{"doi":"10.1002/sop2.30","title":"Preventing adolescent suicide: Recommendations for policymakers, practitioners, program developers, and researchers","abstract":null,"journal":"Child Policy Nexus","year":2023,"id":676013,"datarank":0.7794538752725804,"base_score":3.091042453358316,"endowment":3.091042453358316,"self_citation_contribution":0.4636563680037475,"citation_network_contribution":0.3157975072688328,"self_endowment_contribution":0.4636563680037475,"citer_contribution":0.3157975072688328,"corpus_percentile":null,"corpus_rank":null,"citation_count":21,"citer_count":17,"citers_with_citation_signal":10,"citers_with_endowment":10,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1766354,"name":"Rachel Abenavoli","orcid":null,"position":1,"is_corresponding":false},{"id":337106,"name":"Adam Benzekri","orcid":"0000-0002-3043-1966","position":2,"is_corresponding":false},{"id":1766358,"name":"Sarah Rosenbach-Jordan","orcid":null,"position":3,"is_corresponding":false},{"id":1766359,"name":"Gianna Rose Boccieri","orcid":null,"position":4,"is_corresponding":false},{"id":1766353,"name":"Pamela Morris-Perez","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Preventing adolescent suicide: Recommendations for policymakers, practitioners, program developers, and researchers","abstract":"For much of the past decade, suicide has been the second leading cause of death for adolescents in the United States, and suicide rates among adolescents have been rising for the last 15 years. Suicidal thoughts and behaviors among adolescents were common before COVID-19 and have become an increasing public health priority in the pandemic′s wake. In this Social Policy Report, we review evidence for suicide prevention strategies designed to address these rising trends. We make recommendations for federal, state, and local policymakers and practitioners; program developers in organizations that design and implement programming for youth; and academic and nonacademic researchers. Where research evidence is strong, we suggest legislation, funding, and implementation. In areas where gaps in evidence exist, we recommend program development and research. Our recommendations follow the order in a taxonomy adapted from the Centers for Disease Control and Prevention, beginning with strategies that change the structural conditions in which adolescents live and concluding with strategies that support adolescents following a suicide (i.e., postvention). We find strong evidence for, and recommend policy implementation of: restricting access to lethal means; LGBTQ+ affirming policies; screening for suicide risk in medical settings; and community-wide investments via the Garrett Lee Smith Memorial Act. In schools, we find benefits of, and recommend funding and implementation of, youth-focused programs. Even so, gaps exist: (a) research on economic policies for adolescents is nonexistent; (b) while mental health care access is a barrier, we do not know how to reduce youth suicide rates via changing care access; (c) data on crisis lines are encouraging but descriptive; and (d) school personnel training increases knowledge and confidence but not adolescent help-seeking. Finally, guidelines for response following a suicide loss focus on immediate support and are based on limited research; this is an area for program development and research. We recommend state-level policymakers restrict access to firearms via regulations and safe storage; public health officials implement firearm safe storage programs and build barriers on buildings/bridges; public health officials and health care providers distribute lockboxes for medications; and the Consumer Product Safety commission enact regulations that restrict the size of bottles for lethal over-the-counter medications. We recommend that state-level policymakers protect and implement strategies that treat LGBTQ+ youth equally and affirm LGBTQ+ identities (e.g., maintain same-sex marriage laws, protect affirming school environments/safe spaces for LGBTQ+ youth); state policymakers and school district/school leaders fight anti-LGBTQ+ legislation, policy, and practices that limit access to medical care, sports, representation in classroom conversations; and school leaders support LGBTQ+ affirming spaces (e.g., GSAs). We recommend that The Joint Commission1 update its recommendations to include universal suicide risk screening for adolescents; the Centers for Medicare & Medicaid Services at the Department of Health and Human Services require screening for suicide risk in pediatrics and emergency departments as part of routine care; and health care providers implement such screening practices. We recommend that the federal government increase funding for the Garrett Lee Smith Memorial Grants that provide funding to communities for suicide prevention activities in youth-serving organizations and for the Suicide Training and Awareness Nationally Delivered for Universal Prevention (STANDUP) Act of 2021 that offers suicide prevention funding to schools to implement effective programs. We also recommend that public health and school district leaders apply for such funding and implement evidence-based practices. We recommend that state and local policymakers fund and monitor school district- and school-level implementation of state-wide suicide prevention laws and that school district/school leaders ensure implementation of such laws. We recommend that the state and federal Departments of Education fund and encourage implementation of evidence-based school