***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study employed a self-report question naire in a Solomon four-groups design to assess the efficacy of suicide intervention classes in achieving their instructional objectives . Because adolescents are often the first to know of a peer 's suicidal thoughts or plans , the goal of the classes was to increase the likelihood that students who come into contact with potentially suicidal peers can more readily identify them and will be consistently inclined to take responsible action on their behalf . Students who participated in the classes as compared to controls showed significant gains in relevant knowledge about suicidal peers and significantly more positive attitudes toward help seeking and intervening with troubled peers . Results of this study will be used to strengthen components of the lessons aim ed at enhancing the likelihood of performance of responsible interventions Gatekeeper-training programs , design ed to increase identification and referral of suicidal individuals , are widespread but largely untested . A group-based r and omized trial with 32 schools examined impact of Question , Persuade , Refer ( QPR ) training on a stratified r and om sample of 249 staff with 1-year average follow-up . To test QPR impact , the authors introduced and contrasted 2 models of gatekeeper-training effects in a population : gatekeeper surveillance and gatekeeper communication . Intent-to-treat analyses showed that training increased self-reported knowledge ( effect size [ ES ] = 0.41 ) , appraisal s of efficacy ( ES = 1.22 ) , and service access ( ES = 1.07 ) . Training effects varied dramatically . Appraisal s increased most for staff with lowest baseline appraisal s , and suicide identification behaviors increased most for staff already communicating with students about suicide and distress . Consistent with the communication model , increased knowledge and appraisal s were not sufficient to increase suicide identification behaviors . Also consistent with the communication model were results from 2,059 8th and 10th grade rs surveyed showing that fewer students with prior suicide attempts endorsed talking to adults about distress . Skill training for staff serving as " natural gatekeepers " plus interventions that modify students ' help-seeking behaviors are recommended to supplement universal gatekeeper training Suicide is a major public health problem . Nationally , suicide is the third leading cause of death for adolescents . The purpose of this quality improvement project was to initiate and evaluate a gatekeeper suicide-prevention program within a local school system targeting faculty and staff without a medical or psychology background who interact regularly with middle- and high-school students . Following the implementation of this program , evaluation of increased knowledge related to adolescent suicide prevention was completed . All participants completed a pretest and posttest , and results indicate that the staff members ' knowledge about identification of risk factors , behavioral responses to suicidal students , and knowledge of community re sources were increased . This project highlights the need for planned and sustainable education and training for faculty and school staff who regularly interact with adolescents . Additionally , the importance of continued monitoring , training , and advocating for suicide prevention programming is noted OBJECTIVE To examine symptomatology and mental health service use following students ' contact with a large urban school district 's suicide prevention program .  METHOD In 2001 school district staff conducted telephone interviews with 95 r and omly selected parents approximately 5 months following their child 's contact with the district 's suicide prevention program  , a School Gatekeeper Training model . Parents provided information regarding service use , their child 's depressive symptoms ( using the Diagnostic Interview Schedule for Children Predictive Scale , Depression module ) , and their perceptions of their child 's need for services . Information about the crisis intervention was abstract ed from a st and ardized assessment form . RESULTS More than two thirds of students received school or community mental health services following contact with the suicide prevention program .  Depressive symptoms , but not past year suicide attempt , predicted community mental health service use . Latino students had lower rates of community mental health service use than non-Latinos .  School-based service use did not differ by student characteristics including race/ethnicity . CONCLUSIONS Most students identified by a school-based suicide prevention program received follow-up care , although Latinos were less likely to access services outside the school . School-based mental health services may be an important way in which underserved population s at risk of suicide can receive care A national r and om sample of 228 high school health teachers completed a 45-item survey to examine their perceived self-efficacy regarding adolescent suicide . Most respondents were female , White , and held master 's degrees . Most believed it was their role to recognize students at risk for suicide , believed that if they did recognize students at risk it would reduce the chances that the student would commit suicide , and believed that one of the most important things they could do would be to prevent a suicidal student from committing suicide . However , only 9 % believed they could recognize a student at risk for suicide . High efficacy