Piloting Stress Control as a Universal, Community-Based Suicide Prevention Strategy in the U.S.

U.S. suicide rates are increasing while accessible and affordable mental health services are declining. Research has focused on individual or intensive psychotherapy for suicidality with modest efficacy. We will evaluate “Stress Control” (SC) as a feasible, acceptable, and scalable suicide prevention intervention. SC is an already effectively packaged 6-session, 90-minute per week, evidence-based, large-class, lecture-based intervention targeting common mental health symptoms and suicide risk factors. SC has demonstrated large-scale feasibility, acceptability, and effectiveness in the U.K.; however, SC has not been implemented in the U.S., and there are no specific suicide-related outcome studies. There is a critical need to evaluate SC in the U.S. and evaluate suicide-related outcomes to realize SC’s potential as a suicide prevention intervention.

Aim 1: Examine the feasibility and acceptability of SC for U.S. adults screened for elevated suicide ideation in a community setting.

H1: SC participants will evidence high feasibility (high enrollment/attendance and low attrition).

H2: SC participants will report high acceptability of the SC content and materials via the Client Satisfaction Questionnaire and focus group responses.

Aim 2: Assess preliminary indicators of the efficacy of SC in reducing suicide ideation and related cognitions for U.S. adults screened for elevated suicide ideation in a community setting.

H3: There will be greater reductions in suicide ideation and suicide-related cognitions from baseline to follow-up for participants who are randomly assigned to SC compared to the assessment-only condition/treatment-as-usual.

Sample: 220 adults who are screened for past-month suicide ideation; 40 participants will complete post-SC focus groups.

Measures: 1) Feasibility and acceptability metrics (i.e., Client Satisfaction Questionnaire [CSQ-8], focus group responses, enrollment/attendance, attrition); 2) A comprehensive demographics questionnaire; 3) pre- and post-SC self-report assessments of suicide ideation, suicide-related cognitions (primary outcomes), depression, anxiety, and quality of life (secondary outcomes); 4) self-reported suicide ideation and suicide-related cognitions at each SC session to monitor risk.

Procedures: We will recruit through the local health department’s offices/events to screen adults for past-month suicide ideation. We will randomize participants into SC or the assessment-only/TAU condition to complete pre- and post-SC self-report assessments. SC-assigned participants will complete the post-SC survey and be randomly invited to a focus group. We will conduct qualitative and quantitative analyses.

Potential Impact: This work has the potential for significant public health impact by enacting a program designed to increase access to prevention and early intervention services. SC is designed to be delivered by non-doctoral-level individuals and is offered at no cost to attendees, increasing the ability to implement SC on a large scale and removing access barriers. By demonstrating SC’s feasibility, acceptability, and preliminary efficacy while focusing on suicide-related outcomes among those with elevated suicide ideation in the U.S., this study could significantly impact future suicide prevention.

Next Steps: This study will provide rich indicators of SC as a scalable suicide prevention intervention. We will incorporate participant feedback for SC’s continued adaptation for the U.S., begin implementing SC on a larger scale, and demonstrate a robust proof of principle for future suicide prevention studies to be submitted to AFSP and NIMH.