INTRODUCTION:Youth suicide rates have risen steadily in recent decades, with suicide attempts representing a significant risk factor for future mortality. Sexual violence exposure further elevates this risk. This study investigated the efficacy of Sources of Strength, a school-based peer-led program, for reducing suicide attempts school wide as well as specifically among youth with recent sexual violence exposure. STUDY DESIGN:Cluster RCT was conducted in 2017-2019, contrasting 22 schools paired and then randomized to either Sources of Strength intervention (n=11) for 2 school years or wait-listed condition (n=11). Two control schools dropped out prior to completing baseline assessments. SETTING/PARTICIPANTS:Participants were 6,539 students in 20 high schools across 4 assessment waves: baseline prior to random assignment and 6-, 12-, and 18-month follow-ups. INTERVENTION:In schools assigned to immediate Sources of Strength implementation, student peer leaders (n=348) received training in the program's multidimensional healthy coping framework in fall of both school years, and peer leaders conducted school-wide campaigns with ongoing mentoring from staff adult advisors (n=122). MAIN OUTCOME MEASURES:The primary outcome was any new suicide attempt reported at Waves 3 and 4. Recent sexual violence history was also assessed at baseline. Analyses were conducted in 2023. RESULTS:Sources of Strength significantly reduced new suicide attempts by 29%, even after accounting for student characteristics and recent sexual violence history. Moderation analyses showed that this overall intervention effect may not have extended to students with more severe sexual violence victim histories. CONCLUSIONS:Sources of Strength effectively reduced suicide attempts in high-school students overall, suggesting its potential for population-level impact. This is especially important in the face of steadily rising suicide attempt and fatality rates among adolescents and young adults. However, a cautious interpretation of the evidence suggests that Sources of Strength may not prevent attempts among students with recent sexual violence contact victimization, highlighting the need for additional intervention work for this high-risk group. TRIAL REGISTRATION:This trial is registered at Clinical Trials.gov NCT03014271.

Sexual violence among adolescents is a major concern. This study examined the impact of the peer-led Sources of Strength program on gender-based violence and attitudes dismissive of sexual harassment. Twenty high schools in Colorado were randomized to intervention (n = 11) or waitlist control (n = 9); students (N = 6461; 9th-11th graders) were surveyed four times (2017-2019); 45% Hispanic, 38% White, 2% Black, and 12% Multiracial; 78% straight/heterosexual, 11% bisexual, 4% questioning, 2% gay/lesbian, and 4% "other" sexuality. Baseline equivalence was not established for most outcomes. No direct intervention effects were found; however, self-reported exposure to Sources messaging was associated with small decreases in sexual harassment perpetration, forced sexual contact perpetration and victimization, and dismissiveness of sexual harassment in Year 2. Higher fidelity indicators were associated with exposure. School psychologists play key roles in identification and implementation of prevention programs, so suggestions to maximize implementation fidelity are provided.Impact StatementThis study examined the impact of a peer-led intervention on reducing multiple forms of on help-seeking and connections to caring adults they were less likely to dismiss sexual harassment and less likely to perpetrate sexual violence. School psychologists and school administrators should implement programming to fidelity and ensure the school climate supports programming through policies and practices.

Schools are ideal locations for youth to receive mental health and social-emotional programming. Despite the well-established need for school-based mental health programs, many schools do not offer these programs, and those that do often face implementation challenges that hinder the effectiveness of the programs. Peer-led programs may be an effective way to implement school-based mental health prevention efforts. Peer-led programs employ influential student leaders trained to deliver prevention content and serve as role models to their peers. Understanding potential barriers to the implementation of school-based programs is critical to ensure these programs have a meaningful impact on students and schools. The current qualitative phenomenological study examines the lessons learned from implementing the Sources of Strength ( Sources ) prevention program in 11 high schools in a western US state. Sources is an evidence-based peer-led suicide prevention program focused on developing protective factors and promoting resilience in schools. Implementing the Sources program was successful in many ways, including facilitating positive student–staff interactions, cultivating a welcoming and inclusive environment in the school community, and encouraging community outreach. Barriers to implementation were also found, including time constraints, low peer leader engagement, inefficient communication between peer leaders, need for additional guidance from program staff, and school buy-in. The findings provide program developers and schools with strategies to help strengthen program implementation and highlight challenges that Sources and similar peer-led programs face.

Sexual and gender minority (SGM) youth experience higher rates of adverse mental health outcomes, most notably suicidal thoughts and behaviors (STBs). The current study examines risk and protective factors for STBs and depression among 1,078 youth in high schools. We examine these outcomes through an intersectional lens, and we extend the use of the minority stress theory framework by focusing on resilience and protective factors and argue that bias against lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth should be addressed at the systemic, rather than the individual, level. Our findings suggest that family support is a notable factor protective of depression and suicide-related behavior among LGBTQ youth. Additionally, peer support, help-seeking beliefs, access to medical and counseling services, engaging in healthy activities, spirituality, and having trusted adults are protective factors for some groups. The nuanced findings in this study offer suggestions for school psychologists and professionals to promote healthy and safe school environments.Impact StatementThe present study addresses the prevalence of suicide among LGBTQ adolescents and protective factors that may buffer their heightened risk. LGBTQ students are not inherently at risk because of their identities, but because of stigmatization they may face in society. As such, recommendations are provided to guide school psychologists and other professionals to foster a safe and inclusive environment for this population to reduce suicide risk.

