Indirect effects of the coping power intervention on latent suicidal thoughts and behaviors

Abstract

There has been growing interest in preventive intervention "crossover" effects on suicidal thoughts and behaviors (STBs), in which targeting early risk factors may mitigate distal risk for STBs without STBs having been the targeted outcomes of the primary study. The present study extends an 11-study integrative data analysis of the Coping Power (CP) intervention (N = 3182) to assess indirect effects of different forms of CP on teacher- and parent-reported STBs as transmitted through different subdimensions of internalizing and externalizing problems. Compared to school-as-usual, all forms of CP (Standard/Group CP, Individual CP, CP with Mindfulness, Internet-Enhanced CP) led to reductions in parent- and/or teacher-reported youth STBs. Subgroup analyses suggested that boys benefitted from Individual CP and CP with Mindfulness mediated by reductions in aggressive behavior, whereas boys in Standard CP saw reductions in STBs mediated by reductions in conduct problems. Girls saw reductions in STBs in CP with Mindfulness mediated by reductions in anxiety. Some inferences made for individual α ^ and β ^ paths and mediation effects differed when using standard parametric approaches for inference versus bias-corrected percentile bootstrapping. These differences highlight cautions regarding statistical inference for prevention researchers who study highly skewed zero-inflated latent variables such as STBs. Findings are discussed in light of (a) earlier etiological research on biological sex-specificity in the pathways to early risk for suicide and (b) how variation in program components of CP and its adaptations may reduce STB risk across different populations, age groups, and modes of program delivery.