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

Abstract

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.