Abstract
Adolescent perceived behavioral control (self-efficacy) plays a key role in influencing decision-making processes within the context of suicide prevention programming. Guided by Theory of Planned Behavior, models tested attitudinal and social factors predicting adolescent intentions and actual engagement in suicide prevention behaviors. Participants included 233 racially and ethnically diverse high school students (54% female) in a southwestern U.S. school district. Measures included attitudes, norms, perceived behavioral control, intentions, and behavior over follow-up. Structural equation modeling indicated that perceived behavioral control, rather than intentions, was the direct predictor of behaviors. For adolescents, beliefs about effectively utilizing learned suicide prevention behavior may be more important than intentions. The design of suicide prevention efforts should account for this important influence on adolescent decision-making.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ajzen, I. (1985). From intentions to actions: a theory of planned behavior. In J. Kuhl & J. Beckmann (Eds), Action control. SSSP Springer series in social psychology. Berlin, Germany: Springer.
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211.
Ajzen, I. (2011). The theory of planned behavior: reactions and reflections. Psychology & Health, 26(9), 1113–1127.
Akaike, H. (1985). Prediction and entropy. In E. Parzen, K. Tananbe, G. Kitagawa (Eds), Selected papers of Hirotugu Akaike. New York, NY: Springer.
Aldrich, R. S. (2015). Using the theory of planned behavior to predict college students’ intention to intervene with a suicidal individual. Crisis, 36, 332–337.
Berkel, C., Mauricio, A. M., Schoenfelder, E., & Sandler, I. N. (2011). Putting the pieces together: an integrated model of program implementation. Prevention Science, 12, 23–33.
Bruffaerts, R., Demyttenaere, K., Hwang, I., Chiu, W. T., Sampson, N., Kessler, R. C., & de Graaf, R. (2011). Treatment of suicidal people around the world. British Journal of Psychiatry, 199, 64–70.
Cakar, F. S., & Savi, S. (2014). An exploratory study of adolescent’s help-seeking sources. Procedia—Social and Behavioral Science, 159, 610–614.
Capp, K., Deane, F. P., & Lambert, G. (2001). Suicide prevention in aboriginal communities: application of community gatekeeper training. Australian and New Zealand Journal of Public Health, 25, 315–321.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (2017). Web-based injury statistics query and reporting system (WISQARS). www.cdc.gov/injury/wisqars.
Centers for Disease Control and Prevention (2005). Youth risk behavior survey data. www.cdc.gov/yrbs. Accessed 1 Dec 2018.
Cigularov, K., Chen, P. Y., Thurber, B. W., & Stallones, L. (2008). What prevents adolescents from seeking help after a suicide education program? Suicide and Life-Threatening Behavior, 38, 74–86.
Condron, S. D., Garraza, L. G., Walrath, C. M., McKeon, R., Goldston, D. B., & Heilbron, N. S. (2015). Identifying and referring youths at risk for suicide following participation in school‐based gatekeeper training. Suicide and Life-Threatening Behavior, 45(4), 461–476.
Cooke, R., & French, D. P. (2011). The role of context and timeframe in moderating relationships within the theory of planned behaviour. Psychology & Health, 26, 1225–1240.
Corry, D. A. S., & Leavey, G. (2017). Adolescent trust and primary care: help-seeking for emotional and psychological difficulties. Journal of Adolescence, 54, 1–8.
Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41(3-4), 327–350.
Fixsen, D. L., Naoom, S. F., Blase, K. A., & Friedman, R. M. (2005). Implementation research: synthesis of the literature. Tampa, FL: University of South Florida.
Gilchrist, H., & Sullivan, G. (2006). Barriers to help-seeking in young people: community beliefs about youth suicide. Australian Social Work, 59, 73–85.
Gould, M. S., Marrocco, F. A., Kleinman, M., Thomas, J. G., Mostkoff, K., Cote, J., & Davies, M. (2005). Evaluating iatrogenic risk of youth suicide screening programs: a randomized control trial. Journal of the American Medical Association, 293, 1635–1643.
Gould, M. S., Velting, D., Kleinman, M., Lucas, C., Thomas, J. G., & Chung, M. (2004). Teenagers’ attitudes about coping strategies and help-seeking behavior for suicidality. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1124–1133.
Hangartner, R. B., Totura, C. M. W., Labouliere, C. D., Gryglewicz, K., & Karver, M. S. (2019). Benchmarking the “Question, Persuade, Refer” program against evaluations of established suicide prevention gatekeeper trainings. Suicide and Life-Threatening Behavior, 49, 353–370.
Husky, M. M., Kaplan, A., McGuire, L., Flynn, L., Chrostowski, C., & Olfson, M. (2011). Identifying adolescents at risk through voluntary school-based mental health screening. Journal of Adolescence, 34, 505–511.
