A Systematic Review of School-Based Suicide Prevention Interventions for Adolescents, and Intervention and Contextual Factors in Prevention

Mental health, risk behaviors, and social life factors in relation to adolescents' suicide ideation, plans and attempt

OBJECTIVE

This study investigated differences in mental health and well-being, risk behaviors, and social life factors among adolescents who experienced different forms of suicidality.

METHODS

We examined 18-years-olds in the Danish National Birth Cohort (N = 47,852). Suicidality was defined with mutually exclusive categories ranging from no suicidality, self-reported suicide ideation, plans, and attempt as well as hospital-recorded suicide attempt. The proportion of adolescents with self-reported poor mental health and well-being, risk behaviors, and social life factors were compared across forms of suicidality. Sample weights were applied.

RESULTS

Depressive symptoms were reported by 14% (95% CI 13%;14%) of girls with no suicidality, 44% (95% CI 43%;45%) of girls with suicide ideation, and 68% (95% CI 65%;72%) 66% (95% CI 60%;72%) of girls with self-reported suicide attempt or hospital-recorded suicide attempt respectively. Among boys, depressive symptoms were reported by 5% (95% CI 4%;5%) of those with no suicidality, 27% (95% CI 26%;28%) of those with suicide ideation, and 51% (95% CI 45%;57%) and 40% (95% CI 22%;58%) of those with self-reported suicide attempt or hospital-recorded suicide attempt respectively. Likewise, other aspects of poor mental health and well-being gradually increased relative with more severe forms of suicidality, while no notable differences were identified between adolescents with self-reported and hospital-recorded suicide attempt. Similar tendencies were observed for risk behaviors and social life factors.

CONCLUSION

These findings suggest that adolescents with suicidality, including the large proportion with suicide ideation only, faces challenges across several parameters of mental health and well-being, risk behavior, and social life factors. This emphasizes the need for community-based interventions to identify and support the large group of adolescents experiencing both more and less severe forms of suicidality. Clinicians should prioritize comprehensive psychiatric intervention to address the complex needs of suicidal adolescents effectively.

The prevalence, course, and risk factors of suicidal ideation and suicide attempts among students in vocational education

BACKGROUND

Worldwide, suicide is one of the leading causes of death among adolescents and young adults. Given that suicide in this age group is common within vocational students, this study aims to provide insights into the prevalence, course, and risk factors of suicidal ideation (SI) and suicide attempts (SA) among students in vocational education over the past 10 years.

METHODS

This study has a repeated cross-sectional design, utilizing data from 2013 to 2023 provided by the 'Testjeleefstijl' foundation in the Netherlands ('Test Your Lifestyle'). In total, 101,182 students in vocational education completed a web-based standardized questionnaire. Univariate logistic regression was used to test the predictive value of risk factors separately (anxiety and depression, gender, age and school year) on SI and SA. In addition, a machine learning model (Berkelmans et al., 2023) ​was used for high-risk identification of combined risk factors (multivariate models).

RESULTS

Within vocational students, 12-month SI and SA prevalence increased from respectively 17.7% and 2.3% in schoolyear 2013-2014 to 23% and 3.2% in 2022-2023. Although female gender significantly predicted SI and SA in the univariate analyses, the multivariate models revealed that female gender decreased the likelihood of both SI (OR 0.9) and SA (OR 0.7). A high risk for anxiety and depression was the strongest predictor in the multivariate models for SI (OR 42.8) and SA (OR 19.0).

CONCLUSION

Over the past decade, the prevalence of SI and SA increased in students in vocational education, with the risk of anxiety and depression being the strongest contributing factor. While females had a higher prevalence of anxiety and depression, the results suggest these conditions tend to lead to SI and SA more quickly among male students. Early intervention in suicide prevention is crucial, highlighting the need to identify and address anxiety and depression. Vocational education schools have a critical role in this, emphasizing early screening and intervention, with specific attention to gender-specific factors.

Association between sleep duration, suicidal ideation, suicidal attempt and suicidal behavior among Chinese adolescents

BACKGROUND

A relatively small number of studies have researched the relationship between sleep duration and suicidal ideation, attempts, and behavior. This research aims to investigate the link between sleep duration and suicide in Chinese adolescents, and to examine the role of depression as a mediating factor.

