This study replicated and extended previous evaluations of the Signs of Suicide (SOS) prevention program in a high school population using a more rigorous pre-test post-test randomized control design than used in previous SOS evaluations in high schools (Aseltine and DeMartino 2004; Aseltine et al. 2007). SOS was presented to an ethnically diverse group of ninth grade students in technical high schools in Connecticut. After controlling for the pre-test reports of suicide behaviors, exposure to the SOS program was associated with significantly fewer self-reported suicide attempts in the 3 months following the program. Ninth grade students in the intervention group were approximately 64 % less likely to report a suicide attempt in the past 3 months compared with students in the control group. Similarly, exposure to the SOS program resulted in greater knowledge of depression and suicide and more favorable attitudes toward (1) intervening with friends who may be exhibiting signs of suicidal intent and (2) getting help for themselves if they were depressed or suicidal. In addition, high-risk SOS participants, defined as those with a lifetime history of suicide attempt, were significantly less likely to report planning a suicide in the 3 months following the program compared to lower-risk participants. Differential attrition is the most serious limitation of the study; participants in the intervention group who reported a suicide attempt in the previous 3 months at baseline were more likely to be missing at post-test than their counterparts in the control group.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5--5th ed. Washington, DC: American Psychiatric Publishing.
Aseltine, R. H., Jr., & DeMartino, R. (2004). An outcome evaluation of the SOS suicide prevention program. American Jounal of Public Health, 94, 446–451.
Aseltine, R. H., Jr., James, A., Schilling, E. A., & Glanovsky, J. (2007). Evaluating the SOS suicide prevention program: A replication and extension. BMC Public Health, 7, 161.
Bogenschutz, M. P., Donovan, D. M., Adinoff, B., Crandall, C., Forcehimes, A. A., Lindblad, R., & Walker, R. (2011). Design of NIDA CTN protocol 0047: screening, motivational assessment, referral, and treatment in emergency departments (SMART-ED). The American Journal of Drug and Alcohol Abuse, 37, 417–425. doi:10.3109/00952990.2011.596971.
Brown, M. M., & Grumet, J. G. (2009). School-based suicide prevention with African American youth in an urban setting. Professional Psychology: Research and Practice, 40, 111–117.
Centers for Disease Control and Prevention. (2012). Data retrieved from http://apps.nccd.cdc.gov/youthonline/App/Default.aspx, Accessed on 6/13/12.
Chatard, A., & Selimbegovic, L. (2011). When self-destructive thoughts flash through the mind: failure to meet standards affects the accessibility of suicide-related thoughts. Journal of Personality and Social Psychology, 100, 587–605.
Connecticut State Department of Education. (2007). Strategic school profile 2006-2007, Connecticut technical high school system. Retrieved from http://www.cttech.org/central/about-us/ssp/CTHSS%20Dist.pdf. accessed June 26, 2008.
Conner, K. R., Meldrum, S., Wieczorek, W. F., Duberstein, P. R., & Welte, J. W. (2004). The association of irritability and impulsivity with suicidal ideation among 15- to 20-year-old males. Suicide and Life-Threatening Behavior, 34, 363–373.
Cusimano, M. D., & Sameem, M. (2011). The effectiveness of middle and high school-based suicide prevention programmes for adolescents: A systematic review. Injury Prevention, 17, 43–49. doi:10.1136/ip.2009.025502.
De Silva, S., Parker, A., Purcell, R., Callahan, P., Liu, P., & Hetrick, S. (2013). Mapping the evidence of prevention and intervention studies for suicidal and self-harming behaviors in young people. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 34, 223–232. doi:10.1027/0227-5910/a000190.
Fergusson, D. M., Horwood, L. J., Ridder, E. M., & Beautrais, A. L. (2005). Suicidal behaviour in adolescence and subsequent mental health outcomes in young adulthood. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 35, 983–993.
Flay, B. R., Biglan, A., Boruch, R. F., Castro, F. G. I., Gottfredson, D., Kellam, S., & Ji, P. (2005). Standards of evidence: criteria for efficacy, effectiveness and dissemination. Prevention Science, 6, 151–175.