Isaac, M., Elias, B., Katz, L. Y., Belik, S. L., Deane, F. P., & Enns, M. W., Swampy Cree Suicide Prevention Team. (2009). Gatekeeper training as a preventative intervention for suicide: a systematic review. The Canadian Journal of Psychiatry, 54(4), 260–268.
Kalafat, J. (2003). School approaches to youth suicide prevention. American Behavioral Scientist, 46, 1211–1223.
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., & Ethier, K. A. (2018). Youth risk behavior surveillance—United States, 2017. Surveillance Summaries, 67(8), 1–114.
Kuhlman, S. T. W., Walch, S., Bauer, K., & Glenn, A. D. (2017). Intention to enact and enactment of gatekeeper behaviors for suicide prevention: an application of the theory of planned behavior. Prevention Science, 18, 704–715.
Labouliere, C. D., Tarquini, S. J., Totura, C. M. W., Kutash, K., & Karver, M. S. (2015a). Revisiting the concept of “knowledge gain:” how much is learned by students participating in suicide prevention gatekeeper training? Crisis, 36, 274–280.
Labouliere, C. D., Kleinman, M., & Gould, M. S. (2015b). When self-reliance is not safe: associations between reduced help-seeking and subsequent mental health symptoms in suicidal adolescents. International Journal of Environmental Research and Public Health, 12, 3741–3755.
Lamblin, M., Murawski, C., Whittle, S., & Fornito, A. (2017). Social connectedness, mental health, and the adolescent brain. Neuroscience and Biobehavioral Reviews, 80, 57–68.
Menna, R., & Ruck, M. (2004). Adolescent help-seeking behavior: how can we encourage it? Guidance and Counseling, 19, 176–183.
Montaño, D. E., & Kasprzyk, D. (2015). Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In K. Glanz, B. K. Rimer & K. V. Viswanath (Eds), Health behavior: theory, research, and practice (pp. 95–124). San Francisco, CA: Jossey-Bass.
Moore, J. T., Cigularov, K., Chen, P. Y., Martinez, J. M., & Hindman, J. (2011). The effects of situational obstacles and social support on suicide-prevention gatekeeper behaviors. Crisis, 32, 264–271.
Moskos, M. A., Olson, L., Halbern, S. R., & Gray, D. (2007). Utah youth suicide study: barriers to mental health treatment for adolescents. Suicide and Life-Threatening Behavior, 37(2), 179–186.
Nearchou, F. A., Bird, N., Costello, A., Duggan, S., Gilroy, J., Long, R., McHugh, L., & Hennessy, E. (2018). Personal and perceived public mental-health stigma as predictors of help-seeking intentions in adolescents. Journal of Adolescence, 66, 83–90.
Norman, P. (2011). The theory of planned behavior and binge drinking among undergraduate students: assessing the impact of habit strength. Addictive Behavior, 36, 502–507.
O’Donnell, L., Stueve, A., Wardlaw, D., & O’Donnell, C. (2003). Adolescent suicidality and adult support: the reach for health study of urban youth. American Journal of Health Behavior, 27(6), 633–644.
Office of the Surgeon General & National Action Alliance for Suicide Prevention (2012). National strategy for suicide prevention. Washington, D.C.: U.S. Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK109917/pdf/Bookshelf_NBK109917.pdf. Accessed 1 Dec 2018.
O’Neill, S., Corry, C. V., Murphy, S., Brady, S., & Bunting, B. P. (2014). Characteristics of deaths by suicide in Northern Ireland from 2005 to 2011 and use of health services prior to death. Journal of Affective Disorders, 168, 466–471.
Osteen, P., Frey, J. M., Woods, M. N., Ko, J., & Shipe, S. (2017). Modeling the longitudinal direct and indirect effects of attitudes, self‐efficacy, and behavioral intentions on practice behavior outcomes of suicide intervention training. Suicide and Life-Threatening Behavior, 47(4), 410–420.
Pisani, A. R., Schmeelk-Cone, K., Gunzler, D., Petrova, M., Goldston, D. B., Tu, X., & Wyman, P. A. (2012). Associations between suicidal high school students’ help-seeking and their attitudes and perceptions of social environment. Journal of Youth and Adolescence, 41, 1312–1324.
Rice, S. M., Purcell, R., & McGorry, P. D. (2018). Adolescent and young adult male mental health: transforming system failures into proactive models of engagement. Journal of Adolescent Health, 62(3), S9–S17.
Schmeelk-Cone, K., Pisani, A. R., Petrova, M., & Wyman, P. A. (2012). Three scales assessing high school students’ attitudes and perceived norms about seeking adult help for distress and suicide concerns. Suicide and Life-Threatening Behavior, 42(2), 157–172.