There are consistently high rates of sexual victimization and substance misuse among youth in the United States. Although there is a known relation between sexual victimization and substance use, there is a gap in the research regarding the magnitude and temporality of these associations. This study examined whether latent classes of sexual victimization and help-seeking attitudes longitudinally predict intentions of future substance misuse 7–10 months later. Students from nine Colorado high schools ( N = 533; M = age 16 years) completed surveys across two consecutive school semesters. Latent class analysis was used to identify classes of students who experienced at least one form of sexual victimization (e.g., sexual harassment, unwanted sexual contact) according to 13 sexual victimization items, and level of positive attitudes regarding help-seeking for sexual victimization. Classes were compared on demographic characteristics and for distal outcomes of likelihood of future substance misuse (cigarettes, alcohol, cannabis, prescription drugs, and electronic vaping products) using latent class regression, controlling for previous intentions to use. At Time 1, four classes of sexual victimization were identified with two main classes for comparison: low odds of experiencing sexual victimization (60.1% of sample) and high odds of endorsing all forms of sexual victimization (7.7% of sample). The high sexual victimization class had higher proportions of male and transgender students, compared to other classes. At Time 2 (7–10 months later), students in the high sexual victimization class reported a significantly greater likelihood of future cigarette ( p = .017) and prescription drug misuse ( p = .007) when compared to the low sexual victimization class. There was no evidence that having higher positive attitudes towards help-seeking resulted in lower intentions to use substances in the future. These findings highlight that addressing sexual violence in prevention programming may have crossover effects of reducing substance misuse and other forms of violence among youth.

Homophobic name-calling and sexual violence are prevalent among US high school students and have been associated with a host of negative consequences including anxiety, depression, and substance use disorders, especially among sexual and gender minority youth. Although homophobic name-calling and sexual violence are linked to common risk and protective factors, most prior studies have failed to include gender and sexual minority groups. The present study used path analyses to explore the associations between eight protective factors and the outcomes of homophobic name-calling perpetration, homophobic name-calling victimization, sexual violence perpetration, and sexual violence victimization. The sample included LGB (n = 938), transgender (n = 140), and heterosexual (n = 3,744) high school students in Colorado, USA (N = 4,822). Protective factors included: (1) family support; (2) peer support; (3) friendships with trusted adults; (4) participating in healthy activities; (5) helping others; (6) spirituality; (7) access to counseling; and (8) access to medical services. For homophobic name-calling perpetration and victimization, significant negative associations emerged across different groups for the protective factors of family support, peer support, helping others, spirituality, counseling, and medical access. For sexual violence perpetration and victimization, significant negative associations emerged across different groups for the protective factors family support, peer support, and counseling access. Findings suggest that prevention and intervention efforts to address gender-based harassment should focus on building protective, supportive environments across the schools, families, and communities.

Peer victimization, also referred to as bullying victimization, is associated with deleterious mental health outcomes including depression and suicidality. However, most of the bullying literature in the USA is centered around the experiences of non-Latinx White and African American adolescents. To center Latinx experiences, this cross-sectional study includes a sample of Latinx students from 19 Colorado high schools (n = 2554). School-level ethnic peer representation (proportion of Latinx peers) and individual student's willingness to seek help were examined independently as moderators between bullying victimization and mental health outcomes (depression and suicidality) separately by gender. Results indicated that Latinx youth who experienced peer victimization also reported higher symptoms of depression and suicidality. A greater willingness to seek help was associated with less symptoms of depression and suicidality among young Latinx youth, while school-level ethnic peer representation was only associated with lower symptoms of depression for Latinx adolescent females. Among Latinx youth who were victimized, a greater willingness to seek help was protective for symptoms of depression and suicidality. Results suggest that school-based programs for bullying prevention and mental health promotion need to examine culturally specific protective factors to reduce victimization and promote help-seeking norms among Latinx youth.

Purpose: Sexual and gender minority (SGM) youth (e.g., gay, lesbian, bisexual, questioning, transgender) are systemically impacted by victimization and poor mental health because of discrimination in society. To prevent adverse outcomes, we must understand factors that help communities support and protect SGM youth. This study examined to what extent protective factors longitudinally predict outcomes 2 years later in an effort to inform more sensitive prevention efforts. Methods: Students from nine Colorado high schools (N = 2,744) completed surveys across four consecutive school semesters (T1 to T4). Structural equation modeling was conducted to determine the longitudinal associations between baseline protective factors (access to medical and counseling services, help-seeking beliefs, trusted adults, family support, peer support, spirituality) and distal adverse outcomes (substance use, depression, suicidal ideation, peer victimization, bullying perpetration, sexual violence victimization and perpetration, homophobic name-calling victimization, and perpetration), by sexual orientation. Results: All protective factors examined, except for access to medical services, were associated with lower likelihood of adverse outcomes. Associations differed across sexual orientations. For students identified as questioning or something other than heterosexual, lesbian, gay, or bisexual, family support is a notable protective factor of depression, peer victimization, bullying perpetration, and sexual violence perpetration. Family support was not significantly protective for these outcomes among heterosexual, lesbian, gay, and bisexual students. Conclusions: There is no singular protective factor or universally impactful intervention for public health. Public health initiatives should recognize intersectional identities of young people and build strategies that are relevant to specific identities to create more comprehensive and effective programing. (C) 2021 Society for Adolescent Health and Medicine. All rights reserved.

