School- and Community-Based Youth Suicide Prevention Interventions: Hot Idea, Hot Air, or Sham?

Development of the Life Gatekeeper suicide prevention training programme in China: a Delphi study

Background

Youth suicide has been a pressing public mental health concern in China, yet there is a lack of gatekeeper intervention programmes developed locally to prevent suicide among Chinese adolescents.

Aims

The current Delphi study was the first step in the systematic development of the Life Gatekeeper programme, the first gatekeeper programme to be developed locally in China that aims to equip teachers and parents with the knowledge, skills and ability to identify and intervene with students at high risk of suicide.

Methods

The Delphi method was used to elicit a consensus of experts who were invited to evaluate the importance of training content, the feasibility of the training delivery method, the possibility of achieving the training goals and, finally, the appropriateness of the training materials. Two Delphi rounds were conducted among local experts with diversified professional backgrounds in suicide research and practice. Statements were accepted for inclusion in the adjusted training programme if they were endorsed by at least 80% of the panel.

Results

Consensus was achieved on 201 out of 207 statements for inclusion into the adapted guidelines for the gatekeeper programme, with 151 from the original questionnaire and 50 generated from comments of the panel members. These endorsed statements were synthesised to develop the content of the Life Gatekeeper training programme.

Conclusions

This Delphi study provided an evidence base for developing the first gatekeeper training programme systematically and locally in China. We hope that the current study can pave the way for more evidence-based suicide prevention programmes in China. Further study is warranted to evaluate the effectiveness of the Life Gatekeeper training programme.

Can We Notice the Suicidal Warning Signs of Adolescents With Different Psychometric Profiles Before Their Death?: Analysis of Teachers' Reports

BACKGROUND

This study aimed to analyze the suicidal warning signs of Korean students with different psychometric profiles based on teacher reports.

METHODS

This was a retrospective cohort study based on Korean school teachers' responses to the Student Suicide Report Form. In total, 546 consecutive cases of student suicide were reported from 2017 to 2020. After missing data were excluded, 528 cases were included. The report consisted of demographic factors, the Korean version of the Strengths and Difficulties Questionnaire (SDQ) for teacher reporting, and warning signs of suicide. Frequency analysis, multiple response analysis, the χ² test, and Latent Class Analysis (LCA) were performed.

RESULTS

Based on the scores of the Korean version of the teacher-reported SDQ, the group was divided into nonsymptomatic (n = 411) and symptomatic (n = 117) groups. Based on the LCA results, four latent hierarchical models were selected. The four classes of deceased students showed significant differences in school type (χ² = 20.410, P < 0.01), physical illness (χ² = 7.928, P < 0.05), mental illness (χ² = 94.332, P < 0.001), trigger events (χ² = 14.817, P < 0.01), self-harm experience (χ² = 30.618, P < 0.001), suicide attempts (χ² = 24.072, P < 0.001), depressive symptoms (χ² = 59.561, P < 0.001), anxiety (χ² = 58.165, P < 0.001), impulsivity (χ² = 62.241, P < 0.001), and social problems (χ² = 64.952, P < 0.001).

CONCLUSION

Notably, many students who committed suicide did not have any psychiatric pathology. The proportion of the group with a prosocial appearance was also high. Therefore, the actual suicide warning signals were similar regardless of students' difficulties and prosocial behaviors, so it is necessary to include this information in gatekeeper education.

A Descriptive Overview of Mental Health Services Offered in Post-Secondary Educational Institutions Across Canada

OBJECTIVE

Access to adequate mental health (MH) services is necessary for nearly half of Canadian youth (18-24 years) who enroll in post-secondary education given the relatively high risk of MH problems. Our objectives were to determine the status of MH services available to students in post-secondary institutions in Canada and to determine the extent to which these services are based on the principles of a high-quality youth MH (YMH) service.

