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SOS Signs of Suicide

SOS Signs of Suicide is a secondary school-based suicide prevention program that includes screening and education. Students are screened for depression and suicide risk and referred for professional help as indicated. Students also view a video that teaches them to recognize signs of depression and suicide in themselves and others. They are taught that the appropriate response to these signs is to use the ACT technique: acknowledge that there is a problem, let the person know you care, and tell a trusted adult. Students also participate in guided classroom discussions about suicide and depression. The program attempts to prevent suicide attempts, increase knowledge about suicide and depression, develop desirable attitudes toward suicide and depression, and increase help-seeking behavior among youth.

Descriptive Information

Areas of Interest Mental health promotion
Outcomes Review Date: September 2006
1: Suicide attempts
2: Knowledge of depression and suicide
3: Attitudes toward depression and suicide
Outcome Categories Mental health
Suicide
Ages 13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings School
Geographic Locations No geographic locations were identified by the developer.
Implementation History SOS Signs of Suicide has been implemented in more than 7,000 schools in the United States, Canada, and Ireland. In 2012, two gatekeeper tools were made available for use in program implementation: Training Trusted Adults, a 22-minute DVD for use in staff meetings or parent nights, and Plan, Prepare, Prevent: The SOS Online Gatekeeper Training, a 90-minute online course providing in-depth suicide prevention information and step-by-step implementation guidance.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations DVDs are available with Spanish subtitles, and additional program materials are available in Spanish.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal
Selective
Indicated

Quality of Research
Review Date: September 2006

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Aseltine, R. H., & DeMartino, R. (2004). An outcome evaluation of the SOS suicide prevention program. American Journal of Public Health, 94, 446-451.  Pub Med icon

Study 2

Aseltine, R. H., Schilling, E. A., James, A., & Glanovsky, J. (n.d.). Evaluating the SOS suicide prevention program: A replication and extension. Unpublished manuscript.

Supplementary Materials

Adolescent Suicide Prevention Program. (2005). Center for Social Policy and Community Development.

Aseltine, R. H. (2001). An outcome evaluation of the 2000-2001 SOS Suicide Prevention Program. Report prepared for Screening for Mental Health, Inc.

Aseltine, R. H. (2002). An evaluation of the SOS Suicide Prevention Program: Final report for findings from the 2001-2002 school year. Report prepared for Screening for Mental Health, Inc.

McDade, M. (n.d.). Process evaluation of the referral and follow-up services used by schools participating in the SOS/CMHS program. Unpublished manuscript.

Newspaper articles about local school's SOS implementation (nine articles)

Pigeon, S. (n.d.). Signs of Suicide: An evidence-based suicide prevention program for secondary school students [PowerPoint presentation].

Proposal for Suicide Prevention Pilot Project

SOS Signs of Suicide High School Program trainer's manual

SOS Signs of Suicide High School Program training video

SOS Signs of Suicide Program quarterly report (January-March 2006) prepared for Screening for Mental Health, Inc.

