A longitudinal examination of the interpersonal theory of suicide and effects of school‐based suicide prevention interventions in a multinational study of adolescents

Abstract

Background Predictions of two different models for suicide attempts (SA) over 12 months, as differentially impacted by specific school‐based suicide prevention interventions, were compared. These were as follows: (a) interpersonal theory (IPTS) and (b) a two‐pathway model, one path associated with externalizing symptoms and continuum of self‐harm behaviors, and the other with internalizing symptoms. Methods Self‐report questionnaires were completed by 11,110 high school students from ten EU countries enrolled in the Saving and Empowering Young Lives in Europe (SEYLE) study. Baseline measures included perceived burdensomeness, thwarted belongingness from parents and peers, health risk behaviors, self‐injury, suicide ideation (SI), and attempts (SA). SI and SA were reassessed at 12‐month follow‐up. Each model's predictions of SI and SA groups over time (i.e., repeated SA, remitted SA, SA onset, and no SA) were estimated in the no intervention/control group. The superior model was estimated across intervention groups. Results Interpersonal theory showed better fit compared to the two‐pathway model. In partial agreement with IPTS predictions, parental low belongingness but not peer belongingness or burdensomeness predicted greater likelihood of SI. The likelihood of repeated SA versus no SA was higher among adolescents who reported SI, self‐injury, risk behaviors, and particularly both SI and self‐injury. All three interventions attenuated the combined effect of SI and self‐injury. Youth Aware of Mental Health Program (YAM) additionally decreased the effect of risk behaviors on the likelihood of repeated SA. Conclusions Interpersonal theory assumptions were partially supported. Perceived interpersonal difficulties with parents were primarily related with SI, and risk behaviors and self‐injury were important predictors of SA. Suicide prevention interventions may be effective by mitigating the hazardous effect of varying self‐harm behaviors and may be further advanced by increasing parental involvement.

Practitioner Review: Treatment for suicidal and self‐harming adolescents – advances in suicide prevention care

“…Accumulating data indicate that youths with self‐harm histories are at increased risk of suicide deaths and increased risk of death by other unnatural causes, such as overdoses (Hawton et al., ; Morgan, Byrne, Boylan, McLearie, & Fitzpatrick, ). These results in conjunction with evidence reported in this issue that health risk behaviors such as substance abuse are associated with increased risk of SAs (Barzilay et al., ; King, Grupp‐Phelan et al., ) underscore the importance of clinical evaluation and monitoring of substance use in youths with suicide/self‐harm risk.…”

“…Barzilay et al. () found that among YAM youths the effect of health risk behaviors (e.g., smoking, substance use, risky sexual behavior) on increasing the likelihood of repeated SAs (vs. no SAs) was reduced, relative to controls. Further, while the combination of baseline SI and self‐harm was associated with increased likelihood of repeat SAs over 12 months among control‐youths (no study intervention), this was not the case for youths receiving the SEYLE interventions (YAM; Screening by Professionals; Question, Persuade and Refer).…”

“…More direct evidence for the value of universal school‐based suicide prevention is provided by the report by Barzilay et al. () on the Saving and Empowering Young Lives in Europe (SEYLE) study. The primary SEYLE finding was that the Youth Aware of Mental Health program (YAM) was significantly more effective than a no‐intervention control condition in preventing youths from developing SAs and or severe SI, with a greater than 50% reduction in SAs among YAM youths, relative to controls (Wasserman et al., ).…”

Editorial: Suicide and self‐harm: advancing from science to preventing deaths

“…The effects of the program are long‐lasting when programs are maintained, but wane with discontinuation. These data combined with that from other programs such as the Youth Aware of Mental Health (YAM) school‐based intervention found to reduce SA rates (Wasserman et al., ; Barzilay et al., ) highlight the value of our science for developing effective suicide prevention initiatives.…”

“…Barzilay et al. () confirm that suicidal ideation and self‐harm predict which youths in a school sample will attempt suicide and that health risk behaviors are associated with increased likelihood of repeat SAs 12 months later, suggesting one path to death by unnatural causes such as drug‐related deaths and accidents.…”