Abstract
OBJECTIVE: Despite evidence-based interventions for psychiatric disorders that often precede suicidality, suicide remains a leading cause of death among youth. There has been increased interest in whether preventive interventions targeting early risk factors lead to decreased distal risk for suicidal thoughts and behaviors (STBs). This study examined the impact of Coping Power (CP), a school-based preventive intervention targeting externalizing problems, on STBs. METHOD: The sample included 3,182 youths (36.4% female; 77.3% Black) who participated in 1 of 11 randomized controlled trials of CP. Individual-level data across trials were harmonized using integrative data analysis to address cross-study variation in measurement of STBs. The study used meta-analysis of individual participant data for modeling cross-study variation in intervention effects and propensity score weighting for addressing covariate imbalance arising from combining intervention arms across studies. Hypothesis tests were conducted for parent- and teacher-reported STBs under propensity score-weighted multilevel modeling. RESULTS: Compared with school as usual, youth participating in mindfulness-enhanced CP demonstrated significant decreases in parent-reported STBs over time (b = -.08 [.02], p < .001; after 1 year: d = -0.13; after 2 years: d = -0.25), and youth participating in Internet-enhanced CP demonstrated significant decreases in teacher-reported STBs over time (b = -.08 [.03], p = .003; after 1 year: d = -0.20; after 2 years: d = -0.40). Inconsistent results for standard CP and individual CP in sensitivity analyses preclude clear conclusions for these 2 intervention formats. CONCLUSION: Synthesis of the reported findings highlights the promise of digital health and mindfulness-based interventions for youth with externalizing problems in reducing STBs. Additional research is needed to better understand the nature of for whom, how, and under what conditions preventive interventions impact later STBs. DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list.