Monica M. Matthieu

Immigration generation status and its association with suicide attempts, substance use, and depressive symptoms among latino adolescents in the USA.

This study investigated the relation between suicide attempts and immigrant generation status using the Latino subset of the National Longitudinal Study of Adolescent Health, a school-based, nationally representative sample. This study also examined whether generation status predicted risk factors associated with elevated suicide behaviors, namely illicit substance use, problematic alcohol use, and depressive symptoms. Finally, hypothesizing that elevated depressive symptoms and substance use mediate the relation between immigrant generation status and suicide attempts among Latino adolescents, a path model was tested. Our findings revealed immigrant generation status was a determinant for suicide attempts, problematic alcohol use, repeated marijuana use, and repeated other drug use for Latino adolescents. US-born Latinos with immigrant parents (i.e., second-generation youth) were 2.87 (95% CI, 1.34, 6.14) times more likely to attempt suicide, 2.27 (95% CI, 1.53, 3.35) times more likely to engage in problematic alcohol use, 2.56 (95% CI, 1.62, 4.05) times more likely to engage in repeated marijuana use, and 2.28 (95% CI, 1.25, 4.17) times more likely to engage in repeated other drug use than were foreign-born youth (i.e., first-generation youth). Later-generations of US-born Latino youth with US-born parents were 3.57 (95% CI, 1.53–8.34) times more likely to attempt suicide, 3.34 (95% CI, 2.18–5.11) times more likely to engage in problematic alcohol use, 3.90 (95% CI, 2.46, 6.20) times more likely to engage in repeated marijuana use, and 2.80 (95% CI, 1.46, 5.34) times more likely to engage in repeated other drug use than were first-generation youth. Results from the path analysis indicated that repeated other drug use may mediate the effect of generation status on suicide attempts.

Proximate Outcomes of Gatekeeper Training for Suicide Prevention in the Workplace

In this pilot study we report on proximate outcomes of a 1-hour community gatekeeper training in-service for 76 nonclinical employees in a university hospital workplace setting. Pre-post analyses resulted in positive changes in participants knowledge about suicide and attitudes (self-efficacy) about intervening with suicidal individuals. A subset of participants engaged in role play practice of gatekeeper skills following training and rated the experience positively. Fifty-five observations were rated using an observational measure developed for this study and approximately half of these demonstrated satisfactory skills post training. Participants in this workplace gatekeeper training reported sharing new knowledge and skills with family, friends, and coworkers.

Evaluation of Gatekeeper Training for Suicide Prevention in Veterans

Clinical providers and “front line” nonclinical staff who work with veterans, families, and communities are natural gatekeepers to identify and to refer veterans at risk for suicide. A national cohort (n = 602) of community based counseling center staff from the U.S. Department of Veterans Affairs (VA) participated in an evaluation of a brief standardized gatekeeper training program and a scripted behavioral rehearsal practice session. A significant difference in knowledge and self efficacy was observed from pre to post (p < .0001) with the nonclinicians showing larger effect sizes for knowledge (0.96 vs. 0.42) and self efficacy (0.89 vs. 0.41). Gatekeeper training for suicide prevention shows promise for increasing the capacity of VA staff to work with at risk veterans.

Does a brief suicide prevention gatekeeper training program enhance observed skills

BACKGROUNDnSuicide is a significant public health problem worldwide that requires evidence-based prevention efforts. One approach to prevention is gatekeeper training. Gatekeeper training programs for community members have demonstrated positive changes in knowledge and attitudes about suicide. Changes in gatekeeper skills have not been well established.nnnAIMSnTo assess and to predict the impact of a brief, gatekeeper training on community members observed skills.nnnMETHODSnParticipants in a community gatekeeper training were employees at US universities. 50 participants were randomly selected for skills assessment and videotaped interacting with a standardized actor prior to and following training. Tapes were reliably rated for general and suicide-specific skills.nnnRESULTSnGatekeeper skills increased from pre- to posttest: 10% of participants met criteria for acceptable gatekeeper skills before training, while 54% met criteria after training. Pretraining variables did not predict increased skills.nnnLIMITATIONSnResults do not provide conclusions about the relationship between observed gatekeeper skills and actual use of those skills in the future.nnnCONCLUSIONSnGatekeeper training enhances suicide-specific skills for the majority of participants. Other strategies, such as behavioral rehearsal, may be necessary to enhance skills in the remaining participants.

Co-occurring risk behaviors among White, Black, and Hispanic US high school adolescents with suicide attempts requiring medical attention, 1999-2007: Implications for future prevention initiatives

PurposeTo identify subtypes of adolescent suicide attempters by examining risk profiles related to substance use, violent behavior, and depressive symptoms. To examine the relationship between these subtypes and having had two or more suicide attempts during the past year. To explore race and gender differences across subtypes of suicide attempters.MethodsData were combined from five nationally representative cohorts of the US Youth Risk Behavior Surveillance System (YRBSS) and focused on a subpopulation of youth who reported a suicide attempt requiring medical attention. Latent class analysis was used to identify subtypes of suicide attempters.ResultsAnalysis yielded three classes of youth who attempted suicide, distinguishable by their levels of substance use and violent behaviors: low substance use and violent behaviors, high substance use and violent behaviors, and extreme substance use and violent behaviors. All three classes had a high propensity for endorsing depressive symptoms. The proportion of youth with two or more suicide attempts during the past year increased across subgroup of attempters with higher levels of substance use and violent behaviors. Racial and gender differences were found across subtypes of suicide attempters.ConclusionsPreventing and treating the co-occurrence of substance use and violent behaviors may serve as essential strategies for reducing suicide attempts, especially among male youth. The use of public health strategies for suicide prevention should take into account the different needs of youth at risk for suicide.

