The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts

Abstract

Objective-This paper reports the impact of two first-and second-grade classroom based universal preventive interventions on the risk of Suicide Ideation (SI) and Suicide Attempts (SA) by young adulthood. The Good Behavior Game (GBG) was directed at socializing children for the student role and reducing aggressive, disruptive behavior. Mastery Learning (ML) was aimed at improving academic achievement. Both were implemented by the teacher.⋆ Supplementary data on the second cohort can be accessed with the online version of this paper at http://dx.doi.org by entering *Corresponding author. Tel.: +1 410 502 0629. E-mail address: hwilcox1@jhmi.edu (H.C. Wilcox). Conflict of interest All other authors declare that they have no conflicts of interest.Contributors: Dr. Wilcox led data analyses, managed the literature searches, participated in project management and supervision of the NIDA young adult assessment, wrote the first draft and incorporated coauthor feedback on all subsequent drafts.Dr. Kellam was P.I. of the main grants that supported this work throughout the period of the trial and the young adult outcomes, with the important exceptions of the Prevention Science Methodology grant led by Dr. Brown and many of the grants supporting studies and measures of drug use from early childhood into early adulthood and suicidality led by Dr. Anthony. Both Brown and Anthony collaborated with Kellam in the initial forming of the designs and periodic follow-up. Kellam led the Life Course/Social Field and Developmental Epidemiological conceptual frame that underlies the work, and led the trial reported here including the measures and choice of the intervention and its lead staff persons and the precision of its implementation. He led the community and institutional base building and its maintenance including the core partnership with Baltimore City Public School System. He collaborated in defining the research question reported in this paper and the analytic strategies employed. Lastly, he participated in the writing of the manuscript and its final assessment prior to submission.Drs. Brown, Anthony, and Wang provided supervision on data analyses and interpretation. Brown and Wang also undertook mediation analysis.Drs. Poduska and Ialongo participated in manuscript writing, data design and collection, and project supervision. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptMethods-The design was epidemiologically based, with randomization at the school and classroom levels and balancing of children across classrooms. The trial involved a cohort of firstgrade children in 19 schools and 41 classrooms with intervention at first and second grades. A replication was implemented with the next cohort of first grade children with the same teachers but with little mentoring or monitoring.Results-In the first cohort, there was consistent and robust GBG-associated reduction of risk for suicide ideation by age 19-21 years compared to youths in standard setting (control) classrooms regardless of any type o...

Methods for testing theory and evaluating impact in randomized field trials: Intent-to-treat analyses for integrating the perspectives of person, place, and time

“…Even if no interactive impact with baseline individual level risk is found, individual level risk may affect outcomes as a main effect. Even when the outcome is far removed in time from the intervention period, there can be dramatic continuities of these antecedent risks over time, as we have found in our analyses of the role of aggressive, disruptive behavior in the long-term effects of the GBG Petras et al, 2008;Poduska et al, 2008;Wilcox et al, 2008).…”

“…Only the ML classrooms were excluded because they provided no information about the GBG impact nor could they be used as controls because of ML's own potential impact. In Wilcox et al (2008), ML classes were included since hypotheses about this intervention were also tested. In Petras et al (2008) the GBG analyses were based on comparisons between the GBG classrooms and the internal GBG controls.…”

The Good Behavior Game for Latino English Language Learners in a small-group setting

“…Kellam and colleagues found that the GBG was associated with greater likelihood of a range of positive outcomes, including lower alcohol and substance use or dependence, reduced smoking, lowered incidence of Antisocial Personality Disorder (ASPD) and improved graduation rate , as well as reduced engagement in high-risk sexual behaviors and lowered incidence of drug dependence disorders (Kellam et al, 2014) and reduced suicide ideation and attempt by age 19-21 (Wilcox et al, 2008). Another trial found that when compared to a family-school partnership or control group, students who received the GBG throughout grade 1 had significantly higher college attendance rates and reduced likelihood of special education placement than both groups (Bradshaw, Zmuda, Kellam & Ialongo, 2009).…”

The Neglected Role of Adolescent Emotional Well-Being in National Educational Achievement: Bridging the Gap Between Education and Mental Health Policies

“…School-based interventions involving social skills training to change behavior, such as the Good Behavior Game [37], have shown long-term effects on externalizing behavior. Furthermore, mental health services provided by school-based health centers have been shown to improve academic outcomes [38].…”