Sel Youth Suicide Prevention
Sel Youth Suicide Prevention
Sel Youth Suicide Prevention
Social-Emotional Learning
and Preventing Youth Suicide
Illinois passed legislation in 2019 to promote education and
Content Warning programming on suicide prevention. California, Iowa, and New
The content in this publication is sensitive. You can
York among others have also tried to bolster suicide prevention
find support at National Hopeline Network by calling
through legislation. At the same time, schools and school sys-
800-442-HOPE (4673), through the Crisis Text Line by
texting HOME to 74174, or by calling SAMHSA’s National tems are incorporating social-emotional learning (SEL) in their
Helpline at 800-662-HELP (4357), which can provide efforts to prevent youth suicide.
mental health information and service referrals.
Anecdotally, Committee for Children has seen cases where
SEL appears to contribute to decreases in youth suicide. Tooele
Introduction County Public Schools in Utah, for example, implemented an
evidence-based SEL curriculum throughout all elementary and
Youth suicide is on the rise across the country. It’s one of the junior high schools in response to a tragic series of suicides. Two
top two causes of premature death of youth between ages 10 years later, it recorded decreasing rates of youth suicidality (and
and 19 (Curtin & Heron, 2019). Approximately one in 12 high substance use), even while other counties in the state continued
schoolers have attempted suicide; middle schoolers have a to experience increases (Second Step, n.d.).
slightly lower rate (Mazza, 2006). Recently, state legislatures
have responded with various policies. Arizona, Louisiana, and
There are major limitations with this method. Results are mixed
on whether such curricula can change knowledge and attitudes
about suicide—and whether suicide decreases when knowledge
and attitudes do change (Gould, Greenberg, Velting, & Shaffer,
2003; Katz et al., 2013).
Gatekeeper Training
A gatekeeper can be anyone in a position to recognize the warning
signs that someone might be contemplating suicide. Gatekeep-
er training teaches adults and students to recognize suicide
warning signs, identify at-risk students, and respond effectively
(Lake & Gould, 2011; Katz et al., 2013). For example, Question,
Persuade, Refer (QPR) is a universal gatekeeper program that
trains students and school staff to recognize suicide warning
signs. The program also trains staff on the QPR intervention
method, trains counselors to accurately assess at-risk students,
and organizes referrals and relationships with professional as-
sessment and treatment (Katz et al., 2013; Quinnett, 2007). A
DBT STEPS-A is an SEL program founded on dialectical behavior Another universal intervention, the Youth Aware of Mental Health
therapy (DBT) (Miller, Rathus, & Linehan, 2007). This program, Program (YAM), has the goal of increasing awareness of protective
delivered consistently over the course of the school year, targets and risk factors for suicide. It includes information on depression
Summary of Reported Outcomes diverse student needs (Mazza, 2006); they shouldn’t be applied
separately. These strategies can incorporate help-seeking and
Looking at specific examples of these five types of intervention, suicide awareness efforts, though those efforts aren’t upstream
we can summarize the key outcomes associated with each. In interventions and don’t address behavioral or cognitive challenges
Table 1, check marks indicate significant outcomes that were (Mazza, 2006). Programs should be selected with knowledge
studied in the research we reviewed. of their intent and limitations. For example, prevention programs
that target depression or anxiety can miss the wide spectrum
Note: Lack of a check mark indicates one of two situations:
of other emotions that children experience as precursors to
either the reviewed study didn’t make a significant impact or it
suicide (Flynn et al., 2018). In general, suicide prevention pro-
wasn’t designed to evaluate the outcome. We don’t distinguish
grams can be improved by addressing risk factors early, and by
between the two options in Table 1. More research might be
providing tools for coping with challenges through a consistent
needed to determine whether a program and an outcome
and comprehensive strategy.
(without a check mark) are in fact associated.
