title: High school students' knowledge and experience with a peer who committed or attempted suicide: a focus group study.
abstract: BACKGROUND
  Suicide is a major public health problem for adolescents in South Africa, and also affects those associated with them. Peers become more important during adolescence and can be a significant source of social support. Because peers may be the first to notice psychological problems among each other, the present study's objectives were to assess students' knowledge about suicide, perceived risk factors, signs of poor mental health in adolescents who committed suicide, students' awareness of available mental health care and resources, and beliefs about prevention.
  
  
  METHODS
  This qualitative study used focus group discussions to elicit the thoughts and feelings of high school students who had a peer who committed or attempted suicide. Peers and class mates of suicide attempters and suicide completers were identified with the help of a social worker and school management and were invited to participate. All focus group discussions were audio taped and analyzed. A total of 56 adolescents (13-19 years of age) from Limpopo schools in South Africa participated in six focus group discussions. The data were analyzed by NVivo version 8, using an inductive approach.
  
  
  RESULTS
  Participants reported to be affected by the suicide attempt or completed suicide. They felt guilty about their failure to identify and prevent the suicide and displayed little knowledge of warning signs for suicidal behaviour. They identified several risk factors for the suicide of their peers, such as poor relationship issues, teenage pregnancy, punishment, and attention seeking behaviour. Resources for students with mental health problems and survivors of suicide attempts were not perceived to be available at schools and elsewhere.
  
  
  CONCLUSIONS
  School-based suicide prevention programs based on theory and evidence are necessary. Such interventions should also focus on detection of mental health problems by peers. Counseling services for students with mental health problems and suicide survivors should be available and made known to students at risk and peers.
authors.affiliation: Department of Advanced Nursing Sciences, University of Venda, Private Bag X 5050, Thohoyandou, South Africa. hilda.shilubane@univen.ac.za.
authors.forename: Hilda N
authors.initials: HN
authors.lastname: Shilubane
authors.forename: Robert A C
authors.initials: RA
authors.lastname: Ruiter
authors.forename: Arjan E R
authors.initials: AE
authors.lastname: Bos
authors.forename: Priscilla S
authors.initials: PS
authors.lastname: Reddy
authors.forename: Bart
authors.initials: B
authors.lastname: van den Borne
mesh_terms: D000293:Adolescent; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders; D008605:Mental Health Services; D010379:Peer Group; D036301:Qualitative Research; D012307:Risk Factors; D012572:School Health Services; D012574:Schools; D012944:Social Support; D013019:South Africa; D013334:Students / Q000523:psychology*; D059020:Suicidal Ideation; D013405:Suicide; D013406:Suicide, Attempted; D055815:Young Adult