Objectives:Suicide is a leading causes of death for adolescents, and is a developmental period with the highest rates of suicide attempts. Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are a high-risk population for suicidal ideations and behaviors when compared with their non-LGBTQ counterparts. However, a dearth of research exists on the protective factors for suicidal ideation and attempts specifically within the LGBTQ population. The current study proposes a model in which peer victimization, drug use, depressive symptoms, and help-seeking beliefs predict suicidal ideation and attempts among a statewide sample of LGBTQ adolescents. Methods:Among 4867 high school students in 20 schools, 713 self-identified as LGBTQ and had higher rates of attempts and ideation than their non-LBGTQ peers. Two logistic regression analyses were used to predict suicidal ideation and attempts among the 713 LGBTQ students (M = age 15 years). Results:Results indicated that intentions to use drugs, peer victimization, and elevated depressive symptoms predicted both suicidal ideation and attempts. Additionally, help-seeking beliefs predicted suicidal attempts but not ideation, while the interaction of help-seeking beliefs and depressive symptoms significantly predicted suicidal ideation. Conclusions:These findings underscore the importance of increasing access to effective treatment services for depression and promoting safe and accepting school and community cultures for LGBTQ youth in particular.

Year to year, homelessness continues to be a challenge facing the United States. It is estimated that on a given night in January 2016, 549,928 people were experiencing homelessness in the U.S.1 About 10,550 homeless individuals were located in Colorado, representing a 6 percent increase in the homeless population in Colorado from 2015.1 Not only are the homelessness rates rising in Colorado, but morbidity and mortality rates have also been shown to be higher among people experiencing homelessness when compared to non-homeless individuals.2 Both physical and mental health conditions may become exacerbated when exposed to communicable disease, extreme weather conditions, and violence while living in homeless shelters or on the street.3 Additionally, stressors that often come with homelessness—including lack of access to medical care, stigma toward people experiencing homelessness, and involvement in the criminal justice system— contribute to the worsening of health conditions and the development of substance abuse issues.4 People experiencing homelessness are also at greater risk for being exposed to violence and being victims of crime.3 Several studies that have examined mortality among homeless individuals in the U.S. have concluded that violence and injury-related death rates, including suicide and homicide, are higher among the homeless population when compared with the general population.5-6

Suicide is a public health concern with risks that vary between occupation groups. Many suicide victims with a health care occupation die by poisoning, but few studies have epidemiologically studied this association. The objective of this study was to quantify the increased risk of suicide death by poisoning among health care professionals in Colorado. Eleven years (2004-2014, N = 8,753) of suicide deaths in Colorado were compiled from the Colorado Violent Death Reporting System. A retrospective cohort study using multivariate logistic regression was conducted to examine the risk associated with having a health care occupation and eventual suicide death by poisoning, compared independently to firearm and hanging methods. Suicide victims with a health care occupation were more likely to die by poisoning rather than by hanging (RR 1.54, 95% CI: 1.41-1.68) or firearm (RR 1.79, 95% CI: 1.60-2.01), when compared to suicide victims without a health care occupation. The association between health care occupation and suicide method was significantly (p = .032) modified by gender. The results show that health care workers who die by suicide have an increased risk of eventual suicide death by poisoning rather than by firearm or hanging. These results can be used to inform tailored suicide prevention efforts in health care professionals.

Background: Divorced individuals carry unique suicide risks, from both acute and chronic exposure to stressors from divorce. Aims: Several statewide data sets were linked to assess the relationship between divorce and suicide. Method: Divorced suicide decedents in the Colorado Violent Death Reporting System. 2004-2015. were matched with divorce decree, using multiple identifiers. Statistically significant differences between the linked cohort and all divorced suicide decedents were assessed using chi-square statistics. Kaplan-Meier survival analyses were conducted assessing which demographics and circumstances had a significant effect on the time between divorce and death. Results: The linkage resulted in 381 divorced suicide decedents linked to a divorce decree. Time between divorce and death ranged from less than 1 year to more than 10 years. Age and intimate partner problems both had significant effects on reducing the survival probability at 1 year and beyond. Limitations: Only 14% of divorced suicide decedents were linked to a Colorado divorce decree.There were noted significant differences between the linked cohort and the total divorced suicide population. Conclusion: Better understanding the relationship between divorce and suicide is imperative to design effective prevention programs for this specific population.