Education/Awareness
SOS
Training
Responsible
Self- Self- Social Relationship
Program Type Program Decision
Awareness Management Awareness Skills
Making
Behavioral
TeenScreen
Screening
Gatekeeper
QPR
Training
Education/
Awareness SOS
Training
Sources of
Whole School
Strength
Connections Between SEL and SEL can play a significant role in youth suicide prevention strat-
egy. It can mitigate or protect against at least four risk factors
Suicide Risk Factors associated with suicidal thoughts and behavior: hopelessness,
anxiety, substance use, and child sexual abuse. The five so-
This section focuses on risk factors for youth suicide and ex- cial-emotional competencies can map to each of these risk
amines how components of SEL can mitigate those identified factors (Table 3), offering considerable mitigation.
risks. We’ll provide an overview of the five core social-emotional
competencies, with evidence we found to be particularly sal-
ient in addressing suicidal thoughts and behaviors, and then
discuss the identified risks and the research that connects SEL
components to upstream suicide prevention.
Responsible Relationship
Risk Factor Self-Awareness Self-Management Social Awareness
Decision Making Skills
Hopelessness
Anxiety
Substance Use
Social-Emotional Competencies
the research as a protective ability for risk of suicide. Emotion
regulation includes the abilities to clearly identify emotions (con-
and Suicide Prevention nected to self-awareness), accept them, and then respond to
and use that information to meet a goal such as help-seeking or
Self-Awareness self-soothing in times of emotional distress (Pisani et al., 2012).
Self-awareness consists of accurate self-perception, self-con-
The experience of emotional distress coupled with depressive
fidence, self-efficacy, and emotion identification (CASEL, n.d.).
symptoms precedes suicidal behavior (Pisani et al., 2012). For
These factors lay the foundation for other protective factors,
adolescents, lack of emotion-regulation skills plays an influen-
reducing risk for hopelessness and anxiety while promoting
tial role in risk for suicide, especially when coupled with a history
strengths and resiliency. Self-esteem is closely related to
of nonsuicidal self-injury or with lack of access to a trusted adult
self-perception, accurate or not, and the value placed on one-
(Brausch & Woods, 2019; Pisani et al., 2012).
self (Carnevale, 2016). Strengthening self-esteem can protect
against suicidal ideation (Chioqueta & Stiles, 2007; Overholser, Related to emotion regulation, having emotional self-confi-
Adams, Lehnert, & Brinkman, 1995), and people can strengthen dence means that a person believes they can cope with and
self-esteem when they challenge distortions of self-perception change an internal emotional stressor; high emotional self-con-
(Cohen, 1959). fidence can protect against suicidal ideation (Deely & Love,
2013). The cultivation of emotion regulation is key to fostering
Self-awareness can play a foundational role in suicide prevention.
positive coping strategies and protective factors before a crisis
High self-esteem has implications for coping with life’s stressors;
can take place.
it’s part of the foundation of stress management skills through
the self-management competency. Self-esteem influences the Responsible Decision Making
cognitive appraisal process in determining whether individuals Just as self-management skills promote positive strategies
believe they can employ a coping strategy in a stressful situation for navigating strong emotions and stressful situations, so do
(Yoo, 2019). Thus, self-esteem can affect the experience of and responsible decision-making skills come into play, particularly
response to hopelessness as well as anxiety. Self-esteem, like through the ability to problem-solve in the context of primary
depression, is also affected by social connectedness. Higher prevention for suicide. Responsible decision-making skills per-
engagement in activities and social connections across different tain to the ability to analyze situations, identify problems, and
contexts can predict higher self-esteem and lower depression solve problems while considering one’s own well-being and that
(Pedersen et al, 2005). Self-management and emotion regula- of others (CASEL, n.d.).
tion also have a role to play, and central to that skill is emotion
identification through the self-awareness competency (Pisani
et al., 2012).
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral Caprara, G. V., Regalia, C., Bandura, A. (2002). Longitudinal impact
change. Psychological Review, 84(2), 191–215. doi:10.1037/0033- of perceived self-regulatory efficacy on violent conduct. European
295X.84.2.191 Psychologist, 7, 63–69. doi:10.1027//1016-9040.7.1.63
Barrish, H. H., Saunders, M., & Wolf, M. M., (1969). Good behavior Carnevale, J. (2016). Self-esteem. In H. L. Miller (Ed.), The SAGE
game: Effects of individual contingencies for group consequences encyclopedia of theory in psychology. doi:10.4135/9781483346274.
on disruptive behavior in a classroom. Journal of Applied Behavioral n284
Analysis, 2(2) 119–24. doi:10.1901/jaba.1969.2-119
CASEL. (n.d.). Core SEL competencies. Retrieved from
Basile, K., DeGue, S., Jones, K., Freire, K., Dills, J., Smith, S., & Raiford, J. https://casel.org/core-competencies/
(2016). STOP SV: A technical package to prevent sexual violence.
