Principal Investigator: Israel Orbach

Level of Intervention: Universal

Target Population: High School (11th grade) students

References: Orbach & Bar-Joseph, 1993

Theory (Risk & Protective Factors Targeted):
The program is based on the underlying notion that a gradual controlled confrontation with inner experiences and life difficulties related to suicidal behavior accompanied by an emphasis on coping strategies can immunize students against self-destructive behavior.

Description of Intervention:
An elaboration of the model advocated by Ross (1987), the program consisted of seven weekly meetings of two hours each. These student workshops were aimed at eliciting introspective discussion about the students’ own emotional experiences. The guided discussions focused on critical issues for adolescents, emphasizing coping and learning alternative ways to solve problems, and encouraging self-help and peer-help.

The meetings were semi-structured and centered on three phases of discussion: description of students’ actual experiences; working through the experience being discussed; and coping with the external problem and/or the inner experience of emotions. The discussion leaders (trained school counselors and psychologists) were provided with guidelines for each meeting, including how to promote discussion and how to handle resistance, negativistic responses, and anxiety.

Research Subjects:
393 high school juniors from six different high schools in Israel participated. 5 of the participating schools represented a normal, middle-class population. The participating class from the sixth school was a special education class made up of students with conduct disorder, but of normal intelligence. 45% of the subjects were male.

Research Design:
Students were randomly assigned to experimental (n=215) and control groups (n=178). Students completed pretest and post-test questionnaires relating to suicidal tendencies, hopelessness, ego identity, and coping ability. The primary measures used included the Israeli Index of Potential Suicide (Tzuriel & Bar-Joseph, 1989, Cronbach’s alpha = .81), the Adolescent’s Ego Identity Scale (Tzuriel, 1984, alpha = .85), Beck’s Hopelessness Scale (Beck, Weissman, Lester & Trexler, 1974, alpha = .89), and the Self-Control Schedule (Rosenbaum, 1986, alphas ranged from .70 to .86).

Outcomes:
Complete randomized block design ANOVAs were calculated for all six schools on the dependent variables. Group X time interactions were significant for suicidal tendencies, ego identity and coping. The interaction for hopelessness was not significant. Further group X time ANOVAs were conducted for each school individually. These showed significant interactions for 5 of the six schools (including the conduct disorder class) on the measure of suicidal tendencies, and 3 of 6 schools for the other three measures. In group X time X gender repeated ANOVAs, females in two of the schools showed a larger decrease on the measure of suicidal tendencies.

Strengths & Limitations:
This program, like the other Israeli Suicide Prevention Program referenced in this report, is unusual in that it targets internalizing behavior problems through a universal intervention. Although the complete randomized block ANOVA showed significant interaction for the combined group, the stronger effects for girls (significant in 2 of the six schools on the suicide potential measure) may be due to the cathartic, introspective nature of the program. The study did not examine distal effects, and there has been no replication of the program. Without replication, it is unclear what impact the cultural aspects of the program may have on the generalizability of the results. Attrition was less than 10%.