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Youth Suicide Preliminary Data Report

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In response to rising youth suicide rates in mid-Michigan, the LifeSavers Suicide Prevention Coalition was established in partnership with Community Mental Health (CEI-CMH) and the Eaton Regional Education Service Agency (Eaton RESA). As a part of this Coalition, the steering committee engaged Corbin J. Standley, doctoral student in Ecological-Community Psychology at Michigan State University, to conduct a secondary data analysis study to determine the risk and protective factors for youth suicide in Clinton, Eaton, and Ingham counties. This report addresses the first of three major questions proposed in the study: What are the major demographic risk factors for youth in the tri-county area? Subsequent questions will be addressed in future reports.

Data for the study came from the 2015-2016 wave of the Michigan Profile for Healthy Youth (MiPHY) survey provided in accordance with a data use agreement with the Michigan Department of Education. Additional publicly available aggregate data are also presented. The study began in January of 2018.

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Youth Suicide Preliminary Data Report

  1. 1. Page | 0 Tri-County Youth Suicide Preliminary Data Report Corbin J. Standley, B.S. Michigan State University May 1, 2018
  2. 2. Page | 1 Table of Contents Executive Summary..........................................................................................................................................2 Acknowledgements..........................................................................................................................................3 Overall Dashboard...........................................................................................................................................4 Middle School Dashboard...............................................................................................................................5 High School Dashboard...................................................................................................................................6 Introduction.......................................................................................................................................................7 Data Sources......................................................................................................................................................8 Michigan Profile for Healthy Youth (MiPHY).........................................................................................8 Suicide-Related Questions.....................................................................................................................8 Missing and Invalid Data.........................................................................................................................9 Aggregate Data.............................................................................................................................................9 Methods and Analysis ................................................................................................................................... 10 Data Usage and Security.......................................................................................................................... 10 Indicators and Research Questions ...................................................................................................... 10 Sample.......................................................................................................................................................... 11 Analysis........................................................................................................................................................ 11 Findings............................................................................................................................................................. 12 National Data............................................................................................................................................. 12 Michigan Data............................................................................................................................................. 12 MiPHY Data................................................................................................................................................ 12 Gender.................................................................................................................................................... 12 Race and Ethnicity ................................................................................................................................ 13 Sexual Orientation ............................................................................................................................... 15 Recommendations......................................................................................................................................... 16 Public Policy................................................................................................................................................ 16 Interventions and Programs.................................................................................................................... 16 Future Research ........................................................................................................................................ 17 Data Next Steps.................................................................................................................................... 17 Focus Groups ........................................................................................................................................ 17 Theory of Change..................................................................................................................................... 18 References....................................................................................................................................................... 19 Appendix A ..................................................................................................................................................... 20
  3. 3. Page | 2 Executive Summary In response to rising youth suicide rates in mid-Michigan, the LifeSavers Suicide Prevention Coalition was established in partnership with Community Mental Health (CEI-CMH) and the Eaton Regional Education Service Agency (Eaton RESA). As a part of this Coalition, the steering committee engaged Corbin J. Standley, doctoral student in Ecological-Community Psychology at Michigan State University, to conduct a secondary data analysis study to determine the risk and protective factors for youth suicide in Clinton, Eaton, and Ingham counties. This report addresses the first of three major questions proposed in the study: What are the major demographic risk factors for youth in the tri-county area? Subsequent questions will be addressed in future reports. Data for the study came from the 2015-2016 wave of the Michigan Profile for Healthy Youth (MiPHY) survey provided in accordance with a data use agreement with the Michigan Department of Education. Additional publicly available aggregate data are also presented. The study began in January of 2018. Major findings from the study include the following: 1. In the state of Michigan, suicide is the second leading cause of death for young people ages 15-34 and the third leading cause of death for youth ages 10-14. 2. Over six percent of youth in the tri-county area reported having attempted suicide. This means that, on average, in a classroom of 33 students, two students have attempted suicide. 3. Over 1,400 students (13.1%) in the tri-county area reported having seriously considered suicide. 4. Female middle school and high school students are significantly more likely to report experiencing suicidal ideation and having planned to attempt than are male students. 5. Lesbian, gay, and bisexual students are significantly more likely to report experiencing suicidal ideation and having planned to attempt than are heterosexual students. There are five major recommendations based upon these findings: 1. The prevention, education, and intervention efforts of the Coalition might benefit from having an agreed-upon Theory of Change which could promote alignment of efforts and a prioritized set of outcomes and metrics. 2. Programs and interventions aimed at youth suicide prevention should work to address the issue at the individual, community, and systems levels in order to create change across contexts. 3. The implementation of a peer-to-peer support program in local schools could serve as a great way to (1) build social support for students, (2) increase students’ ability to intervene in crisis situations, and (3) foster a culture of mental health promotion and wellness. 4. Further research is necessary in order to fill gaps uncovered in the data. Qualitative research methods have the potential to shed light on important areas such as resilience and coping skills, mental health, and social support. 5. The LifeSavers’ efforts would benefit greatly from the input, feedback, and inclusion of youth, parents, and representatives from marginalized populations in order to more accurately reflect the community it aims to serve.
