Association for Public Policy Analysis & Management

Suicide is the 3^rd leading cause of death in people aged 10 to 24 and rates of hospitalization and emergency room visits by youth for suicide and self-harm have increased 104% between 2006 and 2011 (Torio et al. 2015). Furthermore, 90 % of teens who commit suicide have a psychiatric diagnosis, but only 1% of teens who commit suicide are in treatment at the time of their suicide (Moskos et al. 2007). There is general agreement among scholars the stigma around mental health issues and suicide is a driving force behind teen’s decisions not to access preventative care and treatment (Bailey et al. 2011; Chandra and Minkowitz 2006, 2007; Hartman et al. 2013; Issakainen 2014; Mak et al. 2007; Strunk et al. 2014). Yet, this stigma is only addressed in one area of the United States’ teen suicide prevention policy: school prevention programs.

Currently school prevention programs present with mixed evidence, and they are not required in every state. Stone and Drosby (2015) examined numerous school prevention studies from 1988 to 2011 which measured varying outcomes, such as improvement of knowledge of the signs of suicide or a reduction in levels of suicide ideation among students. They cite a 2009 methodological literature review of school prevention programs which found weak evidence of effectiveness based on 8 features of the studies conducted including comparison group, outcomes and measurement (2015). Their study, and others, illustrate the potential importance of school prevention programs in reducing teen suicide, but also the need to better determine their effectiveness (Moskos et al. 2007; Stone and Drosby 2015).

This paper takes up that call to more rigorously study the effect of school prevention programs on teen suicide. Specifically, it will consider whether a state requirement for suicide prevention/awareness to be taught in high school health classes has an effect on teen suicide and suicide ideation. This macro approach addresses the current gap in studies of school prevention programs. Currently, studies focus on particular school prevention programs, resulting in findings that cannot be generalized (Strunk et al. 2014). Looking at the effectiveness of school prevention programs at the state level will give these fine-grained studies more context. It will also provides new insights into how state education policies can reduce the stigma around mental health and suicide, and whether school prevention programs have an aggregate effect on reducing teen suicide.

To study the relationship between state requirements for school prevention programs and teen suicide and suicide ideation, I will employ data from a variety of sources. The Youth Risk Behavior Survey will be used to track suicide attempts and ideation, as well as behavioral risk factors. Data on suicide rates will be drawn from the Centers for Disease Control’s National Violent Death Reporting System database.  For data on state requirements for suicide prevention/awareness to be taught in high school health classes I have been utilizing the self-reported National Association of State Boards of Education database. I analyze this data using linear regression modeling and a difference-in-differences approach (Dynarski 2003).