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Suicide prevention

Interventions to prevent suicide - Schools

Read Overview

The research identified has focused on school based interventions for pupils aged 12 to 19. Much of the evidence comes from North America. Some studies are of poor quality and the programmes vary hugely in content and intensity. The emerging messages are mixed.

We found a total of 34 systematic reviews and seven RCTs. Six of the systematic reviews but none of the RCTs included material relevant to the school setting. 1 2 3 4 5 6



In this section:

Key Messages

  • There was insufficient evidence to support curriculum-based suicide prevention programmes for adolescents
  • Some curriculum-based interventions may actually be harmful, especially to boys/young men
  • Skills based programmes are more promising, especially if targeted on adolescents already identified as high risk for suicide
  • Future efforts must take account of the need for gender-specific interventions.

Population Interventions

Population interventions that work

We have not found any randomised controlled trials of school based interventions that show a significant reduction in completed suicides. However, this may be because suicide itself is a fairly rare event, and very large-scale studies would be needed to show that an intervention was really effective.

Population interventions that may work

Skills training and social support programmes

Programmes for adolescents at high risk which focus on skills training and social support seem to be effective in reducing risk factors (depression, hopelessness, stress, anxiety and anger) and enhancing protective factors (personal control, problem-solving skills, self-esteem and network support) 1 and may therefore be considered “promising”. 2

One systematic review identified 10 studies that focused on skills training and social support: seven from the USA, one from Australia and two from Israel. 1 Of these studies, seven were cohort studies and three were RCTs. The total number of children included was 4449. However, the duration of programmes ranged from one 1.5-hour session to 180 sessions of 55 minutes each. Some of the studies did not establish the validity and reliability of the outcome measurement tools, and different tools were used to measure the same outcomes. Therefore, it is difficult to compare the results of these studies directly.

Behavioural change programmes

Two suicide prevention programmes that focused on behavioural change and coping strategies in the general school population demonstrated lower suicidal tendencies, improved ego identity and improved coping ability. 1

Population interventions that do not work (and may even be harmful)

Curriculum-based suicide education programmes

Curriculum-based suicide education programmes for the general school population may improve knowledge about help resources, but do not appear to change attitude towards suicide or to have any impact on subsequent suicidal behaviours. 1

Some studies have found a differential effect on boys and girls, with several finding that curriculum-based suicide prevention might actually be harmful, 3 4 5 6 with males more likely than females to suffer detrimental effects, in that it increased: the number of boys suggesting that suicide was a possible solution to their problems; the number of boys stating that talking about suicide makes some teenagers more likely to try to kill themselves; or the level of hopelessness in boys.

School-based post intervention

School-based interventions after a suicidal attempt did not demonstrate any benefits. 1

What we don't know

We do not yet understand the basis for the apparent differential response of males and females to schools-based interventions, although the huge disparity in rates of suicidal behaviour by gender, especially among young people, suggests that this is of key importance.

Furthermore, we cannot specify in detail the optimal content or duration of a skills-based programme for schools, nor the primary target group in terms of age, gender, or any other factor.

References

  1. Guo B, Harstall C. For which strategies of suicide prevention is there evidence of effectiveness? Copenhagen, WHO Regional Office for Europe Health Evidence Network report; 2004. External Link (accessed 30 Mar 2007)
  2. Guo B, Scott A, Bowker S. Suicide prevention strategies: evidence from systematic reviews. HTA 28:Health Technology Assessment. Edmonton, Canada:Alberta Heritage Foundation for Medical Research, 2003.
  3. Ploeg J, Ciliska D, Dobbins M, Hayward S, Thomas H, Underwood J. A systematic overview of adolescent suicide prevention programs. Can J Public Health. 1996;87:319-324. External Link
  4. Ploeg J, Ciliska D, Brunton G, MacDonnell J, O’Brien MA. The effectiveness of school-based curriculum suicide prevention programs for adolescents. Effective Public Health Practice Project. Public Health Branch. Ontario Ministry of Health;1999.
  5. Gould MS, Kramer RA. Youth suicide prevention. Suicide Life Threat Behav 2001;31:S6-31. External Link
  6. Hider P. Youth suicide prevention by primary healthcare professionals. New Zealand Health Technology Assessment Report No.4,1998. External Link
  7. van der Sande R, Buskens E, Allart E, van der Graaf Y, van Engeland H. Psychosocial intervention following suicide attempt: a systematic review of treatment interventions. Acta Psychiatr Scand 1997;96:43-50. External Link
  8. National Institute for Mental Health in England (NIMHE). National Suicide Prevention Strategy for England Annual Report on Progress 2006. NIMHE. Department of Health; 2007. . External Link

Contributors

Dr Jenny Bywaters

Suicide Prevention

Dr Jenny Bywaters is Senior Public Mental Health Advisor for the National Institute for Mental Health in England (NIMHE) where she directs the national programmes for suicide prevention and mental health promotion/public mental health. She has been seconded to North East Public Health Observatory (NEPHO) two days a week since April 2005 as part of the Public Mental Health Observatory team. She previously worked in the mental health policy branch at the Department of Health, and before that as Senior Commissioning Manager for Mental Health and Learning Disability Services at Birmingham Health Authority. She chairs the joint Faculty of Public Health/NIMHE Working Group on Mental Health.