expectations scores were associated with working at a school that offered an inservice program on adolescent suicide , included teaching about suicide prevention in the curriculum , and had a crisis intervention team . This study suggests that teacher health education programs should spend more time on developing the skills necessary to identify students at risk . In addition , a comprehensive school suicide prevention program is strongly encouraged for all high schools Background The traditional wait-listed design , where half are r and omly assigned to receive the intervention early and half are r and omly assigned to receive it later , is often acceptable to communities who would not be comfortable with a notreatment group . As such this traditional wait-listed design provides an excellent opportunity to evaluate short-term impact of an intervention . We introduce a new class of wait-listed design s for conducting r and omized experiments where all subjects receive the intervention , and the timing of the intervention is r and omly assigned . We use the term “ dynamic wait-listed design s ” to describe this new class . Purpose This paper examines a new class of statistical design s where r and om assignment to intervention condition occurs at multiple times in a trial . As an extension of a traditional wait-listed design , this dynamic design allows all subjects to receive the intervention at a r and om time . Motivated by our search for increased statistical power in an ongoing school-based trial that is testing a program of gatekeeper training to identify suicidal youth and refer them to treatment , this new design class is especially useful when the primary outcome is a count or rate of occurrence , such as suicidal behavior , whose rate can fluctuate over time due to uncontrolled factors . Methods Statistical power is computed for various dynamic wait-listed design s under conditions where the underlying rate of occurrence is allowed to vary non systematic ally . We also present as an example a large ongoing trial to evaluate a gatekeeper training suicide prevention program in 32 schools which we initially began as a classic r and omized wait-listed design . The primary outcome of interest in this study is the count of the number of children who are identified by the school system as having suicidal thoughts or behaviors  who are then vali date d as being suicidal by mental health professionals in the community . Results A general result shows that dynamic wait-listed design s always have higher statistical power over a traditional wait-listed design . This power increase can be substantial . Efficiency gains of 33 % are easy to obtain for situations where the intervention has a small effect and the variation in rate across time is quite high . When the rate variation for an outcome is very low or the intervention effect is large , efficiency gains approach 100 % . A small increase in the number of times where r and om assignment occurs from 2 – for the st and ard wait-listed design , to say 4 – can provide a large reduction in variance . Efficiency gains can also be high when converting st and ard wait-listed design to a dynamic one half-way into the study . Limitations As with all wait-listed design s , dynamic wait-listed design s can only be used to evaluate short-term impact . Since all subjects eventually receive the intervention , no comparison can be made after the end of the r and om assignment period . The statistical power benefits are primarily limited to outcomes that can be treated as count or time to event data . Conclusions A dynamic design r and omly assigns units – either individuals or groups – to start the intervention at varying times during the course of the study . This design is useful in testing interventions that screen for new or existing cases , as well as testing the scalability of interventions as they are disseminated or exp and ed system wide . They can improve on the traditional wait-listed design both in terms of statistical power and robustness in the presence of exogenous factors . This paper demonstrates that such design s yield smaller st and ard errors and can achieve higher statistical power than that of a st and ard wait-listed design . Just as important , dynamic design s can also help reduce the logistical challenges of implementing an intervention on a wide scale . When the intervention requires that significant training re sources be allocated throughout the study , the dynamic waitlisted design is likely to increase the rate of training and lead to a higher level of program implementation Objectives : To evaluate a suicide prevention training workshop for staff working in the field of traumatic brain injury ( TBI ) and to develop new measures for evaluation of similar training in the future . Design : A prospect i ve controlled pre- and posttest evaluation with a 6-month follow-up . Subjects : Multidisciplinary TBI rehabilitation and disability staff from the state of Victoria attending the workshop ( n = 50 ) and an equivalent control group ( n = 28 ) recruited from New South Wales . Setting : A statewide training workshop was held at a major rehabilitation center in Melbourne . Outcome measures : Three design ed measures including an objective knowledge test , a self- assessment inventory of knowledge/skills and an attitudinal inventory . Results : Participants recorded statistically significant increases in their scores comparing the pre- to postworkshop evaluations . Many of these gains were maintained at the 6-month follow-up evaluation . In contrast , the control group