METHOD

Information on MH services was collected from websites of a representative sample (N = 67) of post-secondary institutions across all provinces. Data were analysed descriptively according to four categories (universities with a Faculty of Medicine (FoM) n = 18, other large universities n = 15, small universities n = 16, and colleges n = 18).

RESULTS

Most institutions provided 24-h crisis line support (84%) and indicated the availability of free counselling or psychotherapy (n = 62 of 67, 92.5%), while only a minority indicated provision of an initial clinical assessment (25%) and provision of multiple sessions of therapy (37%). Wait time for first contact was impressively low (<72 h) in the minority of institutions (40%) which provided this information. Access to either a prescribing physician or psychiatrist was infrequent, though several mentioned an unexplained model of "stepped care" and outside referrals. While relevant information was not uniformly easy to access, larger institutions both with and without a FoM appear to be better poised to provide MH services. None of the institutions appeared to follow all the principles of service delivery recommended for a high-quality YMH, with only two showing early identification activities.

CONCLUSIONS

MH services in post-secondary institutions may need a transformation similar to YMH services, including a clear pathway to care, an initial clinical assessment, early identification of MHA disorders, and better utilization of institutional resources through greater collaboration and matching of timely interventions to the presenting problems.

Do associations between suicide ideation and its correlates (substance use, anxiety, and depression) differ according to victimization type among youth? A Smart platform study

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23% of the youth reported suicide ideation in the past year.

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Suicide ideation was higher among those victimized by bullying.

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Suicide ideation was also higher with reported anxiety, or poor subjective health.

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Poor health did not play a role between victimization and suicide ideation.

The issues associated with mental health, substance misuse, and suicide ideation are complex and sensitive among youth. We sought to investigate the role that subjective health, internalizing and externalizing risk factors play in the association between victimization and suicide ideation among youth in Canada via used a custom-built digital epidemiological smartphone application (Smart Platform) on their personal smartphones.

A sample of 818 youth citizen scientists in Saskatchewan, Canada downloaded the app to provide information on victimization, subjective health, internalizing problems (symptoms of stress, anxiety, and depression), externalizing behaviours (cannabis use, alcohol, smoking), and suicide ideation. Binary regression models were used to estimate associations and controlled for gender, age, perpetration, and ethnicity.

From our sample, 23% of youth reported suicide ideation (i.e., thoughts) in the past year. Three types of victimization (cyberbullied, made fun or teased, or bullied via being left out) are associated with a two-times higher risk of suicide ideation. Although certain risk factors (anxiety, poor subjective health, and cannabis use) were associated with higher suicide ideation risk, they did not moderate the association between victimization and suicide ideation. Symptoms of depression were found to be protective against suicide ideation.

Suicide ideation is high among this sample of youth in Canada. Certain types of victimization, internalizing and externalizing risk factors, and poor subjective health are associated with a higher risk of suicide ideation. However, our findings confirm that the pathway from victimization to suicide ideation is complex and is potentially moderated by factors other than the ones explored here.

Scoping review of 30 years of suicide prevention in university students around the world: efficacy, effectiveness, and cost-effectiveness

