School-based suicide prevention programmes: Are they effective? Lancet.April.2015.

24.04.2015

Suicide is the second  the leading cause of death in young people. Globally, suicide account for 7.3% of all deaths in the age group 15-19 yrs. (Road traffic accidents is the first leading cause  (11.6%)) . Suicide prevention among this group is a national priority in many countries. School based intervention programmes usually  adopt universal ( delivered to all), selective ( high risk groups only) or indicated ( for those presenting with suicidal ideas) approach.

 What kind of school intervention programme is  effective?

Empowering Young Lives in Europe (SEYLE) study is a large, multi country, randomised controlled trial of school-based prevention of suicidal behaviour in adolescents.Pupils were recruited from 168 schools in ten European Union countries.Pupils with incident (new) suicide attempt(s) or severe suicidal ideation at 3 months and 12 months follow-up were identified to investigate the preventive effects of the interventions. Pupils who reported suicide attempts ever, or severe suicidal ideation in the past 2 weeks before the baseline assessment were not included in the final analysis.

Intervention included one of the following: 1. Question, Persuade, and Refer (QPR): a manualised programme to train teachers and other school personnel to recognise the risk of suicidal behaviour in pupils and to enhance their com- munication skills to motivate and help pupils at risk of suicide to seek professional care  2.Youth Aware of Mental Health Programme (YAM): A manualised, universal intervention targeting all pupils, which includes  role-play sessions with interactive workshops ,  booklet that pupils could take home, educational posters displayed  classroom and interactive lectures about mental health at the beginning and end of the intervention.3.Screening by Professionals programme (ProfScreen): is a selective or indicated intervention based on responses to the  baseline questionnaire.

All interventions were undertaken during a 4 week period, after a baseline assessment. Pupils received one of the  three interventions or were in control group. Control group had  posters in their class rooms.Study recruited 11110 pupils.

Results:

At 3 months, of 9724 pupils who answered both outcome questions,( suicidal ideation, suicidal attempt)   3·4% reported either an attempt or ideation and  0·9% reported both. At 12 months, this was 2·9%  reported either and 0·6% reported both.

At the 3 month follow-up, there were no significant effects of QPR, YAM, or ProfScreen compared with the control group.

At the 12 month follow-up, YAM was associated with a significant reduction of incident suicide attempts (odds ratios [OR] 0·45, 95% CI 0·24–0·85; p=0·014) and severe suicidal ideation (0·50, 0·27–0·92; p=0·025), compared with the control group.

At 12 months in the YAM group absolute risk for suicide attempt fell by 0·60 % (ie, 6·0 of 1000 pupils) and relative risk (RR) was reduced by 54·6% (ie, of 1000 pupils, 11 attempted suicide in the control group vs five attempts in YAM).  In terms of severe suicidal ideation, in the YAM group absolute risk fell by 0·50% and RR fell by 49·6%. 

Conclusion: YAM, a universal, school-based intervention of short duration (5 h in 4 weeks), was significantly more effective in preventing new cases of suicide attempts and severe suicidal ideation, including planning, than no intervention

Decrease in suicidal attempt at 3 months is previously reported by Signs of Suicide (SOS) , a US  school intervention. Good Behaviour Game , another US  class room intervention study  has shown  reduced incidence of suicidal ideation and suicide attempts when followed up at ages 21–22 years.

The QPR and ProfScreen interventions did not have significant effects. The result show that  adolescents personal engagement in the intervention is crucial in bringing benefits. Adolescents might be reluctant to accept adult driven interventions.

Summary of the article:

School-based suicide prevention programmes: the SEYLE cluster-randomisedcontrolled trial.

Wasserman D, Hoven CW, Wasserman C, Wall M, Eisenberg R, Hadlaczky G, Kelleher I, Sarchiapone M, Apter A, Balazs J, Bobes J, Brunner R, Corcoran P, Cosman D, Guillemin F, Haring C, Iosue M, Kaess M, Kahn JP, Keeley H, Musa GJ, Nemes B, Postuvan V, Saiz P, Reiter-Theil S, Varnik A, Varnik P, Carli V.

Lancet. 2015, Vol 385 April 18, 2015

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