Atlanta, GA: National Center for Injury Prevention and Control, Centers Centers for Disease Control. (2015). Suicide facts at a glance.
for Disease Control and Prevention. Retrieved from https://www.cdc. Retrieved from https://www.cdc.gov/violenceprevention/pdf/suicide-
gov/violenceprevention/pdf/SV-Prevention-Technical-Package.pdf datasheet-a.pdf
Beck, A. T., Brown, G. K., Berchick, R. J., Stewart, B. L., & Steer, R. A. (1990). Centers for Disease Control. (2018). Youth risk behavior surveillance
Relationship between hopelessness and ultimate suicide: A replication – United States, 2017. Morbidity and Mortality Weekly Report
with psychiatric patients. American Journal of Psychiatry, 147, 190–195. Surveillance Summaries, 67(8). Retrieved from
doi:10.1176/ajp.147.2.190 https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2017/ss6708.pdf
Beck, A. T., Steer, R. A., Kovacs, M., & Garrison, B. (1985). Hopelessness Cha, C. B. & Nock, M. K. (2009). Emotional intelligence is a protective
and eventual suicide: A 10-year prospective study of patients factor for suicidal behavior. Journal of the American Academy of
hospitalized with suicidal ideation. American Journal of Psychiatry, 142, Child and Adolescent Psychiatry, 48(4), 422–430. doi:10.1097/
559–563. CHI.0b013e3181984f44
Bohanna, I., & Wang, X. (2012). Media guidelines for the responsible Chioqueta, A. P. & Stiles, T. C. (2005). Personality traits and the
reporting of suicide: A review of effectiveness. Crisis: The Journal development of depression, hopelessness, and suicide ideation.
of Crisis Intervention and Suicide Prevention, 33(4), 190–198. Personality and Individual Differences, 38(6), 1283–1291. doi:10.1016/j.
doi:10.1027/0227-5910/a000137 paid.2004.08.010
Bonner, R. L., & Rich, A. R. (1991). Predicting vulnerability to Chioqueta, A. P. & Stiles, T. C. (2007). The relationship between
hopelessness: A longitudinal analysis. Journal of Nervous and Mental psychological buffers, hopelessness, and suicidal ideation: Identification
Disease, 179, 29–32. doi:10.1097/00005053-199101000-00006 of protective factors. Crisis: The Journal of Crisis Intervention and
Suicide Prevention, 28(2), 67–73. doi:10.1027/0227-5910.28.2.67
Bothe, D. A., Grignon, J. B., & Olness, K. N. (2014). The effects of a stress
management intervention in elementary school children. Journal of Cisler, J. M., James, G. A., Tripathi, S., Mletzko, T., Heim, C., et al. (2013).
Developmental & Behavioral Pediatrics, 35(1), 62–67. doi:10.1097/ Differential functional connectivity within an emotion regulation
DBP.0000000000000016 neural network among individuals resilient and susceptible to the
depressogenic effects of early life stress. Psychological Medicine, 43(3),
Brady, K. T., Myrick, H., & McElroy, S. (1998). The relationship between 507–528. doi:10.1017/S0033291712001390
substance use disorders, impulse control disorders, and pathological
aggression. American Journal on Addictions, 7(3), 221–230. Cohen, A. R. (1959). Some implications of self-esteem for social
influence. In C. I. Hovland & I. L. Janis (Eds.), Personality and persuasibility
Braquehais, M. D., Oquendo, M. A., Baca-Carcia, E, Sher, L. (p. 102–120). New Haven, CT: Yale University Press.