A scoping review of systematic reviews was carried out to identify evidence of efficacy, effectiveness, and cost-effectiveness of universal and selective suicide prevention programs among university students worldwide. Five databases were reviewed using terms in English, Spanish, and Portuguese. The following were the inclusion criteria: systematic review or meta-analysis or meta-synthesis, suicide prevention in college students, evaluation of the efficacy, effectiveness and/or cost-effectiveness of interventions, and peer-reviewed studies. The quality of reviews was assessed. The field of study features three decades of publication in high-income countries. The strategy used, the components of the program, and the target audience to which they are delivered interfere with efficacy. In the psychoeducation strategy, the experiential and didactic components are more efficacious in the knowledge about suicide. And the motivational enhancement component promotes greater self-efficacy in suicide prevention. Programs that take a multimodal approach are effective in increasing short-term attitudes related to suicide and reducing rates of completed suicide. The gatekeeper strategy delivered to peer counselors is the most effective one in the outcomes, including short-term and long-term knowledge about suicide and its prevention and self-efficacy in suicide prevention. A greater number of evaluated studies of gatekeeper interventions were identified, indicating a trend in this research field. No review addressed the effects on subgroups that were classified based on sex, racial or sexual minorities, and special (indigenous) populations. Only one study addressed cost-effectiveness, pointing out that the psychoeducation and gatekeeper strategies have relevant net benefit rates, but the gatekeeper strategy has a higher cost–benefit ratio compared to the psychoeducation strategy. The findings indicate that psychoeducation and gatekeeper interventions tend to be more efficacious when they combine education and skills training to intervene in suicidal behavior. The components of the intervention and the target audience to which it is delivered influence efficacy. Multimodal interventions evaluate completed suicide outcomes, but require greater implementation efforts, in terms of human and financial resources and more time for the evaluation.

Quo vadis? Problems of prevention of suicidal behavior in adolescents (narrative review)

Among the existing problems related to the health and quality of life of Russian youth, the topic of suicidal behavior is the most biased, but at the same time the least solvable in a practical sense. This is due to the fact that suicide is an integrative phenomenon, and the suicidal act itself is interpreted in essence as the tip of the iceberg. Especially clearly manifested in adolescence is the fact that suicidal readiness is associated not so much with the level of severity of mental pathology and personality dysfunction, but with the general social context of total trouble. In this regard, suicide prevention cannot be based only on the timely identification of persons at risk for mental pathology. The purpose of this article is to provide a meaningful overview of modern integrated prevention programs that have shown to be effective in reducing the level of suicidal behavior among young people, compared with isolated approaches. The article discusses the problems associated with the implementation and evaluation of the effectiveness of such preventive programs, and also suggests approaches that allow them to be adapted in the public health system and, in particular, in the clinical practice of psychiatrists.

Evaluating the Longitudinal Efficacy of SafeTALK Suicide Prevention Gatekeeper Training in a General Community Sample

OBJECTIVE

The majority of individuals experiencing depression or in crisis do not seek assistance through formal support pathways. Thus, the presence of informal "gatekeepers" in the community is vital to identifying and supporting these individuals through crisis. The objective of this study was to evaluate the longitudinal effectiveness of "SafeTALK" suicide prevention gatekeeper training in a general community sample.

METHOD

Two hundred and sixty-two community members participated in half-day (4-h) gatekeeper training sessions. Surveys were taken pre- and post-training and at 6-month follow-up to evaluate participants' knowledge, preparedness, and efficacy, as well as reluctance to intervene as a suicide prevention gatekeeper.

RESULTS

Longitudinal effects were revealed for three of four evaluated appraisals. Scores for knowledge, preparedness, and efficacy were significantly higher (improved) 6 months after training, compared to pre-test. While participants showed even greater immediate effects (i.e., pre-test to post-test), follow-up scores indicate that the positive effects of training were sustained over 6 months.

CONCLUSIONS

This study is the first to evaluate SafeTALK in a community population. SafeTALK was shown to be effective at improving knowledge, preparedness, and efficacy with effects declining over time but remaining significant from pre-test. Community suicide prevention programs can benefit from the inclusion of gatekeeper training programs.

Mental health and wellbeing coordinators in primary schools to support student mental health: protocol for a quasi-experimental cluster study

Background

Half of mental health disorders begin before the age of 14, highlighting the importance of prevention and early-intervention in childhood. Schools have been identified globally by policymakers as a platform to support good child mental health; however, the majority of the research is focused on secondary schools, with primary schools receiving very little attention by comparison. The limited available evidence on mental health initiatives in primary schools is hindered by a lack of rigorous evaluation. This quasi-experimental cluster study aims to examine the implementation and effectiveness of a Mental Health and Wellbeing Co-ordinator role designed to build mental health capacity within primary schools.