  4. 4. Page | 3 Acknowledgements This initiative and the following report would not have been possible without the support of the following individuals and organizations. Their dedication, passion, and drive helped make this project successful. Kim Thalison Prevention Services Supervisor Eaton RESA Jody Nelson Prevention Therapist, Families Forward Community Mental Health Joel Hoepfner Prevention and Outreach Coordinator Community Mental Health Annemarie Hodges Temporary Survey Specialist Michigan Department of Education Nicole Kramer Survey Specialist Michigan Department of Education Abigail Lynch Community Health Promotion Specialist Barry-Eaton District Health Department This report contains citations and references in according to the American Psychological Association Publication Manual, 6th Edition. This study was approved by the Michigan Department of Education and was conducted in accordance with all ethical guidelines set forth by the American Psychological Association.
  5. 5. Page | 4 Overall Dashboard The following infographics display findings and demographics from the Youth Suicide Data Initiative. Data represent a total of 11,221 students across middle schools and high schools in Clinton, Eaton, and Ingham counties who participated in the 2015-2016 wave of the MiPHY survey. Sadness and Hopelessness Survey Demographics Females students were 1.8 times more likely to report these feelings than were male students. A total of 11,221 students completed the MiPHY survey during the 2015-2016 year. LGB Students Race/Ethnicity of Students 1.6% American Indian 2.1% Arab/Chaldean 4.4% Asian 9.2% Black 13.7% Hispanic/Latino 63.3% White A total of 2,315 students (20.6%) did not respond to this question. 6.1% of respondents indicated “Other” or did not respond to this question. Students Who Have Attempted Suicide For 7th -grade students, this is over a lifetime. For 9th - and 11th -grade students, this is over the previous 12 months. Middle School 3,985 High School 7,236 Male 51.1% Female 48.4% As/Bs 74.7% Ds/Fs 4.4% Number of students who report having attempted suicide. 229 278 173 7th Grade 9th Grade 11th Grade Percentage of students who report feeling sadness or hopelessness that interferes with daily activities. 21.6%38.4% 83.9% Heterosexual 8.8% Not Sure 6.1% Bisexual 1.2% Gay or Lesbian
  6. 6. Page | 5 Middle School Dashboard The following infographics display the major findings from the Youth Suicide Data Initiative. Data represent a total of 3,985 students across middle schools in Clinton, Eaton, and Ingham counties who participated in the 2015-2016 wave of the MiPHY survey. Sexual Orientation* Gender Gay and lesbian students were 4.7 times more likely to report suicidal ideation than heterosexual students. χ2 (1, N = 3357) = 62.52 p <.001 Bullying Suicide Plan Those who reported being bullied were 3.5 times more likely to report considering suicide. Female students were two times more likely to report having seriously considering suicide. Suicide Attempts Sadness and Hopelessness Female students were 1.6 times more likely to report these feelings than were male students. Suicidal Ideation On average, in a classroom of 26 students, about four students have seriously considered attempting suicide. * These data should be interpreted with the understanding that the number of students identifying as LGB was significantly smaller than those identifying as heterosexual. Females were 1.81 times more likely to report considering suicide. Percentage of students who reported experiencing suicidal ideation in the previous 12 months by sexual orientation. 16.1% 75.0% 62.3% 15.4% Heterosexual Gay or Lesbian Bisexual Not Sure Percentage of students who reported being bullied while at school. 35.8% 26.8% 404 (10.1%) students reported having made a plan for attempting suicide. 19.8% percent of students reported feeling sadness or hopelessness that interferes with daily activities. 5.7% percent of students reported having attempted suicide at some point in their lives. 15.5% of students report having seriously considered suicide.