Educational Preferences and Outcomes From Suicide Prevention Training in the Veterans Health Administration: One-Year Follow-Up With Healthcare Employees in Upstate New York

This study identifies training outcomes and educational preferences of employees who work within the Veterans Health Administration (VHA). Using a longitudinal pre- postsurvey design, 71 employees from one geographic region of VHA healthcare facilities participated in an evaluation of a brief standardized gatekeeper program and a needs assessment on training preferences for suicide and suicide prevention. Results indicate significant differences in knowledge and self-efficacy from pre to post (p < 0.001), although only self-efficacy remained significant at 1 year follow-up, (M = 3.01; SD = 0.87) as compared to pretraining (M = 2.50, SD = 1.05) (t = -5.64, p < 0.001). At post-training, 90% of the participants were willing to learn more about suicide, with 88% willing to spend more than 1 hour in future training activities on more advanced topics. This training program can increase the knowledge and abilities of VHA staff to engage, identify, and refer veterans at risk for suicide to appropriate care.

Factors Predicting Crisis Counselor Referrals to Other Crisis Counseling, Disaster Relief, and Psychological Services: A Cross-Site Analysis of Post-Katrina Programs

An important aspect of crisis counseling is linking survivors with services for their unmet needs. We examined determinants of referrals for disaster relief, additional crisis counseling, and psychological services in 703,000 crisis counseling encounters 3–18xa0months after Hurricane Katrina. Referrals for disaster relief were predicted by clients’ losses, age (adults rather than children), and urbanicity. Referrals for additional counseling and psychological services were predicted by urbanicity, losses and trauma exposure, prior trauma, and preexisting mental health problems. Counseling and psychological referrals declined over time despite continuing mental health needs. Results confirm large urban–rural disparities in access to services.

Training Outcomes from the Samaritans of New York Suicide Awareness and Prevention Programme among Community- and School-Based Staff

The Samaritans of New York public education suicide awareness and prevention programme is designed to train lay and professional staff on effective suicide prevention practices and how to befriend a person in crisis. However, little is known about the individual level characteristics of staff who attend these trainings. Community- and school-based staff (N=365) completed pre and post training measures of self-efficacy regarding their knowledge about suicide and suicide prevention and their ability to intervene with individuals at risk for suicide. Results indicate increased self-efficacy after suicide prevention training (M=3.7, SD=0.6) than before (M=3.3, SD=0.7) (t= -13.24, p<.05). Trainees with higher levels of education and previous contact with suicidal individuals were significantly more likely to indicate gains in self-efficacy after training.

Group Therapy Among OEF/OIF Veterans: Treatment Barriers and Preferences

Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) combat Veterans are at risk for developing post-traumatic stress disorder (PTSD). Many are seeking treatment from the Veterans Health Administration; yet, it is an ongoing challenge to engage some Veterans in sustained mental health services, especially group therapy for PTSD. This pilot study assessed OEF/OIF Veterans prior use of mental health treatment and perceived barriers to and interest in group therapy for PTSD using a survey distributed in one outpatient OEF/OIF PTSD specialty clinic in the Midwest. The 110 OEF/OIF Veterans reported experience with a range of mental health treatment services and most frequently identified perceptions of the group process to be barriers to engaging in group therapy. Specifically, OEF/OIF Veterans endorsed concerns about taking part in a group, expressing emotions, being misunderstood, and disliking the group composition. A clear preference for individual over group therapy for PTSD treatment was reported with 57% reporting disinterest in group therapy. Data suggest that Veterans are apprehensive about taking part in group therapy for PTSD. Awareness of barriers and treatment preferences can inform clinical practice and aid in developing patient-centered Veterans Health Administration services.

Accelerating Research Productivity in Social Work Programs: Perspectives on NIH's Postdoctoral T32 Research Training Mechanism

This article describes the experiences of four social work researchers who pursued an alternative career path immediately following their doctorate in social work by accepting a postdoctoral training fellowship funded by the National Institutes of Health (NIH). As schools of social work look for creative ways to build research capacity, this article describes the authors perspectives regarding the considerations to accept postdocs, key elements in their training programs, lessons learned, and outcomes from training. To provide an overview of the funding mechanism and distribution of funds to institutes and centers relevant to social work, data were obtained from databases that list NIH training grants awarded each year. Study results showed a limited amount of variation in fellows training plans. The majority of training time was spent building skill in manuscript preparation, grant development, and socialization to the NIH culture. Above all other themes, the desire for advanced research training was a critically important factor in accepting a postdoctoral training position. Finally, the outcomes of training may have a profound effect on professional development, yet the long-term trajectory of postdoctoral fellows in academic positions as compared with people without postdoctoral training in social work programs requires further study.