When I tell people what I do for a living, without fail, the most popular question I am asked is: What is the key to suicide prevention? Suicide is a complex event, and like most public health problems, there is no one solution. For each individual who dies by suicide, there are multiple factors which have influenced that outcome.
For those of us who care about suicide prevention, the fact that suicide is complex can be a hopeful reality. Multiple entry points for intervention and prevention exist.
When I think about risk and protective factors, I think big. I see risk and protective factors that are both proximal - close to the event - and distal - farther away. For example, a proximal risk factor for suicide is access to means. Childhood trauma is an example of a distal risk factor.
The same concept can be applied to protective factors. A proximal protective factor would be restricted access to a highly lethal means of suicide, while a distal protective factor would be coping skills.
It's important to note that risk and protective factors are associated with suicide, not causal of suicide. Reducing risk factors and increasing protective factors are the goals of suicide prevention work.
The Centers for Disease Control and Prevention (CDC) recently released a report on one particular protective factor. School connectedness, or "the belief by students that adults and peers in the school care about their learning as well as about them as individuals," is the focus of this report.
As I read the report, I thought of one school in which I worked several years ago. In the year before I started working in that community, several high school students died by suicide. Before those deaths, I hadn't really thought of suicide as a community or public health issue, but a personal, psychological health issue. But, as I learned more about the school, the community, and the youth who had died by suicide, I realized that there were relationships between all of those elements that had influenced the tragic outcome.
The CDC report states that "school connectedness was second in importance, after family connectedness, as a protective factor against emotional distress, disordered eating, and suicidal ideation and attempts." Contributing to increased school connectedness are adult support, belonging to a positive peer group, commitment to education, and school environment.
When I remember that community, that school, and those young people, I think of the absence of adult support that existed (too many kids with too many needs), the lack of a positive peer group (drug use was the extra-curricular activity of choice for many), little commitment to education (most kids didn't plan to go to college, so didn't see the purpose of high school), and the school environment (while not full of graffiti, the school environment couldn't have been described as warm or really even safe).
Those young people who died in that year had a lot working against them. They lacked a core piece of a foundation that could have protected them, reducing other risks that they were also experiencing. I wish that instead they would have felt they had adults in their lives that supported them, who saw them as whole people rather than just students or charges. I wish that their peer groups had been pro-social, engaging in productive after-school activities instead of prescription drug abuse. I wish that they had goals for life after high school and something to which to look forward. Finally, I wish they had felt respected in their school environment and had positive relationships with adults at school.
Copyright 2009 Elana Premack Sandler, All Rights Reserved
