking. The suicide prevention curriculum should aim to raise mental health literacy levels, reduce stigmatising attitudes and limit the normalisation of suicide.
Public knowledge and attitudes toward suicide may influence help-seeking for suicidality. This study aimed to identify correlates of suicide attitudes and knowledge. Australian adults were invited to complete an online survey, with 1,286 responders. Less exposure to suicide, older age, male gender, less education, and culturally diverse backgrounds were associated with poorer knowledge; while younger age, male gender, and culturally diverse backgrounds were associated with more stigmatizing attitudes toward people who die by suicide. The results suggest suicide literacy and stigma reduction programs would benefit community members, particularly males and individuals from culturally diverse backgrounds.
Globally, more than 70% of people with mental illness receive no treatment from health care staff. Evidence suggests that factors increasing the likelihood of treatment avoidance or delay before presenting for care include (1) lack of knowledge to identify features of mental illnesses, (2) ignorance about how to access treatment, (3) prejudice against people who have mental illness, and (4) expectation of discrimination against people diagnosed with mental illness. In this article, we reviewed the evidence on whether large-scale anti-stigma campaigns could lead to increased levels of help seeking. (Am J Public Health. Published online ahead of print March 14, 2013: e1-e4. doi:10.2105/AJPH.2012.301056).
Social science research on stigma has grown dramatically over the past two decades, particularly in social psychology, where researchers have elucidated the ways in which people construct cognitive categories and link those categories to stereotyped beliefs. In the midst of this growth, the stigma concept has been criticized as being too vaguely defined and individually focused. In response to these criticisms, we define stigma as the co-occurrence of its components–labeling, stereotyping, separation, status loss, and discrimination–and further indicate that for stigmatization to occur, power must be exercised. The stigma concept we construct has implications for understanding several core issues in stigma research, ranging from the definition of the concept to the reasons stigma sometimes represents a very persistent predicament in the lives of persons affected by it. Finally, because there are so many stigmatized circumstances and because stigmatizing processes can affect multiple domains of people's li...
Many suicidal college students do not receive mental health treatment, and the reasons for this are not fully understood. This study examines how attitudes, beliefs, and social network factors relate to help seeking among suicidal students.
A random sample of 8,487 undergraduate and graduate students from 15 US universities participated.
A Web-based survey administered in spring 2009 examined correlates of mental health service utilization among students reporting serious thoughts of suicide in the previous year (n = 543).
Correlates of treatment use included perceived need, beliefs that treatment is effective, contact with service users, lower personal stigma, higher perceived stigma, fewer positive relationships, and sexual minority or Caucasian identity.
Help seeking among suicidal students is associated with a range of personal and social network factors. Campus strategies to enhance help seeking should be tailored to address identified facilitators and barriers to treatment use among target populations.
The Yellow Ribbon Suicide Prevention Program has gained national and international recognition for its school- and community-based activities. After the introduction of Yellow Ribbon to a Denver-area high school, staff and adolescents were surveyed to determine if help-seeking behavior had increased. Using a pre-post intervention design, staff at an experimental school and comparison school were surveyed about their experiences with student help-seeking. Additionally, 146 students at the experimental high school were surveyed. Staff did not report any increase in student help-seeking, and students' reports of help-seeking from 11 of 12 different types of helpers did not increase; the exception was help-seeking from a crisis hotline, which increased from 2.1% to 6.9%. Further research with larger, more inclusive samples is needed to determine whether Yellow Ribbon is effective in other locations.
Prior research has identified a negative association between suicidal ideation and help-seeking, a phenomenon called "help-negation." Help-negation has been documented to occur for both professional and nonprofessional sources of help. In this study help-seeking attitudes, stigma concerns, and perceptions of social support were examined as possible mediators of help-negation. Data were collected from a nonclinical sample of college undergraduates at a midwestern university (N = 321). Findings provided partial support for the mediation hypotheses. Help-seeking attitudes and stigma were significant predictors of help-seeking intentions (β = .34 and β = -.17, p < .05, respectively), but did not mediate help-negation for professional sources. Perceptions of social support, on the other hand, fully mediated help-negation for nonprofessional sources (β = .27, p < .05).
This study examined the experiences of teenagers seeking and receiving care for depression from primary care providers. We investigated teens' perceived barriers in obtaining care to determine how primary care can effectively address depressed teens' stated needs. In-depth individual (n = 15) and focus group (n = 7) interviews with adolescents were conducted and analyzed using grounded theory and prominent themes were identified. Teenagers reported faring best when providers actively considered and reflected upon the teenagers' developmentally appropriate desires to be normal, to feel connected, and to be autonomous. These goals are achieved by providers establishing rapport, exchanging information about depression etiology and treatment, and helping teens make decisions about their treatment. To the extent that providers improve efforts to help teens feel normal, autonomous, and connected, the teens report they are more likely to accept treatment for depression and report success in treatment.
- Chen
Youth suicide: History, epidemiology, risks, and management
- Greydanus