  7. 7. Page | 6 High School Dashboard The following infographics display the major findings from the Youth Suicide Data Initiative. Data represent a total of 7,236 students across high schools in Clinton, Eaton, and Ingham counties who participated in the 2015-2016 wave of the MiPHY survey. Sexual Orientation* Gender Bisexual students were 4.12 times more likely to report experiencing suicidal ideation than heterosexual students. χ2 (1, N = 5682) = 170.65 p <.001 Bullying Suicide Plan Those who reported being bullied were 3 times more likely to report considering suicide. Female students were 2.4 times more likely to report having seriously considering suicide. Number of Attempts Sadness and Hopelessness Male students reported more suicide attempts in the previous 12 months than did female students. Female students were 1.9 times more likely to report these feelings than were male students. Suicidal Ideation On average, in a classroom of 26 students, about five students have seriously considered attempting suicide. * These data should be interpreted with the understanding that the number of students identifying as LGB was significantly smaller than those identifying as heterosexual. Females were 2.13 times more likely to report considering suicide.14.4% 44.0% 59.3% 29.4% Heterosexual Gay or Lesbian Bisexual Not Sure Percentage of students who reported being bullied while at school. 26.3% 16.5% 825 (14.5%) students reported having made a plan for attempting suicide. 26.6% percent of students reported feeling sadness or hopelessness that interferes with daily activities. Percentage of students who reported experiencing suicidal ideation in the previous 12 months by sexual orientation. 18.7% of students report having seriously considered suicide. 92.1% 0 Times 4.1% 1 Time 0.6% 4-5 Times 2.1% 2-3 Times 1.1% 6+ Times
  8. 8. Page | 7 Introduction orldwide, almost 800,000 people die by suicide each year.1 Recently, suicide rates have reached a 30-year high in the United States with the sharpest increases occurring in the last 10 years.2 3 Even more alarming, suicide is the second leading cause of death among 15-29-year-olds globally.1 Moreover, in the U.S., suicide is currently the third leading cause of death among youth ages 10 to 14, and the second leading cause of death among youth and young adults ages 15 to 34.4 In 2016, an average of one young person (age 24 or younger) died by suicide every 92 minutes—an average of 15.6 suicides per day.5 To that end, the LifeSavers Suicide Prevention Coalition (“LifeSavers”) emerged out of a partnership between Community Mental Health (CEI-CMH) and the Eaton Regional Education Service Agency (Eaton RESA) in order to investigate and work to stop the rising youth suicide rates in Clinton, Eaton, and Ingham counties in mid-Michigan. The LifeSavers brings together stakeholders from across these three counties in order to address the issue of youth suicide. Members of the LifeSavers include representatives from education, juvenile justice, mental health, policy and local government, and local non-profit organizations. Once established, the LifeSavers’ steering committee partnered with Corbin J. Standley and Michigan State University to establish the Youth Suicide Data Initiative. The purpose of the project is to examine existing data to better understand the incidence of youth suicide in Clinton, Eaton, and Ingham counties in order to uncover risk, preventive factors for youth suicide and use that information to inform prevention and intervention strategies. The following report is the result of those efforts. Data from the 2015-2016 wave of the Michigan Profile for Health Youth (MiPHY), the Centers for Disease Control and Prevention (CDC), and Community Commons, were analyzed over a period of four months to inform the results. Implications for policy, practice, and future research are also discussed. The study was approved by the Michigan Department of Education and was conducted in accordance with all ethical guidelines set forth by the American Psychological Association. Any questions, concerns, or feedback regarding the methods or findings in this report should be directed to: Corbin J. Standley Ph.D. Student, Ecological-Community Psychology Michigan State University corbinjs@msu.edu (801) 675-7796 W Suicidal ideation and suicide attempts are the most commonly reported mental health crises among youth.6
  9. 9. Page | 8 Data Sources Multiple sources of data were utilized for the development of this report. Each source is discussed in detail below. Michigan Profile for Healthy Youth (MiPHY) The Michigan Profile for Healthy Youth (MiPHY) is an online student health survey administered by the Michigan Department of Education (MDE) and the Michigan Department of Health and Human Services (MDHHS) to support local and regional needs assessment. The MiPHY provides student results on health risk behaviors including substance use, violence, physical activity, nutrition, sexual behavior, and emotional health in middle schools (seventh grade) and high schools (ninth and eleventh grades) across the state. The survey also measures risk and protective factors most predictive of alcohol, tobacco, and other drug use and violence. Suicide-Related Questions Table 1 below lists the suicide-related questions asked in the MiPHY survey. Given the way in which the questions are asked, the results in this report are presented separately for middle school and high school students. Analyses for “Sadness and Hopelessness” and “Suicide Attempt Injury” are not reported beyond this point but will be made available in subsequent reports. Comparisons between middle school and high school results should be done cautiously and with the understanding that the data represent responses to different questions. Table 1. Suicide-related questions in the MiPHY survey by school level. Construct Middle School Survey High School Survey Sadness and Hopelessness 148. During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities? 163. During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities? Suicidal Ideation 149. Have you ever seriously thought about killing yourself? 164. During the past 12 months, did you ever seriously consider attempting suicide? Suicide Plan 150. Have you ever made a plan about how you would kill yourself? 165. During the past 12 months, did you make a plan about how you would attempt suicide? Suicide Attempts 151. Have you ever tried to kill yourself? 166. During the past 12 months, how many times did you actually attempt suicide? Suicide Attempt Injury 152. If you attempted suicide during the past 12 months, did any attempt result in an injury, poisoning, or overdose that had to be treated by a doctor or nurse? 167. If you attempted suicide during the past 12 months, did any attempt result in an injury, poisoning, or overdose that had to be treated by a doctor or nurse?