METHOD

Data were collected from 3315 students using a multi-stage random cluster sampling method and self-administered questionnaires. The study applied logistic regression to investigate the relationship between sleep duration and various forms of suicidal behavior, and mediation analysis to understand how depression might influence this relationship.

RESULTS

The average sleep duration among the adolescents was 7.25 h (±0.20), with 59.67 % reporting insufficient sleep. The logistic regression analysis showed that longer sleep duration is linked with lower risks of suicidal ideation (OR: 0.753, 95%CI: 0.696 to 0.814), suicidal attempts (OR: 0.830, 95%CI: 0.748 to 0.922), and suicidal behavior (OR: 0.841, 95%CI: 0.713 to 0.992). Analysis using restricted cubic spline plots indicated the connection between sleep duration and these suicidal factors was not linear. The study found that depression plays a partial mediating role between sleep duration and suicidal ideation, with an effect of 52.29 %.

LIMITATIONS

The cross-sectional study design could not prove causation.

CONCLUSIONS

There is a clear non-linear association between sleep duration and suicidal tendencies in adolescents, with depression acting as a mediator. This suggests that future research could focus on sleep and mood management as ways to address suicide risk in this age group.

Public health measures related to the transmissibility of suicide

Transmission is an important concept in suicide prevention. It can occur when exposure to another person's death by suicide (or to suicide-related information more generally) draws attention to suicide or highlights specific suicide methods. In this paper, the fourth in a Series on a public health approach to suicide prevention, we contend that the transmissibility of suicide must be considered when determining optimal ways to address it. We draw on five examples of how transmission might occur and be prevented. The first two examples relate to transmission initiated by representations of suicide in traditional and new media. The third concerns transmission that leads to suicide clusters, and the fourth considers a specific setting in which transmission occurs, namely secondary schools. Finally, we discuss how suicide risk might be countered by the transmission of suicide prevention messages in media campaigns.

Advances in the management of bipolar disorder in children and adolescents: an update on the literature

INTRODUCTION

Early diagnosis and treatment concerning bipolar disorder (BD) are related to a better functioning over the long-term period. Although pharmacotherapy is indicated for approximately all youths with BD, nearly one-third of patients do not receive adequate medications for their condition.

AREAS COVERED

The authors discuss the available scientific evidence from the current literature about the management of BD in both children and adolescents, giving particular focus to the efficacy and tolerability of the available pharmacological agents. Studies were identified searching MEDLINE and retrieved from reference listings of relevant articles and through consultation with experts in the field.

EXPERT OPINION

Many D2-blockers, approved by the Food and Drug Administration (FDA) based on their antimanic properties in youths, are related to both short- and long-term side effects. Lurasidone was found to be effective for the treatment of acute juvenile bipolar depression, while lithium for the treatment and recurrence prevention of manic/mixed episodes. The most common anticonvulsants were found to be most useful as adjunctive antimanic agents in non-responders to first-line monotherapies. No data was found to support the use of antidepressants in juvenile BD.

The Beck Hopelessness Scale's psychometric features: A new short form based on item response theory

BACKGROUND

The assessment of hopelessness plays a significant role in preventing various psychological disorders and major life events within the general population. However, the psychometric properties of the Beck Hopelessness Scale (BHS) have been a subject of controversy, primarily studied in clinical groups. The aim of the present study was to gain new psychometric insights and propose a new short version of the BHS for the general population using the Item Response Theory (IRT) approach.

METHODS

A total of 2164 Argentinean individuals completed the BHS alongside the Inventory of Suicide Orientation-30. We compared IRT models with two and three parameters for the original BHS version, exploring the removal of redundant and less informative items. Convergent and discriminant validity was also examined.

RESULTS

Our results support the 2PL model for the BHS-19. In addition, the BHS-10 short version adequately depicted the same range of the measured trait as the original version, showing reasonable measurement accuracy in the middle-high levels of the trait (marginal reliability = 0.70, Cronbach's α = 0.86). Notably, a positive correlation was found between the factorial score of BHS-10, BHS-19, and suicide orientation.

