Release Date:  March 13, 2000

PA NUMBER:  PA-00-077

National Institute of Mental Health
National Institute on Drug Abuse



The National Institute of Mental Health (NIMH) and the National Institute on 
Drug Abuse (NIDA) invite research grant applications to study interventions to 
reduce suicidal behaviors in youth. Although youth suicidal behavior has been 
recognized as a significant public health problem for several decades, there are 
few effective treatments or preventive interventions that have been developed 
and specifically tested to reduce suicidal behavior in youth.  The purpose of 
this announcement is to support efforts to develop and test such interventions 
that build on both risk and protective factors.  This PA identifies the need to 
test the effectiveness of interventions for reducing suicidal behavior from a 
number of approaches, ranging from broad-based community or school-based 
prevention efforts, to more targeted approaches that reduce suicidal behavior in 
youth with identified mental disorders or substance use disorders (SUD).


The Public Health Service (PHS) is committed to achieving the health promotion 
and disease prevention objectives of "Healthy People 2010," a PHS-led national 
activity for setting priority areas.  This Program Announcement (PA), 
Interventions for Suicidal Youth, is related to the priority areas of reducing 
completed suicide and suicide attempts among adolescents, and reducing drug-
related deaths and proportion of youth who have used addictive substances per 
the Violent and Abusive Behavior, Mental Health and Mental Disorders, and 
Alcohol and Drugs Objectives.  Potential applicants may obtain a copy of 
"Healthy People 2010" at


Applications may be submitted by domestic and foreign, for-profit and non-profit 
organizations, public and private, such as universities, colleges, hospitals, 
laboratories, units of State and local governments, and eligible agencies of the 
Federal government. Racial/ethnic minority individuals, women, and persons with 
disabilities are encouraged to apply as principal investigators.


This PA will use the National Institutes of Health (NIH) R21 and R01 grant award 
mechanisms.  Responsibility for the planning, direction, and execution of the 
proposed project will be solely that of the applicant.  The total project period 
for an application submitted in response to this PA may not exceed five years 
for an R01 application or three years for an R21.

For all R21 applications and for competing R01 awards requesting up to $250,000 
direct costs per year, specific application instructions have been modified to 
reflect “MODULAR GRANT” and “JUST-IN-TIME” streamlining efforts being undertaken 
at NIH.  More detailed information about modular grant applications, including a 
sample budget narrative justification pages and a sample biographical sketch, is 
available via the Internet at:  Applications that 
request more than $250,000 in any year must use the standard PHS 398 (rev. 4/98) 
application instructions.

Because the R21 grants have a special application format and review criteria, 
applicants are strongly encouraged to consult with program staff (listed under 
INQUIRIES) and to obtain the appropriate additional announcements for those 
grant mechanisms.  Individual grants are limited to 3 years and are not 
renewable.  Special instructions and information for the NIMH R21 can be found 
at Special 
instructions and information for the NIDA R21 can be found at

Applicants interested in applying for the Collaborative R01 award, an NIMH-
specific mechanism, are strongly encouraged to consult with program staff 
(listed under INQUIRIES) and to obtain appropriate additional information 
concerning the program.  PAR-98-017, “Collaborative R01s for Clinical Studies of 
Mental Disorders,” is available at 



In 1997, suicide was the third leading cause of death for persons aged 10 to 24 
years.  Increases in youth suicide completion rates over the past few decades, 
and annual survey data that indicate that up to 7 percent of high school youth 
have attempted suicide, have prompted a number of calls by public health 
officials to improve efforts to prevent and treat suicidal behaviors in youth.  
Most recently, the Office of the Surgeon General issued a “Call to Action to 
Prevent Suicide” [see].
This call recognizes the advances in understanding the potential precursors and 
risk factors for youth suicidal behavior, specifically mental and substance use 
disorders (SUD includes both substance dependence and substance abuse).  
Increased knowledge about precursors for completed adolescent suicides has come 
from several controlled psychological autopsies.  For adolescent males, comorbid 
conduct disorder, mood disorder and SUD are among the most common diagnoses.  
For adolescent females, mood disorders predominate, with lower rates of comorbid 
SUD and conduct disorder compared to male suicide decedents.  Epidemiologic 
studies of suicidal youth have also identified co-occurring mood disorders, SUD, 
and stressful life events as risk factors for suicidal behaviors.