Methods

This is a primary (ages 5–12) school-based cluster quasi-experimental study in Victoria, Australia. Before baseline data collection, 16 schools selected by the state education department will be allocated to intervention, and another 16 matched schools will continue as ‘Business as Usual’. In intervention schools, a mental health and well-being coordinator will be recruited and trained, and three additional school staff will also be selected to receive components of the mental health training. Surveys will be completed by consenting staff (at 2-, 5-, 10- and 17-months post allocation) and by consenting parents/carers (at 3-, 10- and 17-months post allocation) in both intervention and business as usual schools. The primary objective is to assess the change in teacher’s confidence to support student mental health and wellbeing using the School Mental Health Self-Efficacy Teacher Survey. Secondary objectives are to assess the indirect impact on systemic factors (level of support, prioritisation of child mental health), parent and teachers’ mental health literacy (stigma, knowledge), care access (school engagement with community-based services), and student mental health outcomes. Implementation outcomes (feasibility, acceptability, and fidelity) and costs will also be evaluated.

Discussion

The current study will examine the implementation and effectiveness of having a trained Mental Health and Wellbeing Coordinator within primary schools. If the intervention increases teachers’ confidence to support student mental health and wellbeing and builds the capacity of primary schools it will improve student mental health provision and inform large-scale mental health service reform.

Trial registration

The trial was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) on July 6, 2021. The registration number is ACTRN12621000873820.

Dos and Don'ts in Designing School-Based Awareness Programs for Suicide Prevention

Abstract.Background: Despite the promising evidence for the effectiveness of school-based awareness programs in decreasing the rates of suicidal thoughts and suicide attempts in young people, no guidelines on the targets and methods of safe and effective awareness programs exist. Aims: This study intends to distill recommendations for school-based suicide awareness and prevention programs from experts. Method: A three-stage Delphi survey was administered to an expert panel between November 2018 and March 2019. A total of 214 items obtained from open-ended questions and the literature were rated in two rounds. Consensus and stability were used as assessment criteria. Results: The panel consisted of 19 participants in the first and 13 in the third stage. Recommended targets included the reduction of suicide attempts, the enhancement of help-seeking and peer support, as well as the promotion of mental health literacy and life skills. Program evaluation, facilitating access to healthcare, and long-term action plans across multiple levels were among the best strategies for the prevention of adverse effects. Limitations: The study is based on opinions of a rather small number of experts. Conclusion: The promotion of help-seeking and peer support as well as facilitating access to mental health-care utilities appear pivotal for the success of school-based awareness programs.

Suicide

Throughout the world, approximately 800,000 people die by suicide every year, accounting for 1.5% of all deaths. Suicide is the 10th leading cause of death in North America and the foremost cause of death worldwide among persons 15 to 24 years of age.

Suicide portrayal in the Canadian media: examining newspaper coverage of the popular Netflix series '13 Reasons Why'

Background

Evidence suggests that the media can influence societal attitudes and beliefs to various social issues. This influence is especially strong for mental health issues, particularly suicide. As such, the aim of this study is to systematically examine Canadian newspaper coverage of the popular fictional Netflix series 13 Reasons Why, wherein the lead character dies by suicide in the final episode.

Methods

Articles mentioning the series were systematically collected from best-selling Canadian newspapers in the three-month period following series release (April–June 2017). Articles were coded for adherence to key best practice recommendations on how to sensitively report suicide. Frequency counts and proportions were produced. An inductive qualitative thematic analysis was then undertaken to identify common themes within the articles.

Results

A total of 71 articles met study inclusion criteria. The majority of articles did not mention the suicide method (88.7%) and did not use stigmatizing language such as ‘commit suicide’ (84.5%). Almost half of the articles linked suicide to wider social issues (43.7%) or quoted a mental health professional (45.1%). 25% included information telling others considering suicide where to get help. Our qualitative analysis indicated that articles simultaneously praised and criticized the series. It was praised for (i) promoting dialogue and discussion about youth suicide; (ii) raising awareness of youth suicide issues; (iii) shining a spotlight on wider social issues that may affect suicide. It was criticized for (i) glorifying suicide, (ii) harmfully impacting young viewers; (iii) prompting pushback from educators and schools.

