Preventing Suicidal Thoughts and Behaviors Among Youth: Integrative Data Analysis of Crossover Impacts of the Coping Power Preventive Intervention

Objective

Despite evidence-based interventions for psychiatric disorders that often precede suicidality, suicide remains a leading cause of death among youth. There has been increased interest in whether preventive interventions targeting early risk factors lead to decreased distal risk for suicidal thoughts and behaviors (STBs). This study examined the impact of Coping Power (CP), a school-based preventive intervention targeting externalizing problems, on STBs.

Method

The sample included 3,182 youths (36.4% female; 77.3% Black) who participated in 1 of 11 randomized controlled trials of CP. Individual-level data across trials were harmonized using integrative data analysis to address cross-study variation in measurement of STBs. The study used meta-analysis of individual participant data for modeling cross-study variation in intervention effects and propensity score weighting for addressing covariate imbalance arising from combining intervention arms across studies. Hypothesis tests were conducted for parent- and teacher-reported STBs under propensity score–weighted multilevel modeling.

Results

Compared with school as usual, youth participating in mindfulness-enhanced CP demonstrated significant decreases in parent-reported STBs over time (b = −.08 [.02], p < .001; after 1 year: d = −0.13; after 2 years: d = −0.25), and youth participating in Internet-enhanced CP demonstrated significant decreases in teacher-reported STBs over time (b = −.08 [.03], p = .003; after 1 year: d = −0.20; after 2 years: d = −0.40). Inconsistent results for standard CP and individual CP in sensitivity analyses preclude clear conclusions for these 2 intervention formats.

Conclusion

Synthesis of the reported findings highlights the promise of digital health and mindfulness-based interventions for youth with externalizing problems in reducing STBs. Additional research is needed to better understand the nature of for whom, how, and under what conditions preventive interventions impact later STBs.

Plain language summary

There has been increased interest in preventive interventions that target risk factors for suicidal thoughts and behaviors. In this study, we analyzed data from 3,182 youth (36.4% female youth; 77.3% Black youth) who participated in one of 11 randomized controlled trials of the Coping Power program, a school-based preventive intervention for youth demonstrating externalizing problems. Youth participating in versions of Coping Power that were optimized with online content or mindfulness-based content had reduced suicidal thoughts and behaviors, as compared to youth participating in school as usual. Our findings highlight the promise of digital health and mindfulness-based interventions in reducing suicidal thoughts and behaviors among youth with externalizing problems.

Diversity & Inclusion Statement

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list.