Evidence

Please email Jaymie Sheehan with any questions regarding our evidence-base or to receive PDF copies of journal articles. To read the Sources of Strength research summary, scroll down on the document below:

“Sources of Strength is the first suicide prevention program involving peer leaders to enhance protective factors associated with reducing suicide at the school population level.” 

American Journal of Public Health

 

Sources of Strength Executive Summary

Sources of Strength is a radically strength-based, upstream suicide prevention program with shown effectiveness in both preventative upstream and intervention outcomes. Sources of Strength has been involved in several large randomized control trials and is one of the most rigorously evaluated and broadly disseminated prevention programs in the country. Sources of Strength is considered the first suicide prevention program to demonstrate effectiveness in using peer leaders to enhance protective factors associated with reducing suicide across a school population. Sources of Strength teams are active across the United States, Canada, Australia, and many American Indian/Alaska Native and First Nations communities.

Sources of Strength has been listed on the National Best Practices Registry (BPR) by the Suicide Prevention Resource Center (SPRC) and The American Foundation for Suicide Prevention (AFSP) since 2009. Sources of Strength has also been listed on SAMHSA’s National Registry of Evidence-based Programs and Practices(NREPP) since 2011. The Center for Disease Control and Prevention’s(CDC) 2017 Preventing Suicide: A Technical Package of Policy, Programs, and Practices, featured Sources of Strength as an evidence-based Peer Norm Program stating:

“Evaluations show that programs such as Sources of Strength can improve school norms and beliefs about suicide that are created and disseminated by student peers. In a randomized controlled trial of Sources of Strength conducted with 18 high schools (6 metropolitan, 12 rural), researchers found that the program improved adaptive norms regarding suicide, connectedness to adults, and school engagement. Peer leaders were also more likely than controls to refer a suicidal friend to an adult (emphasis added). For students, the program resulted in increased perceptions of adult support for suicidal youths, particularly among those with a history of suicidal ideation, and the acceptability of help-seeking behaviors. Finally, trained peer leaders also reported a greater decrease in maladaptive coping attitudes compared with untrained leaders.”

The conclusion and designation of Sources of Strength as an Evidence-Based strategy has been promoted by the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, the Suicide Prevention Resource Center, and the National Institute for Mental Health. 

Research Partnerships

Sources of Strength is committed to continuing research and has several research and funding partners located throughout the United States, Australia, and Canada. 

Funding Partners include (but are not limited to):

Research Partners include (but are not limited to):

  • Australian National University 

  • Johns Hopkins University

  • Stanford University

  • University of North Carolina

  • University of Manitoba

  • University of Montana

  • University of Rochester

  • Texas Tech University

Current Research:

  • National Peer Leadership Study RCT funded by National Institute of Mental Health; the largest study ever conducted on peer leader’s impact on suicide outcomes

    • Sources of Strength and the University of Rochester began a follow-up randomized control trial using Sources of Strength with more than 40 high schools to measure the impact of 1,500 peer leaders on approximately 15,000 adolescents in 2010. Publications from this NIMH study are forthcoming.

  • Randomized Control Trial funded by the Center for Disease Control and Prevention evaluating shared risk and protective factors framework and outcomes on sexual violence, bullying, and harassment, and suicide. Study analysis and drafting of initial outcome papers is underway. 

    • The study is in partnership with the CDC, the Colorado Department of Public Health and Environment (CDPHE), and research teams at the University of Rochester,  University of Florida, and Texas Tech. The randomized control trial was launched in the fall of 2017 and will conclude in the spring of 2021.

