Educator effectiveness in identifying symptoms of adolescents at risk for suicide.

This study examined educators' capabilities to identify symptoms of adolescents at risk for suicide when influenced by the adolescent's race, gender, and socioeconomic stares. Participants were 882 regular and special educators in a southeastern state who completed mailed questionnaires presenting hypothetical vignettes of adolescents at risk for suicide. Vignettes were varied according to the adolescents' gender, race, and socioeconomic status. Respondents rated 35 behaviors selected from the DSM III R as either covert or overt signs of suicidal behavior. Multivariate analysis of educator responses revealed no significant difference between the capabilities of regular and special educators to identify these symptoms, either covert or overt. However, all participants experienced some difficulty in accurately identifying these symptoms. Relationships among race, gender, and highest degree attained by educators were also identified. Implications for an expanded role of educators in the identification process of youth at risk for suicide are suggested.

**********

Research examining factors influencing suicidal behavior of adolescents in school settings is limited. Studies of the suicidal behavior of students with emotional problems are few and those investigating suicide in the general school population are almost nonexistent. (1) Although most suicidal attempts and completions occur away from a school setting, schools are logical settings for crisis and suicide intervention because students spend as many waking hours in schools as with their families. (2) Educators are in a critical position to consistently observe children and youth, (3) but they are often overlooked as a key source of information regarding student behavior. Often educators and peers are more sensitive to behavioral precursors of suicide than are members of the victim's family. (4) Suicidal youngsters may communicate poorly with their families and reveal more of their distress to peers, teachers, or both.

The criteria for intervention with suicidal youths in educational settings depends on the degree of lethality exhibited by the youth and the immediacy of risk. (4) Educators must be knowledgeable regarding identification, intervention, referral, notification of parents and guardians, and follow-up. The legal responsibility of school personnel is to be vigilant in identifying suicidal students and responding immediately. Negligence is a legal concern and prudence is recommended in terms of assessment, referral, and notification. (4)

One salient aspect of suicide in adolescents is its link with depression. Adolescents with depressive disorders are substantially at risk for suicidal behavior (5, 6, 7) and, while information regarding the prevalence of depression in those who receive special education services is limited, depression among adolescents with learning and behavior disorders is more prevalent than indicated in the general population. (8, 9) A related study found that 50% of adolescents referred for possible placement in special education met the criteria for a diagnosis of depression. (10)

Unfortunately relatively few students are referred for assessment even when symptoms of depression are evident. (11, 12) Gifted students with depression, along with students who do not exhibit symptoms of any other disorder, are likely to be overlooked in the identification and referral process. (11) Stark (12) used interviews and checklists in a "multiple gate" process to identify depressed students in school and found that fewer than 5% of the students who presented symptoms of depression had been classified by the schools as emotionally disturbed.

Assessment of indicators of adolescent suicide requires an extensive knowledge of relevant risk factors and observable symptoms. Given their intensive and long-term contacts with adolescents, educators are in an advantageous position to identify significant signs and symptoms of adolescents at risk for suicide. Hence, they could play a critical role in the dynamics of adolescent suicide. To date little research focusing on educators' ability to identify at risk adolescents has been conducted, and the literature often portrays educators as a part of the intervention process rather than the identification process. (13, 14)

This study examined the knowledge and skiffs of professional educators in the southeast in relation to assessing hypothetical adolescents at risk for suicide. Professional educators were further identified as male or female, regular or special educators at both elementary and secondary school sites. The primary purposes of this study were (a) to assess educators' capabilities to identify signs of adolescents at risk for suicidal behavior when influenced by the adolescent's race, gender, and socioeconomic status and (b) to examine how educators' characteristics predicted their capabilities to identify at risk adolescents.

