HAVEN: A Multi-generational Suicide Prevention Program Embedded in African American Churches

Suicide is the second leading cause of death in Black children aged 10-14, and the third leading cause of death in Black adolescents aged 15-19. Suicide attempts rose by 73% between 1991-2017 for Black adolescents and injury by attempt rose by 122% for adolescent Black boys during that same time period. These dramatic increases in suicide are particularly concerning in the current context of the "Black syndemic" as Black youth wrestle with the co-occurring pandemics of racial injustice, health disparities, economic inequities, and COVID-19. The U.S. Congress, NIMH, and National Action Alliance for Suicide Prevention have highlighted the pressing scientific need to address the rise in Black youth suicide. In response to this pressing public health concern, we will refine, optimize, and test the "HAVEN" (Helping to Alleviate Valley Experiences Now) suicide prevention program in predominantly Black churches in New York state. The Black church is an ideal location for mental health interventions because it remains one of the most influential institutions in the Black community and is a context that already supports psychological well-being and reinforces help-seeking behaviors. HAVEN has three aims: Aim 1: Efficacy: we will implement HAVEN in 12 churches using a clustered randomized wait-list design and enroll 240 adolescents (ages 13-19) with 6-month follow-up. We hypothesize that adolescents in HAVEN churches vs. those in wait-listed churches will have decreased depression symptoms (primary outcome) and suicide risk scores at 1-month and 6-month follow-up. We will test for differences by youth gender, age, and level of depression and suicide risk at baseline. With 240 adults enrolled from the same churches we will test if HAVEN benefits extend to reducing adult depression and suicide risk (exploratory). Aim 2: Mechanisms. We will test hypothesized mediators of HAVEN impact. We hypothesize that HAVEN will increase (a) adolescents' positive bonds to peers and adults in their church, perceptions of cohesion, and healthy norms in those networks; and (b) healthy emotional and behavior regulation, and (c) increased use of clinical services (H1). HAVEN impact on reducing depression and suicide risk will be mediated by those changes (H2). Aim 3: Implementation: identify implementation barriers and facilitators by examining adherence data (i.e., completion of HAVEN steps) and then gathering qualitative data from a subset of 4 churches, 2 identified as implementing HAVEN with high adherence and 2 with lower adherence. This aim involves semi-structured key informant interviews. We will also train church and community members as Family-Connect co-trainers, assess their fidelity of training using fidelity measures. Outcomes we will be measured using the CAT-MH and K-CAT and mental health utilization; mediators assessed include peer networks, emotion regulation, help-seeking acceptability, peer norms, and group cohesion. The project will provide pilot data for a R01 trial using Hybrid Type 2 Effectiveness Implementation design to implement HAVEN across diverse church settings. This innovative project addresses current inequities in suicide prevention by conducting the first randomized trial for youth suicide prevention in Black churches, using a multi-generational prevention that can be delivered in an in-person or virtual environment.