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A recent survey estimated that each month 8.8 percent of high school-aged youths make at least one suicide attempt (1). Since 1986, the Los Angeles Unified School District, which serves more than 700,000 students and is the second largest school district in the nation, has implemented a Gatekeeper-model youth suicide prevention program. The program seeks to improve identification of students who are at high risk of suicide and to enhance follow-up with appropriate services through training of school personnel and the provision of crisis intervention services.
This study sought to better understand program participants. We examined randomly selected records from 1999 for 100 youths who received services from the program.
Fifty-nine percent of students who received crisis intervention services were girls. Forty-two percent were in high school, 37 percent in middle school, and 21 percent in elementary school. As shown in F1, Caucasian students were most likely to receive crisis intervention, and Latino students were least likely. Seventy-seven percent of the students had made a suicidal threat, and 11 percent had made a suicide attempt; 22 percent had made a previous suicide attempt. Reasons for referral did not vary by race or ethnicity. A majority of students were referred to school support services (83 percent); 62 percent of students were also referred to inpatient or outpatient mental health care. Referral to mental health services did not vary by age, gender, or race. However, it was more common among students with observed mood symptoms or substance use problems. Of the students who were referred to mental health services, 82 percent had mood symptoms or substance use problems; only 18 percent of the students who did not have these problems were referred to mental health services (χ2=7.1, df=1, p<.01).
Our review of records from the Los Angeles program suggests that Latino students may be underidentified by such a program. This disparity is of particular concern given recent data showing higher rates of suicide attempts among Latino youths than among Caucasian youths in Los Angeles (14.2 percent compared with 2.5 percent) and nationally (12.1 percent compared with 7.9 percent) (2) as well as recent studies showing that Latino youths are less likely to receive needed mental health services (3). Future research should focus on barriers to identifying Latino students who are at risk of suicide.
Dr. Kataoka is affiliated with the Health Services Research Center of the University of California, Los Angeles, 10920 Wilshire Boulevard, Suite 300, Los Angeles, California 90024 (e-mail, firstname.lastname@example.org). Dr. Stein is with Rand in Santa Monica, California, and with the department of psychiatry at the University of Southern California in Los Angeles. Mr. Lieberman is coordinator of the Los Angeles Unified School District suicide prevention unit. Ms. Wong is director of crisis counseling and intervention services of the Los Angeles Unified School District. Harold Alan Pincus, M.D., and Terri L. Tanielian, M.A., are editors of this column.
Proportions by race of a sample of 100 students served by the youth suicide prevention program of the Los Angeles Unified School District and of the total student population
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