  10. 10. Page | 9 Missing and Invalid Data Of the 12,475 completed MiPHY surveys during the 2015-2016 wave, 1,254 (10.1%) were not included in the analyses. Table 2 below details the reasoning behind their exclusion. After eliminating invalid surveys, the data reported herein come from a total valid sample of 11,221 middle and high school students in Clinton, Eaton, and Ingham counties. Table 2. Count and percentage of excluded surveys by reasoning and school level. Reasoning n % Middle School Chosen grade does not exist for survey1 38 0.9% Response count less than 20%2 93 2.3% Total 131 3.2% High School Chosen grade does not exist for survey 797 9.5% Response count less than 20% 326 3.9% Total 1,123 13.4% Total 1,254 10.1% 1 Student selected a grade other than the grade selected for participation in the survey. 2 Student responded to fewer than 20% of the questions asked. Aggregate Data National and state-level aggregate data were obtained from a variety of sources including the Centers for Disease Control and Prevention (CDC), Community Commons, and the American Association of Suicidology (AAS). Data reports sourced include the U.S.A. Suicide 2016: Official Final Data report (Drapeau & McIntosh, 2017), the 10 Leading Causes of Death report (CDC, 2016), and the Rural Suicide Rates report (CDC, 2017).
  11. 11. Page | 10 Methods and Analysis The findings reported herein emerged from a quantitative study of secondary data from the sources described above. Secondary data analysis can be defined as “second-hand” analysis. It is the analysis of information that was either gathered by someone else or for some other purpose other than the one currently being considered. Secondary data analysis is helpful in (1) providing a baseline with which to compare other data, (2) designing potential subsequent research, and (3) informing recommendations for policy, practice, and research. Data Usage and Security In January of 2018, a data use agreement was made between Eaton RESA (on behalf of the LifeSavers Suicide Prevention Coalition) and the Michigan Department of Education (see Appendix A). As a part of this agreement, the complete electronic database of 2015-2016 individual, student-level MiPHY survey data from all Clinton, Eaton, and Ingham county middle and high school buildings who participated in the MiPHY survey during the 2015-2016 academic year were sent to Corbin J. Standley (hereafter referred to as “the researcher”). These data did not include school building or district identifiers in an effort to maintain data confidentiality. The data from each district and county were combined into two separate databases (high school and middle school). As a part of this agreement, the researcher employed all data usage protocols set forth by the Michigan Department of Education in order to maintain the reliability and validity of the results and, most importantly, the anonymity of students. Data based upon a sample size of fewer than 10 students are suppressed in this and all reports resulting from these data. These raw data were not shared or distributed and were maintained on the researcher’s encrypted computer and secure server in accordance with the agreement. Indicators and Research Questions In collaboration with the LifeSavers’ steering committee, a preliminary list of factors and indicators of interest were identified including suicidal ideation, suicide attempts, substance and alcohol use, school climate, and demographic factors such as race and ethnicity, age, sexual orientation, and county. In an effort to determine the risk and preventive factors for youth suicide in the tri-county area, three primary research questions emerged from these preliminary indicators and guided the analysis of the data. The findings reported herein attempt to answer the first of following three questions. 1. What are the major demographic risk factors for youth in the tri-county area? 2. Is school climate significantly related to suicidal ideation or suicide risk among youth? In what ways? 3. What are the major protective factors for youth suicide? To what extent are they available to youth in the tri-county area?
