The increase in adolescent suicides has led to an increase in the development of suicide prevention programs throughout the United States. The most common programs are school-based and are directed to students. There is evidence that many of these programs are initiated after a suicide has occurred in a school or community (postvention). However, a review of the literature indicates that current knowledge about the sequelae of a suicide within a school community is restricted to anecdotal accounts, that there is no empirical basis for traditional postvention programs, and that their efficacy or impact is untested. We propose a program of epidemiologic research in 24 community schools, reaching an estimated 24,000 students, to address these deficiencies. The goal of the project is to identify the prevalence of postulated sequelae (such as, induction of suicidal behavior or ideation; new onset depression; post-traumatic stress responses; and pathological bereavement responses) in a series of schools where a suicide has occurred and use this information to identify the logical components of a postvention program. The exposed group will consist of all children in 12 high schools, within specified geographical limits in three downstate counties in New York State, in which a fellow student has committed suicide within the past month. A two-stage screening procedure will be employed to estimate the range of disorders in those schools. The two-stage screening procedure will also be conducted in a matched comparison group of schools in which no death occurred, in order to determine the extent to which excess morbidity is associated with the occurrence of a suicide. To determine whether distress among the surviving student body is transient or of a more persistent nature, a six month and twelve month follow-up will be conducted. The examination of the duration of clinical distress following a student's death and the identification of pathological sequelae that evolve over time are of particular import. The implications for the need or type of intervention are different if the death of a student generates transient symptoms in the surviving student body in contrast to more enduring disorders. The information yielded by this study will provide the empirical basis upon which to develop a school-based suicide postvention program, rather than merely relying on well-intentioned but not necessarily well-informed efforts. Our ultimate goal is to utilize the information generated from the present study to develop a school based suicide postvention program and to prepare a controlled clinical trial to examine the efficacy of the postvention.
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