youth-focused programs,2 in tandem with school staff training programs, and that school district/school leaders implement such programs. We recommend that the National Committee on Vital and Health Statistics create national standards for suicide death classifications and require workforce training to reduce variation across place and persons that can lead to underreporting for minoritized racial/ethnic and LGBTQ+ groups. We also recommend that public health officials ensure that coroners and medical examiners receive such training. Engage peer leaders to spread messages of help-seeking as normative in schools, in youth-serving organizations, and on social media. Develop programs that address unique needs of groups at high risk (e.g., Indigenous, multi-racial, LGBTQ+, and rural adolescents). Also develop programs for racial/ethnic minority youth for whom there is limited Develop programs that support adolescent needs for and for the youth in the design of programs, youth and youth to Develop strategies that support the of adolescents have the loss of a peer to and research on the of economic policies to reduce on adolescent suicide death and research on policies and practices (i.e., and for minoritized racial/ethnic groups Indigenous, and adolescents). and on the of increasing mental health care on adolescent suicide on the of crisis across in implementation across and to recommendations for practices and gaps in program design and the of effective peer programs on minoritized racial/ethnic and LGBTQ+ adolescents and in a of school and to data for of suicide and thoughts and and that of and policy in Our on the following youth the of and thoughts suicide and thoughts of to and suicide do not include is an in which with an to but not is the for suicide research. The suicide is with in part of its as a and We the following for of thoughts and behaviors among which to the of suicide as a suicide that as a of the suicide social that an for of risk among in social groups. For much of the past decade, suicide has been the second leading cause of death for adolescents in the United States, for Disease Control and Prevention Suicide is a public health in the United Health suicide have been rising in the United for the last 15 with an at adolescents in 2021 of thoughts (i.e., and behaviors (i.e., and are common and much among adolescents In in adolescents suicide and in suicide in the last The increase in thoughts and a of rising that in the for and in this groups at risk for suicide include and adolescents in rural communities at risk for thoughts and include and LGBTQ+ and adolescents data a increase in suicide rates for racial/ethnic minority Indigenous, and adolescents as with adolescents and a increase in thoughts and for in rates for adolescents to that for adolescents minority adolescents are an increasing of suicide among adolescents to increasing suicide rates and changing in the United for on rates and trends. adolescent have been rising for a the pandemic′s on social and these as a and a National of in and Health the a youth mental health of the and the of and for Suicide Prevention a for youth-serving organizations funding the National of Health for youth suicide research from in to in follow suicide prevention and Suicide on and a for research on youth-focused strategies limited at the of the The in care, emergency and schools, as part of a for mental health and Social Policy to these evidence for prevention strategies that have the last to reduce adolescent suicide and thoughts and behaviors among and recommendations for policy, program and Our review strategies and adolescent (i.e., and that for from that strategies and with research policy and We focus on adolescents a at increasing risk of suicide this have a of high in which can lead to while of can in suggest adolescents have a that to and that can (e.g., for a (e.g., an in and the to have the in which are limited research the of on youth youth have been to in have the of and social and are a crisis which mental We focus on prevention strategies that school and health care providers can implement for adolescents of for adolescents at risk to an mental health as a mental health have been the for this barriers to mental health care make suicide on care for adolescents at an in suicide risk We the of such adolescents know where to the and can the of and know how to to and youth to and are to of this in a in which youth and the the benefits of communities and are not Our review that prevention strategies the We evidence policy and public health strategies effective in care and emergency and a rising of programs in We provide recommendations for program and a for the of adolescent suicide taxonomy for suicide prevention strategies from for and for prevention strategies research review on which we recommendations for on and recommendations for program and researchers. We strategies in the order in the beginning with strategies at changing the structural conditions in which adolescents live and concluding with strategies at suicide and adolescents following a suicide (i.e., postvention). We the taxonomy with a on data suicide but this has not been for for is and and research on the of economic policies to reduce on adolescent suicide death and access to lethal access to lethal is effective in suicide with benefits of firearm regulations and of barriers and in for suicide the Act of to in suicide rates in the research in the the of the size of and access to firearms via regulations and safe health firearm