SUICIDE PREVENTION PROGRAM I (Klingman & Hochdorf, 1993)

Principal Investigator: Avigdor Klingman

Level of Intervention: Universal

Target Population: Junior High (8th grade) students

References: Klingman & Hochdorf, 1993

Theory (Risk & Protective Factors Targeted):
The program targets hopelessness, loneliness, and depression as precursors to self-harm and suicide. Through a cognitive-behavioral approach, the program seeks to teach students how to think about stress and distress, to provide them with coping and problem-solving skills, and to help them identify and utilize a peer support network.

Description of Intervention:
The program is implemented in groups (of about 18 students each), over the course of 12 weekly sessions of about 50 minutes each. The intervention includes seven distinct topical units which collectively follow Meichenbaum’s (1977, 1985) three-phase intervention model (i.e. an educational-conceptual phase, an exercise-training phase, and an implementation-application phase).

In the educational-conceptual phase, a warm, collaborative and socratic environment is created in which to discuss the universality of stress/distress and educate students on the role cognitions and emotions play in fostering and maintaining distress. The units utilize warm-up exercises, illustrated handouts, and optional home assignments of free-writing and story completion.

The skill acquisition phase focuses on developing a repertoire of adaptive coping skills and identifying signs of distress and suicide risk among peers. The units utilize vignettes/role plays, group discussion, modeling, newspaper clips, and handouts listing suicide risk warning signs and steps to be taken.

The application phase occurs concurrent to the skill acquisition phase and seeks to provide opportunities for rehearsing and practicing new skills in contexts beyond the classroom. With a focus on modifying cognitive events, irrational thinking, internal dialogue, and automatic thoughts, activities consist of graded home and out-of-class assignments coupled with in-class feedback and discussion.

Research Subjects:
237 primarily low to middle class 8th grade students from a single junior high school in Israel. 47% of the subjects were boys.

Research Design:
Students in each 8th grade class were randomly assigned to two groups; the groups were then randomly assigned to experimental or wait-list control conditions. Pretest measurements were taken one week prior to the start of the intervention. Post-test measurements were taken two weeks after completion of the program. The primary emotional measures included the Isreali Index of Potential Suicide (IIPS), adapted from the original Index of Potential Suicide (Zung, 1974), the UCLA Loneliness Scale (Russell, Peplau and Cutrona, 1980), and the Index of Empathy for Children and Adolescents (Bryant, 1982). Reliabilities for the IIPS were .81 for the whole scale and .71 to .86 for subscales.

Outcomes:
ANCOVA showed a significant main effect for males only on the IIPS and Index of Empathy. There was no significant main effect for the Loneliness Scale.

Strengths & Limitations:
As a universal preventive intervention targeting internalizing behavior problems, the program discussed by Klingman and Hochdorf is unusual. The results, though significant only for boys, did not show the iatrogenic effects thought likely according to some of the suicide prevention literature (Shaffer, et al, 1988). The authors posit that the stronger effect for boys may be a function of the didactic and cognitive (as opposed to emotion-oriented and group-centered) nature of the program – which may be more appealing to 8th grade boys. 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.

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