Adolescent Help-Seeking After a Suicide Prevention Program: Evidence from Staff and Students

BACKGROUND AND PURPOSE: As the third leading cause of death for U.S. adolescents, suicide constitutes a significant problem. Research indicates that most teens at risk for suicide, as well as peers of suicidal teens, do not turn to an adult for help. A Colorado-based group, the Yellow Ribbon Suicide Prevention Program, strives to increase adolescent help-seeking via staff, student, and school-wide programs that incorporate the message “It's OK to ask for help.” The Yellow Ribbon program has been widely used in schools nationally and internationally, but reports about its effectiveness have remained anecdotal. This study investigated rates of student help-seeking before and six months after the introduction of the Yellow Ribbon Suicide Prevention Program.

METHODS: In Fall 2007, before the introduction of Yellow Ribbon activities to a Denver-area high school, and six months later in Spring 2008, 168 staff members at the experimental school and at a control school were surveyed about students seeking help from them. Also, a sample of 146 students (59% female; 43.4% Latino, 39.2% White, 17.5% of another race or ethnicity) at the experimental school completed pre- and post-intervention surveys about help-seeking from 12 different types of helpers. Neither school had received Yellow Ribbon programming before the study. The staff and student surveys were developed in consultation with two suicide prevention experts and a counselor and the principal at the experimental school; also, for the student survey, 27 students in focus groups provided input. Using the equality of proportions test in Stata, pre- and post-intervention differences in the proportions of staff or students reporting help-seeking were tested for statistical significance. Changes in staff-reported help-seeking at the experimental and control schools also were compared for differences.

RESULTS: Based on both staff and student reports, almost all types of help-seeking by students did not increase to a statistically significant degree after the Yellow Ribbon program's introduction. Although the proportion of staff reporting that at least one student came to them for help for emotional or behavioral problems increased by almost 5 percent at the experimental school, from 60.0% in Fall 2007 to 64.9% in Spring 2008, neither the within-school nor between-schools changes attained statistical significance. With one exception, students' reported generally similar levels of help-seeking from Fall to Spring, with about 35% turning to a teacher for help, 16% consulting a mental health professional, and 18% seeking help online. One type of student-reported help-seeking – use of a crisis hotline – did increase to a statistically significant degree, from 2.1% pre-intervention to 6.9% post-intervention. The study failed to find any increase in students telling a school-based adult when a friend disclosed suicidal thoughts or acts.

DISCUSSION: This study appears to be the first to test the effects of the Yellow Ribbon Suicide Prevention Program on students' help-seeking, providing needed evidence for school social workers in need of an effective suicide prevention program. Although most types of help-seeking did not increase after the program's introduction, students' increased use of crisis hotlines is encouraging and merits further exploration.