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LETTER |
Denise Hallfors and Allan Steckler are with the Pacific Institute for Research and Evaluation, Chapel Hill, NC. Allan Steckler is also with the Department of Health Behavior and Health Education, School of Public Health, University of North Carolina at Chapel Hill.
Correspondence: Requests for reprints should be sent to Denise Hallfors, PhD, 1516 E Franklin St, Suite 200, Chapel Hill, NC 27514 (e-mail: hallfors{at}pire.org).
We appreciate Rotheram-Borus’s interest in our study and her letter. We agree that interventions often need to be reconsidered when they do not fit the context for which they were developed. We conducted a feasibility test of a screening instrument for suicide that was specifically developed for high school students in the school setting. It should be noted that we did not develop the screening instrument and that we were testing it within a randomized control trial for a separate but related intervention. For just the reasons stated by Rotheram-Borus, we believe that interventions must be independently evaluated before they are widely adopted.
We administered the screening instrument in 10 high schools according to the developers’ protocols, and we worked closely with school staff throughout the trial. We listened to and reported their concerns. Given those concerns, we made recommendations for making the screen more specific so that there would be fewer false positives. Our findings suggested that a more specific instrument would identify 11% (rather than 23%) of students as being at high risk for suicide. This proportion closely approximates the proportion of high school youths who report in national surveys that they have attempted suicide in the past year.1 It is important to identify these adolescents and further screen them for behavioral and mental health disorders. In our study, for example, the 11% of students who were at highest risk for suicide had the highest levels of substance use, and it is likely that they were involved in other risky behaviors that are strongly associated with suicide risk.2
School is the one institution with which the vast majority of youths are affiliated; thus schools represent an important opportunity to identify youths with serious mental health and behavioral problems. Rotheram-Borus’s description of her research with homeless youths is intriguing and may have implications for schools, but the 2 populations and their circumstances are quite different.
Our study was particularly important and timely in light of recent federal grants stemming from the Garrett Lee Smith Memorial Act, which specifically gives preference to strategies that "provide early intervention and assessment services, including screening programs, to youth who are at risk for mental or emotional disorders that may lead to a suicide attempt."3 It is essential that schools and other collaborators in suicide prevention efforts have access to unbiased scientific information about the feasibility of the intervention strategies available to them.
Accepted for publication March 20, 2006.
References
1. Grunbaum JA, Kann L, Kinchen SA, et al. Youth risk behavior surveillance—United States, 2003. MMWR Morb Mortal Wkly Rep. 2004;53(SS-2):5–13.
2. Hallfors DD, Waller MW, Ford CA, Halpern CT, Brodish PH, Iritani B. Adolescent depression and suicide risk: association with sex and drug behavior. Am J Prev Med. 2004;27:224–231.[ISI][Medline]
3. Pub L No. 108–355, 42 USC (Oct 21, 2004).
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