(2010). Is impulsivity a link between childhood abuse and
suicide? Comprehensive Psychiatry, 51, 121–129. doi:10.1016/j. Committee for Children. (2008). Second Step middle school complete
comppsych.2009.05.003 review of research. Retrieved from https://app.secondstep.org/Portals/0/
G6/Research_Alignment/full_review_research_ms.pdf
Davidson, C. L., Wingate, L. R., Grant, D. M., Judah, M. R., & Mills, A. Hirsch, J. K. (2006). A review of the literature on rural suicide. Crisis,
C. (2011). Interpersonal suicide risk and ideation: The influence of 27(4), 189–199. doi:10.1027/0227-5910.27.4.189
depression and social anxiety. Journal of Social and Clinical Psychology,
30, 842–855. doi:10.1521/jscp.2011.30.8.842 Hofmann, S. G. (2016). Anxiety disorders. In H. Miller (Ed.), The SAGE
encyclopedia of theory in psychology. doi:10.4135/9781483346274.
Davila, J., & Beck, J. G. (2002). Is social anxiety associated with n284
impairment in close relationships? A preliminary investigation. Behavior
Therapy, 33(3), 427–446. doi:10.1016/S0005-7894(02)80037-5 Jenner, E., Jenner, L. W., Matthews-Sterling, M., Butts, J. K., & Williams,
T. E. (2010). Awareness effects of a youth suicide prevention media
Deeley, S. T. & Love, A. W. (2013). A preliminary investigation into the campaign in Louisiana. Suicide and Life-Threatening Behavior, 40(4),
emotion self-confidence model of suicidal ideation in adolescents. 394–406. doi:10.1521/suli.2010.40.4.394
Archives of Suicide Research, 17(2), 161–172. doi:10.1080/13811118.201
3.776458 Katz, C., Bolton, S. L., Katz, L. Y., Isaak, C., Tilston-Jones, T., & Sareen,
J. (2013). A systematic review of school-based suicide prevention
Dour, H. J., Cha, C. B., & Nock, M. K. (2011). Evidence for emotion- programs. Depression and Anxiety, 30(10), 1030–45. doi:10.1002/
cognition interaction in the statistical prediction of suicide attempts. da.22114
Behavior Research and Therapy, 49(4), 294–298. doi:10.1016/j.
brat.2011.01.010 LaFromboise, T. D., & Howard-Pitney, B. (1995). The Zuni Life Skills
Development Curriculum: Description and evaluation of a suicide
Dyck, M. J. (1991). Positive and negative attitudes mediating suicide prevention program. Journal of Counseling Psychology, 42(4), 479–486.
ideation. Suicide and Life-Threatening Behavior, 21(4), 360–373. doi:10.1037/0022-0167.42.4.479
Finkelhor, D., Shattuck, A., Turner, H., & Hamby, S. (2014). The lifetime LaFromboise, T. D., & Hussain, S. (2015). Chapter 16: School-based
prevalence of child sexual abuse and sexual assault assessed in adolescent suicide prevention. In Bosworth, K. (Ed.) Prevention science
late adolescence. Journal of Adolescent Health, 55(3), 329–333. in school settings. Advances in Prevention Science. New York, NY:
doi:10.1016/j.jadohealth.2013.12.026 Springer. doi:10.1007/978-1-4939-3155-2
Flynn, D., Joyce, M., Weihrauch, M., & Corcoran, P. (2018). Innovations Lake, A. M., & Gould, M. S. (2011). Chapter 29: School-based strategies
in practice: Dialectical behavior therapy—skills training for emotional for youth suicide prevention. In R. C. O’Connor, S. Platt, & J. Gordon
problem solving for adolescents (DBT STEPS-A): evaluation of a pilot (Eds.), International handbook of suicide prevention: Research, policy
implementation in Irish post-primary schools. Child and Adolescent and practice (pp. 507–529). Chichester, West Sussex, U.K.:
Mental Health, 23(4). doi:10.1111/camh.12284 Wiley-Blackwell.
Gibson, L. E. & Leitenberg, H. (2000). Child sexual abuse prevention Leavitt, R. A., Ertl, A., Sheats, K., Petrosky, E., Ivey-Stephenson, A., &
programs: do they decrease the occurrence of child sexual abuse? Fowler, K. A. (2018). Suicides among American Indian/Alaska Natives—
Child Abuse & Neglect, 24(9), 1115–1125. doi:10.1016/s0145- National Violent Death Reporting System, 18 states, 2003–2014.