Gould, M. S., Marrocco, F. A., Kleinman, M., Thomas, J. G., Mostkoff, K., Cote, J., & Davies, M. (2005). Evaluating iatrogenic risk of youth suicide screening programs: A randomized controlled trial. JAMA: Journal of the American Medical Association, 293, 1635–1643.
Grunbaum, J. A., Kann, L., Kinchen, S. A., Ross, J. G., Gowda, V. R., Collins, J. L., & Kolbe, L. J. (2000). Youth risk behavior surveillance national alternative high school youth risk behavior survey, United States, 1998. Journal of School Health, 70, 5–17.
Grunbaum, J. A., Lowry, R., & Kann, L. (2001). Prevalence of health-related behaviors among alternative high school students as compared with students attending regular high schools. Journal of Adolescent Health, 29, 337–343.
Hanley, J. A., Negassa, A., Edwardes, M. D. D., & Forrester, J. E. (2003). Statistical analysis of correlated data using generalized estimating equations: An orientation. American Journal of Epidemiology, 157, 364–375. doi:10.1093/aje/kwf215.
Harel, O., Stratton, J., & Aseltine, R. H. (2011). Designed Missingness to Better Estimate Efficacy of Behavioral Studies. Paper presented at the Tenth Conference on Health Survey Research Methods, Hyattsville, MD.
Horowitz, J. L., Garber, J., Ciesla, J. A., Young, J. F., & Mufson, L. (2007). Prevention of depressive symptoms in adolescents: A randomized trial of cognitive-behavioral and interpersonal prevention programs. Journal of Consulting and Clinical Psychology, 75, 693–706.
Jacobs, B., & Beam, L. (2008). Mobilizing extension for youth suicide prevention using the Signs of Suicide (SOS) program. Journal of Extension, 46, Article Number: 1TOT7.
Jacobs, D. G., Brewer, M., & Klein-Benheim, M. (1999). Suicide assessment: overview and recommended protocol. In D. G. Jacobs (Ed.), Guide to suicide assessment and intervention (pp. 3–39). San Francisco: Jossey-Bass.
Joiner, T. E., Jr. (2009). Suicide prevention in schools as viewed through the interpersonal-psychological theory of suicidal behavior. School Psychology Review, 38, 244–248.
Joiner, T. E., Jr., Conwell, Y., Fitzpatrick, K. K., Witte, T. K., Schmidt, N. B., Berlim, M. T., & Rudd, M. D. (2005). Four studies on how past and current suicidality relate even when “everything but the kitchen sink” is covaried. Journal of Abnormal Psychology, 114, 291–303.
Kann, L., Kinchen, S. A., Williams, B. I., Ross, J. G., Lowry, R., Grunbaum, J. A., & Kolbe, L. J. (2000). Youth risk behavior surveillance—United States, 1999. MMWR. CDC Surveillance Summaries, 49, 1–32.
Kessler, R. C., & Greenberg, D. F. (1981). Linear panel analysis: Models of quantitative change. New York: Academic.
Lester, D., Wood, P., Williams, C., & Haines, J. (2004). Motives for suicide—a study of Australian suicide notes. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 25, 33–34.
Lowry, R., Crosby, A. E., Brener, N. D., & Kann, L. (2014). Suicidal thoughts and attempts among U.S. high school students: Trends and associated health-risk behaviors, 1991–2011. Journal of Adolescent Health, 54, 100–108.
Miller, D. N., Eckert, T. L., & Mazza, J. J. (2009). Suicide prevention programs in the schools: a review and public health perspective. School Psychology Review, 38, 168–188.
Miranda, R., De Jaegere, E., Restifo, K., & Shaffer, D. (2014). Longitudinal follow-up study of adolescents who report a suicide attempt: Aspects of suicidal behavior that increase risk of a future attempt. Depression and Anxiety, 31, 19–26.
Pena, J. B., Matthieu, M. M., Zayas, L. H., Masyn, K. E., & Caine, E. D. (2012). 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. Social Psychiatry and Psychiatric Epidemiology, 47, 29–42. doi:10.1007/s00127-010-0322-z.
