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

• Published in: Injury prevention Vol. 29; no. 5; pp. 442 - 445
• Main Authors: Wyman, Peter, Cero, Ian, Brown, Charles Hendricks, Espelage, Dorothy, Pisani, Anthony, Kuehl, Tomei, Schmeelk-Cone, Karen
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.10.2023; BMJ Publishing Group
• Subjects: Adolescent; Adolescent Behavior; Fatalities; Humans; Intervention; Mortality; Public health; Randomized Controlled Trials as Topic; Schools; Secondary schools; Short Report; Social networks; Students; Suicide; Suicide Prevention; Suicides & suicide attempts; Teenagers; United States > US; Program evaluation; School; Mortality; Adolescent; Suicide/Self?Harm
• ISSN: 1353-8047; 1475-5785
• DOI: 10.1136/ip-2023-044944

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 (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.