  12. 12. Page | 11 Sample The data represent a total of 11,221 students across middle schools and high schools in Clinton, Eaton, and Ingham counties who participated in the 2015-2016 wave of the MiPHY survey. Table 3 below outlines the demographic characteristics of the sample. Table 3. Demographic characteristics of students who participated in the 2015-2016 wave of the MiPHY survey. Demographic n %* County Clinton 1,889 16.8% Eaton 2,919 26.0% Ingham 6,413 57.2% Gender Male 5,731 51.3% Female 5,432 48.7% School Level Middle School 3,985 35.5% High School 7,236 64.5% Sexual Orientation Bisexual 543 4.8% Gay or Lesbian 110 1.0% Heterosexual 7472 66.6% Not Sure 781 7.0% Academics As/Bs 8,385 76.0% Cs 1,463 13.3% Ds/Fs 488 4.5% Race/Ethnicity American Indian/Alaska Native 177 1.6% Arab/Chaldean 238 2.2% Asian 477 4.4% Black 996 9.2% Hispanic/Latino 1533 13.8% White 7101 65.7% TOTAL 11,221 * Percentages within a category may not add up to 100% given missing data and incomplete survey responses. Analysis Data were analyzed using version 24 of the Statistical Package for the Social Sciences (SPSS). Descriptive statistics, correlational analyses, t-tests, and analyses of variance (ANOVAs) were used to analyze the data. For reports of statistical significance for correlations, the Pearson correlation coefficient (r) measures the strength of a linear relationship between two variables. For statistical significance for ANOVAs, Tukey’s HSD post-hoc test measures the degree of variance between the means of two samples on a given variable. T-test values determine whether two averages are statistically significant from one another. F-test values determine whether the averages of the compared groups significantly differ from each other.
  13. 13. Page | 12 Findings National Data Suicide rates in the United States have reached a 30-year high with the sharpest increases occurring in the last 10 years.2, 3 Moreover, in the U.S., suicide is currently the third leading cause of death among youth ages 10 to 14, and the second leading cause of death among youth and young adults ages 15 to 34.4 In 2016, an average of one young person (age 24 or younger) died by suicide every 92 minutes—an average of 15.6 suicides per day.5 Michigan Data In general, suicide rates in the Midwestern United States are lower than the national average. Based on 2016 rates, Michigan currently ranks 34th in the nation for suicide deaths.5 In addition, suicide is the second leading cause of death among youth and young adults ages 15-34 and the third leading cause of death among youth ages 10-14 in the state. On average, one person dies by suicide every six hours in Michigan. Moreover, in 2010, suicide is estimated to have cost the state of Michigan more than 1.5 billion dollars in medical costs and work loss.7 MiPHY Data The following paragraphs report the findings specific to the 2015- 2016 wave of the MiPHY survey conducted in middle schools and high schools in Clinton, Eaton, and Ingham counties. These data are representative only of these counties and age groups and should not be generalized to broader populations. Gender Findings indicate that female high school students were significantly more likely to report experiencing suicidal ideation (t (5680) = - 13.26, p < .001) and having planned to attempt (t (5650) = -9.91, p < .001) in the previous 12 months than were male students. This same pattern emerged among middle school students such that female students were significantly more likely to report experiencing suicidal ideation (t (3355) = -7.98, p < .001) and having planned to attempt (t (3349) = -7.32, p < .001) in their lifetime. High school and middle school students differed with regards to gender and suicide attempts such that high school males were reported more suicide attempts in the previous 12 months than did female students (t (5684) = 5.21, p < .001). Conversely, middle school females were more likely to report attempting in their lifetime than were males (t (3345) = -6.25, p < .001). Key Findings 1. Female students are significantly more likely to report experiencing suicidal ideation and having planned to attempt suicide than are male students. 2. High school students with multiple racial identities (both Hispanic and non- Hispanic) were significantly more likely to report suicidal ideation and report having planned to attempt suicide than were students of other racial identities. 3. Black/African American students were most likely to report having attempted suicide, followed by White and multiple identity (Hispanic) students, respectively. 4. Gay, lesbian, and bisexual students are significantly more likely to report experiencing suicidal ideation, having planned to attempt, as well as attempt suicide more frequently than their heterosexual peers.