Schreiber, J. B., Nora, A., Stage, F. K., Barlow, E. A., & King, J. (2006). Reporting structural equation modeling and confirmatory factor analysis results: a review. The Journal of Educational Research, 99, 323–337.
Sears, H. A., Graham, J., & Campbell, A. (2009). Adolescent boys’ intentions of seeking help from male friends and female friends. Journal of Applied Developmental Psychology, 30, 738–748.
Steinberg, L. (2009). Adolescent development and juvenile justice. Annual Review of Clinical Psychology, 5, 459–485.
Stone, L. B., Hankin, B. L., Gibb, B. E., & Abela, J. R. (2011). Co-rumination predicts the onset of depressive disorders during adolescence. Journal of Abnormal Psychology, 120, 752–757.
Symonds, M. R. E., & Moussalli, A. (2011). A brief guide to model selection, multimodal inference, and model averaging in behavioural ecology using Akaike’s information criterion. Behavioral Ecology and Sociobiology, 65, 13–21.
Topa, G., & Moriano, J. A. (2010). Theory of planned behavior and smoking: a meta-analysis and SEM model. Substance Abuse and Rehabilitation, 1, 23–33.
Totura, C. M. W., Labouliere, C. D., Gryglewicz, K., & Karver, M. S. (2019). The role of youth trainee-trainer alliance and involvement in school-based prevention: a moderated-mediation model of student gatekeeper suicide prevention training. Administration and Policy in Mental Health, 46, 209–219.
Totura, C. M. W., Labouliere, C. D., Tarquini, S., Gunderson, S., Brown, R., Kutash, K. et al. (2009). Why some succeed and others fail: the effect of organizational climate, training engagement, and perceived attitudes and intentions on the implementation and effectiveness of gatekeeper suicide prevention training. Paper presented at the American Association of Suicidology Conference, Orlando, FL.
U.S. Department of Health and Human Services (2011). Healthy people 2020 initiative—adolescent health. http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=2.
Wilson, C. J., & Deane, F. P. (2001). Adolescent opinions about reducing help-seeking barriers and increasing engagement. Journal of Educational and Psychological Consultation, 12(4), 345–364.
Wyman, P. A., Brown, C. H., Inman, J., Cross, W., Schmeelk-Cone, K., Guo, J., & Pena, J. B. (2008). Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. Journal of Consulting and Clinical Psycholology, 76, 104–115.
Acknowledgements
Special thanks to Sarah Gunderson, Renee Brown Hangartner, Jason I. Chen, Sarah J. Tarquini, and Krista Kutash for their invaluable assistance.
Authors’ Contributions
C.T. had the primary responsibility for designing the study, collecting data, and preparing the manuscript; C.L. had primary responsibility for data analyses, and assisted with conducting the study and data collection; K.G. provided substantial input in the conceptualization of and in conducting the study; M.K. assisted with the development and implementation of the research design and data collection protocol. All authors read and approved the final manuscript.
Funding
This research was supported by Substance Abuse and Mental Health Services Administration grants (#SM57442-01, 02-3) to Drs. Karver, Kutash, and Totura. Dr. Labouliere was supported as a post-doctoral fellow by Award #2T32 MH16434-34 from the National Institute of Mental Health (NIMH) at the National Institutes of Health (NIH). The contents of the manuscript are solely the responsibility of the authors and do not necessarily represent the official views of NIMH or SAMHSA.
Data Sharing and Declaration
This manuscript’s data will not be deposited.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
University Institutional Review Board approval for secondary data analysis was obtained.
Additional information
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendix
Appendix
Supplemental figures of the traditional Theory of Planned Behavior model and unconstrained models of relationships between constructs as suggested by modification indices. **p < 0.01; ***p < 0.001 (Figs. 2–8).
Traditional theory of Planned Behavior model
Unconstrained model 1 without the perceived behavioral control to intentions pathway
Unconstrained model 2 with only perceived behavioral control and intentions predicting behavior
Unconstrained model 3 with only perceived behavioral control predicting behavior
Unconstrained model 4 with only attitudes and perceived behavioral control predicting behavior
Unconstrained model 5 with attitudes, subjective norms, and perceived behavioral control predicting behavior
Unconstrained model 6 with only subjective norms and perceived behavioral control predicting behavior
Rights and permissions
About this article
Cite this article
Totura, C.M.W., Labouliere, C.D., Gryglewicz, K. et al. Adolescent Decision-Making: The Value of Perceived Behavioral Control in Predicting Engagement in Suicide Prevention Behaviors. J Youth Adolescence 48, 1784–1795 (2019). https://doi.org/10.1007/s10964-019-01066-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10964-019-01066-3