CONCLUSIONS

In conclusion, our findings support the use of a simplified version as a practical and valuable tool for both research and clinical practice in the future.

School-Based Suicide Prevention Efforts: The Impact of School Nurse Exclusivity on Moral Distress

School nurses are well-positioned to assess, identify, and refer children and adolescents who are at risk of suicide. This multiple-case study examined the personal, behavioral, and environmental factors that influence the role of the school nurse in youth suicide prevention and intervention. Purposive sampling was used to recruit two school nurses who were identified as unique cases. Data from interviews, surveys, and documents generated a cross-case analysis. Findings indicate that school-level exclusive practices, such as a lack of communication and collaboration, greatly influence the role and reach of school nurses. Further, dilemmas arising from environmental barriers hinder school nurse capacity to promote student safety and affect moral distress levels. Leveraging data to demonstrate the pivotal role of school nurses to support mental health equity and reduce disparities in youth suicide is crucial to developing inclusive and responsive suicide prevention programs.

Latent Class Analysis on Suicide-related Behavior and Associated Factors in Korean Adolescents

PURPOSE

This study aimed to analyze the latent class of suicide-related behaviors among Korean adolescents and identify related factors.

METHODS

This study used 2021 Korean Youth Risk Behavior Web-Based Survey data and analyzed 7300 participants using latent class analysis.

RESULTS

Suicide-related behaviors were categorized into four classes: suicide ideation only (Class 1), suicide plan without ideation or attempt (Class 2), suicide attempt with ideation and plan (Class 3), and suicide attempt without ideation or plan (Class 4). Sexual intercourse experience, habitual drug use experience, and hospital treatment experience due to violence, which were set as risky behavior-related variables, were found to be factors influencing Class 3. However, these variables were not statistically significant factors affecting those belonging to Class 2 and Class 4.

CONCLUSION

The findings emphasize the necessity of understanding the variances in suicide-related behaviors among adolescents to tailor interventions effectively. Adolescents who plan and attempt suicide despite having low levels of suicidal ideation exhibited high levels of stress and a tendency for sadness and despair compared to the suicide attempt with the ideation and plan group. These insights underscore the importance of addressing psycho-emotional factors and developing intervention strategies that cater specifically to the nuanced needs of each group to prevent potential suicide attempts.

The iceberg model of suicidal ideation and behaviour in Danish adolescents: integration of national registry and self-reported data within a national birth cohort

Hospital records are used to identify suicide attempts in many countries but not all individuals present to hospital after a suicide attempt i.e., suggesting a 'hidden number'. Our aim was to present the prevalence of suicide ideation, plans, attempts, and suicides among Danish adolescents, including attempts not resulting in hospital contact. The study population consisted of participants in the Danish National Birth Cohort participating in an 18-year follow-up, with individual-level linkage to national register data. Prevalence was estimated with a variable with mutually exclusive categories ranging from no suicidality to self-reported suicide ideation, -plans, -attempt and hospital-recorded suicide attempt and stratified on sex and parental income. The 'hidden number' was estimated as the ratio between suicide attempts with and without hospital contact. Among 47 858 participants, all aged 18-years, 36% girls and 28% boys reported suicide ideation at least once in their life. In addition, 6% girls and 3% boys had either reported or been recorded with a suicide attempt. For every attempt recorded in the hospital setting, two girls (ratio, 1:2) and six boys (ratio, 1:6) reported having attempted suicide without hospital contact. The prevalence of any suicide attempt was 8% and 3% in the lowest and highest income group, respectively. Before age 18, 0·011% girls and 0·016% boys had died by suicide. In conclusion, suicidal ideation and behaviour are common in adolescents and there is a substantial 'hidden number' of adolescents with suicide attempt. These results emphasize the need for early age suicide preventive interventions in community-settings e.g., school environments.