safe storage programs and build barriers on health officials and health care lockboxes for medications. Consumer Product Safety regulations that restrict size of bottles for lethal over-the-counter medications. policies and of same-sex marriage laws suicide among high school for and practices affirming LGBTQ+ youth on policies for minoritized racial/ethnic groups is and and implement strategies that treat LGBTQ+ youth equally and affirm LGBTQ+ identities (e.g., maintain same-sex marriage laws, protect affirming school for LGBTQ+ policymakers and school district/school anti-LGBTQ+ legislation, policy, and practices that limit access to medical care, sports, representation in classroom LGBTQ+ affirming spaces (e.g., GSAs). research on (i.e., for minoritized racial/ethnic groups. mental health and increase access to mental health care and access to health laws increase mental health care and for access is of there is limited research on the of access on suicide rates of crisis lines to are but lines in are following but there is evidence of the of crisis lines on suicide training and to for is for adolescents). and on the of increasing mental health care on adolescent suicide on the of crisis across national implementation of crisis in implementation across and to recommendations for practices and gaps in program design and adolescents at risk in suicide prevention in schools and youth-serving organizations peer and change universal screening is in medical adolescents that not lead to and The Garrett Lee Smith Memorial Act of for a of youth suicide prevention across in communities and has been to The Act of 2021 offers suicide prevention funding to schools to implement effective programs. in school laws and there is variation in implementation at the district Training school personnel to and adolescents in schools increases knowledge and confidence but not adolescent help-seeking. Training in schools is at and programs peer programs have not been for on minoritized LGBTQ+ racial/ethnic groups. focus on the and youth to care, with to adolescent needs for and a programs youth to in the design of program and The Joint recommendations to include universal suicide risk screening for Centers for Medicare & Medicaid Services at the Department of Health and Human screening for suicide risk in pediatrics and emergency departments as part of routine such screening practices. and funding for the Garrett Lee Smith Memorial Grants and the Suicide Training and Awareness Nationally Delivered for Universal Prevention (STANDUP) Act of health and school district for such funding and implement evidence-based practices. and and local and monitor school district- and school-level implementation of state-wide suicide prevention laws. district/school implementation of such laws. and and federal departments of and encourage implementation of evidence-based school youth-focused programs, in tandem with school staff training programs. district/school such programs. Engage peer leaders to spread messages of help-seeking as normative in schools, in youth-serving organizations, and on social media. Develop programs that address unique needs of groups at high risk (e.g., Indigenous, multi-racial, LGBTQ+, and rural adolescents). Also develop programs for racial/ethnic minority youth for whom there is limited Develop programs that support adolescent needs for and youth in the design of programs, youth and youth to the of effective peer programs on minoritized racial/ethnic and LGBTQ+ adolescents and in a of school and and suicide and for prevention a suicide to a suicide death is with and national guidelines reduce such research to the benefits of guidelines a suicide guidelines are on crisis response support and are based on limited research. Develop strategies that support the of adolescents have suicide to data is the of universal of and standards that in research on youth suicide has on with to the in which youth and National Committee on Vital and Health national standards for suicide death classifications and require workforce training to reduce variation across place and health that coroners and medical examiners receive such training. data for of suicide and and that of and in Our review a of strategies to address adolescent suicide and the in which the has the last We find strong evidence for, and recommend policy implementation of: restricting access to lethal (e.g., and LGBTQ+ affirming policies; screening for suicide risk in medical settings; and community-wide investments via the Garrett Lee Smith Memorial Act. In schools, we find benefits of, and recommend funding and implementation of, youth-focused programs, at and changing social Even so, gaps exist: (a) research on economic policies for adolescents is nonexistent; (b) while mental health care access is a barrier, we do not know how to reduce youth suicide rates via changing care access; (c) data on crisis lines are encouraging but descriptive; and (d) school personnel training increases knowledge and confidence but not adolescent help-seeking. Finally, guidelines following a suicide loss (i.e., focus on immediate support and are based on limited research; this is an area for program development and research. have in effective strategies for adolescent a of youth-focused strategies have been effective that with and high school programs programs do not address adolescent needs for and a where we recommend program Finally, programs have to with minoritized youth (i.e., racial/ethnic minority and LGBTQ+ youth; is and (e.g., and