Engaging Youth, Caregivers, and Teachers for Suicide Prevention: Developing and Implementing a Multi-Level Intervention in Rural China

PROJECT SUMMARY This collaborative project between Brown University and Beijing Normal University responds to RFA-MH-23-260 by developing and testing a multi-level intervention program (“Together We Can”) to engage adolescents (age 12-19), school teachers, and caregivers in suicide prevention in rural China. Suicide has become the top 1

leading cause of death among adolescents in China. In particular, adolescents in rural China – a population exposed to chronic poverty and resource deprivation – are at high risk of suicide. There is a lack of mental health literacy while stigma against suicide and seeking professional psychological help runs deep in rural China. No

training exists for teachers and caregivers to recognize signs of suicide risk, normalize conversations related to mental health, and refer at-risk adolescents to resources. Further, the current psychological education in China lacks teaching applicable coping and help-seeking skills and stigma reduction on mental health and suicide.

There is an urgent need to address this public health crisis in school settings and develop interventions that engage adolescents, teachers, and caregivers in the rural, low-resource context. Our research team has taken the first step to collectively developed and test a teacher-focused gatekeeper program (“Life Gatekeeper”) for

teachers in rural China, with promising findings from a recent RCT with teachers. Building on our prior work and leveraging our existing relationships with schools in rural Guangdong, we aim to build the next building blocks of a universal intervention (“Together We Can”) by engaging adolescents (via socioemotional learning), teachers

(via the existing “Life Gatekeeper” program) and caregivers (via adapting the “Life Gatekeepers” for caregivers). We will also incorporate technology-mediated support via existing mobile platforms to maximize scalability. By developing a low-cost, multi-level suicide prevention program and establishing a protocol with community-

centered and implementation perspectives, the “Together We Can” program has the potential to achieve scalability and sustainability, if proven to be efficacious. The aims of this early phase, clinical project include (1) to conduct focus groups with caregivers, school teachers, and individual interviews with adolescents on needs

related to suicide prevention on various levels, preferred intervention content, and implementation strategies for successful delivery, (2) to prepare the RCT phase by creating the multi-level “Together We Can” program, forming an implementation resource team, and conducting workshops and staff training, and (3) to evaluate the

feasibility, acceptability, safety, and preliminary effects of the Together We Can program via a randomized controlled trial (RCT) with two schools in rural China (intervention vs. usual care). We will conduct assessment at baseline, 4-months, and 8-months follow-ups. We will also collect data on barriers and facilitators to

implementation of the “Together We Can” program through surveys and exit-interviews. This developmental grant will provide essential data to guide subsequent application for a fully powered RCT with multiple schools in rural area and invest in capacity development for researchers and local professionals in China.