Certain subpopulations of youth are known to have greater risk for suicidal 
behavior.  American Indian and Alaskan Native male youth have completed suicide 
rates that are ten times the U.S. average.  However, there is substantial 
variation in suicide rates and various risk factors, such as SUD, by tribe.  
African American male youth had historically low suicide rates.  However, 
between 1980 and 1996 their rates doubled, approximating the rates of their 
white counterparts.  Increasing homicide rates, including “victim-precipitated 
homicide” (by deliberately getting in the line of fire of either gang or law 
enforcement activity) also highlight the critical need to address potentially 
specific ethnic and cultural risk and protective factors.  Youth at greater risk 
for attempted suicide include Hispanic females, and lesbian, gay, and bisexual 
youth.  Recent school shootings and subsequent suicidal behavior by perpetrators 
have resulted in the U.S. Department of Education assisting schools to prepare 
for crisis situations, including early identification of behaviors or “warning 
signs” among youth at risk [see].  Many of the early warning 
signs for later violent behavior have also been found to be correlates and 
precursors of suicidal behavior.  Runaway and homeless youth are at greater risk 
for suicidal behavior relative to their counterparts who attend school.  
Incarcerated youth, as well as those in residential treatment for mental and 
substance abuse disorders, also have multiple risk factors for suicidal and 
other self-harming behaviors, such as drug use and unprotected sex, that 
increase injury and illness.

Despite advances in knowledge about putative risk and protective factors, and 
correlates of suicidal behavior in youth, few preventive or treatment 
interventions have been developed and tested to determine their efficacy, 
effectiveness, safety, and utility for the various groups of youth at risk.  For 
example, interventions developed and tested in emergency room settings indicate 
that few youth and their families adhere to follow-up treatment.  In addition to 
the clinical challenges found in treating high risk youth and their families, 
there are other reasons for the limited research on this topic.  Suicidal 
behaviors, in particular completed and attempted suicide, are relatively rare 
phenomena, and few studies have been adequately designed with sufficient power 
to determine the efficacy of interventions.  A third reason is that high risk 
youth are often excluded from clinical trials.  Most treatment trials of youth 
with mental disorders or SUD have excluded those with a history of suicide 
attempts, as well as those youth perceived to be a current or future risk for 
suicide.  A common rationale offered for these exclusions was that the 
capability of the investigators and the design of the treatments were not 
adequate for monitoring and treating suicidal crises.  Thus exclusion of youth 
with suicidal histories or risk for future suicidal behavior was justified based 
on patient safety and perceived liability risks to investigators and/or sponsors 
of research.

NIMH is expanding its efforts to include more representative samples in 
intervention trials with youth who have mental disorders and comorbid SUD.  NIH 
policies on the inclusion of children have also led to adult intervention 
studies lowering the age of inclusion to enroll younger subjects.  It is likely 
that a subgroup of the youth enrolled in these trials will either have a history 
of suicidal behavior, or exhibit suicidal behavior during the course of an 
intervention.  With appropriate informed consent, clinical expertise, and 
adequate monitoring and safety protocols, it should be possible in future 
intervention studies to include a greater proportion of youth who have either 
been suicidal in the past, or may become suicidal during trials.  A review of 
reliable and valid measures for youth suicidal behavior, as well as general 
guidelines for the development of informed consent, safety monitoring, crisis 
protocols, and adequate follow-up of suicidal patients are available at  However, the implementation and 
further testing of these measures and guidelines in treatment trials is 
critically needed for high risk youth for a number of conditions and settings.