  • Randomized Control Trial funded by  Black Dog institute evaluating outcomes in Australian schools throughout New South Wales and Australian Capital Territory

  • Evaluation with Stanford on impacts in communities that have experienced Suicide Contagion effect

Research  Details

An outcome evaluation of the Sources of Strength suicide prevention program delivered by adolescent peer leaders in high schools

From 2007 to 2009, Sources of Strength was the subject of one of the nation’s largest studies (at the time) on peer leaders and their impact on suicide prevention. The results of this study evaluated by the University of Rochester were published in 2010 in the American Journal of Public Health, showing:

“Training improved the peer leaders’ adaptive norms regarding suicide, their connectedness to adults, and their school engagement, with the largest gains for those entering with the least adaptive norms. Trained peer leaders in larger schools were 4 times as likely as were untrained peer leaders to refer a suicidal friend to an adult. Among students, the intervention increased perceptions of adult support for suicidal youths and the acceptability of seeking help. Perception of adult support increased most in students with a history of suicidal ideation.”

“Conclusions. Sources of Strength is the first suicide prevention program involving peer leaders to enhance protective factors associated with reducing suicide at the school population level.”

Positive-Themed Suicide Prevention Messages Delivered by Adolescent Peer Leaders: Proximal Impact on Classmates’ Coping Attitudes and Perceptions of Adult Support. Suicide and life-threatening behavior

This study evaluated positive themed messages by Sources of Strength peer leaders in 36 classrooms. Of the 706 high school students evaluated, 12.7% of students reported suicide ideation within the past year. This was the first study to demonstrate that Sources of Strength measures including, peer modeling, positive or strength-based messaging, and classroom interaction were promising alternatives to suicide prevention strategies that focus on risk and negative mental health problems. Evidence in this study demonstrated that students with recent suicide ideation benefited more than students without suicide ideation in increasing; help-seeking acceptability, perceptions that natural protective factors can help with coping, and the belief that adults can be engaged, caring, and helpful for suicidal youth. This study suggests that distressed youth respond more favorably to messages that convey strength and hopefulness. It also showed that distressed youth may more favorably view messaging styles that model healthy coping over a directive style, which may undermine autonomy and promote reactivity.  

Associations Between Suicidal High School Students’ help-seeking and their attitudes and perceptions of the social environment

This study examined patterns and predictors of help-seeking behavior among 2,737 students in 12 high schools in rural or underserviced areas. Of the surveyed students 381 had seriously considered suicide in the past year. The relationship between adolescents’ help-seeking disclosure and help-seeking attitudes and perceptions of social resources was examined among suicidal help-seeking youth, suicidal non-help-seeking youth, and non-suicidal youth. Conclusions of the study provided added validity to the Sources of Strength measures finding:

“healthy coping, help-seeking norms and trusted adults were linked to greater adolescent disclosure of suicidality and intentions to seek help. This study supports prevention strategies that change student norms, attitudes, and social environments to promote help-seeking among adolescents with SI. Promising intervention targets include increasing students’ perceptions of the availability and capability of adults to help them, and strengthening students’ understanding of how existing resources can help them cope.”

Emotion regulation difficulties, youth-adult relationships, and suicide attempts among high school students in underserved communities

This study used a cross-sectional design to examine the associations between self-reported suicide attempts, emotion regulation difficulties, and positive youth-adult relationships in 7,978 high-school students, 683 of whom had reported a suicide attempt in the past year. The participating students were in 30 high schools from predominantly rural, low-income communities. Adding validity to the Sources of Strength measures  the study found:

“After accounting for depressive symptoms, emotion regulation, and demographic factors, students with who reported connections to parents or other adults in their family that they saw as trustworthy, safe, and supportive were less likely (OR = 0.76, CI: 0.67, 0. 87) to have had a suicide attempt within the past year. Having caring and trustworthy adults at school also significantly reduced the likelihood of a suicide attempt (OR = 0.85, CI: 0.74, .98), above and beyond depressive symptoms, emotion regulation, and the youth-family communication. Having a trusted adult in the community was associated with fewer suicide attempts in models that controlled only for demographic covariates, but not in models where symptoms of depression were taken into account.”

