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Student Evaluation of the Yellow Ribbon Suicide Prevention Program in Midwest Schools.

OBJECTIVE
Yellow Ribbon is a gatekeeper-type suicide prevention program that is widely used in public schools. However, data on its effectiveness are limited. The purpose of our study was to evaluate self-reported changes in knowledge and comfort level communicating about suicide following Yellow Ribbon training for a large, representative sample of students from a public school system in the midwestern United States.


METHODS
The program was administered to students within the same school district during 2006 through 2009. A pre-post survey using a 4-point Likert scale was administered to rate students' knowledge of risk factors and available resources, comfort level communicating about suicide, estimate of friends at risk for suicide, and behavioral intent toward help-seeking.


RESULTS
Aggregate responses from 3,257 students, aged 11 to 18 years, were collected by the schools; 51% were female, 33% were Hispanic, and 30% were white. Suicide-related knowledge of risk factors, where to go for help, and resources, along with comfort level in asking for help, all significantly improved following program participation (Cramer's V = 0.243 to 0.376, P < .001). Responses were associated with age and gender, indicating that younger males may benefit more than older males.


CONCLUSIONS
Implementation of the Yellow Ribbon school-based suicide prevention program appears to be beneficial for students in the midwestern United States. We observed significant improvement in knowledge, comfort level, and behavioral intent for help-seeking if suicidal thoughts occur. Findings also suggested that Yellow Ribbon training administered during middle school may be especially helpful for males.