Addressing help-seeking, stigma and risk factors for suicidality in secondary schools: short-term and mid-term effects of the HEYLiFE suicide prevention program in a randomized controlled trial.

BACKGROUND: Suicidal ideation and suicide attempts present a serious public health concern among adolescents and young adults. School-based suicide prevention programs are a key tool for addressing this problem. However, more research is necessary to assess their effectiveness, acceptability, and safety. In response, the HEYLiFE suicide prevention program was developed to enhance help-seeking, reduce stigma towards suicidal peers and diminish risk factors for suicidality. This article presents the evaluation findings of the HEYLiFE program in German secondary schools. METHODS: We conducted a randomized-controlled trial measuring short-term pre-post within-group effects in the intervention group only and mid-term effects at 6-months-follow-up compared to a waitlist-control group. Schools were assigned randomly to the intervention or control group (no blinding). We recruited students ≥12 years of age. Primary outcomes were knowledge about suicidality, attitudes towards suicidality, stigma towards a suicidal peer, help-seeking intentions and behaviours, risk factors for suicidality. The data was analysed with linear mixed models and generalized linear mixed models. RESULTS: A total of N = 745 students participated (n = 353 intervention group, n = 392 control group). We observed favourable short-term effects on knowledge, attitudes towards suicidality and fear towards a suicidal peer. Unexpectedly, the program also led to an increase in desire for social distance and a decrease in prosocial emotions towards a suicidal peer. The mid-term effects of the program were exclusively favourable, resulting in enhanced attitudes towards help-seeking while protecting from a sharper rise in risk-factors for suicidality and from an increase in social distance. The program had more favourable effects on females and on students aged >13 years. The program was well-received by the students, and no serious adverse events were reported. CONCLUSIONS: These findings demonstrate the effectiveness of the HEYLiFE universal suicide prevention program in addressing variables associated with suicidal ideation and suicide attempts among adolescents on the mid-term. The short-term negative effects on stigma and more negative effects on males should be addressed in the future. Future evaluation studies should examine its effects on suicidality and its effectiveness within populations at high risk. TRIAL REGISTRATION: The study was preregistered in the German Clinical Trials Register (registration number: DRKS00017045; registration date: 02/04/2019).

[How good are teachers at recognising mental health issues and assistance needs in adolescents? A vignette-based study]. / Wie gut erkennen Lehrkräfte psychische Störungen und Hilfebedarfe bei Jugendlichen? Eine vignettenbasierte Studie.

INTRODUCTION: Teachers can help identify mental health issues in adolescents and act as gateway-providers by referring adolescents at risk to a mental health professional. Studies have so far investigated awareness concerning mental health issues among primary school teachers in the USA. The present study uses case vignettes to examine whether secondary school teachers in Germany can detect and assess the presence and severity of mental disorders in adolescents, and which factors predict referral to professional support services. METHODS: N=136 secondary school teachers completed an online questionnaire with case vignettes depicting students with moderate or severe internalizing and externalizing disorders. We assessed the ability to recognize mental health issues and evaluate the level of severity, worry and perceived prevalence of the problem as well as the helping behaviour among teachers. RESULTS: 66 and 75% of the teachers were able to identify mental health issues in case vignettes of externalizing and internalizing disorders, respectively. 60% and 61%, respectively, designated the mental disorder correctly as externalizing or internalizing, and the true positive rates did not differ between externalizing vs. internalizing disorders. However, moderate and externalizing disorders were identified with less precision, and recommendations to seek professional mental help were more seldom made for these disorders. DISCUSSION: The results indicate that teachers can validly and probably intuitively identify (at least severe cases of) mental disorders in their students. Given the uncertainty expressed and the substantial interest of teachers, further education and training on mental health conditions disorders in adolescents is recommended.

Dos and Don'ts in Designing School-Based Awareness Programs for Suicide Prevention.

Background: Despite the promising evidence for the effectiveness of school-based awareness programs in decreasing the rates of suicidal thoughts and suicide attempts in young people, no guidelines on the targets and methods of safe and effective awareness programs exist. Aims: This study intends to distill recommendations for school-based suicide awareness and prevention programs from experts. Method: A three-stage Delphi survey was administered to an expert panel between November 2018 and March 2019. A total of 214 items obtained from open-ended questions and the literature were rated in two rounds. Consensus and stability were used as assessment criteria. Results: The panel consisted of 19 participants in the first and 13 in the third stage. Recommended targets included the reduction of suicide attempts, the enhancement of help-seeking and peer support, as well as the promotion of mental health literacy and life skills. Program evaluation, facilitating access to healthcare, and long-term action plans across multiple levels were among the best strategies for the prevention of adverse effects. Limitations: The study is based on opinions of a rather small number of experts. Conclusion: The promotion of help-seeking and peer support as well as facilitating access to mental health-care utilities appear pivotal for the success of school-based awareness programs.

Emotional dysregulation in borderline personality disorder and its influence on communication behavior and feelings in romantic relationships.

Dysfunction in romantic relationships constitutes one of the most burdensome symptoms of borderline personality disorder (BPD). The aim of this study was to ascertain how emotional dysregulation affects behavior and relationship related feelings of women with BPD in threatening conversations with their own romantic partner. Thirty couples in which the women were diagnosed with BPD and 34 healthy control (HC) couples were videotaped while discussing personally threatening (i.e., personal failure) and relationship-threatening (i.e., separation) themes. Third party raters evaluated stress and communication behaviors during the conversations. Relationship related feelings, i.e., closeness and relationship insecurity, were assessed by self-report. Overall, women with BPD were rated as more stressed in threatening situations than HC women and their partners, but not more stressed in relationship-threatening than personally threatening situations. A heightened stress response of women with BPD predicted more negative and less positive communication behaviors and a stronger decline in self-rated closeness to the partner compared to HC. Stress-induced increases in relationship insecurity were specific to women with BPD. Our results highlight the central role of emotional dysregulation in interpersonal dysfunctions of persons with BPD and the need to address individual emotion regulation strategies more explicitly in dyadic contexts.