• Rates of referrals for students identified as suicidal risks
  
• school staff knowledge and attitudes
  
• outcomes of mental health evaluations for accurate detection of suicidal risk
  

The rate of suicide among adolescents has significantly increased in recent years. Psychiatric disorders are often associated with increased suicide risk; therefore, the ability to identify adolescents with signs of depression and other psychiatric conditions is clear. This study will determine the effectiveness of a suicide prevention training program called Question, Persuade, Refer (QPR) in increasing the number of potentially suicidal adolescents who are referred to mental health services. The training is designed to help school staff recognize signs that a student may be suicidal, provide tips on how to question students about any suicidal thoughts they may have, and provide techniques to persuade students to seek suicide prevention help.

School staff will be randomly assigned to either receive QPR training for 2 years starting immediately or be placed on a waiting list for later training. The rates of referral to the school district's prevention/intervention centers will be used to assess the effectiveness of QPR training. In addition, the impact of QPR training on school staff members' knowledge and attitudes about intervening with at-risk students will be assessed through surveys at four time points over the 2-year study duration with a randomly selected portion of staff in the 32 participating schools. Surveys completed by randomly selected 8th and 10th grade students will also be used to determine whether the intervention is effective in reducing suicidal thoughts or attempts.

Study hypothesis: More students in schools that have Question, Persuade, Refer (QPR)-trained staff will be referred for a mental health evaluation than in schools without QPR-trained staff.