Reducing suicidal ideation in African American adolescents: A randomized controlled clinical trial.

OBJECTIVE: Suicide rates among African American adolescents have increased exponentially in recent years. The socioecological stressors that can increase suicide risk for African American adolescents, in conjunction with unique suicide risk manifestations within this group, require culturally sensitive preventive interventions. This study examines the efficacy of the Adapted-Coping With Stress course (A-CWS), a culturally tailored preventive intervention, to reduce suicidal ideation in African American adolescents, utilizing a randomized controlled design. METHOD: Participants included 410 ninth-grade students in a large Midwestern city; most students identified as Black/African American. Participants were randomly assigned to either the A-CWS intervention or standard care control condition. All participants were assessed at baseline, immediately postintervention, and 6 and 12 months postintervention. RESULTS: Treatment effects were examined using latent growth models comparing suicidal ideation trajectories in control and intervention conditions. Analyses were conducted using both intention-to-treat and treatment-as-received samples (i.e., intervention condition participants who attended at least 80% of sessions). In both intention-to-treat and treatment-as-received analyses, there was a significant treatment effect: Individuals in the A-CWS intervention condition with higher baseline ideation evidenced a superior reduction in suicidal ideation over the course of the study, relative to their counterparts in the standard care control condition. CONCLUSION: Findings indicate that the A-CWS preventive intervention is efficacious in reducing suicidal ideation among African American adolescents with higher levels of baseline suicidal ideation and that effects sustain over time, with the strongest effect evidenced 12 months postintervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Longitudinal patterns and predictors of suicidal ideation in African American adolescents.

Suicide rates among African American adolescents have increased dramatically. Suicidal ideation is associated with both suicide attempts and completions, thus understanding ideation patterns and predictors in African American adolescents is critical to informing prevention efforts. This study recruited 160 African American ninth grade students. Participants were those students randomized to the control condition of a randomized controlled preventive intervention. Of the 160 participants, 99 completed all assessment points and were included in latent transition analyses. We assessed participants four times: baseline then again at 6-, 12-, and 18-month postbaseline. Constructs of interest for this study included suicidal ideation, depression, hopelessness, and community violence exposure. A 2-class model (i.e., low ideation [LI] and high ideation [HI]) characterized ideation at each time point. A total of 86%-90% of participants were in the LI class in any given time point and 27.3% of participants were in the HI class at least once. Participants in the LI class tended to stay in that class, whereas those in the HI class often transitioned to the LI group. Depression and hopelessness, but not exposure to community violence, predicted HI class membership. Findings suggest that (a) most African American adolescents may experience suicide ideation at some point in time, (b) a concerning proportion of African American adolescents may experience high ideation, (c) high ideation is often time-limited, and (d) depression and hopelessness predict high ideation.

A longitudinal study of home-based involvement and dyadic adjustment during the transition to early elementary school.

Home-based involvement refers to caregivers' active efforts to create learning opportunities for their children at home and in the community. Across child development, home-based involvement is a positive influence on children's social-emotional and academic functioning. Findings have suggested that home-based involvement tends to decline during elementary and middle school, but the extent to which home-based involvement changes over time during the transition to early elementary school is less clear. Dyadic adjustment is the quality of the relationship between two partners. Grounded in family systems theory, the spillover hypothesis suggests that dyadic adjustment is an important influence on home-based involvement. However, there is limited research on the extent to which dyadic adjustment predicts home-based involvement. The present study used latent growth curve analysis to examine the trajectory of home-based involvement during the transition to early elementary school, as well as the extent to which dyadic adjustment predicts home-based involvement during this transition. Participants were 157 primary caregivers of children in kindergarten through second grade. Results suggest that home-based involvement has a negative, linear trajectory between kindergarten and second grade, and that dyadic adjustment predicts higher levels of home-based involvement at kindergarten, first grade, and second grade. Implications of study findings for research and practice are discussed, with a focus on preventive interventions that aim to promote dyadic adjustment and home-based involvement during the transition to early elementary school. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining conjoint behavioral consultation to support students in middle school with social, emotional, and behavior concerns.

The purpose of this study was to conduct a small-scale pilot study of Conjoint Behavioral Consultation (CBC), modified for middle school students with social, emotional, and behavioral concerns. Participants were 30 middle school students with social, emotional, and behavioral concerns, along with their parents and teachers. Participants were randomized to a CBC or school-as-usual control condition. Outcome measures included (a) teacher-report of student academic enablers and social, emotional, and behavioral competencies; (b) parent-, teacher-, and student report of target behavior outcomes; (c) parent- and teacher-report of the parent-teacher relationship; and (d) parent- and teacher-report competence in problem-solving. In addition, parents, teachers, and students reported their perceptions of the intervention. Findings suggested greater improvements in the intervention condition relative to the school-as-usual condition on teacher-report of student interpersonal skills, teacher-report of the parent-teacher relationship, and parent-report of competence in problem-solving. In addition, parents, teachers, and students reported improvements in the target behavior outcomes during the consultation and each stakeholder rated the intervention favorably. Limitations, future research directions, and implications for family-school interventions in middle school are discussed.

Suicide in African American Adolescents: Understanding Risk by Studying Resilience.

Historically, suicide rates for African American adolescents have been low, relative to rates for youth of other racial-ethnic backgrounds. Since 2001, however, suicide rates among African American adolescents have escalated: Suicide is now the third leading cause of death for African American adolescents. This disturbing trend warrants focused research on suicide etiology and manifestation in African American adolescents, along with culturally sensitive and effective prevention efforts. First, we revisit leading suicide theories and their relevance for African American adolescents. Next, we discuss health promotive and protective factors within the context of African American youth development. We also critique the current status of suicide risk assessment and prevention for African American adolescents. Then, we present a heuristic model of suicide risk and resilience for African American adolescents that considers their development within a hegemonic society. Finally, we recommend future directions for African American adolescent suicidology.

African American adolescent suicidal ideation and behavior: The role of racism and prevention.

Suicide is one of the most devastating, yet preventable, health disparities for African American adolescents. African American adolescent suicidal ideation and behavior may have different manifestations and risk factors relative to those of adolescents from other ethnic backgrounds that impact prevention efforts. For example, in addition to more common manifestations of suicidal ideation and behavior, African American youth may engage in violent or high-risk behaviors, use more lethal means, or report ideation at lower depression levels. The Adapted-Coping with Stress Course (A-CWS), an adaptation of Gregory Clarke and colleagues' Coping with Stress Course, was developed to address the cultural nuances of African American adolescents. The A-CWS is a 15-session cognitive-behavioral, group-based preventive intervention that aims to enhance adaptive coping skills and reduce suicidal ideation, by incorporating strategies that counter stressors associated with systemic racism that burden African American adolescents. This study evaluated the feasibility and acceptability of the A-CWS intervention, using a sample of predominantly African American ninth-grade students. Results indicated that the adolescents were very favorable and receptive to the A-CWS intervention and that the intervention could be conducted feasibly. The A-CWS intervention serves as a model to advance culturally-grounded, evidence-based preventive intervention, for an underserved sector of adolescents.