title: The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts.
abstract: OBJECTIVE
  This paper reports the impact of two first- and second-grade classroom based universal preventive interventions on the risk of Suicide Ideation (SI) and Suicide Attempts (SA) by young adulthood. The Good Behavior Game (GBG) was directed at socializing children for the student role and reducing aggressive, disruptive behavior. Mastery Learning (ML) was aimed at improving academic achievement. Both were implemented by the teacher.
  
  
  METHODS
  The design was epidemiologically based, with randomization at the school and classroom levels and balancing of children across classrooms. The trial involved a cohort of first-grade children in 19 schools and 41 classrooms with intervention at first and second grades. A replication was implemented with the next cohort of first grade children with the same teachers but with little mentoring or monitoring.
  
  
  RESULTS
  In the first cohort, there was consistent and robust GBG-associated reduction of risk for suicide ideation by age 19-21 years compared to youths in standard setting (control) classrooms regardless of any type of covariate adjustment. A GBG-associated reduced risk for suicide attempt was found, though in some covariate-adjusted models the effect was not statistically robust. No statistically significant impact on these outcomes was found for ML. The impact of the GBG on suicide ideation and attempts was greatly reduced in the replication trial involving the second cohort.
  
  
  CONCLUSIONS
  A universal preventive intervention directed at socializing children and classroom behavior management to reduce aggressive, disruptive behavior may delay or prevent onset of suicide ideation and attempts. The GBG must be implemented with precision and continuing support of teachers.
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street/CMSC 346, Baltimore, MD 21287, United States. hwilcox1@jhmi.edu
authors.forename: Holly C
authors.initials: HC
authors.lastname: Wilcox
authors.forename: Sheppard G
authors.initials: SG
authors.lastname: Kellam
authors.forename: C Hendricks
authors.initials: CH
authors.lastname: Brown
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Poduska
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Ialongo
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: James C
authors.initials: JC
authors.lastname: Anthony
mesh_terms: D000124:Achievement; D000293:Adolescent; D000328:Adult; D000374:Aggression / Q000523:psychology*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000628:therapy*; D015142:Baltimore; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012306:Risk; D012574:Schools; D012951:Socialization; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000706:statistics & numerical data; D014505:Urban Population