Conclusions

Newspaper coverage of ‘13 Reasons Why’ generally adhered to core best practice media recommendations, and sensitively discussed suicide from various angles, prompting productive discussion and dialogue about youth suicide. These findings suggest that the media can be an ally in promoting dialogue and raising awareness of important public health issues such as suicide.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5987-3) contains supplementary material, which is available to authorized users.

A scoping review of community pharmacists and patients at risk of suicide

Background

Medications are commonly used in suicide attempts. Pharmacists are inextricably linked to medications and may have roles in helping those at risk of suicide. We conducted a scoping review to characterize the existing literature and make recommendations about future research.

Methods

We used a 6-step approach based on an existing scoping review methodological framework, including identifying the research question; identifying relevant studies and other literature; study and literature selection; data charting; collating, summarizing and reporting results; and dissemination of results. We searched electronic databases, various grey literature sources and mobile app stores.

Results

Thirty-five articles were included following screening of 1013 database citations. Of 1085 results from grey literature searches, we included 12. Most publications were opinion pieces (n = 22), followed by survey studies (n = 9), primarily assessing pharmacists' knowledge and attitudes. Themes included education and training to impact knowledge and attitudes, gatekeeping of medication supply, collaboration and integration, and role perception. Public perspectives on pharmacists' roles were limited.

Conclusions

Research regarding pharmacists' roles in the care of people at risk for suicide is limited. The areas that have dominated the literature include legal liability, especially with respect to gatekeeping medications, ethical decision making and education and training. Research is needed to determine what methods, outcomes and measures are required to best serve in building the evidence base for policy and practice decisions in this area.

Strategies to prevent death by suicide: meta-analysis of randomised controlled trials

BackgroundFew randomised controlled trials (RCTs) have shown decreases in suicide.AimsTo identify interventions for preventing suicide.MethodWe searched EMBASE and Medline from inception until 31 December 2015. We included RCTs comparing prevention strategies with control. We pooled odds ratios (ORs) for suicide using the Peto method.ResultsAmong 8647 citations, 72 RCTs and 6 pooled analyses met inclusion criteria. Three RCTs (n = 2028) found that the World Health Organization (WHO) brief intervention and contact (BIC) was associated with significantly lower odds of suicide (OR = 0.20, 95% CI 0.09-0.42). Six RCTs (n = 1040) of cognitive-behavioural therapy (CBT) for suicide prevention and six RCTs of lithium (n = 619) yielded non-significant findings (OR = 0.34, 95% CI 0.12-1.03 and OR = 0.23, 95% CI 0.05-1.02, respectively).ConclusionsThe WHO BIC is a promising suicide prevention strategy. No other intervention showed a statistically significant effect in reducing suicide.

A CBPR Approach to Finding Community Strengths and Challenges to Prevent Youth Suicide and Substance Abuse

Purpose: To improve health and reduce health disparities, research partnerships with American Indian and Alaska Native communities should build on existing traditions and strengths. The overall goal of this pilot project was to clarify the needs of tribal community members and determine strengths and resources available to the community. Design: Community-based participatory research was the approach used to obtain community input. Data collection methods included, Photovoice ( n = 16), digital storytelling ( n = 4), and community capacity surveys ( n = 128). Results: Quantitative and qualitative findings supported the need to (1) address youth suicide and substance abuse on the reservation and (2) use preexisting resources available in the community. The results led to the development of a strengths-based intervention incorporating the Gathering of Native American’s curriculum. Conclusion: Integral to the development, implementation, and sustainability of the intervention was the truly reciprocal relationship developed between community and university partners.