2134(00)00179-4 Morbidity and Mortality Weekly Report, 67(8), 237–242. Retrieved
from https://www.cdc.gov/mmwr/volumes/67/wr/mm6708a1.htm
Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2003). Youth
suicide risk and preventive interventions: a review of the past 10 years. Linehan, M., Goodstein, J. L., Nielsen, S. L., & Chiles, J. A. (1983). Reasons
Journal of the American Academy of Child & Adolescent Psychiatry, for staying alive when you are thinking of killing yourself: The Reasons
42(4), 386–405. doi:10.1097/01.CHI.0000046821.95464.CF for Living Inventory. Journal of Consulting and Clinical Psychology, 51(2),
276–286. doi:10.1037/0022-006X.51.2.276
Gould, M. S., King, R., Greenwald, S., Fisher, P., Schwab-Stone, M., Kramer,
R., . . . Shaffer, D. (1998). Psychopathology associated with suicidal Lipsicas, C. B., & Apter, A. (2011). Evidence-based prevention and
ideation and attempts among children and adolescents. Journal of treatment of suicidality in children and adolescents. In R. O’Connor, S.
the American Academy of Child and Adolescent Psychiatry, 37(9), Platt, & J. Gordon (Eds.), International handbook of suicide prevention:
915–923. doi:10.1097/00004583-199809000-00011 Research, policy and practice (pp. 291–307). Chichester, West Sussex,
U.K.: Wiley-Blackwell.
Grover, K. E., Green, K. L., Pettit, J. W., Monteith, L. L., Garca, M. J., & Venta,
A. (2009). Problem solving moderates the effects of life event stress Locke, E.A., & Latham, G. P. (2002). Building a practically useful theory
and chronic stress on suicidal behaviors in adolescence. Journal of of goal setting and task motivation: A 35-year odyssey. American
Clinical Psychology, 65(12), 1281–1290. doi:10.1002/jclp.20632 Psychologist, 57(9), 705–717. doi:10.1037/0003-066X.57.9.705
Mazza, J. (2006). Youth suicidal behavior: A crisis in need of attention. In Quinnett, P. (2007). QPR gatekeeper training for suicide prevention: The
F. A. Villarruel, & Luster, T. (Eds). Adolescent mental health (pp. 156–177). model, rationale, and theory. Spokane, WA: QPR Institute. Retrieved from
Westport, CT: Greenwood Publishing Group. https://www.academia.edu/27982950/QPR_Gatekeeper_Training_for_
Suicide_Prevention_The_Model_Rationale_and_Theory
Mazza, J. J., Dexter-Mazza, E. T., Miller, A. L., Rathus, J. H., & Murphy,
H. E., (2016). DBT skills in schools: Skills training for emotional Sarkisian, K. L., Van Hulle, C. A., & Hill Goldsmith, H. (2018). Brooding,
problem solving for adolescents (DBT STEPS-A). New York, NY: inattention, and impulsivity as predictors of adolescent suicidal ideation.
Guilford Publications. Journal of Abnormal Child Psychology, 47(2), 333–344. doi:10.1007/
s10802-018-0435-5
Mazza Consulting. (n.d.). DBT STEPS-A. Retrieved from
http://www.mazzaconsulting.com/dbt-steps-a/ Scott, M. A., Wilcox, H. C., Schonfeld, I. S., Davies, M., Hicks, R. C., Turner,
J. B., & Shaffer, D. (2009). School-based screening to identify at-risk
Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behaviour students not already known to school professionals: the Columbia
therapy with suicidal adolescents. New York: Guilford Press. suicide screen. American Journal of Public Health, 99(2), 334–339.
doi:10.2105/AJPH.2007.127928
Miranda, R., Tsypes, A., Gallagher, M., & Rajappa, K. (2013). Rumination
and hopelessness as mediators of the relation between perceived Second Step. (n.d.). Tooele, UT: A district and community respond to
emotion dysregulation and suicidal ideation. Cognitive Therapy and trauma. Retrieved from https://www.secondstep.org/success-stories/
Research, 37(4), 786–795. doi:10.1007/s10608-013-9524-5 tooele-a-district-and-community-respond-to-trauma
Oshri, A., Kogan, S. M., Kwon, J. A., Wickrama, K. A. S., Vanderbroek, Shaffer, D., Scott, M., Wilcox, H., Maslow, C., Hicks, R., Lucas, C. P., ...
