The Role of Primary Prevention

June 06, 2013

News Type:  Director's Corner
Author:  Phillip Rodgers, Ph.D.

When we talk about suicide prevention, we usually refer to “prevention” writ large, meaning anything and everything we do to prevent suicide. But the word “prevention” can actually be used to refer to three types of activities:

1)   Primary prevention, which seeks to prevent the onset of a condition

2)   Secondary prevention, which seeks to treat people who exhibit signs of a condition or risks closely associated with that condition

3)   Tertiary prevention, which treats people already afflicted by a condition, such as cancer or heart disease

In a commentary in the May 2013 issue of the American Journal of Public Health, University of Rochester Medical Center researcher Eric Caine noted that most of our suicide prevention efforts have focused on the identification, referral, and treatment of people at risk for suicide – and that these efforts have met with limited success. Caine suggests that it is also important to “alter the life trajectories of people before they become suicidal” – that is, to engage in primary prevention.

One example of primary prevention that has received attention lately is the Good Behavior Game. The Good Behavior Game is a classroom management technique for early elementary grades.  Studies indicate that the Good Behavior Game results in several positive outcomes, including greater time on task, fewer disruptions, and other immediate benefits.  But most interesting are the long-term benefits.

By early adulthood, students who had participated in the Good Behavior Game in first and second grade were 19 percent less likely to have drug abuse or dependence disorders, 17 percent less likely to have used services for emotional, behavioral, drug or alcohol problems, 8 percent less likely to be diagnosed with antisocial personality disorder, and 50 percent less likely to report a suicide attempt than students who did not participate in the Good Behavior Game.

While the Good Behavior Game is not the whole solution to the problem of suicide, the long-term outcomes of the Good Behavior Game remind us of the important role that primary prevention, when combined with secondary and tertiary prevention activities, can play  in efforts to reduce the burden of suicide in this country.  


Caine, E. D., (2013). Forging an agenda for suicide prevention in the United States. American Journal of Public Health, 103(5), 822-829.

Wilcox, H. C., Kellam, S. G., Brown, C. H., Poduska, J. M., Ialongo, N. S.,  Wang, W., & Anthony, J. C. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attemptsDrug and Alcohol Dependence, 95(Suppl. 1), S60–S73.