• Evaluations of mental health and suicide-related educational campaigns are relatively rare and generally methodologically weak, which limits definitive conclusions.¹Nevertheless, the research to date does suggest some directions for future efforts.
• Recent reviews have concluded that suicide prevention and so–called “mental health literacy” campaigns can make short-term improvements in mental health and suicide-related knowledge and attitudes, for example, increased recognition of depression. However, most studies show limited effects on behaviors when communications is used alone.^2,3
• Public education and outreach efforts generally achieve better results with combined strategies (media plus other programs), repeated exposure to messages through multiple channels, and locally planned efforts, presumably due to the ability to tailor messages to local circumstances and homogeneous populations.³
• These findings align with the broader communications literature, which suggests that interventions are more effective when they combine communications with other programmatic components when addressing complex health issues.
• Consistent with this conclusion, a four-level intervention that used media to complement more intensive training and service components was associated with reductions in suicide in two German cities.⁴This finding suggests the potential value of using communications strategically to support, reinforce, and publicize existing programs and services.
• Some studies suggest that simple informational messages may be able to change behavior if they promote relatively straightforward actions.⁵
• For example, two local U.S. campaigns conducted campaigns to publicize crisis lines. They did see concomitant increases in call volume, although they were unable to verify whether the additional calls resulted directly from the campaign or came from those at greatest risk.^6,7
• As noted above, changing more complex behaviors most likely requires combining informational messages with other interventions and sustaining these efforts over time.
• One study recommended the use of behavior change theories to guide the development of suicide prevention campaigns, which is consistent with the broader communications literature. Specifically, the authors suggested using the Theory of Planned Behavior to create messages to persuade individuals to intervene when someone they know is suicidal.⁸
• When promoting a program or service, it is important to plan ahead and include other program components if needed to ensure there is sufficient capacity, expertise, and resources to meet the resulting demand⁹
• A 2003 expert panel was convened to consider safe and effective public information efforts, and their conclusions were published in 2005. ¹⁰While the group met over a decade ago, they made several important points that remain valid today
• Suicide prevention professionals can benefit from “lessons learned” from evaluations of communications campaigns outside suicide prevention. Specifically:
• Communications efforts should be carefully planned, implemented, and evaluated using available research and theory.
• The planning phase should include assessment of the problem to be addressed, the reasons the problem exists, the audience to be addressed and needed behavior changes, and the audience’s barriers to taking action. This information is used to establish clear and specific campaign outcomes.
• Implementation planning is equally important, including establishing the duration, intensity, what delivery channels will be used, and the level of campaign exposure needed to achieve the intended outcomes.
• It is important to focus efforts on the most important messages and pre-test messages and materials to ensure they maintain the campaign’s purpose.
• Assessment is essential for both planning and testing outcomes. The authors stated:

“Successful campaigns incorporate evaluation strategies for both campaign development and outcome assessment; evaluations should be designed to detect campaign outcomes, including changes in awareness, attitudes, and behavior; and the outcome measures should mirror the objectives of the campaign. It was noted that outcomes may be short-term, intermediate, and/or long-term, and that developers of campaigns should be aware that their choice of a timeframe and design should consider comprehensiveness, scope, and feasibility of the campaign.” (Chambers et al., p. 136)

• Safety is a key issue. The research on “social contagion” or imitation effects from media coverage about suicide raises safety concerns for public information efforts as well. Specifically, public messaging should:
• Avoid normalizing unsafe behaviors by implying that they are typical or acceptable.
• Avoid sharing high prevalence rates, which may also normalize suicidal behavior as an expected and inevitable behavior.
• Avoid approaches that may glorify or increase the recognition of individual cases of suicide.
• Background research and testing can help to prevent dissemination of messages with unintended negative effects. It is important to mindful that broadly disseminated messages reach multiple audiences, and some subgroups of the intended audience (or among those groups not targeted) may respond to messages differently than other groups.
• Tailor messages to specific audiences and goals. For example, it may be useful to inform policymakers and health care providers that suicide is more prevalent than homicide and commonly seen in health care settings in order to motivate political support and systems changes. However, for persons at risk, it may be more helpful to send the message that most people are able to find their way through a suicidal crisis and to describe various help and support options that are available.
• More research is needed on public messaging efforts, an observation that is still true in 2014 (see the Action Alliance’s Prioritized Research Agenda).

References

1. Collins C, Edwards A, Jones P, Kay L, Cox P, Puddy R. A Comparison of the Interactive Systems Framework (ISF) for Dissemination and Implementation and the CDC Division of HIV/AIDS Prevention’s Research-to-Practice Model for Behavioral Interventions. Am J Community Psychol
2. Goldney RD, Fisher LJ. Have broad-based community and professional education programs influenced mental health literacy and treatment seeking of those with major depression and suicidal ideation? Suicide Life Threat Behav. 2008;38(2):129-142. doi:10.1521/suli.2008.38.2.129.
3. Dumesnil H, Verger P. Public awareness campaigns about depression and suicide: a review. Psychiatr Serv Wash DC. 2009;60(9):1203-1213. doi:10.1176/appi.ps.60.9.1203.
4. Hegerl U, Mergl R, Havers I, et al. Sustainable effects on suicidality were found for the Nuremberg alliance against depression. Eur Arch Psychiatry Clin Neurosci. 2010;260(5):401-406. doi:10.1007/s00406-009-0088-z.
5. Hornik R. Introduction: public health communication: making sense of contradictory evidence. In: Hornik R, ed. Public Health Communication: Evidence for Behavior Change. Mahwah, NJ: Lawrence Erlbaum Associates; 2002.
6.  Jenner E, Jenner LW, Matthews-Sterling M, Butts JK, Williams TE. Awareness effects of a youth suicide prevention media campaign in Louisiana. Suicide Life Threat Behav. 2010;40(4):394-406. doi:10.1521/suli.2010.40.4.394.
7. Oliver RJ, Spilsbury JC, Osiecki SS, Denihan WM, Zureick JL, Friedman S. Brief report: preliminary results of a suicide awareness mass media campaign in Cuyahoga County, Ohio. Suicide Life Threat Behav. 2008;38(2):245-249.
8. Shemanski Aldrich R, Cerel J. The development of effective message content for suicide intervention: theory of planned behavior. Crisis. 2009;30(4):174-179. doi:10.1027/0227-5910.30.4.174.
9. Boeke M, Griffin T, Reidenberg DJ. The physician’s role in suicide prevention: lessons learned from a public awareness campaign. Minn Med. 2011;94(1):44-46.
10. Chambers DA, Pearson JL, Lubell K, Brandon S, O’Brien K, Zinn J. The science of public messages for suicide prevention: a workshop summary. Suicide Life Threat Behav. 2005;35(2):134-145.