L., Palmer, A. A., & MacKillop, J. (2018). Impulsivity as a mechanism & Greenwald, S. (2004). The Columbia Suicide Screen: Validity and
linking child abuse and neglect with substance use in adolescence reliability of a screen for youth suicide and depression. Journal of the
and adulthood. Development and Psychopathology, 30(2), 417–435. American Academy of Child & Adolescent Psychiatry, 43(1), 71–79.
doi:10.1017/S0954579417000943 doi:10.1097/00004583-200401000-00016
Overholser, J. C., Adams, D. M., Lehnert, K. L., & Brinkman, D. C. (1995). Shin, H. S., & Khu, B. Y. (2001). Stress coping and its relationship
Self-esteem deficits and suicidal tendencies among adolescents. to adjustment in Korean adolescents. The Korea Journal of Youth
Journal of the American Academy of Child & Adolescent Psychiatry, Counseling, 9(1), 189–225.
34(7), 919–928. doi:10.1097/00004583-199507000-00016
Simmons, D. N., Brackett, M. A., & Adler, N. (2018, June 1). Applying an
Pan, L. A., Hassel, S., Segreti, A. M., Nau, S. A., Brent, D. A., & Phillips, M. equity lens to social, emotional, and academic development. Edna
L. (2013). Differential patterns of activity and functional connectivity Bennett Pierce Prevention Research Center, Pennsylvania State
in emotion processing neural circuitry to angry and happy faces in University. Retrieved from https://www.rwjf.org/content/dam/farm/
adolescents with and without suicide attempt. Psychological Medicine, reports/issue_briefs/2018/rwjf446338
43(10), 2129–2142. doi:10.1017/S0033291712002966
Skerrett, D. M., Gibson, M., Darwin, L., Lewis, S., Rallah, R., & De Leo, D.
Pedersen, S., Seidman, E., Yoshikawa, H., Rivera, A. C., LaRue Allen, J., (2017). Closing the gap in Aboriginal and Torres Strait Islander youth
& Aber, L. (2005). Contextual competence: Multiple manifestations suicide: A social-emotional wellbeing service innovation project.
among urban adolescents. American Journal of Community Psychology, Australian Psychologist, 53(1), 12–22. doi:10.1111/ap.12277
35(1/2). doi:10.1007/s10464-005-1890-z
Steca, P., Abela, J. R. Z., Monzani, D., Greco, A., Hazel, N. A., & Hankin, B. L.
Pérez-Fuentes, G., Olfson, M, Villegas, L., Morcillo, C., Wang, S., & (2013). Cognitive vulnerability to depressive symptoms in children: The
Blanco, C. (2013). Prevalence and correlates of child sexual abuse: A protective role of self-efficacy beliefs in a multi-wave longitudinal study.
national study. Comprehensive Psychiatry, 54(1), 16-27. doi:10.1016/j. Journal of Abnormal Child Psychology, 42(1), 137–148. doi: 10.1007/
comppsych.2012.05.010 s10802-013-9765-5
Peters, E. M., Balbuena, L., Marwaha, S., Baetz, M., Bowen, R. (2015). Suicide Prevention Resource Center. (2007). American Indian life skills.
Mood instability and impulsivity as trait predictors of suicidal thoughts. Retrieved from https://www.sprc.org/resources-programs/american-
Psychology and Psychotherapy: Theory, Research and Practice, 89(4), indian-life-skills-developmentzuni-life-skills-development
435–444. doi:10.1111/papt.12088
Suicide Prevention Resource Center. (2016). SOS signs of suicide
Pharris, M. D., Resnick, M. D., & Blum, R. W. (1997). Protecting against middle school and high school prevention programs. Retrieved from
hopelessness and suicidality in sexually abused American Indian http://www.sprc.org/resources-programs/sos-signs-suicide
adolescents. Journal of Adolescent Health, 21(6), 400–406. doi:10.1016/
S1054-139X(97)00166-3 Taylor, R. D., Oberle, E., Durlak, J. A., & Weissberg, R. P. (2017). Promoting
positive youth development through school-based social and emotional
learning interventions: A meta-analysis of follow-up effects. Child
Development, 88(4), 1156–1171. doi:10.1111/cdev.12864