and research and public have the suicide risk of and to & we recommend program development and research. funding for youth suicide has in the last of the in funding for youth mental health research the National of Health is to youth funding for youth suicide these We suggest to ensure to adolescents strategies in medical and We are in rates of suicide and from the Garrett Lee Smith Memorial Grants that access to with and is to the in adolescent but a of with rates of adolescent this public health In the we in the evidence prevention strategies that provide the for Social suicide risk and of economic The of in this area has policies to address (i.e., of research have across from to & with evidence for increases in and for policies to reduce suicide risk is not such as and and that are with suicide risk are to have been to reduce suicide rates in but have not been for adolescents & For that for state-level that the implementation of state-level policies that the suicide rates for with a (e.g., increasing for state social increasing state on medical and is with state-level suicide rates & For and are with and but not suicide evidence on the of in adolescent suicide is also policies there is evidence that such policies adolescent suicide and research is suicide prevention is access to the (i.e., which can access to a for suicide can reduce and for but not include with for lethal & and with firearm on safe practices We focus on but to research on in and to the size of for in the to lethal is access to that suicide via firearms in death of the rates suicide rates are in with for suicide rates but data on the of firearm programs (e.g., safe storage is of the implementation of laws in in in suicide before the to with in and firearm laws in and in in firearm suicide rates to in in following the but the & have such as to reduce the size of its firearms from and in in suicide among a design a is in which For & find that suicide in not are find that of the in firearm were Even so, have been to in a in and we recommend for implementation. the of public health that that the Act with in and adolescent suicide from the to the the Act the of in the there were suicide via in barriers and the of in for suicide has effective for a review of such an in at in which a is a increase in suicide at but not to the benefits there is a in a in to and with risk of suicide for minoritized groups policies and practices that support and (e.g., and these research is on the of such policies on the thoughts and behaviors of racial/ethnic minoritized research on policies and practices for LGBTQ+ adolescents has been of policies and practices to school for LGBTQ+ youth are with of youth and & include policies that based on and development for school staff that address LGBTQ+ LGBTQ+ safe spaces (e.g., and and LGBTQ+ in the at the state also evidence state-level for state-level that laws to same-sex marriage federal there a in the of high school suicide the past and a for youth anti-LGBTQ+ from with a but increase in adolescent LGBTQ+ youth to suicide support lines in the such there is research on the of such on suicide rates the of the of anti-LGBTQ+ In policies at the school state, and federal that and of minoritized LGBTQ+ adolescents suicide risk for LGBTQ+ for & and we recommend as part of an adolescent suicide prevention to access is health for mental that state-level variation in the and in the of mental health laws that require health mental health benefits at with health benefits in suicide rates in to the of the Health and Act in the of in a increase in mental health care and a increase in of for adolescents adolescents in such laws to with in with such laws in & to mental health care are and include the of the high of the of to and the of research on the of care access on adolescent suicide rates is in mental health have been to with increases in suicide rates for state-level but are not In a of data from youth suicide rates were with mental health for and this in with of youth and youth in the The of increasing mental health care, such care increasing the of providers on adolescent suicide has not been in and is among research Even so, suicide prevention and medical support increasing the and of mental health care providers in the of adolescent suicide lines are designed to reduce and provide to mental health lines are an of a suicide prevention and are on a and In the United States, the National Suicide Act of as a for the National Suicide Prevention in as the Suicide & The is via and a of crisis across the and are to a local crisis with knowledge of mental health in the to a local is not crisis lines national support via from via The and for LGBTQ+ youth); and support via for and of lines are also a strong for crisis a review that research on the of crisis lines for youth in of suicide prevention lines for and youth and crisis lines for youth but not limited to suicide prevention are the of to and a of crisis to (e.g., from the were before and the national implementation of crisis we recommend research to practices and gaps in design and of of lines are but rates to are The of adolescents of crisis lines can (e.g., from of high school in to of adolescents in a in rates in the but there is evidence that can increase and crisis as and rates among rural and to to adolescents & of that of were were as a and as a minority rates of minority of the are high adolescents a have were to a the not were and with as Indigenous, the of and were national while the of were national lines are an