Examining the effectiveness of a family‐focused training to prevent youth suicide

• Published date: 01 February 2023
• Author: Allison Schuck,Kim Gryglewicz,Ansley Bender,Eunji Nam,Marissa McNeil,Michael Cosare,Melanie Rosler,Marc Karver
• Date: 01 February 2023
• DOI: http://doi.org/10.1111/fare.12700

RESEARCH

Examining the effectiveness of a family-focused

training to prevent youth suicide

Allison Schuck

1

| Kim Gryglewicz

2

| Ansley Bender

1

|

Eunji Nam

3

| Marissa McNeil

2

| Michael Cosare

2

|

Melanie Rosler

1

| Marc Karver

1

1

Department of Psychology, University of

South Florida, Tampa, Florida, United States

2

School of Social Work, University of Central

Florida, Orlando, Florida, United States

3

Department of Social Welfare, Incheon

National University, Incheon, South Korea

Correspondence

Allison Schuck, Department of Psychology,

University of South Florida, 4202 E. Fowler

Avenue, PCD 4118G, Tampa, FL 33612,

USA.

Email: aschuck@usf.edu

Funding information

U.S. Department of Health and Human

Services; Substance Abuse and Mental Health

Services Administration, Grant/Award

Number: U79SM061748

Abstract

Objective: The present study investigates the effectiveness

of a novel, consumer-informed, family training for youth

suicide prevention.

Background: Research suggests family members play a key

role in reducing suicide risk for their children. However,

family members often do not possess the necessary knowl-

edge, confidence, and skills needed to intervene with a

suicidal youth.

Method: Family members (N=582) participated in the

It’s Time to Talk About It: Family Training for Youth

Suicide Prevention (ITT-FT) and completed pretest and

posttest measures. Additionally, 158 family members com-

pleted a 6-month follow-up evaluation.

Results: Results indicated significant improvements in

knowledge, effective attitudes, perceived behavioral

control, social norms, and intentions immediately after

the training. Knowledge and perceived behavioral

control were sustained at follow-up. Participants identi-

fying as Hispanic/Latinx exhibited greater decreases in

stigma related to help-seeking. Those who had a family

history of mental health treatment experienced a greater

increase in social norms related to other families

seeking help.

Conclusion: Findings underline the importance of imple-

menting a family-focused program aimed at improving

training outcomes such as knowledge, confidence, and

intentions—key constructs associated with behavior

change.

Implications: Improvement in several domains following

the training highlight the critical role family members can

play in reducing youth suicide risk.

Received: 17 May 2021 Revised: 13 October 2021 Accepted: 26 February 2022

DOI: 10.1111/fare.12700

© 2022 National Council on Family Relations.

Family Relations. 2023;72:325–346. wileyonlinelibrary.com/journal/fare 325

KEYWORDS

adolescent, at-risk youth, family training, parent education, suicide,

suicide prevention

Youth suicide continues to be a significant public health concern in the United States. It

accounted for more than 6,400 deaths in 2019 alone, making it the second leading cause of

death for youth between the ages of 10 and 24 years (Centers for Disease Control and

Prevention, 2020). Recent studies infer that a large segment of the youth population seriously

contemplates suicide: In a 12-month period, 17.2% of high school youth had seriously consid-

ered making a suicide attempt, and 8% attempted suicide one or more times (Kann

et al., 2018). Furthermore, of particular concern is the growing number of studies noting ele-

vated rates of mental health problems, hospitalizations, and suicide risk amid the COVID-19

pandemic (Hill et al., 2021; Krass et al., 2021). Given the importance of early identification of

suicide risk, there is a critical need to implement effective and timely interventions (Torok

et al., 2019). Various strategies to reduce the risk of suicide in youth have been employed,

such as connecting at-risk youth to existing mental health services, training youth and adults

in identification and referral strategies (e.g., “gatekeeper training”), developing eHealth

interventions, and increasing the use of mobile crisis response services (Busby et al., 2020).

However, such strategies have largely neglected to include family members in the suicide pre-

vention process.

Evidence suggests family variables—such as ineffective communication, family dysfunction,

and parental psychopathology—may be associated with youth suicide risk (Consoli et al., 2013;

You & Leung, 2012). Indeed, factors involved in parent–child relationships (e.g., parental

warmth, connectedness) tend to be associated with suicide ideation and suicide-related behav-

iors (Connor & Rueter, 2006; Kuramoto-Crawford et al., 2016). Family members (defined as

parents, legal guardians, or caregivers, hereinafter) also serve as gatekeepers of resources

(e.g., transportation to therapy, payment for treatment) as well as influential sources for making

health care decisions and conveying relevant information to their children, some of which may

be influenced by negative attitudes and beliefs about mental health issues, treatment, and sui-

cide (Raviv et al., 2009). Conversely, other family variables—such as emotional support and

effective communication strategies, especially relating to the ability to talk about suicide

(Prabhu et al., 2010; Sharaf et al., 2009)—may be highly protective for at-risk youth. Relatedly,

although youth are often reluctant to disclose suicidal ideation to adults (Amarasuriya

et al., 2017; Michelmore & Hindley, 2012), when they do make this disclosure, it is often to a

parent (Hooven, 2013). With this avenue of communication as a potential source of support,

families can play a substantial role in mitigating risk for their children (Ibrahim et al., 2017;

Rathus et al., 2015). Because of this, they have been identified as key gatekeepers for suicidal

youth and are recommended to be directly involved in interventions aimed at preventing suicide

(Hom et al., 2015). It may be especially important to involve multiple gatekeepers, especially

fathers who tend to take a lesser role in such efforts (Panter-Brick et al., 2014). Studies suggest

fathers may play an instrumental role in reducing emotional and behavioral problems in youth

(Bögels & Phares, 2008).

Although families can be a notable source of risk mitigation, research shows that parents

often feel helpless when faced with issues such as suicide and thus react either ineffectively or

not at all (Omer & Dolberger, 2015; Owens et al., 2011). This may reflect limited suicide

prevention knowledge (Barnes et al., 2014; Toumbourou & Gregg, 2002), negative or self-

stigmatizing attitudes related to mental health difficulties and suicide (Kim & Salyers, 2008), or

perceived lack of competence or skill in effectively responding (Walsh et al., 2013). Taken

together, these factors may inadvertently interfere with intentions to intervene with a suicidal

326 FAMILY RELATIONS