Methods

Samples

Two groups of 186 special educators and counselors and 691 regular educators served as participants in the study. Questionnaires were sent to 1,500 subjects through the school's mailing system and 882 (58.8%) were returned. The gender of the subjects was 763 females and 119 males. Race was combined into two groups of 203 African-American and 679 Caucasian/others. Four hundred and twenty of the respondents were under the age of 40 and 463 were over 40. Two hundred and thirty five had attained Bachelor's Degree and 644 a graduate degree. All data were gathered during the 1993-1994 school year.

Measures

The Student Behavior Survey (SBS) is a questionnaire designed by the senior author to assess an educator's efficacy in identifying symptoms of suicidal behavior, when influenced by an adolescent's race, gender, and socioeconomic status. The SBS is comprised of eight vignettes and questions relating to respondent's demographic information. Each vignette summarized a case of an adolescent at risk for suicidal behavior. The vignette described a typical adolescent (a) living either in an affluent or economically impoverished environment, (b) being either African American or Caucasian, and (c) being male or female. The adolescent's parents were portrayed as concerned about a number of behavioral changes observed over a period of six months. They were attempting to determine whether the behaviors were typical or indicative of a more serious issue such as a suicidal ideation. Each respondent was given a list of 35 behaviors indicative of a conduct disorder or depression. (15) The respondents rated the risk level of the behaviors using a four-point Likert-type scale. Pretesting of the questionnaire with two selected groups of university graduate students indicated that the questionnaire could be completed in about 10 minutes.

Behavioral symptoms associated with depression leading to suicidal ideation or suicidal attempt were generated from the DSM III-R15 as well as theoretical, descriptive, and research literature. In addition, eight behavioral symptoms more commonly associated with conduct disorders than depression were included to explore issues raised by researchers regarding the identification of proper symptomatology for depression in African American youth. (16, 17)

Procedures

The research was conducted using a modified marled survey methodology. Content validity of the instrument was established through use of questions based on a review of the literature and judgment of an expert panel. Survey responses were coded for data recording, analyzed and entered into a classification format using the SAS System for Elementary Statistical Analysis 18 and SPSS For Windows Based System User's Guide Release 6.0. (19) Ten percent (88) of the respondents' surveys were randomly selected and reviewed to determine coding reliability. The established interrater reliability was 87%.

Analysis

Demographic information and responses to Likert-type items were reported using descriptive statistics. Responses to open-ended questions were analyzed qualitatively. The primary statistical analyses were run using SAS18 and SPSS19 statistical software. A preliminary analysis of the demographic data to determine which variable contributed the greatest amount of variance was conducted using the Kroskall-Wallis nonparametric test for analysis of variance. (20)

After completion, four variables were retained: gender of educator, race of educator, highest degree attained by educator, and certification as a regular educator or special educator. Subsequently, multiple regression employing the backward elimination model (21, 22) was used to determine whether these key demographic factors predicted educators' capabilities to identify symptoms of suicidal behavior of a hypothetical adolescent.

For the Likert-type items, rating choices were stated so that that the higher the response on the scale, the more accurate the respondent was in identifying symptoms of suicidal behavior in adolescents. The criteria for accurate identification of overt and covert symptoms of suicidal behavior in educators was scoring at least 81 for overt symptoms, 24 for covert symptoms, and 105 when identifying a combination of overt and covert symptoms of suicidal behavior. The Kruskall-Wallis test was also used to compare the three symptom identification scores, total score (max = 140), overt score (max = 108), and covert score (max 32) for significance.

Results

The first question was to determine ff regular educators and special educators differed in identifying symptoms of suicidal behavior in a hypothetical adolescent when influenced by the adolescent's race, gender, and socioeconomic status. Table 1 presents separate analysis for the 27 overt symptoms, 8 covert symptoms, and 35 combined symptoms using the Kruskali-Wallis test.

No significant differences were obtained and both groups had difficulty in accurately identifying symptoms of suicidal behavior in hypothetical adolescents regardless of the adolescents' race, gender, and socioeconomic status. They achieved about 77% of the criterion score for symptom identification, and their greatest difficulty was in identifying covert symptoms of suicidal behavior.

