Long‐term impact of the Garrett Lee Smith Youth Suicide Prevention Program on youth suicide mortality, 2006–2015

Abstract

Background Comprehensive suicide prevention programs funded through the Garrett Lee Smith Memorial Youth Suicide Prevention Program (GLS) have previously been shown to be associated with lower youth suicide mortality rates 1 year following program implementation. However, longer term effects of GLS have yet to be examined. Methods The impact of GLS implementation on youth suicide mortality through 2015 was estimated for U.S. counties initially exposed to state and tribal GLS activities between 2006 and 2009. The analytic approach combined propensity score‐based techniques to address potential confounding arising from differences between counties exposed and not exposed to the program along an extensive set of characteristics, including historical suicide rates. Results Counties exposed to GLS during a single year had youth suicide mortality rates lower than expected and for longer than previously reported following implementation of GLS activities. Youth suicide mortality rates in counties implementing GLS were estimated to be 0.9 per 100,000 youths lower than control counties (p = .029) 1 year after the implementation, and 1.1 per 100,000 youths lower than control counties (p = .010) 2 years after the implementation. Further, persistent implementation during multiple years was associated with larger effects during longer periods. Additionally, among rural counties, the youth suicide rates 2 years after exposure were estimated to be 2.4 per 100,000 youths lower than in the absence of the program (p = .003). There was no significant evidence of a decrease in youth suicide rates three or more years after the GLS activities were discontinued. Conclusions The effects of GLS comprehensive suicide prevention program were found to be stronger and longer lasting than previously reported, particularly in rural counties. In the face of well‐documented increases in national suicide prevention rates, these results support the widespread and persistent implementation of comprehensive, community‐based youth suicide prevention programs.

Practitioner Review: Treatment for suicidal and self‐harming adolescents – advances in suicide prevention care

“…In the new GLS evaluation (Godoy Garraza et al., ), comparisons of counties and tribal communities implementing GLS, with matched control counties, indicated significantly lower youth suicide mortality rates in GLS counties, with an estimated 882 deaths avoided/lives saved between 2007 and 2015. The benefits of GLS programs were significantly stronger and more long‐lasting than previously known, particularly in rural counties.…”

“…Step 3: Community-level care strategies & universal community suicide prevention New results on the U.S. Garrett Lee Smith Suicide Prevention Program (GLS) support the longer term effectiveness of universal community-based suicide prevention approaches for reducing youth suicide mortality (Godoy Garraza, Kuiper, Goldston, McKeon, & Walrath, 2019). From the practitioner perspective, it is important to note that GLS programs were diverse and adapted for their communities.…”

Supporting a public health approach to suicide prevention: Recommendations for state infrastructure

“…This work has been started in substance misuse prevention (e.g., Orwin et al, 2014), and a similar approach will be needed to better understand the impact of infrastructure on suicide prevention. For example, a 2019 study examined the outcomes of the Garrett Lee Smith Memorial Suicide Prevention Program, a SAMHSA grant that awards competitive grants for suicide prevention activities to states, tribal communities, and institutions of higher education throughout the United States (Garraza et al, 2019). Results indicated a decrease in suicide attempts among youth following the implementation of a Garrett Lee Smith program in a community, although effects were not sustained beyond three years post‐grant.…”

Psychological and neurobiological aspects of suicide in adolescents: Current outlooks

“…In 2019, Godoy Garraza, Kuiper, Goldston et al. examined data from counties that received grants for suicide prevention in youths as part of the Garrett Lee Smith Youth Suicide Prevention Program ( Godoy Garraza et al., 2019 ). Previous analyses had found this program, which involves training, outreach programs, and early intervention programs aimed at youths aged 10–24, was associated with a significant decrease one year after implementation of the program in counties compared to matched controls.…”

“…This association was greatest in rural counties (where there were 2.4 fewer expected deaths). One limitation is that larger metropolitan counties in New England were excluded as adequate matched-controls were not available ( Godoy Garraza et al., 2019 ). One large, multicenter, cluster-randomized controlled trial did find that a manualized, universal school-based intervention for pupils known as the Youth Aware of Mental Health Program (YAM) involving role-play with interactive workshops, booklets, and lectures about the risk of suicide and importance of mental health had a significant decrease in suicide and suicide ideation at 12-month follow-up with an odds ratio of 0.45 and 0.50 respectively ( Wasserman et al., 2015 ).…”