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Systems change for suicide prevention among adolescents: a rural Wisconsin county approach
  1. Sara Kohlbeck1,
  2. Nicole Fumo1,
  3. Stephen Hargarten2
  1. 1 Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  2. 2 Emergency Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
  1. Correspondence to Sara Kohlbeck, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI 53226-3548, USA; skohlbeck{at}


Background Suicide is the tenth leading cause of death in Wisconsin. Between the years 2012 and 2016, rural counties in Wisconsin had statistically significantly higher rates of suicide than urban counties. Counties in northern and western Wisconsin have some of the highest rates of suicide, with several counties having rates nearly double the state suicide rate for the same time period.

Study aim This study investigates the utility of a systems-level, primary prevention suicide prevention strategy in reducing suicide in a rural Wisconsin county. This project focuses upstream to promote behavioural health resiliency and decrease risk factors for suicide.

Results County-level suicide rates decreased over time. Youth Risk Behaviour Survey results demonstrate that the percentage of students in the high school who report that they have an adult in the school to turn to for support increased by 11%. In addition, the number of students reporting a suicide attempt over the past 12 months decreased from 8.4% to 7.2%. Trust among project partners remained above 75% across the three survey timepoints, and the results demonstrated that power became more equally dispersed over time. There was an increase in community knowledge in where to go for help in an emotional crisis.

Discussion Systems change to prevent suicide is a complex undertaking but can affect change at the county level. In our study county, we learnt that a strong implementation body (our Partnership Council) and buy-in from key partners is essential in creating change at the systems level.

  • public health
  • social marketing
  • suicide/self-harm
  • community research

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  • Collaborators Monica Lobenstein, Lisa Listle

  • Contributors SH and SK conceived of the presented idea. SK and NF planned out and carried out the project evaluation, surveys, focus groups and data analysis. SK and NF wrote the manuscript in consultation with SH.

  • Funding This work was supported by the Advancing a Healthier Wisconsin Endowment grant number 551070.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Medical College of Wisconsin Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information. Suicide outcome data is available in a public open access repository. Survey data and the study protocol will be made available upon reasonable request beginning three months and ending five years after publication to researchers who provide a methodologically sound proposal to achieve aims in the approved proposal. Proposals should be made to To gain access, researchers will need to sign a data use agreement.