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Grosselli L, Knappe S, Baumgärtel J, Lewitzka U, Hoyer J. Addressing help-seeking, stigma and risk factors for suicidality in secondary schools: short-term and mid-term effects of the HEYLiFE suicide prevention program in a randomized controlled trial. BMC Public Health 2024; 24:113. [PMID: 38191336 PMCID: PMC10773084 DOI: 10.1186/s12889-023-17557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Suicidal ideation and suicide attempts present a serious public health concern among adolescents and young adults. School-based suicide prevention programs are a key tool for addressing this problem. However, more research is necessary to assess their effectiveness, acceptability, and safety. In response, the HEYLiFE suicide prevention program was developed to enhance help-seeking, reduce stigma towards suicidal peers and diminish risk factors for suicidality. This article presents the evaluation findings of the HEYLiFE program in German secondary schools. METHODS We conducted a randomized-controlled trial measuring short-term pre-post within-group effects in the intervention group only and mid-term effects at 6-months-follow-up compared to a waitlist-control group. Schools were assigned randomly to the intervention or control group (no blinding). We recruited students ≥12 years of age. Primary outcomes were knowledge about suicidality, attitudes towards suicidality, stigma towards a suicidal peer, help-seeking intentions and behaviours, risk factors for suicidality. The data was analysed with linear mixed models and generalized linear mixed models. RESULTS A total of N = 745 students participated (n = 353 intervention group, n = 392 control group). We observed favourable short-term effects on knowledge, attitudes towards suicidality and fear towards a suicidal peer. Unexpectedly, the program also led to an increase in desire for social distance and a decrease in prosocial emotions towards a suicidal peer. The mid-term effects of the program were exclusively favourable, resulting in enhanced attitudes towards help-seeking while protecting from a sharper rise in risk-factors for suicidality and from an increase in social distance. The program had more favourable effects on females and on students aged >13 years. The program was well-received by the students, and no serious adverse events were reported. CONCLUSIONS These findings demonstrate the effectiveness of the HEYLiFE universal suicide prevention program in addressing variables associated with suicidal ideation and suicide attempts among adolescents on the mid-term. The short-term negative effects on stigma and more negative effects on males should be addressed in the future. Future evaluation studies should examine its effects on suicidality and its effectiveness within populations at high risk. TRIAL REGISTRATION The study was preregistered in the German Clinical Trials Register (registration number: DRKS00017045; registration date: 02/04/2019).
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Affiliation(s)
- Luna Grosselli
- Fakultät Psychologie, Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany.
- Werner-Felber-Institut e. V, Dresden, Germany.
| | - Susanne Knappe
- Fakultät Psychologie, Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
- Werner-Felber-Institut e. V, Dresden, Germany
- Evangelische Hochschule Dresden (ehs), University of Applied Sciences for Social Work, Education and Nursing, Dresden, Germany
| | - Julia Baumgärtel
- Fakultät Psychologie, Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
| | - Ute Lewitzka
- Werner-Felber-Institut e. V, Dresden, Germany
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Hoyer
- Fakultät Psychologie, Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
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Cai C, Yin C, Tong Y, Qu D, Ding Y, Ren D, Chen P, Yin Y, An J, Chen R. Development of the Life Gatekeeper suicide prevention training programme in China: a Delphi study. Gen Psychiatr 2023; 36:e101133. [PMID: 37859750 PMCID: PMC10582848 DOI: 10.1136/gpsych-2023-101133] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/30/2023] [Indexed: 10/21/2023] Open
Abstract
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.
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Affiliation(s)
- Chengxi Cai
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Chen Yin
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yongsheng Tong
- Beijing Huilongguan Hospital, Beijing, China
- HuiLongGuan Clinical Medical School, Peking University, Beijing, China
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Diyang Qu
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yunzhi Ding
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Daixi Ren
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Peiyu Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yi Yin
- Beijing Huilongguan Hospital, Beijing, China
- HuiLongGuan Clinical Medical School, Peking University, Beijing, China
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Jing An
- Beijing Huilongguan Hospital, Beijing, China
- HuiLongGuan Clinical Medical School, Peking University, Beijing, China
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
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De Oliveira JM, Dueñas JM, Morales-Vives F, Gallardo-Nieto E. Educational agents and institutions called into action in suicide prevention, intervention, and postvention. Front Psychol 2023; 14:1213751. [PMID: 37780143 PMCID: PMC10539586 DOI: 10.3389/fpsyg.2023.1213751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Suicide is the second leading cause of death in the 15 to 29 age group worldwide, and is a severe public health problem. Adolescent and young adult individuals attend educational institutions which can play an essential role in detecting and preventing suicide. For this reason, the purpose of this research is to identify what educational institutions and agents are called into action in suicide prevention, intervention, and postvention. Methods The method of systematic review of the literature based on the PRISMA protocol was used. The review protocol was registered in PROSPERO (PROSPERO 2020 CRD42020189127). The systematic review yielded 66 articles published between 1990 and February 2023. Results The results show that a wide variety of educational stakeholders are required to intervene for suicide prevention, interventions and postvention between primary education and college. The study describes the different programs that have been provided, the countries in which they have been implemented and the agents who have been targeted. It also identifies gaps in the research on suicide in the educational field. Discussion Overall, educational suicide initiatives report positive effects on participants' understanding, attitudes, and beliefs regarding suicide and suicide prevention, although some studies have expressed some caution.
