title: The Sources of Strength Australia Project: study protocol for a cluster randomised controlled trial.
abstract: The school system has been identified as an ideal setting for the implementation of prevention and early intervention programs for suicide. However, in Australia, suicide-prevention programs that are routinely delivered in the schools are lacking. Internationally, evidence exists for the effectiveness of peer-led interventions that take a social connectedness approach to improve help-seeking for suicide. The aim of the current trial is to test the effectiveness of the Sources of Strength program to promote help-seeking for suicide in adolescents in Australian high schools.
  
  
  
  This study is a two-arm, cluster-randomised, controlled trial that will compare the evidence-based Sources of Strength program to a wait-list control condition. Sixteen Australian high schools will be recruited to the trial, with all adolescents in years 7 to 10 (12-16 years of age) invited to participate. Peer leaders from intervention-condition schools will receive training in the Sources of Strength program and will integrate positive messages, across 3 months, with the support of adult advisors. Activities may take the form of class presentations, posters, videos, and messages on social media sites and will aim to change help-seeking norms, strengthen youth-adult connections, and promote positive coping. The primary outcome measure for the study is help-seeking intentions, whereas secondary outcomes include help-seeking behaviour, help-seeking attitudes and norms, referral of distressed peers, availability of adult help, positive coping, and suicidal behaviour. Data will be collected pre-intervention, post-intervention (after the initial 3 months of messaging), and at the end of the first (6-month follow-up) and the second year after implementation (18-month follow-up). Primary analyses will compare changes in help-seeking intentions for the intervention condition relative to the wait-list control condition using mixed-effect repeated-measures analyses to account for clustering within schools.
  
  
  
  If proven effective, this universal social connectedness program for suicide could be more widely delivered in Australian high schools, providing a valuable new resource. The Sources of Strength program has the potential to significantly contribute to the mental health of young people in Australia by improving help-seeking for suicide. The findings from this research will also contribute to the evidence-base for peer-leadership programs internationally.
  
  
  
  Australian New Zealand Clinical Trials Registry, ACTRN12616000048482 . Registered on 19 January 2016.
authors.affiliation: Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Road, Acton ACT 2601, Canberra, Australia. Alison.Calear@anu.edu.au.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Calear
authors.affiliation: Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Road, Acton ACT 2601, Canberra, Australia.
authors.forename: Jacqueline L
authors.initials: JL
authors.lastname: Brewer
authors.affiliation: Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Road, Acton ACT 2601, Canberra, Australia.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Batterham
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Mackinnon
authors.affiliation: Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Wyman
authors.affiliation: Sources of Strength, Bismarck, ND, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: LoMurray
authors.affiliation: Black Dog Institute, University of New South Wales, Sydney, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Shand
authors.affiliation: Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Road, Acton ACT 2601, Canberra, Australia.
authors.forename: Dominique
authors.initials: D
authors.lastname: Kazan
authors.affiliation: Black Dog Institute, University of New South Wales, Sydney, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Christensen
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000294:Adolescent Behavior; D000367:Age Factors; D020958:Australian Capital Territory; D002648:Child; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008603:Mental Health; D009517:New South Wales; D010342:Patient Acceptance of Health Care; D010379:Peer Group; D015397:Program Evaluation; D012107:Research Design; D012307:Risk Factors; D012572:School Health Services; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology; D013997:Time Factors; D000092864:Suicide Prevention
keywords: Adolescent; Help-Seeking; Mental health; Prevention; School; Suicide