SOS Signs of Suicide Secondary School Program procedure manual

Outcomes

Outcome 1: Suicide attempts
Description of Measures Suicide attempts were indicated by a single self-report item from the Centers for Disease Control and Prevention Youth Risk Behavior Survey: "During the past 3 months, did you actually attempt suicide (yes or no)?"
Key Findings In randomized controlled trials involving more than 6,000 students in five high schools, SOS Signs of Suicide participants were 40% less likely than comparable students who did not participate in the intervention to report attempting suicide in the past 3 months. In one evaluation, 3.6% of intervention participants reported suicide attempts, compared with 5.4% of control students.
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 2.3 (0.0-4.0 scale)
Outcome 2: Knowledge of depression and suicide
Description of Measures Knowledge about depression and suicide was measured by 10 true/false questionnaire items. The measure was adapted from instruments previously used to evaluate school-based suicide prevention programs.
Key Findings In randomized controlled trials, SOS Signs of Suicide participants demonstrated greater knowledge about depression and suicide after participating in the intervention than comparable high school students. In one evaluation, the intervention achieved a small effect size on knowledge (Cohen's d = 0.35).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 2.2 (0.0-4.0 scale)
Outcome 3: Attitudes toward depression and suicide
Description of Measures Attitudes toward depression and suicide were measured with an 8-item Likert scale. The measure was adapted from instruments previously used to evaluate school-based suicide prevention programs.
Key Findings SOS Signs of Suicide participants had more desirable attitudes regarding depression and suicide after participating in the intervention than comparable high school students. The intervention achieved a small effect size on attitudes (Cohen's d = 0.25, 0.37) in each of the two evaluations that looked at this outcome.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent) 51.4% Female
48.6% Male
42.8% Hispanic or Latino
25.3% Black or African American
16.4% White
15.5% Race/ethnicity unspecified
Study 2 13-17 (Adolescent) 50% Female
50% Male
35% Hispanic or Latino
25% White
24% Black or African American
16% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Suicide attempts 0.8 2.0 2.0 3.0 3.0 3.0 2.3
2: Knowledge of depression and suicide 0.0 2.0 2.0 3.0 3.0 3.0 2.2
3: Attitudes toward depression and suicide 2.0 2.0 2.0 3.0 3.5 4.0 2.8

Study Strengths

The majority of suicide prevention interventions for adolescents only assess the impact of programs on proximal variables such as knowledge, not on actual suicide attempts, as is the case in this study. The large sample and presence of a comparison group suggest adequate power for analyses and the ability to look at differences between students exposed to the program and those who were not. The high overall response rate and intent-to-treat approach to analyses also are strengths.

Study Weaknesses

Additional documentation of the reliability and validity of outcome measures would have strengthened the study. Pretest differences between schools in outcome measures were not assessed prior to combining data, which would have aided in the interpretation and clarification of results. The effects of demographic variables, but not schools, were examined in statistical models of outcome measures. Pretest measures of outcomes also would have added confidence that assignment of classes to experimental and control conditions resulted in equivalent groups being compared.

Readiness for Dissemination
Review Date: September 2006

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Pigeon, S. (n.d.). Creating change: Overcoming obstacles in implementing a youth suicide prevention program [PowerPoint presentation].

Pigeon, S. (n.d.). SOS Signs of Suicide: An evidence-based suicide prevention program for secondary school students [PowerPoint presentation].

SOS Evaluation Form

SOS Signs of Suicide DVD: Friends for Life: Preventing Teen Suicide

SOS Signs of Suicide High School Program implementation guide, trainer's manual, and training video

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.5 2.5 1.5 2.5

Dissemination Strengths

The implementation materials offer detailed information that can directly assist implementation. The intervention is well described in videos, brochures, and other implementation materials with considerable attention paid to implementing this program in a school setting. The program DVD is racially and culturally diverse, includes a mix of brief presentation of facts and stories from teens that have been suicidal, and is generally an excellent resource that seems appealing to a teen audience. The training manual provides step-by-step guidance for providers in addition to online resources and articles to increase implementer knowledge about depression and suicide. Feedback forms, screening tools, and response cards, along with examples of data that have been collected in other schools, provide guidance on data that could be collected and analyzed for quality assurance.

Dissemination Weaknesses

No formal training curriculum is offered to teach implementers the skills required to work with systems to gain support for the program, be an effective trainer, or do effective presentations. Supervision and support for the lead implementer is not addressed, and very little information is provided on how this program can fit into existing high school schedules. Fidelity and outcomes measures are not provided.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
SOS high school kit $395 each Yes
1-day, on-site training $2,000 per site No
Half-day, on-site training $1,600 per site No
Training Trusted Adults (training DVD) Free No
Plan, Prepare, Prevent (online course) Free No
Technical assistance via phone and email Free No
Summary form Included in the SOS high school kit No
Replications

No replications were identified by the developer.

Contact Information

To learn more about implementation, contact:
Meghan Diamon, MSW, LCSW
(781) 591-5230
youth@mentalhealthscreening.org

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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