Perez, V. W. (2005). The relationship between seriously considering, planning, and attempting suicide in the youth risk behavior survey. Suicide and Life-Threatening Behavior, 35, 35–49.
Raich, R. M., Portell, M., & Pelaez-Fernandez, M. A. (2010). Evaluation of a school-based programme of universal eating disorders prevention: is it more effective in girls at risk? European Eating Disorders Review, 18, 49–57.
Robinson, J., Cox, G., Malone, A., Williamson, M., Baldwin, G., Fletcher, K., & O’Brien, M. (2013). A systematic review of school-based interventions aimed at preventing, treating, and responding to suicide-related behavior in young people. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 34, 164–182. doi:10.1027/0227-5910/a000168.
Rudd, M. D., Joiner, T., Brown, G. K., Cukrowicz, K., Jobes, D. A., Silverman, M., & Cordero, L. (2009). Informed consent with suicidal patients: Rethinking risks in (and out of) treatment. Psychotherapy: Theory, Research, Practice, Training, 46, 459–468. doi:10.1037/a0017902.
Schilling, E. A., Aseltine, R. H., Jr., Glanovsky, J. L., James, A., & Jacobs, D. (2009). Adolescent alcohol use, suicidal ideation, and suicide attempts. Journal of Adolescent Health, 44, 335–341.
Schilling, E. A., Lawless, M., Buchanan, L., & Aseltine, R. H. (2014). Signs of Suicide (SOS) shows promise as a middle school suicide prevention program. Suicide and Life-Threatening Behavior, 44, 653–667. doi:10.1111/sltb.12097.
Shaffer, D., Garland, A., Vieland, V., & Underwood, M. (1991). The impact of curriculum-based suicide prevention programs for teenagers. Journal of the American Academy of Child & Adolescent Psychiatry, 30, 588–596.
Spirito, A., Overholser, J., Ashworth, S., & Morgan, J. (1988). Evaluation of a suicide awareness curriculum for high school students. Journal of the American Academy of Child & Adolescent Psychiatry, 27, 705–711.
Substance Abuse and Mental Health Services Administration. (2011). SAMHSA’s National registry of evidence-based programs and practices: SOS Signs of Suicide. Retrieved March 8, 2011 from http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=2053.
Sveticic, J., McPhedran, S., & De Leo, D. (2013). Reviewing the revisions: What are the Australian Bureau of Statistics suicide figures really telling us? Medical Journal of Australia, 198, 478.
Timmons, K. A., Selby, E. A., Lewinsohn, P. M., & Joiner, T. E. (2011). Parental displacement and adolescent suicidality: exploring the role of failed belonging. Journal of Clinical Child and Adolescent Psychology, 40, 807–817. doi:10.1080/15374416.2011.614584.
Tkaczyk, J. M., & Edelson, A. (2009). School nurses: a bridge to suicide prevention. NASN School Nurse, 24, 124–127.
Valentine, J. C., Biglan, A., Boruch, R. F., Castro, F. G., Collins, L. M., Flay, B. R., & Schinke, S. P. (2011). Replication in prevention science. Prevention Science, 12, 103–117. doi:10.1007/s11121-011-0217-6.
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E., Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575–600. doi:10.1037/a0018697.
Conflict of Interest
The authors declare that they have no conflict of interest.
A portion of the results in this manuscript were previously presented at the 2010 American Association of Suicidality Annual Meeting in Orlando, Florida, and the State and Tribal Suicide Prevention Grantees Meeting, March 15–18, 2010 in Las Vegas, Nevada. This study was supported by a Garrett Lee Smith Memorial Act Grant. We thank Andrea Igar Duarte, William Turek, Bill Mecca, Aaron Igdalsky, and the State Department of Education and participating high schools for their help with data collection and research support.
About this article
Cite this article
Schilling, E.A., Aseltine, R.H. & James, A. The SOS Suicide Prevention Program: Further Evidence of Efficacy and Effectiveness. Prev Sci 17, 157–166 (2016). https://doi.org/10.1007/s11121-015-0594-3