  14. 14. Page | 13 Table 4. Means and response rates for suicidal ideation, suicide plan, and suicide attempts among high school and middle school students by gender. Middle School High School Outcome Variable by Gender n M n M Suicidal Ideation Female 1661 1.76 2800 1.75 Male 1696 1.87 2885 1.88 Suicide Plan Female 1660 1.84 2784 1.81 Male 1691 1.92 2868 1.90 Suicide Attempts Female 1663 1.90 2801 1.18 Male 1684 1.96 2885 1.10 Race and Ethnicity Significant differences in suicidal ideation, plans to attempt suicide, and suicide attempts as a function of racial identity emerged across middle school and high school students. Means and response rates for these findings are reported in Table 5 on page 14. Data representing responses from a pool of fewer than ten students are suppressed to protect student anonymity. Middle School Among middle school students, no significant differences in suicidal ideation by racial or ethnic identity emerged such that no group or groups of students were significantly more likely to report experiencing suicidal ideation than any other group (F (6, 3230) = 2.59, p < .05). With regards to planning, only one significant difference emerged such that multiple identity (Hispanic) students were significantly more likely to report having planned to attempt suicide than were White students (F (6, 3228) = 3.38, p < .01). Significant differences with regard to suicide attempts among middle school students emerged in three cases such that those with multiple racial identities (including Hispanic) were significantly less likely to report attempting suicide than were Black/African American or White students. Black/African American students were most likely to report attempting, followed by White and multiple identity (Hispanic) students, respectively (F (6, 3222) = 3.27, p < .01). High School Among high school students, significant differences with regards to suicide were found among four racial groups such that students with multiple racial identities (both Hispanic and non-Hispanic) were significantly more likely to report experiencing suicidal ideation than were White or Asian students. Multiple identity (Hispanic) students were most likely to report ideation followed by multiple identity (non-Hispanic), White, and Asian students, respectively. Reports of ideation between White and Asian students did not significantly differ from each other (F (6, 5510) = 5.72, p < .001). Similarly, significant differences emerged with regards to having planned to attempt suicide among five racial groups such that students with multiple racial identities (both Hispanic and non-Hispanic) were significantly more likely to report having planned to attempt suicide than were White, Black/African American, or Asian students. Multiple identity (Hispanic) students were most likely
  15. 15. Page | 14 to report having planned to attempt followed by multiple identity (non-Hispanic), White, Black/African American, and Asian students, respectively. Reports of planned attempts between White, Black/African American, and Asian students did not significantly differ from each other (F (6, 5481) = 7.68, p < .001). Lastly, significant differences emerged for number of attempts among four racial groups such that students with multiple identities (including Hispanic) reported significantly more attempts than did White or Asian students, respectively. Moreover, Black/African American students reported significantly more attempts than did White or Asian students, respectively. No significant differences between Asian and White students or between multiple identity (Hispanic) and Black/African American students emerged (F (6, 5515) = 11.59, p < .001). Table 5. Means and response rates for suicidal ideation, planned attempts, and suicide attempts among high school and middle school students by race. Middle School High School Outcome Variable by Race n M n M Suicidal Ideation American Indian/Alaska Native 87 1.86 55 1.78 Asian 148 1.86 231 1.88 Black/African American 298 1.85 481 1.81 Native Hawaiian/Pacific Islander -* - 12 1.75 White 1998 1.82 3776 1.83 Multiple-Hispanic 479 1.77 578 1.75 Multiple-Non-Hispanic 225 1.78 384 1.76 Suicide Plan American Indian/Alaska Native 86 1.90 53 1.83 Asian 147 1.89 230 1.89 Black/African American 296 1.91 481 1.89 Native Hawaiian/Pacific Islander - - 11 1.64 White 2001 1.89 3756 1.87 Multiple-Hispanic 479 1.84 571 1.79 Multiple-Non-Hispanic 224 1.84 386 1.80 Suicide Attempts American Indian/Alaska Native 86 1.92 53 1.08 Asian 147 1.95 231 1.06 Black/African American 298 1.95 483 1.24 Native Hawaiian/Pacific Islander - - 12 1.50 White 1997 1.94 3775 1.11 Multiple-Hispanic 476 1.89 580 1.27 Multiple-Non-Hispanic 223 1.93 388 1.18 * Data suppressed due to number of responses.