The second question concerned the degree to which selected variables: race of educator, gender of educator, highest degree attained by educator, and certification as regular or special educator impacted educator's perceptions when identifying symptoms of suicidal behavior in a hypothetical adolescent. In order to include all important explanatory variables and to maintain simplicity in the model, a multivariate analysis using a backward elimination procedure was completed for the dependent variable total score. The significance level was selected at (p = <.05), and a regressor was dropped if its partial F-statistic was greater than (>) .05. In the first run, certification as a regular educator was dropped (p=.9872) as a significant predictor. Step two dropped the African American race (p = .9387) as a significant predictor. The remaining two variables, female (p = <.0001) and graduate level of training (p = <.008), remained in the model and were significant at the .05 level (see Table 2).

Therefore, an educator's certification, either regular or special, and an educator's race had no predictive value on one's ability to identify symptoms of suicidal behavior in hypothetical adolescents. In contrast, an educator's gender and highest degree earned were moderate predictors of efficacy to identify suicidal symptoms in the identification process. An educator who was female and an educator who had a graduate degree were significantly more effective in identifying suicidal symptoms in a hypothetical adolescent.

Similarly, a backward elimination procedure for overt symptoms of suicidal behavior was performed with race, gender, highest degree attained, and certification included in the model. Step one removed the regressor African American race (p = .5361). Step two removed the regressor certification as a regular educator (p = .4347). The remaining two variables, gender (p = .0001) and level of training (p = 0046), remained in the model with significance at the .05 level (see Table 3). Thus, an educator's race and certification had little predictive value on educators' efficacy to identify overt symptoms. However, one's gender and graduate status enhanced his or her ability to identify overt symptoms of suicidal behavior.

The backward step elimination procedure was also performed for the dependent variable: covert symptoms. Step one dropped the regressor of graduate level of training (p = .1247). Step two dropped the regressor of certification as a regular educator (p =.0609). The remaining variables were retained in the model (p = < .05), Gender (p = .0214) and race (p = .0465) predicted educators' efficacy to identify covert symptoms of suicidal behavior in hypothetical adolescents (see Table 4). African American educators and female educators more accurately identified covert symptoms of suicidal behavior in hypothetical adolescents.

No significant difference between regular and special educators was obtained when identifying adolescents at risk for suicidal behavior. However, the gender of the educator (female) was related to more accurate identification of symptoms of suicidal behavior in hypothetical adolescents. Further, female gender had significant predictive value in determining one's effectiveness in identifying adolescents in conflict. There is also evidence to suggest that an educator with a graduate degree was more effective in identifying adolescents at risk. In the analysis of covert symptoms of suicidal behavior, race and gender were significant predictors of the ability to identify covert symptoms in hypothetical adolescents. African American educators and female educators were most effective in identifying covert symptoms. Gender and highest degree attained were the most consistent predictors for accurate identification of suicidal behavior in adolescents whether one considers overt or covert symptoms.

Discussion

A major outcome of this study was the relative inefficiency of both regular and special educators in correctly identifying overt and covert indicators of adolescent suicide. While the degree of difficulty experienced by both groups in identifying relevant symptoms was unexpected, identification of covert symptoms proved to be the most difficult task. The proximity of the total score comparisons of both regular and special educators suggests that level of training had little differential effect on their ability to identify suicidal symptoms. This outcome raises questions regarding the nature and efficacy of teacher preparation programs as related to assessing the psychological needs of adolescents.

Anecdotal data gathered in this study suggests that educators' difficulties in identifying adolescents exhibiting suicidal signs and symptoms may be increased by the lack of functional assessment instruments. A related issue is the educator's lack of knowledge about current assessment tools and their potential role in suicide prevention. Although educators are not mental health clinicians, those skilled in assessment procedures could collaborate more effectively with mental health professionals who have the clinical expertise to provide guidance for further interventions.