for this of were not from a to and this among racial/ethnic minority that an barriers to include and of knowledge the of crisis lines change in from the beginning to the of the as research staff a following the of adolescents in that of risk to from to from the to the of the of crisis and in adolescent have in and the of a with of that were for but not minority of and this is among not to have the of and for of crisis with the of Suicide Training a training that on and a with in and to with were not have that with in a and that with are to and to in (i.e., where the from the to prevention is at risk for Suicide risk screening health care a as part of the National for Suicide of the & National for Suicide Prevention, and in of The Joint that to for suicide Safety In a National Safety to for suicide but for for health conditions Joint a of adolescents suicide were in the a medical based on of data in across were for health care providers for mental health (e.g., for to adolescents with thoughts and adolescents do not to thoughts and behaviors the for screening in from where are and are with and health care of adolescents of adolescents suicide with care of adolescents were a mental health in the to suicide for suicide risk and suicide not in (i.e., suicide not the in a have via an design that adolescents not make with in a across of adolescents and & the youth with of and with suicide a in as a of for suicide risk have a of suicide risk screening for adolescents The at the National of is a with past and and has been to adolescents The and and has been to youth a screening has been from the at The for Suicidal an to screening while In and emergency have the and of suicide risk of organizations recommend suicide risk screening at and the for that the Services the we recommend universal screening and on The Joint and the Centers for Medicare & Medicaid Services to require universal screening and health care providers to implement We are not of of screening on adolescent to a across schools, screening with a with a suicide in of and for youth at risk of suicide the of for suicide screening with of risk and with suicide in a of in emergency departments the federal the Garrett Lee Smith Memorial Act in which The federal funding to and for youth and suicide prevention activities across the on the to For the implementation of suicide prevention and strategies in schools, mental health programs, care and youth-serving organizations Lee Smith Memorial The funding for development and implementation of suicide prevention in access to and mental health of of of suicide as a public health and development and implementation of strategies for with for mental health and suicide for Health & of the The also data to monitor at and policy and a to programs have that and suicide in the where programs were and benefits to we recommend funding and implementation. the Suicide Training and Awareness Nationally Delivered for Universal Prevention (STANDUP) Act of 2021 Act of federal funding and the Department of Health and Human Services to to state, and local that to implement evidence-based suicide and prevention training policies and to with the Department of Education and the Department of the to provide with practices for these research on prevention programs with to implementation the of programs we recommend funding for the state there is variation in suicide laws and recommendations for school include training recommendations for school suicide on suicide prevention in mental health training for and and recommendations The Even suicide prevention of also policies and and school of & & and are at the state and district to ensure suicide prevention practices are programs in schools to the of adolescents thoughts and and adolescents to care school personnel are not mental health providers and are not to provide mental health and school staff are to and encourage adolescents to care with 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rates in programs, which as has not programs across and the for groups (e.g., suicide prevention build from research on peer in and as and as of & are the to of a and are lines of in adolescents to care and suicide and programs in schools that adolescents how to to a peer mental health and and a & offers training for staff and mental health and health program with screening for suicide and and to for a & increases and suicide at but has on help-seeking for a there is of on of Health with and how to address and and and thoughts to reduce suicide and at but not across The program has and in the United and in changing help-seeking mental health mental health and in a in and programs knowledge and with also and in with a peer programs on and suicide are and on on racial/ethnic and LGBTQ+ youth is the peer in health there has been an in that peer to change help-seeking behaviors & Social on have in and health for and adolescents and is an area in which we recommend program The programs that social to change are of and & & has evidence of to and peer leaders to and via has been to (a) peer suicide that and support for and (b) for and help-seeking In create on mental is a for as as a program where create and a screening for the school In a the knowledge and and and behaviors to mental health and suicide & to the program is & and on and LGBTQ+ youth for whom is youth-focused the of the we recommend funding and implementation of youth-focused programs, in tandem with school staff training programs. 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