Informing Equitable Prevention Practices: A Statewide Disaggregated Analysis of Suicide for Ethnoracially Minoritized Adolescents

The increase in adolescent suicide rates in the United States is a pervasive public health issue, and ethnoracial youth with diverse identities are disproportionately impacted, yet less studied. National planning efforts reinforce state-level approaches to suicide prevention through an equitable lens to prevent adolescent suicide. This study examined disaggregated state-level data over time to determine changes to suicide outcomes based on race/ethnicity, sex, sexual orientation, and the intersection of these identities and determined which sub-groups had higher odds of suicide outcomes. Data from the 1991-2019 Centers for Disease Control and Prevention Youth Risk Behavioral Surveillance System were analyzed for 17,419 ethnoracially minoritized high school adolescents in North Carolina. Descriptive analyses and multinominal logistic regression models were employed. Findings indicated that subgroups within categories of ethnoracial populations, specifically Black female adolescents unsure of their sexual orientation, reported higher rates of suicide attempts. Additionally, Multiracial adolescents reported higher means for suicide consideration and attempts over time. Recommendations for investigating state-level suicide data by focusing on diverse intersecting identities to illuminate areas for potential prevention efforts and support health equity are provided.

The self-perceived needs of adolescents with suicidal behaviour: a scoping review

Suicidal behaviour in adolescents is a major public health problem. Much research on this issue has focused on epidemiology and risk factors for suicidal behaviour, paying less attention to the self-perceived needs of adolescents. However, to increase engagement in suicide prevention, it is important to include the views of adolescents. A scoping review was performed to identify the available empirical study findings, of any study design, related to the self-perceived needs of adolescents with suicidal behaviour. The literature databases Medline, Embase, Psycinfo, CINAHL, ERIC, Scopus, and Web of Science were searched. Twenty-nine studies from 14 predominantly Anglo countries were included in the scoping review. The review showed that girls were overrepresented and that studies predominantly used qualitative approaches. The identified needs of adolescents with suicidal behaviour can broadly be grouped into needs related to the following areas: the importance of connecting with other people; adolescents' self-help strategies and personal growth after self-harm; mental healthcare; school or study programs; and needs related to society in relation to taboo on suicidal behaviour. Prevention of suicidal behaviour in adolescents will need to focus on development and strengthening of interventions fitting the needs of adolescents in these areas.

Exploring adolescents' perspectives on and experiences with post-primary school-based suicide prevention: a meta-ethnography protocol

BACKGROUND

Globally, suicide is the fourth leading cause of adolescent mortality. Although post-primary school-based suicide prevention (PSSP) interventions are an evidence-based strategy for targeting adolescent suicidal thoughts and behaviors (STBs), PSSP effectiveness does not easily translate to school settings. Adolescents' perspectives on PSSP are particularly important for (1) intervention effectiveness and implementation in both research and practice, (2) addressing PSSP evidence-practice gaps, and (3) enhancing meaningful adolescent involvement in PSSP, yet there is a gap in understanding adolescents' experiences of engaging with PSSP. As such, this protocol outlines a meta-ethnography which will explore and synthesize adolescents' perspectives on engaging with PSSP interventions, as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers.

METHODS

The meta-ethnography protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The protocol was guided by the seven-stage process for meta-ethnography proposed by Noblit and Hare. Searches of PsycINFO, MEDLINE, Web of Science, CINAHL, ERIC, Scopus, and study reference lists will identify peer-reviewed studies. Gray literature will be identified by searches in ProQuest, British Library EThOS, and DART-Europe E-theses Portal. The main reviewer will initially assess the eligibility of studies based on title and abstract, with full texts reviewed by at least two reviewers. Findings of the included studies will be synthesized in line with Noblit and Hare's stages and evaluated using the Critical Appraisal Skills Program (CASP) checklist.

DISCUSSION

To our knowledge, this is the first proposed meta-ethnography to explore and integrate the findings of qualitative studies exploring adolescents' perspectives on engaging with PSSP interventions. Understanding adolescents' experiences of engaging with PSSP will impact the field of PSSP in several ways by (1) enhancing research processes and intervention effectiveness and implementation, (2) informing decision-making and policymaking relevant to practice, (3) guiding meaningful adolescent involvement in PSSP, and (4) contributing to knowledge on the safety implications of engaging adolescents in PSSP. Finally, it is expected that the insights from this meta-ethnography will be widely applicable, given the growing demand for meaningful youth involvement in health-related fields.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022319424.