A second outcome of this study was that differences in identification skills of educators were related to one's gender. Female educators were more skilled in identifying suicidal adolescents than were male educators, regardless of the adolescent's race, gender or socioeconomic status. It is well established that adolescent males commit suicide more frequently while females attempt suicide more frequently. (13) It was unexpected that male educators would be less effective in identifying adolescents at risk. As gender identification is indicated as a factor a contributing to adolescent suicide, it may also be a factor in one's ability to accurately identify symptoms related to depression and adolescent suicide.

Attaining a graduate degree was another significant predictive factor. This outcome is consistent with the position enunciated earlier regarding the need for further training for all educators working with adolescents. Currently, many undergraduate teacher education programs appear to be of little value to educators who attempt to identify suicidal symptoms in adolescents. Further, as the majority of the respondents in this study had attained graduate degrees, it is important to note the potential impact of an educator's adequate training on the identification of suicidal symptoms. Identifying functional areas of graduate training that facilitate an educator's identification capabilities and enhance his or her knowledge of prevention strategies would be beneficial.

Racial identity was also identified as a predictor of an educator's ability to identify symptoms of adolescent suicide. However, racial identity interacted with symptom type and gender as differences were found only for identification of covert symptoms. Also, African American female educators were more effective than both African American males and Caucasian males and females in identifying covert symptoms. Previous studies suggest that African American adolescents may exhibit signs and symptoms of depression in aggressive ways such as conduct disorders and delinquent behaviors which may mask more subtle indicators of suicidal behavior. (4) Hence, African American educators, particularly females, may be more sensitive to the latent content of these acting out behaviors.

Conclusion

This study explored factors associated with adolescent suicide that influence an educator's capabilities to identify students in a hypothetical setting portrayed as at risk for suicidal behavior. These outcomes suggest the need to re-examine the preparation programs of both regular and special educators as it relates to their training in the identification of signs and symptoms of adolescent suicide. The identification of the relationships among level of training, gender, and racial identity and their predicted impact on identification of symptoms of adolescent suicide suggest some fruitful areas for further research. The magnitude and severity of the phenomenon of adolescent suicide require a careful reexamination of identification and prevention issues by those educators who are major stakeholders in the lives of adolescents at risk for suicide.

Table 1

Comparison of Scores of Regular and Special Educators

                                    Total Score
                                                              p-
                     n       M       SD     Min.    Max.    value

Regular Educator    691    104.9    14.3     49     140     0.4512
Special Educator    186    105.5    13,7     44     140

                                    Overt Score

Regular Educator    691    83.3     11.5     37     108     0.1017
Special Educator    186    84.6     11.0     40     108

                                    Covert Score

Regular Educator    691    21.6     4.1      7       32     0.0684
Special Educator    186    20.9     3.9      0       32

Note: p-value determined by t-test procedure.

Educator Effectiveness 16

Table 2

Multivariate Analyses of Features Associated With Identifying Suicidal
Tendencies: Total Score (n=801)

Features                        F        P

Female gender                 18.88    0.000
Graduate level of training     7.7     0.008

Note: Eighty of the 882 respondents excluded (did not complete
questions). Model explains 3% of the variance.

Table 3


Multivariate Analyses of Features Associated With Identifying Suicidal
Tendencies: Overt Score (n = 801)

Features                         F

Female gender                 2103       0.0001
Graduate level of training       8.09      00046

Note: Eighty of the 882 respondents excluded (did not complete
questions). Model explains 1.5% of the variance.

Table 4

Multivariapte Analyses of Features Associated With Identifying Suicidal
Tendencies: Covert Score (n = 802)

Features          F        P

Female gender    5.32    0.0214
Race             3.98    0.0465

Note: Eighty of the 882 respondents were excluded (did not complete
questions). Model explains 3% of the variance.

References

(1.) Miller D. Suicidal behavior of adolescents with behavior disorders and their peers without disabilities. Behavioral Disorders. 1994;20(1):61-68.

(2.) Nelson ER, Slaikeu KA. Crisis intervention in the schools. In Slaikeu KA, ed. Crisis Intervention: A Handbook for Practice and Research. Boston: Allyn & Bacon; 1984.