  16. 16. Page | 15 Sexual Orientation Significant differences with regard to suicidal ideation, having made a plan to attempt, attempting suicide, and number of attempts as a function of sexual orientation emerged across both middle school and high school students. Means and response rates for these findings are reported in Table 6 below. Among middle school students, students who identified as gay, lesbian, or bisexual were significantly more likely to report experiencing suicidal ideation than were heterosexual students or students unsure of their orientation (F (3, 3222) = 85.98, p < .001). Similarly, students identifying as gay or lesbian were most likely to report having planned to attempt followed by bisexual students (F (3, 3222) = 83.11, p < .001). Heterosexual students and those unsure of their orientation were least likely to report having a plan and did not significantly differ from one another. Finally, students identifying as gay, lesbian, or bisexual were significantly more likely to report having attempted suicide than were heterosexual students or those unsure of their orientation (F (3, 3216) = 77.19, p < .001). Among high school students, those who identified as bisexual were most likely to report experiencing suicidal ideation in the previous 12 months followed by gay and lesbian students, students who indicated they were unsure of their orientation, and heterosexual students, respectively (F (3, 5491) = 192.81, p < .001). These same significant differences were found for students who reported having planned to attempt suicide, although in this case, gay and lesbian students did not significantly differ from bisexual students (F (3, 5464) = 138.03, p < .001). Similarly, students identifying as gay, lesbian, or bisexual were significantly more likely to report a higher number of suicide attempts followed by those who were unsure of their orientation and heterosexual students (F (3, 5499) = 87.27, p < .001). Table 6. Means and response rates for suicidal ideation, planned attempts, and suicide attempts among high school and middle school students by sexual orientation. Middle School High School Outcome Variable by Orientation n M n M Suicidal Ideation Bisexual 151 1.38 376 1.41 Gay or Lesbian 16 1.25 91 1.56 Heterosexual 2603 1.84 4725 1.86 Not Sure 456 1.85 303 1.71 Suicide Plan Bisexual 151 1.53 372 1.55 Gay or Lesbian 16 1.31 91 1.59 Heterosexual 2603 1.90 4700 1.89 Not Sure 456 1.90 305 1.77 Suicide Attempts Bisexual 150 1.65 376 1.53 Gay or Lesbian 16 1.69 92 1.46 Heterosexual 2600 1.95 4729 1.10 Not Sure 454 1.95 306 1.25
  17. 17. Page | 16 Recommendations Based on the findings presented above, the following paragraphs discuss recommendations for public policy, interventions and programs, and future research. Public Policy The findings above further emphasize the need for legislative and fiscal support for policies aimed at suicide prevention among youth. Included in such policies should be a focus on the multiple contexts in which youth interact with adults and with each other (i.e. schools, families, and communities). In addition, bills in the current legislative session are a step in the right direction. For example, House Bill 4772 mandates age-appropriate and medically accurate instruction for students and teachers regarding the warning signs, risk factors, and protective factors for suicide and prevention. Such legislation is imperative if we hope to curb rising youth suicide rates in mid- Michigan. Interventions and Programs Similarly, interventions and programs aimed at suicide prevention should target multiple ecological levels in order create sustainable outcomes. For example, the ideal intervention focuses on developing resilience and mental health among youth, fostering family relationships, improving community supports, and creating system- level changes through policy and social norms. In addition, the implementation of a peer-to-peer support program within tri-county schools has the potential to accomplish three things. Firstly, it would aid in building social support for students. Secondly, it would increase students’ ability to intervene in suicidal crisis situations. Thirdly, it would help foster a culture of mental health promotion and wellness both in schools and in communities more broadly. The Hope Squad model (Hudnall, 2018) is an exemplar program in this area. Finally, it is recommended that the LifeSavers develop and adopt a comprehensive Theory of Change to align its efforts (see Figure 1). A Theory of Change provides a useful framework for outlining programs and interventions in terms of desired outcomes via short-term, intermediate, and long-term outcomes. In addition, a Theory of Change provides a valuable tool for setting priorities and metrics to achieve these outcomes. Key Recommendations 1. The development and adoption of a Theory of Change could promote alignment of efforts and a prioritized set of outcomes and metrics. 2. Programs should work to address suicide across ecological levels in order to create change across contexts. 3. A peer-to-peer support program in local schools could serve as a great way to build social support, increase students’ ability to intervene, and foster a culture of mental health promotion. 4. Further research is necessary to shed light on important areas such as resilience and coping skills, mental health, and social support. 5. The inclusion of youth, parents, and representatives from marginalized populations could accurately reflect the community the LifeSavers aim to serve.