To expand the knowledge base of effective and safe approaches to preventing and 
treating youth suicidal behavior, applications pertaining to the following 
research topics are encouraged.  However, these topics should be considered 
illustrative, and not restrictive.

o  Secondary analyses of previously conducted prevention, intervention, or 
service system studies to assess their effectiveness in reducing suicidal 
behavior in youth is encouraged.  Such interventions may have targeted 
depression, anxiety, attention-deficit hyperactivity, aggressive and violent 
behavior, serious emotional disturbances, SUD or substance use in youth.  
Examples:  Do SUD prevention efforts also reduce suicidal behaviors, and if so, 
for which children?  Does greater enforcement of under-age drinking laws reduce 
youth suicide rates?  Are treatments effective for reducing anxiety in youth 
also effective in reducing suicidal behavior?  Do the increased availability 
and/or utilization of mental health insurance coverage reduce suicidal behavior 
in youth?

o  Interventions designed specifically to reduce self-destructive behavior and 
suicide attempts among youth who suffer from severe mental illness, including 
schizophrenia, major depression and bipolar disorders, obsessive-compulsive 
disorder, conduct disorder, as well as behavior disturbances, and/or SUD are 

o  Innovative interventions designed to reduce future morbidity and enhance 
future functioning of suicidal youth presenting to ERs are critically needed.  
The application of reliable and valid assessment of youth suicidal behavior in 
ER settings could also help document service needs, use and outcomes. 

o  A number of school-based suicide awareness, risk screening and referral, and 
post-vention efforts have been developed, but few are adequately evaluated to 
determine their effectiveness.  The development and testing of theory driven, 
school-based preventive interventions for depression and SUD, with suicidality 
as a key outcome, are needed.

o  Incorporation of measures of suicidality in school-based interventions 
designed to reduce violence and aggressive behavior would add to the knowledge 
base of effective treatments for suicidality in youth.  Development of school-
based screening approaches, crisis protocol, referral/intervention and services 
for youth at risk for violence, both self- and other-directed, are also needed.

o  Shelters that provide health and counseling services to runaway and homeless 
youth are in need of crisis protocol development, triage, and intervention 
development to reduce suicidal behavior.  Gay, lesbian and bisexual youth are 
often over-represented in these settings. The application of reliable and valid 
assessment to document risk factors and service needs and outcomes are also 

o  Similarly, incarcerated youth have high rates of mental disorders, SUDs, and 
life events that increase their risk for suicidal behavior.  Approaches to 
screening, crisis protocol development, triage, intervention development and 
effective intervention implementation are needed for incarcerated youth.

o  Several uncontrolled community interventions appear to have reduced suicide 
contagion and other risk factors for suicidal behavior.  More systematic 
evaluation of the effectiveness of community interventions is needed, including 
the identification of protective factors, to help refine and identify the most 
potent intervention components.  Replications of interventions are also needed 
to determine their generalizability to other communities.

o  Further specification and utilization of gender-, ethnic- and culturally-
specific risk and protective factors in the testing and implementation of 
interventions is encouraged.


This PA poses a number of issues related to human subjects that must be 
addressed.  1) Prior research has suggested that some interventions using 
school-based suicide awareness programs as a key approach have had untoward 
effects, such as increasing distress in vulnerable youth.  Efforts to minimize 
or avoid such untoward effects must be addressed. 2) Despite the presence of 
multiple risk factors, some youth may not become suicidal.  Applications should 
address how research subjects will be identified, how subjects and their 
families will be approached about research involvement, and reasons for 
maintaining or breaking confidentiality.  3) Clinical trials that include high 
risk youth must address, in detail, consent procedures, safety monitoring, and 
crisis protocols.  Since suicide attempts are relatively rare, adequately 
powered interventions are likely to be multi-site in nature.  Thus 
operationalization of crisis protocols and other procedures for multi-site 
studies is critical to ensure comparable treatments as well as safety for 
patients.  Anticipated circumstances, decision points and procedures regarding 
breaking clinical blinds and making treatment referrals outside of trial 
protocols, should be described.


It is the policy of the NIH that women and members of minority groups and their 
subpopulations must be included in all NIH supported biomedical and behavioral 
research projects involving human subjects, unless a clear and compelling 
rationale and justification is provided that inclusion is inappropriate with 
respect to the health of the subjects or the purpose of the research.  This 
policy results from the NIH Revitalization Act of 1993 (Section 492B of Public 
Law 103-43).

