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Schools are ideal locations for youth to receive mental health and social-emotional programming. Despite the well-established need for school-based mental health programs, many schools do not offer these programs, and those that do often face implementation challenges that hinder the effectiveness of the programs. Peer-led programs may be an effective way to implement school-based mental health prevention efforts. Peer-led programs employ influential student leaders trained to deliver prevention content and serve as role models to their peers. Understanding potential barriers to the implementation of school-based programs is critical to ensure these programs have a meaningful impact on students and schools. The current qualitative phenomenological study examines the lessons learned from implementing the "Sources of Strength" ("Sources") prevention program in 11 high schools in a western US state. "Sources" is an evidence-based peer-led suicide prevention program focused on developing protective factors and promoting resilience in schools. Implementing the "Sources" program was successful in many ways, including facilitating positive student-staff interactions, cultivating a welcoming and inclusive environment in the school community, and encouraging community outreach. Barriers to implementation were also found, including time constraints, low peer leader engagement, inefficient communication between peer leaders, need for additional guidance from program staff, and school buy-in. The findings provide program developers and schools with strategies to help strengthen program implementation and highlight challenges that "Sources" and similar peer-led programs face.

Sexual and gender minority (SGM) youth experience higher rates of adverse mental health outcomes, most notably suicidal thoughts and behaviors (STBs). The current study examines risk and protective factors for STBs and depression among 1,078 youth in high schools. We examine these outcomes through an intersectional lens, and we extend the use of the minority stress theory framework by focusing on resilience and protective factors and argue that bias against lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth should be addressed at the systemic, rather than the individual, level. Our findings suggest that family support is a notable factor protective of depression and suicide-related behavior among LGBTQ youth. Additionally, peer support, help-seeking beliefs, access to medical and counseling services, engaging in healthy activities, spirituality, and having trusted adults are protective factors for some groups. The nuanced findings in this study offer suggestions for school psychologists and professionals to promote healthy and safe school environments.

Homophobic name-calling and sexual violence are prevalent among US high school students and have been associated with a host of negative consequences including anxiety, depression, and substance use disorders, especially among sexual and gender minority youth. Although homophobic name-calling and sexual violence are linked to common risk and protective factors, most prior studies have failed to include gender and sexual minority groups. The present study used path analyses to explore the associations between eight protective factors and the outcomes of homophobic name-calling perpetration, homophobic name-calling victimization, sexual violence perpetration, and sexual violence victimization. The sample included LGB (n = 938), transgender (n = 140), and heterosexual (n = 3,744) high school students in Colorado, USA (N = 4,822). Protective factors included: (1) family support; (2) peer support; (3) friendships with trusted adults; (4) participating in healthy activities; (5) helping others; (6) spirituality; (7) access to counseling; and (8) access to medical services. For homophobic name-calling perpetration and victimization, significant negative associations emerged across different groups for the protective factors of family support, peer support, helping others, spirituality, counseling, and medical access. For sexual violence perpetration and victimization, significant negative associations emerged across different groups for the protective factors family support, peer support, and counseling access. Findings suggest that prevention and intervention efforts to address gender-based harassment should focus on building protective, supportive environments across the schools, families, and communities.

Peer victimization, also referred to as bullying victimization, is associated with deleterious mental health outcomes including depression and suicidality. However, most of the bullying literature in the USA is centered around the experiences of non-Latinx White and African American adolescents. To center Latinx experiences, this cross-sectional study includes a sample of Latinx students from 19 Colorado high schools (n = 2554). School-level ethnic peer representation (proportion of Latinx peers) and individual student's willingness to seek help were examined independently as moderators between bullying victimization and mental health outcomes (depression and suicidality) separately by gender. Results indicated that Latinx youth who experienced peer victimization also reported higher symptoms of depression and suicidality. A greater willingness to seek help was associated with less symptoms of depression and suicidality among young Latinx youth, while school-level ethnic peer representation was only associated with lower symptoms of depression for Latinx adolescent females. Among Latinx youth who were victimized, a greater willingness to seek help was protective for symptoms of depression and suicidality. Results suggest that school-based programs for bullying prevention and mental health promotion need to examine culturally specific protective factors to reduce victimization and promote help-seeking norms among Latinx youth.

There are consistently high rates of sexual victimization and substance misuse among youth in the United States. Although there is a known relation between sexual victimization and substance use, there is a gap in the research regarding the magnitude and temporality of these associations. This study examined whether latent classes of sexual victimization and help-seeking attitudes longitudinally predict intentions of future substance misuse 7–10 months later. Students from nine Colorado high schools (N = 533; M = age 16 years) completed surveys across two consecutive school semesters. Latent class analysis was used to identify classes of students who experienced at least one form of sexual victimization (e.g., sexual harassment, unwanted sexual contact) according to 13 sexual victimization items, and level of positive attitudes regarding help-seeking for sexual victimization. Classes were compared on demographic characteristics and for distal outcomes of likelihood of future substance misuse (cigarettes, alcohol, cannabis, prescription drugs, and electronic vaping products) using latent class regression, controlling for previous intentions to use. At Time 1, four classes of sexual victimization were identified with two main classes for comparison: low odds of experiencing sexual victimization (60.1% of sample) and high odds of endorsing all forms of sexual victimization (7.7% of sample). The high sexual victimization class had higher proportions of male and transgender students, compared to other classes. At Time 2 (7–10 months later), students in the high sexual victimization class reported a significantly greater likelihood of future cigarette (p =.017) and prescription drug misuse (p =.007) when compared to the low sexual victimization class. There was no evidence that having higher positive attitudes towards help-seeking resulted in lower intentions to use substances in the future. These findings highlight that addressing sexual violence in prevention programming may have crossover effects of reducing substance misuse and other forms of violence among youth. [ABSTRACT FROM AUTHOR]

Universal interventions are key to reducing youth suicide rates, yet no universal intervention has demonstrated reduction in suicide mortality through an RCT. This study pooled three cluster-RCTs of Sources of Strength (n=78 high schools), a universal social network-informed intervention. In each trial, matched pairs of schools were assigned to immediate intervention or wait-list. Six schools were assigned without a pair due to logistical constraints. During the study period, no suicides occurred in intervention schools vs four in control schools, that is, suicide rates of 0 vs. 20.86/100,000, respectively. Results varied across statistical tests of impact. A state-level exact test pooling all available schools showed fewer suicides in intervention vs. control schools (p=0.047); whereas a stricter test involving only schools with a randomised pair found no difference (p=0.150). Results suggest that identifying mortality-reducing interventions will require commitment to new public-health designs optimised for population-level interventions, including adaptive roll-out trials., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)