Teenagers’ attitudes about coping strategies and help-seeking behavior for suicidality

Over three years, a self-report survey was completed by 2,419 high school students in six New York State schools to identify youths’ attitudes about coping and help-seeking strategies for suicidal ideation/behavior and examine their demographic and clinical correlates. This study supports the logic model and the Sources of Strength approach. The conclusion of this study, published in the Journal of the American Academy of Child and Adolescent Psychiatry in 2004 found:

“High-risk adolescents’ attitudes are characterized by core beliefs that support the use of maladaptive coping strategies in response to depression and suicidal thoughts and behaviors. Targeting such attitudes is a recommended component of youth suicide prevention efforts.”

Press on Sources of Strength

  1. Sources of Strength has been featured on National Public Radio(NPR), CNN, Psychology Today, Christian Science Monitor, and as a feature for hundreds of local and regional news stations and newspapers
  2. https://www.sprc.org/resources-programs/sources-strength
  3.  The BPR of SPRC lists interventions that have undergone rigorous evaluation and have demonstrated positive outcomes. 
  4.  NREPP is SAMHSA’s online registry of interventions that have demonstrated effectiveness in the prevention or treatment of mental health and substance use disorders, including some interventions that address suicide, such as Sources of Strength. The NREPP registry only lists a handful of programs and is the Gold Standard of prevention in the United States.  https://www.nrepp.samhsa.gov/Legacy/ViewIntervention.aspx?id=248
  5.  https://www.cdc.gov/violenceprevention/pdf/suicidetechnicalpackage.pdf, pg 29
  6.  Preliminary articles published from the NIMH National Peer Leadership study: Pisani, T., et al. 2012 Emotion Regulation Difficulties, Youth-Adult Relationships, and Suicide Attempts Among High School Students in Underserved Communities. Journal of Youth and Adolescence, 42, 807–820.; Pisani, T., et al. 2012. Associations between suicidal high school students’ help-seeking and their attitudes and perceptions of social environment. Journal of Youth and Adolescence, 41(10), 1312–1324.; https://drive.google.com/file/d/0BzUYiHeafDQRaGZzaWdrUW1CcTQ/view?usp=sharing
  7.  Wyman, P. et al. (2010). An outcome evaluation of the Sources of Strength suicide prevention program delivered by adolescent peer leaders in high schools. American Journal of Public Health, Vol. 100: 1653-1661.
  8.  Petrova, M., Wyman, P. A., Schmeelk-Cone, K., & Pisani, A. R. (2015). Positive-Themed Suicide Prevention Messages Delivered by Adolescent Peer Leaders: Proximal Impact on Classmates’ Coping Attitudes and Perceptions of Adult Support. Suicide and life-threatening behavior, 45(6), 651-663.
  9.   Pisani, A. R., Schmeelk-Cone, K., Gunzler, D., Petrova, M., Goldston, D. B., Tu, X., & Wyman, P. A. (2012). Associations between suicidal high school students’ help-seeking and their attitudes and perceptions of social environment. Journal of youth and adolescence, 41(10), 1312-1324.
  10.  Pisani, A. R., Wyman, P. A., Petrova, M., Schmeelk-Cone, K., Goldston, D. B., Xia, Y., & Gould, M. S. (2013). Emotion regulation difficulties, youth–adult relationships, and suicide attempts among high school students in underserved communities. Journal of youth and adolescence, 42(6), 807-820.
  11.  Gould, MS, Velting D, Kleinman M, Thomas JG, Chung M. (2004). Teenagers’ attitudes about coping strategies and help-seeking behavior for suicidality. Journal of the American Academy of Child and Adolescent Psychiatry, 43(9), 1124-1133.
  12. https://www.npr.org/sections/ed/2015/02/25/385418961/preventing-suicide-with-a-contagion-of-strength
  13. https://www.psychologytoday.com/us/blog/promoting-hope-preventing-suicide/201009/peer-leaders-and-trusted-adults-work-together-suicide
  14. https://www.csmonitor.com/USA/Society/2013/1208/Teen-suicide-Prevention-is-contagious-too