All investigators proposing research involving human subjects should read the 
"NIH Guidelines For Inclusion of Women and Minorities as Subjects in Clinical 
Research," which have been published in the Federal Register of March 28, 1994 
(FR 59 14508-14513) and in the NIH Guide for Grants and Contracts, Vol. 23, No. 
11, March 18, 1994 available on the web at the following URL address:


It is the policy of NIH that children (i.e., individuals under the age of 21) 
must be included in all human subjects research, conducted or supported by the 
NIH, unless there are scientific and ethical reasons not to include them.  This 
policy applies to all initial (Type 1) applications submitted for receipt dates 
after October 1, 1998.

All investigators proposing research involving human subjects should read the 
"NIH Policy and Guidelines on the Inclusion of Children as Participants in 
Research Involving Human Subjects" that was published in the NIH Guide for 
Grants and Contracts, March 6, 1998, and is available at the following URL 

Investigators also may obtain copies of these policies from the program staff 
listed under INQUIRIES.  Program staff may also provide additional relevant 
information concerning the policy.


Applicants are strongly encouraged to contact the program contacts listed under 
INQUIRIES with any questions regarding their proposed project and the goals of 
this PA.

Applications are to be submitted on the grant application form PHS 398 (rev.
4/98) and will be accepted at the standard application deadlines as indicated
in the application kit.  Application kits are available at most institutional 
offices of sponsored research and from the Division of Extramural Outreach and 
Information Resources, National Institutes of Health, 6701 Rockledge Drive, MSC 
7910, Bethesda, MD 20892-7910, telephone (301) 710-0267, Email:  Applications are also available on the World Wide Web at:


The modular grant concept establishes specific modules in which direct costs may 
be requested as well as a maximum level for requested budgets.  Only limited 
budgetary information is required under this approach.  The just-in-time concept 
allows applicants to submit certain information only when there is a possibility 
for an award.  It is anticipated that these changes will reduce the 
administrative burden for the applicants, reviewers and Institute staff.  The 
research grant application form PHS 398 (rev. 4/98) is to be used in applying 
for these grants, with the modifications noted below.


Modular Grant applications will request direct costs in $25,000 modules, up to a 
total direct cost request of $250,000 per year.  (Applications that request more 
than $250,000 direct costs in any year must follow the traditional PHS 398 
application instructions.)  The total direct costs must be requested in 
accordance with the program guidelines and the modifications made to the 
standard PHS 398 application instructions described below:

PHS 398

o  FACE PAGE: Items 7a and 7b should be completed, indicating Direct Costs (in 
$25,000 increments up to a maximum of $250,000) and Total Costs [Modular Total 
Direct plus Facilities and Administrative (F&A) costs] for the initial budget 
period.  Items 8a and 8b should be completed indicating the Direct and Total 
Costs for the entire proposed period of support.

of the PHS 398.  It is not required and will not be accepted with the 

categorical budget table on Form Page 5 of the PHS 398.  It is not required and 
will not be accepted with the application.

o  NARRATIVE BUDGET JUSTIFICATION - Prepare a Modular Grant Budget Narrative 
page.  (See for sample 
pages.)  At the top of the page, enter the total direct costs requested for each 
year.  This is not a Form page.

o  Under Personnel, list key project personnel, including their names, percent 
of effort, and roles on the project.  No individual salary information should be 
provided.  However, the applicant should use the NIH appropriation language 
salary cap and the NIH policy for graduate student compensation in developing 
the budget request.

For Consortium/Contractual costs, provide an estimate of total costs (direct 
plus facilities and administrative) for each year, each rounded to the nearest 
$1,000.  List the individuals/organizations with whom consortium or contractual 
arrangements have been made, the percent effort of key personnel, and the role 
on the project.  Indicate whether the collaborating institution is foreign or 
domestic.  The total cost for a consortium/contractual arrangement is included 
in the overall requested modular direct cost amount.  Include the Letter of 
Intent to establish a consortium.