had scores equivalent to those of workshop participants on the pretest evaluations but recorded no similar increase at follow-up . Factor analysis found that the knowledge and skills self- assessment inventory had 2 factors , each having good internal reliability . Conclusion : The current workshop has proved effective in increasing staff knowledge and skills in the assessment and management of people with TBI exhibiting suicidal behaviors . Finally , the initial development of a knowledge and skills self- assessment measure shows promise , providing a re source for the ongoing evaluation of suicide prevention training in the TBI field In this pilot study we report on proximate outcomes of a 1-hour community gatekeeper training in-service for 76 non clinical employees in a university hospital workplace setting . Pre-post analyses result ed in positive changes in participants ' knowledge about suicide and attitudes ( self-efficacy ) about intervening with suicidal individuals . A subset of participants engaged in role play practice of gatekeeper skills following training and rated the experience positively . Fifty-five observations were rated using an observational measure developed for this study and approximately half of these demonstrated satisfactory skills post training . Participants in this workplace gatekeeper training reported sharing new knowledge and skills with family , friends , and coworkers The purpose of this article was to describe patterns of poor mental health/depression ( PMHD ) in a national sample of college students and the relationships among PMHD , alcohol consumption , harm , and abuse . Responses to mailed question naires completed by a r and om sample of 27,409 students at 119 colleges were analyzed using logistic regression . Nationally , 4.8 % of students reported PMHD . The average college prevalence was 5.01 % ( range , 0.68 % to 13.23 % ) . Students with PMHD were more likely than their peers to be female , nonwhite , and from low socioeconomic status families ; less likely to report never drinking ; as likely to report frequent , heavy , and heavy episodic drinking ; and more likely to report drinking to get drunk . Students with PMHD — especially females — were more likely to report drinking-related harms and alcohol abuse . College is a critical context for study ing youth mental health . The interrelationship of mental health problems and their clustering by group and college are important considerations for prevention and treatment BACKGROUND Suicide is a significant public health problem worldwide that requires evidence -based prevention efforts . One approach to prevention is gatekeeper training . Gatekeeper training programs for community members have demonstrated positive changes in knowledge and attitudes about suicide . Changes in gatekeeper skills have not been well established . AIMS To assess and to predict the impact of a brief , gatekeeper training on community members ' observed skills . METHODS Participants in a community gatekeeper training were employees at US universities . 50 participants were r and omly selected for skills assessment and videotaped interacting with a st and ardized actor prior to and following training . Tapes were reliably rated for general and suicide-specific skills . RESULTS Gatekeeper skills increased from pre- to posttest : 10 % of participants met criteria for acceptable gatekeeper skills before training , while 54 % met criteria after training . Pretraining variables did not predict increased skills . LIMITATIONS Results do not provide conclusions about the relationship between observed gatekeeper skills and actual use of those skills in the future . CONCLUSIONS Gatekeeper training enhances suicide-specific skills for the majority of participants . Other strategies , such as behavioral rehearsal , may be necessary to enhance skills in the remaining participants BACKGROUND Gatekeeper suicide prevention programs train staff to increase the identification and referral of suicidal individuals to the appropriate re sources . AIMS We evaluated Act on FACTS : Making Educators Partners in Youth Suicide Prevention ( MEP ) , which is an online training program design ed to enhance the knowledge of suicide risk factors and warning signs as well as improve participants ' attitudes and self-efficacy/confidence . METHOD School personnel ( N = 700 ) completed a survey administered before and immediately after the training to assess gains in training outcomes and to evaluate participants ' satisfaction with the training . RESULTS Results indicated that MEP participants demonstrated significant increases in suicide knowledge , attitudes , and self-efficacy . Moreover , exploratory analyses revealed moderating effects of professional role on pre-/posttest changes in self-efficacy , but not suicide knowledge or attitudes . Specifically , guidance counselors demonstrated significantly smaller increases in self-efficacy/confidence compared with teachers and classroom aids , whereas teachers demonstrated significantly larger increases in self-efficacy/confidence compared with administrators . The majority of school personnel who completed the MEP program were satisfied with the training content and experience . CONCLUSION Although the current findings are promising , more rigorous evaluations employing r and omized controlled research design s are warranted to adequately determine the effectiveness of the MEP program 
    Output:
    
There is also an urgent need to investigate how best improvements in knowledge and skills can be translated into behavioural change