The Promise of Upstream Prevention: Reducing Suicide Attempts and Mortality through Peer-Led, Upstream Public Health Interventions

Body of Abstract: IRB Approval:
Research outlined in this session obtained IRB approval from University of Rochester, University of North Carolina, & Colorado Department of Public Health and Environment

In the Works:
This presentation will offer a detailed analysis of recent findings from a cluster randomized controlled trial (RCT), while seeking audience input on the implications of the findings for addressing gaps in current suicide prevention models, particularly regarding upstream, peer-led approaches.

Abstract:
While the field of suicide prevention has traditionally focused on downstream, crisis-oriented interventions, there is growing recognition of the need for comprehensive, upstream, and public health approaches (Scott et al., 2022). The 2024 National Strategy for Suicide Prevention emphasizes community-based primary prevention that targets the underlying drivers of suicide risk and addresses social determinants of health (Parker, 2024). This aligns with guidance from the CDC’s Technical Package for Suicide Prevention, which highlights the importance of cross-cutting prevention strategies that target shared risk and protective factors to promote well-being at the individual, relational, community, and cultural levels (Gaylor et al., 2024). This shift represents a necessary expansion in the field of suicide prevention, yet the field still lacks evidence-based interventions demonstrating significant impact in these domains.
For the past 26 years, Sources of Strength has pioneered strength-based, peer-led, upstream prevention programming. It was the first program to show through a randomized control trial that peer opinion leaders could shift population-level health norms associated with reduced suicide risk (Wyman et al., 2010). The Sources of Strength model embodies the upstream, public health approaches advocated by the National Strategy and CDC Technical Package, combining peer-led social diffusion with asset-based approaches to build resilience, connectedness, and well-being at both individual and community levels.
This session presents findings from two recent, groundbreaking studies on Sources of Strength and its potential impact on reducing suicide attempts and mortality (Wyman et al., 2023). The first study, published in the Journal of Injury Prevention in 2023, examined suicide mortality across three separate randomized control trials totaling 78 high schools and over 40,000 student-years of exposure to Sources of Strength programming (Wyman et al., 2023). Intervention schools reported no suicide deaths, while control schools experienced four deaths across the trials, representing a statistically significant difference (p = 0.047). Prior to this study, no universal intervention has show reduction in youth suicide mortality through an RCT. This result highlights the critical need for funding and further study of interventions like Sources of Strength, which utilize social diffusion and peer-adult connections as a promising pathway to reducing suicide mortality at scale.
The second study, forthcoming in the American Journal of Preventive Medicine, involved a cluster randomized control trial of 20 high schools, demonstrating a 29% reduction in the probability of a new suicide attempt in Sources of Strength intervention schools (Wyman et al., in press). These results, a rare bright spot in current suicide prevention data, underscore the power of peer-led, strengths-based interventions to achieve population-level impact by strengthening protective factors, increasing connectedness, developing positive coping skills, and enhancing help-seeking behaviors.
This session will explore how these findings align with and advance the CDC and 2024 National Strategy recommendations, addressing critical gaps in the field. The studies suggest that models prioritizing community engagement, asset-based approaches, and upstream strategies are uniquely positioned to reduce suicide attempts and fatalities at a population level. The session will advocate for expanded funding, evaluation, and implementation of such approaches to meet the urgent need for more evidence-based interventions that address these gaps.

Learning Objectives:

• Summarize the evidence supporting peer-led, strengths-based approaches in reducing suicide attempts and mortalities
• Identify key primary prevention strategies that align with the National Strategy for Suicide Prevention
• Analyze the effectiveness of social diffusion and asset-based approaches in preventing suicide, and consider how these models address shared risk and protective factors across communities