Provide an additional narrative budget justification for any variation in the 
number of modules requested.

o  BIOGRAPHICAL SKETCH - The Biographical Sketch provides information used by 
reviewers in the assessment of each individual's qualifications for a specific 
role in the proposed project, as well as to evaluate the overall qualifications 
of the research team.  A biographical sketch is required for all key personnel, 
following the instructions below.  No more than three pages may be used for each 
person.  A sample biographical sketch may be viewed at:

- Complete the educational block at the top of the form page;
- List position(s) and any honors;
- Provide information, including overall goals and responsibilities, on research 
projects ongoing or completed during the last three years.
- List selected peer-reviewed publications, with full citations;

o  CHECKLIST - This page should be completed and submitted with the application.  
If the F&A rate agreement has been established, indicate the type of agreement 
and the date.  All appropriate exclusions must be applied in the calculation of 
the F&A costs for the initial budget period and all future budget years.

o  The applicant should provide the name and phone number of the individual to 
contact concerning fiscal and administrative issues if additional information is 
necessary following the initial review.

Applicants planning to submit an investigator-initiated new (type 1), competing 
continuation (type 2), competing supplement, or any amended/revised version of 
the preceding grant application types requesting $500,000 or more in direct 
costs for any year are advised that he or she must contact the Institute program 
staff before submitting the application, i.e., as plans for the study are being 
developed.  Furthermore, the application must obtain agreement from the 
Institute staff that the Institute will accept the application for consideration 
for award.  Finally, the applicant must identify, in a cover letter sent with 
the application, the staff member and Institute who agreed to accept assignment 
of the application.

This policy requires an applicant to obtain agreement for acceptance of both any 
such application and any such subsequent amendment.  Refer to the NIH Guide for 
Grants and Contracts, March 20, 1998 at

Any application subject to this policy that does not contain the required
information in a cover letter sent with the application will be returned to the 
applicant without review.

The title and number of the program announcement must be typed on line 2 of the 
face page of the application form and the YES box must be marked.

Submit a signed, typewritten original of the application, including the 
Checklist, and five signed photocopies in one package to:

BETHESDA, MD 20892-7710
BETHESDA, MD 20817 (for express/courier service)


Applications will be assigned on the basis of established PHS referral 
guidelines.  Applications will be evaluated for scientific and technical merit 
by an appropriate scientific review group convened in accordance with the 
standard NIH peer review procedures.  As part of the initial merit review, all 
applications will receive a written critique and undergo a process in which only 
those applications deemed to have the highest scientific merit, generally the 
top half of applications under review, will be discussed, assigned a priority 
score, and receive a second level review by the appropriate national advisory 
council or board.

Review Criteria 

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  In the 
written comments reviewers will be asked to discuss the following aspects of the 
application in order to judge the likelihood that the proposed research will 
have a substantial impact on the pursuit of these goals.  Each of these criteria 
will be addressed and considered in assigning the overall score, weighting them 
as appropriate for each application.  Note that the application does not need to 
be strong in all categories to be judged likely to have major scientific impact 
and thus deserve a high priority score.  For example, an investigator may 
propose to carry out important work that by its nature is not innovative but is 
essential to move a field forward.

(1) Significance:  Does this study address an important problem?  If the aims of 
the application are achieved, how will scientific knowledge be advanced?  What 
will be the effect of these studies on the concepts or methods that drive this 

(2) Approach:  Are the conceptual framework, design, methods, and analyses 
adequately developed, well-integrated, and appropriate to the aims of the 
project?  Does the applicant acknowledge potential problem areas and consider 
alternative tactics?

(3) Innovation:  Does the project employ novel concepts, approaches or methods?  
Are the aims original and innovative?  Does the project challenge existing 
paradigms or develop new methodologies or technologies?

(4) Investigator:  Is the investigator appropriately trained and well suited to 
carry out this work?  Is the work proposed appropriate to the experience level 
of the principal investigator and other researchers (if any)?

(5) Environment:  Does the scientific environment in which the work will be done 
contribute to the probability of success?  Do the proposed experiments take 
advantage of unique features of the scientific environment or employ useful 
collaborative arrangements?  Is there evidence of institutional support?