(3.) Goldman R. An educational perspective on abuse. In Goldman R, Gargiulo R, eds. Children at Risk: An Interdisciplinary Approach to Child Abuse. Austin, TX: Pro-Ed; 1994:37-72.

(4.) Kirk WG. Adolescent Suicide: A School Based Approach to Assessment and Intervention. Champaign, IL: Research Press; 1993.

(5.) Carlson G, Cantwell, D. Suicidal behavior and depression in children and adolescents. Journal of the American Academy of Pediatrics. 1982;21:361-368.

(6.) Dyer J, Kreitman N. Hopelessness, depression, and suicidal intent in parasuicide. British Journal of Psychiatry. 1984;144:127-133.

(7.) Pfeffer CK, Plutchik P. Psychopathology of latency-age children: Relation to treatment planning. Journal of Nervous and Mental Disorders. 1982;17:193-197.

(8.) Pfeffer CR, ed. Suicide among Youth: Perspectives on Risk and Prevention. Washington, DC: American Psychiatric Press; 1989.

9. Weinberg W, Rutman J, Sullivan L, Penick E, Dietz S. Depression in children referred to an educational diagnostic center: Diagnosis and treatment. [Preliminary report.] J Pediatr. 1973; 83:1065-1072.

(10.) Mattison R, Humphrey I, Kales S, Hermit R, Finkenbinder R. Psychiatric background and diagnosis of children evaluated for special class placement. Journal of Child Psychiatry. 1986; 25:514-520.

(11.) Kauffman JM. Characteristics of Behavior Disorders of Children and Youth. 4th ed. Columbus, OH: Merrill; 1989

(12.) Stark K. Childhood Depression: School-based Intervention. New York: Guilford; 1990.

(13.) Guetzloe E. Suicide and Depression: The Adolescent Epidemic: Educations Responsibility, rev. ed. Orlando, FL: Advantage Consultants; 1989b.

(14.) Guetzloe E. Suicide and the exceptional child. [ERIC Digest #E508.] Reston, VA: Office of Educational Research and Improvement; 1991.

(15.) Spitzer KL, Williams IBW. DSM-III-R Diagnostic and Statistical Manual of Mental Disorders (Rev. ed.). Washington, DC: American Psychiatric Press, Inc; 1987.

(16.) Baker FM. Black Youth Suicide: Literature Review with a Focus on Prevention. Report of the Secretary's Task Force on Youth Suicide (Vol. II) [DHHS Publication No. ADM S9-1623.]. Washington, 13(2: U. S. Government Printing Office; 1989.

(17.) Hendin H. Black suicide. Archive of General Psychiatry. 1969; 21:407-422.

(18.) Schlotzhauer SD, Littell RC. SAS System for Elementary Statistical Analysis. Cary. NC: SAS Institute, Inc; 1991.

(19.) Norisis MJ. SPSS for Windows Base System User's Guide (Release 6.0). Chicago: SF55, Inc; 1993.

(20.) Ferguson G. Statistical Analysis in Psychology and Education. 4th ed. New York: McGraw-Hill. 1976.

(21.) Montgomery DC, Peck, EA. Introduction to Linear Regression Analysis. New York: John Wiley & Sons; 1982.

(22.) Tabachnik BO, Fidell LS. Using Multivariate Statistics. 2nd ed. New York: Harper & Row; 1989.

Jo Anne Hamrick, Ed. D., President, The Hamrick Group and Associates, Birmingham, AL. Renitta L. Goldman, Ph.D., Professor, Gary L. Sapp, Ed.D, Professor, Maxie P. Kohler, Ph.D., Associate Professor, University of Alabama at Birmingham, Birmingham, AL.

Correspondence concerning this article should be addressed to Jo Anne Hamrick, Ed. D., President, The Hamrick Group and Associates, 3609 Wyngate Lane, Birmingham, AL 35242; Email: [e-mail].