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Affiliation(s)
| | - Jorge-Manuel Dueñas
- Research Center for Behavior Assessment, Psychology Department, Universitat Rovira i Virgili, Tarragona, Spain
| | - Fabia Morales-Vives
- Research Center for Behavior Assessment, Psychology Department, Universitat Rovira i Virgili, Tarragona, Spain
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Kaspersen SL, Kalseth J, Stene-Larsen K, Reneflot A. Use of Health Services and Support Resources by Immediate Family Members Bereaved by Suicide: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10016. [PMID: 36011651 PMCID: PMC9408753 DOI: 10.3390/ijerph191610016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
The knowledge on health service use, systematic follow-up, and support for families bereaved by suicide remains scarce. This scoping review includes studies from 2010 to March 2022 that investigate the follow-up and support offered by health services, peer support services, and other resources available (e.g., internet-based resources) for families bereaved by suicide. We followed the scoping review framework provided by the Johanna Briggs Institute and performed a double-blinded screening process using Covidence. Data were extracted by four researchers and a thematic analysis was performed to summarize the results. The PRISMA Extension for Scoping reviews was used for reporting results. Of 2385 studies screened by title, 190 by abstract, and 93 by full-text reading, we included 63 original articles of which 24, 29 and 10 were quantitative, qualitative, or mixed-methods studies, respectively. The review shows that we have some knowledge about the need for, and experiences with, health services and support resources for immediate family members bereaved by suicide, but a lack of knowledge about their help-seeking behaviour, patient pathways, systematic follow-up, coordination between services, and long-term outcomes. We need more longitudinal observational studies of health service use and patient trajectories for people bereaved by suicide.
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Affiliation(s)
- Silje L. Kaspersen
- Department of Health Research, SINTEF Digital, Pb. 4760 Torgarden, 7465 Trondheim, Norway
| | - Jorid Kalseth
- Department of Health Research, SINTEF Digital, Pb. 4760 Torgarden, 7465 Trondheim, Norway
| | - Kim Stene-Larsen
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, 0456 Oslo, Norway
| | - Anne Reneflot
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, 0456 Oslo, Norway
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Cecchin HFG, Murta SG, de Macedo EOS, Moore RA. Scoping review of 30 years of suicide prevention in university students around the world: efficacy, effectiveness, and cost-effectiveness. PSICOLOGIA-REFLEXAO E CRITICA 2022; 35:22. [PMID: 35856124 PMCID: PMC9294115 DOI: 10.1186/s41155-022-00227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Hareli Fernanda Garcia Cecchin
- Universidade Federal do Tocantins, Pró-reitoria de Assuntos Estudantis – PROEST, Quadra 109 Norte, Avenida NS-15, Prédio da Reitoria, Plano Diretor Norte, 77001-090 Palmas, Tocantins Brazil
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Bockhoff K, Bruder S, Ellermeier W, Rohrbach T, Hertel US. Wer profitiert von einem Workshop zur Suizidprävention an Schulen? ZEITSCHRIFT FUR ENTWICKLUNGSPSYCHOLOGIE UND PADAGOGISCHE PSYCHOLOGIE 2022. [DOI: 10.1026/0049-8637/a000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Um die Suizidprävention an Schulen zu verbessern, wurden psychoedukative Workshops für Schüler_innen implementiert und angeboten. N=200 Schüler_innen der 8.–10. Jahrgangsstufe wurden zufällig einer Experimental- oder Kontrollgruppe zugewiesen. Vor und nach dem Training sowie nach drei Monaten wurden sie zu ihrem hilfesuchenden und hilfegebendem Verhalten sowie ihrer depressiven Symptomatik befragt. Die Ergebnisse weisen darauf hin, dass besonders die als stärker suizidgefährdet eingestuften Jugendlichen von dem Training durch eine Abnahme ihrer depressiven Symptomatik profitierten. Schüler_innen der Kontrollgruppe verbesserten sich demgegenüber nicht signifikant in ihrer depressiven Symptomatik. Für das hilfesuchende ebenso wie das hilfegebende Verhalten zeigten sich positive Trends, die jedoch nicht statistisch signifikant wurden. Diese Ergebnisse zeigen – wenn auch mit Limitationen aufgrund von Ausfällen durch die Coronapandemie 2020 und durch ein restriktives Vor-Screening – die Wirksamkeit einer aufwändigen außerschulischen Suizidprävention auf Befinden und Verhalten.
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Affiliation(s)
- Katharina Bockhoff
- Abteilung für Psychosomatik, Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt
- Institut für Psychologie, Fachbereich Humanwissenschaften, Technische Universität Darmstadt
| | - Simone Bruder
- Abteilung für Psychosomatik, Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt
| | - Wolfgang Ellermeier
- Institut für Psychologie, Fachbereich Humanwissenschaften, Technische Universität Darmstadt
| | - Theresa Rohrbach
- Institut für Bildungswissenschaften, Fakultät für Verhaltens- und Empirische Kulturwissenschaften, Universität Heidelberg
| | - und Silke Hertel
- Institut für Bildungswissenschaften, Fakultät für Verhaltens- und Empirische Kulturwissenschaften, Universität Heidelberg
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