In addition to the above criteria, in accordance with NIH policy, all 
applications will also be reviewed with respect to the following:

o  The adequacy of plans to include both genders, minorities and their 
subgroups, and children as appropriate for the scientific goals of the research.  
Plans for the recruitment and retention of subjects will also be evaluated.

o  The reasonableness of the proposed budget and duration in relation to the 
proposed research

o  The adequacy of the proposed protection for humans, animals or the 
environment, to the extent they may be adversely affected by the project  
proposed in the application.


Applications will compete for available funds with all other recommended 
applications.  The following will be considered in making funding decisions:  
Quality of the proposed project as determined by peer review, availability of 
funds, and program priority.


Inquiries are encouraged.  The opportunity to clarify any issues or questions 
from potential applicants is welcome.

Inquiries regarding programmatic issues of intervention development and 
treatment adherence can be directed to:

Editha D. Nottelmann, Ph.D.
Division of Mental Disorders, Behavioral Research and AIDS
National Institute of Mental Health
6001 Executive Boulevard, Room 6200 MSC 9617
Bethesda, MD 20892-9617
Telephone: (301) 443-9734
FAX: (301) 480-4415

Direct inquiries regarding programmatic issues of application/testing of 
existing interventions, provisions for inclusion of suicidal youth in clinical 
trials, and crisis protocol development for clinical trials and services to:

Jane Pearson, Ph.D.
Division of Services and Intervention Research
National Institute of Mental Health
6001 Executive Boulevard, Room 7160, MSC 9635
Bethesda, MD 20892-9635
Telephone:  (301) 443-3598
FAX:  (301) 594-6784 

Inquiries regarding drug abuse interventions can be directed to:

Jacques Normand, Ph.D.
Division of Epidemiology, Services and Prevention Research
National Institute on Drug abuse
6001 Executive Boulevard
Bethesda, MD  20892-9589
Telephone: (301) 443-6720

Direct inquiries regarding fiscal matters to:

Diana S. Trunnell
Grants Management Branch
National Institute of Mental Health
6001 Executive Boulevard, Room 6115, MSC 9605
Bethesda, MD 20892-9605
Telephone: (301) 443-2805
FAX:  (301) 443-6885

Gary Fleming, J.D., M.A.
Grants Management Branch
National Institute on Drug Abuse
6001 Executive Blvd., Room 3131, MSC 9541
Bethesda, MD  20892-9541
Telephone:  (301) 443-6710
FAX :  (301) 594-6847

The Substance Abuse and Mental Health Services Administration supports 
demonstration programs in the prevention and treatment of mental and substance 
abuse disorders, including suicide prevention.  Information on funding 
opportunities can be found at

Inquiries can be directed to:
Department of Program Development Special Population and Projects
5600 Fishers Lane, Room 17C-26
Rockville, MD 20857
Telephone: (301) 443-2940
FAX: (301) 443-5479

The National Center for Injury Prevention and Control (NCIPC) of Centers for 
Disease Control and Prevention supports research on the prevention of suicide in 
youth.  Information about current requests for proposals can be found on the 
NCIPC internet site


This program is described in the Catalog of Federal Domestic Assistance No. 
93.242 (NIMH) and 93.279 (NIDA).  Awards are made under authorization of the 
Public Health Service Act, Title IV, Part A (Public Law 78-410, as amended by 
Public Law 99-158, 42 USC 241 and 285) and administered under NIH grants 
policies and Federal Regulations 42 CFR 52 and 45 CFR Part 74.  This program is 
not subject to the intergovernmental review requirements of Executive Order 
12372 or Health Systems Agency review.

The PHS strongly encourages all grant and contract recipients to provide a 
smoke-free workplace and promote the non-use of all tobacco products.  In 
addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in 
certain facilities (or in some cases, and portion of a facility) in which 
regular or routine education, library, day care, health care or early childhood 
development services are provided to children.  This is consistent with the PHS 
mission to protect and advance the physical and mental health of the American 

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