A Secondary Analysis of Survey Data Evaluating the Lifelines Suicide Prevention Program Among Middle School Students

PURPOSE: The purpose of this study was to evaluate student feedback of the 2015 Lifelines Suicide Prevention Program at Jessie Clark Middle School. Student feedback was examined by assessing students’ knowledge of suicide, attitudes toward suicide, knowledge of when and from whom to seek help if feeling suicidal or told by a friend that they are suicidal, and impressions of the educational presentation following participation in the Lifelines Suicide Prevention Program. METHODS: In this secondary analysis, anonymous student responses (N=269) from a 2015 middle school survey were examined by using a mixed methods design with the quantitative study measures being examined by summary scores. School grade and teams were determined using frequencies. Summary scores of each of the domains of the evaluation questions were computed and described using means with standard deviations and medians. Chi-square analyses were performed to determine differences in the individual item evaluation questions by school grade and team membership. Kruskal-Wallis test was used to determine differences in the summary scores of the evaluation questions by school grade and team membership. For the qualitative portion, transcripts of student comments were read and reviewed several times by the author, then narrative data were coded to identify themes related to participant perceptions about the program. RESULTS: There were differences between grades in individual knowledge questions as well as the mean knowledge score. Eighth graders were significantly more likely to correctly answer questions about the relationship of depression and suicide (p=0.010). However, 7 graders had significantly higher scores on use of the STOP sign logo (p=0.001). There were differences in scores between grades in individual attitude questions but not in the mean attitude score. Eighth graders were significantly more likely to answer correctly the question about the importance of SECONDARY ANALYSIS OF LIFELINES 2 yearly suicide prevention (p=0.007). There were differences in scores between grades in individual intention questions but not in the mean intention score. Seventh graders’ responses trended toward significance when endorsing having a trusted adult (p=0.053). Overall satisfaction scores were high, however 6 graders found the Lifelines videos depicting different at-risk scenarios more difficult to watch. CONCLUSION: Almost all (98.5%) students understood the seriousness of suicide and understood the risk factors of suicide (96.2%) following the Lifelines Suicide Prevention program. This study also found that as age increased, so did mental health literacy. Overall, students were satisfied with the presenter and the presentation of the program. Students perceived the Lifelines Suicide Prevention program to be relevant to themselves, their peers and to others in general. However, younger students may need adaptations to the program including a video that more closely reflects their developmental stage. An updated version of the videos may also improve the relatability of the content. In addition, results suggested that emphasis on trustbuilding between staff and students is an important factor in facilitation of open communication, which can empower students and suicidal peers to seek assistance. Finally, it is important to incorporate anti-stigma interventions to reduce students’ prejudices regarding mental illness and suicide, which may prevent them from seeking help for themselves or a peer. SECONDARY ANALYSIS OF LIFELINES 3 A Secondary Analysis of Survey Data Evaluating the Lifelines Suicide Prevention Program Among Middle School Students Introduction Lifelines is a multidisciplinary suicide prevention program implemented in middle and high schools. The program incorporates staff training, and student and parent educational efforts aimed at identification and effective response to those identified as being at risk for suicide. Lifelines is listed on the Substance Abuse and Mental Health Services Administration’s (SAMSHA) National Registry of Evidence-based Practice Programs (NREPP, n.d.). Suicide prevention programs are included on the registry through an extensive review of evidence and must meet SAMSHA’s NREPP minimum qualifications for inclusion (SAMHSA, 2016). Eleven legacy programs have been reviewed and scored on reliability and validity of measures, intervention fidelity, missing data and attrition, potential confounding variables, and appropriateness of analysis prior to changes in the grading criteria in 2015 (Suicide Prevention Resource Center (SPRC), n.d. ; SAMHSA, 2015). Four new programs were reviewed using the new NREPP scoring criteria that include rigor, effect size, program fidelity, and conceptual framework (SPRC, n.d.; SAMHSA, 2015). Based on NREPP, Lifelines has demonstrated increases in knowledge of suicide, improvement in attitudes toward suicide, greater improvement in attitudes about seeking adult help following the intervention, and improvement in suicidal secret-keeping behaviors following the intervention, yet it has never been evaluated in the context of the middle school setting (Kalafat, Madden, Haley, & O’Halloran, 2007; NREPP, 2007). Most of the current research on suicide prevention programs has focused on high school populations, however research suggests SECONDARY ANALYSIS OF LIFELINES 4 that students are at the highest risk for suicide during seventh and eighth grade (CrepeauHobson, 2013). Suicide prevention programs intuitively measure quantitative outcomes of data such as improvement in knowledge of suicide, attitudes toward suicide, and help-seeking behaviors. Very few suicide prevention programs measure qualitative outcomes such as likeability, relatability, and importance. Wilson and Deane (2001) examined high school students’ opinions about barriers to help-seeking, however, no study has evaluated middle school students’ qualitative perceptions of suicide prevention programs. The purpose of this mixed methods study was to examine student feedback of the 2015 Lifelines Suicide Prevention Program at Jessie Clark Middle School to evaluate students’ knowledge of suicide, attitudes toward suicide, knowledge of when and from whom to seek help if feeling suicidal or told by a friend that they are suicidal, and to evaluate program satisfaction. In addition, middle school students’ perceptions of the Lifelines Suicide Prevention program were described.