How schools can save lives

Suicidal thoughts and behaviors (STBs) in young people are a major public health problem worldwide, and their prevalence keeps rising.

Schools and universities are ideal environments in which to implement interventions addressing the problem of suicidal thoughts and behaviors (STBs) in young people. A systematic review and network meta-analysis by Kiran et al., published in Clinical Psychology: Science and Practice, examined the effectiveness of various interventions developed to reduce STBs and improve suicide prevention skills among young people, their peers, their guardians, and teachers in educational settings.

The authors searched Medline, APA PsycInfo, and CENTRAL up to April 2021 to find quantitative intervention studies with control groups involving young people 12 to 25 years old. They identified 49 studies involving 42,039 participants.

Interventions were categorized as universal (targeting all participants) or selective (targeting high-risk participants). Universal interventions were associated with an almost twofold reduction in the odds of STBs (odds ratio [OR] = 1.85, 95% confidence interval [CI] [1.43, 2.38]). Both selective interventions (standardized mean difference [SMD] = 0.51, 95% CI [0.32, 0.70]) and universal interventions (SMD = 0.40, 95% CI [0.26, 0.54]) moderately increased suicide prevention competencies.

In terms of content, education and awareness programs (OR = 1.59, 95% CI [1.23, 2.04]) and psychotherapy programs (OR = 2.22, 95% CI [1.25, 3.33]) led to a 1.5- to twofold reduction in the odds of STBs. Gatekeeper universal interventions (SMD = 1.04, 95% CI [0.73, 1.34]) led to large increases in suicide prevention skills compared with no treatment. Education and awareness interventions led to modest improvements in suicide prevention skills (SMD = 0.28, 95% CI [0.12, 0.44]) compared with no treatment.

The study findings align with the findings of previous high-quality trials in the field. However, the low quality of most of the studies included in the meta-analysis suggests that the conclusions should be interpreted and applied with caution, especially in settings lacking large, high-quality clinical trials, such as low- and middle-income countries.

The findings of this study provide clear and informative messages for policymakers. On the basis of the study results, the authors recommend the wide implementation of universal mental health and suicide awareness training as a first-line preventive strategy in schools and educational settings.

Selective and intensive interventions are promising under certain circumstances. Intensive psychotherapeutic programs appear to be more suitable for students who previously engaged with STBs. Gatekeeper training programs hold promise for equipping students, peers, and educators with essential skills to recognize and respond to suicide risks.

This article is in the Clinical Psychology topic area.

Kiran, T., Angelakis, I., Panagioti, M., Irshad, S., Sattar, R., Hidayatullah, S., Tyler, N., Tofique, S., Bukhsh, A., Eylem-van Bergeijk, O., Özen-Dursun, B., Husain, N., Chaudhry, N., & Hodkinson, A. (2024). Controlled interventions to improve suicide prevention in educational settings: A systematic review and network meta-analysis. Clinical Psychology: Science and Practice, 31(1), 85–93. https://doi.org/10.1037/cps0000179

Ioannis Angelakis, PhD, is a lecturer in clinical psychology whose research focuses on applying behavioral science principles to improve health and care services for individuals with psychological trauma and self-harm and suicidal behaviors. His work explores the causes and prevention of suicide, mechanisms of resilience in trauma survivors, and the development of interventions for self-management in mental health conditions.

Maria Panagioti, PhD, is a professor of health services research in the Division of Population Health, Health Services Research, and Primary Care at the University of Manchester. Her research focuses on patient safety, service delivery interventions, workforce well-being, and planning in primary care, as well as the interfaces between primary, secondary, and social care in both high- and low-resource settings.

Sehrish Irshad, PhD, is a clinical psychologist and research associate at the Pakistan Institute of Living and Learning. She has actively contributed to numerous research projects and interventions focused on reducing suicide rates and improving mental health outcomes in vulnerable populations in Pakistan. Her work includes culturally adapted psychosocial interventions and training programs for health care practitioners to effectively manage and prevent suicidal behaviors.

Rabia Sattar is a research associate and clinical psychologist at the Pakistan Institute of Living and Learning. She has been involved in managing large psychosocial research trials on parenting interventions for depressed parents of young children in Pakistan. She is also involved in capacity capability building of researchers and community health workers in parenting interventions both nationally and internationally. She does qualitative research with vulnerable populations. Besides research, she has been instrumental in setting up the Community Engagement and Involvement Group in collaboration with national and international stakeholder groups.

Sobia Hidayatullah is a clinical psychologist and research assistant at the Pakistan Institute of Living and Learning. She works in the Division of Child and Adolescent Mental Health, focusing on self-harm and suicide prevention, parenting, and perinatal mental health. Sobia is also involved in community development and quantitative research, contributing to the enhancement of mental health services and interventions.

Natasha Tyler, PhD, is a research fellow in the National Institute for Health and Care Research School for Primary Care Research at the University of Manchester. Her work focuses on improving patient safety in mental health care transitions.

Ozlem Eylem-van Bergeijk, PhD, is a postdoctoral research associate at the National Institute for Health and Care Research School for Primary Care and Health Services Research at the University of Manchester. Her work focuses on improving the communication and accessibility of mental health services for diverse service-user populations. Her work explores developing and evaluating culturally adapted digital and face-to-face psychological interventions in treating suicidal behavior among ethnic minority populations. She has codesigned mental health literacy campaigns incorporating participatory research methods such as Photovoice in partnership with multiple stakeholders and nongovernmental organizations in high- and low-resource contexts.

Nasim Chaudhry, PhD, is CEO of the Pakistan Institute of Living and Learning and an esteemed consultant psychiatrist renowned for her pioneering work in suicide prevention and self-harm, particularly in low-income countries. Her research addresses critical mental health issues such as maternal depression and adolescent self-harm, focusing on the significant treatment gap in these regions. By developing culturally tailored, cost-effective psychosocial therapies, she has significantly advanced mental health care in Pakistan, leading numerous impactful research initiatives to bridge critical gaps.

Alexander Hodkinson, PhD, is a senior research fellow at the University of Manchester’s National Institute for Health and Care Research School for Primary Care and Health Services Research. His work focuses on creating and applying evidence-based research to enhance care quality and patient safety for those with mental health issues in primary care. He is also dedicated to improving health care organizations’ sustainability and efficiency through evidence-based workforce planning and well-being programs.