Comparative Study of School-Based Suicide Prevention Models for Adolescents

[[abstract]]The purpose of this thesis is to establish the most effective, evidence-based model of adolescent suicide prevention, which combined of screening for psychiatric disorders and three-leveled interventions. Procedures were divided into three steps. First, self-administered inventories were used as tools for large scale screening. Second, subjects with moderate to high cutoff scores were interviewed by psychiatrists to decide tentative diagnosis and exclude those who could not be managed in a school setting. Third, a group of 90 high risk subjects were randomly assigned to three different levels of interventions and received 6 successive weeks of suicide interventions among intensive, usual and minimal intervention groups. A total of 1826 subjects were recruited from one of the high school in southern part of Taiwan. Screening tools were Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS) and Beck Suicide Scale (BSS). Results were summarized as the following: 1.Results of large scale screening by self-administered inventories were as follows, moderate to severe depression were 13.14%, moderate to severe anxiety were 15.61%, moderate to severe hopelessness were 19.71% and suicide ideations were 44.43%. 2.Results from high risk subjects interviewed by the psychiatrist, tentative diagnosis made and distributions were as follows, adjustment disorders with depressed mood 36.67% (n=33), depressive disorder, NOS 33.33% (n=30), depressive disorder with co morbidity 7.78%, adjustment disorder with co morbidity 6.67%, major depressive disorder 4.44% (n=4),dysthymic disorder 3.33% (n=3). 3.Comparison among three-level interventions shown, intensive and usual groups were significantly superior to minimal level intervention in BDI, BAI and BSS scales. Intensive group was significantly superior to usual group in BHS (Hopelessness) but not significantly superior to usual group in other three scales (BDI, BAI and BSS). Conclusions and suggestions: Integrated intensive model, which include large scale screening, diagnostic interview, and intensive interpersonal intervention were shown to be a superior and promising model in adolescent suicide prevention, especially the therapeutic effects by reduction of hopelessness level and further risk of suicide. The model extends medical diagnostic interviews and interventions to school-based suicide prevention. This model could be generalized to larger areas upon further research.