  18. 18. Page | 17 Future Research Further quantitative and qualitative research are recommended in order to holistically understand the nature of suicidality among youth in the tri-county area. Data Next Steps This report presents the preliminary findings from the Youth Data Initiative based on the 2015- 2016 wave of the MiPHY survey. The findings presented pertain only to the demographic factors related to youth suicide in Clinton, Eaton, and Ingham counties. As such, further analysis of these data is necessary in order to investigate the remaining questions outlined for this study: 2. Is school climate significantly related to suicidal ideation or suicide risk among youth? In what ways? 3. What are the major protective factors for youth suicide? To what extent are they available to youth in the tri-county area? Additional correlational and ANOVA analyses are necessary as well as multivariate regression analyses in order to further uncover the risk and protective factors associated with youth suicide. Such factors include neighborhood environment, school climate, and family support. In addition, further complex analyses are needed in order to investigate the intersectional relationship between demographic variables (e.g. racial identity combined with sexual orientation). Focus Groups Finally, a subsequent qualitative study is recommended wherein the perspectives and experiences of youth are uncovered through focus groups and interviewing. In conducting such a study, experiences at the individual, social, and system levels can be better understood. Moreover, understanding the individual and collective perceptions and experiences of suicidality among youth is a useful, often unexplored approach to investigating the issue. Finally, qualitative research approaches are uniquely positioned to examine the socioecological factors that contribute to youth suicide given their emphasis on individual stories and collective narratives.
  19. 19. Page | 18 Theory of Change Strategies Short-Term Intermediate Long-Term Outcomes Decreased Tri-County Youth Suicide Rate Improved Youth Mental Health Decreased Social Isolation Program Teaching Youth Intervention Skills Provide Mental Health and Suicide Awareness Trainings Mental Health Resources Awareness Campaign Youth are Aware of Mental Health Resources Increased Resilience Among Youth Conversations About Mental Health Normalized Increased Access to Mental Health Services Decreased Mental Health Stigma Access to MH Services Resources (e.g. Funding) Training Opportunities Mental Health Stigma Family Environment Positive Social Support Rurality and Isolation Positive School Climate Religious Attendance Mental Health Conditions Resilience Substance Use • Race/Ethnicity • Gender • Sexual Identity Factors Demographic IndividualCommunitySystem Figure 1. The graphic below illustrates a proposed theory of change based on the findings reported herein and the relevant scientific literature. It is designed to illustrate the ways in which proposed interventions and programs contribute to the reduction of youth suicide rates in the tri-county area. A theory of change is a powerful and effective way to promote the alignment of efforts for the LifeSavers and create a prioritized set of outcomes and metrics.
  20. 20. Page | 19 References 7 Centers for Disease Control and Prevention. (2016). 10 leading causes of death by age group, United States – 2015. From National Vital Statistics System, National Center for Health Statistics. Retrieved from https://www.cdc.gov/injury/wisqars/LeadingCauses.html 4 Centers for Disease Control and Prevention. (2017). Americans in rural areas more likely to die by suicide. From National Vital Statistics System, Morbidity and Mortality Report. Retrieved from: https://www.cdc.gov/media/releases/2017/p1005-rural-suicide-rates.html 2 Curtin, S. C., Warner, M., Hedegaard, H., & others. (2016). Increase in suicide in the United States, 1999-2014. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Retrieved from https://www.researchgate.net/profile/Sally_Curtin/publication/301564377_Increase_in_S uicide_in_the_United_States_1999-2014/links/571a31dc08ae408367bc84d6.pdf 5 Drapeau, C. W. & McIntosh, J. L. (for the American Association of Suicidology). (2017). U.S.A. suicide 2016: Official final data. Washington, DC: American Association of Suicidology. Retrieved from http://www.suicidology.org. Hudnall, G. A. (2018). Hope Squad: The successful suicide prevention program for students. Springville, UT: Cedar Fort. 6 Miller, A. B., Esposito-Smythers, C., & Leichtweis, R. N. (2015). Role of social support in adolescent suicidal ideation and suicide attempts. Journal of Adolescent Health, 56(3), 286– 292. https://doi.org/10.1016/j.jadohealth.2014.10.265 3 Twenge, J. M. (2017). Insecure: The new mental health crisis. In J. M. Twenge, iGen. New York, NY: Atria Books, pp. 93-118. 1 World Health Organization. (2018). Suicide: Fact sheet. Retrieved from http://www.who.int/mediacentre/factsheets/fs398/en/
  21. 21. Page | 20 Appendix A
  22. 22. Page | 21Corbin J. Standley corbinjs@msu.edu 2018

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