Adolescent Decision-Making: The Value of Perceived Behavioral Control in Predicting Engagement in Suicide Prevention Behaviors.

Adolescent perceived behavioral control (self-efficacy) plays a key role in influencing decision-making processes within the context of suicide prevention programming. Guided by Theory of Planned Behavior, models tested attitudinal and social factors predicting adolescent intentions and actual engagement in suicide prevention behaviors. Participants included 233 racially and ethnically diverse high school students (54% female) in a southwestern U.S. school district. Measures included attitudes, norms, perceived behavioral control, intentions, and behavior over follow-up. Structural equation modeling indicated that perceived behavioral control, rather than intentions, was the direct predictor of behaviors. For adolescents, beliefs about effectively utilizing learned suicide prevention behavior may be more important than intentions. The design of suicide prevention efforts should account for this important influence on adolescent decision-making.

The Role of Youth Trainee-Trainer Alliance and Involvement in School-Based Prevention: A Moderated-Mediation Model of Student Gatekeeper Suicide Prevention Training.

This study examined the roles that youth involvement and youth trainee-trainer alliance play in school mental health prevention within the context of youth suicide gatekeeper training. Measures included youth involvement in programming, trainee-trainer alliance, and intentions to refer at-risk youth at pre- and post-training. A moderated-mediation design was used to examine associations among these factors. Results show alliance mediating pre- and post-training referral intentions, and involvement moderating the relationship between alliance and post-training intentions. On average, trainee intentions improved from pre- to post-training, but trainees reporting high alliance endorsed higher post-training referral intentions regardless of involvement level. Low alliance resulted in lower than average post-training referral intentions, even with active involvement in programming, and those with both low alliance and involvement showed the lowest post-training referral intentions. Given these findings, fostering the youth trainee-trainer relationship may be an avenue to optimize prevention program effectiveness.

Psychological distress and student engagement as mediators of the relationship between peer victimization and achievement in middle school youth.

Peer victimization is a well-known national and international problem, contributing to a range of emotional, social, and behavioral consequences. Using structural equation modeling, the authors tested a theoretical model suggesting that psychological distress and student engagement mediate the association between the experience of victimization and concurrent academic achievement. Participants were 469 (46.4 % male, 53.6 % female) 6th to 8th grade students, from randomly selected classrooms in 11 middle schools in a southeastern school district. Structural equation models of the hypothesized effects demonstrated adequate fit to the data, with both symptoms of psychological distress and engagement mediating the relationship between victimization and academic achievement. In general, the results suggest that victimization predicts diminished academic achievement by way of psychological distress and poorer engagement in classroom and academic tasks. However, the direct relationship between victimization and measures of achievement lacked significance across many correlational and path analyses conducted. These findings have implications for researchers and practitioners in understanding how psychological distress and student engagement are associated with the academic performance of students who experience peer victimization.

Benchmarking the "Question, Persuade, Refer" Program Against Evaluations of Established Suicide Prevention Gatekeeper Trainings.

Gatekeeper training is a common approach for aiding suicidal youth. This study utilizes comparative effectiveness "benchmarks" from established programs to evaluate the Question, Persuade, Refer (QPR) program. The QPR program was implemented with adults (N = 2,389) working in youth-serving community agencies. Questionnaires assessed suicide prevention knowledge, attitudes, subjective norms, perceived behavioral control, and behaviors. Consistent with benchmarked studies, participants in QPR demonstrated knowledge and suicide prevention behavior gains compared with control groups. Future research should utilize benchmarking methods as a measure of effectiveness, and more thoroughly assess mechanisms that promote behavior change.

The Role of the Therapeutic Relationship in Psychopharmacological Treatment Outcomes: A Meta-analytic Review.

OBJECTIVE: Patient nonadherence to psychopharmacological treatment is a significant barrier to effective treatment. The therapeutic relationship is known to be a critical component of effective psychological treatment, but it has received limited study. A meta-analysis was conducted to examine the role of the therapeutic relationship in the delivery of effective psychopharmacological treatment. METHODS: PubMed, PsycINFO, CINAHL, Google Scholar, Ingenta, and the Web of Science-Science Citation Index were searched, including reference lists of found articles. Meta-analytic methods were used to examine the association between the physician-patient therapeutic relationship and outcomes in psychopharmacological treatment. RESULTS: Eight independent studies of psychopharmacological treatment reported in nine articles met the inclusion criterion (1,065 participants) of being an empirically based study in which measures of the therapeutic relationship were administered and psychiatric treatment outcomes were assessed. The overall average weighted effect size for the association between the therapeutic relationship and treatment outcomes was z=.30 (95% confidence interval=.20-.39), demonstrating a statistically significant, moderate effect. CONCLUSIONS: Findings indicate that a positive therapeutic relationship or alliance between the physician and the psychiatric patient is associated with patient improvement over the course of psychopharmacological treatment. Results suggest that more attention should be paid to psychiatrist communication skills that may enhance the therapeutic alliance in psychopharmacological treatment.

Evaluating Active Parental Consent Procedures for School Programming: Addressing the Sensitive Topic of Suicide Prevention.

BACKGROUND: Suicide is the second leading cause of death for adolescents. Whereas school-based prevention programs are effective, obtaining active consent for youth participation in public health programming concerning sensitive topics is challenging. We explored several active consent procedures for improving participation rates. METHODS: Five active consent methods (in-person, students taking forms home, mailing, mailing preceded by primers, mailing followed by reminder calls) were compared against passive consent procedures to evaluate recruitment success, as determined by participation (proportion who responded yes) and response (proportion who returned any response) rates. RESULTS: Participation acceptance rates ranged from 38 to 100% depending on consent method implemented. Compared with passive consent, active consent procedures were more variable in response and participation rates. In-person methods provided higher rates than less interpersonal methods, such as mailing or students taking consents home. Mailed primers before or reminder calls after consent forms were mailed increased response but not participation rates. Students taking consents home resulted in the lowest rates. CONCLUSIONS: Although passive consent produces the highest student participation, these methods are not always appropriate for programs addressing sensitive topics in schools. In-person active consent procedures may be the best option when prioritizing balance between parental awareness and successful student recruitment.

A multimethod, multi-informant, and multidimensional perspective on psychosocial adjustment in preadolescents with spina bifida.

This study examined the psychosocial adjustment of preadolescents with spina bifida in relation to a comparison sample of able-bodied preadolescents (8- and 9-year-olds; n = 68 in each sample). The study also examined the potential clinical utility of a narrowband multimethod, multi-informant, and multidimensional perspective on the assessment of psychosocial functioning in children and adolescents with pediatric conditions. Findings revealed that children with spina bifida tended to be socially immature and passive, less likely to have social contacts outside of school, more dependent on adults for guidance, less competent scholastically, less physically active, less likely to make independent decisions, and more likely to exhibit attention and concentration difficulties. No group differences were found for externalizing symptoms, affective functioning, or global self-worth, suggesting resilience in these domains for the spina bifida sample. Findings also suggest that low socioeconomic status and the presence of a physical disability may be additive risk factors for certain psychosocial adjustment difficulties.