Systematic review and narrative synthesis of suicide prevention in high-schools and universities: a research agenda for evidence-based practice

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.

Developing recommendations to improve identification, prevention, and response to suicide thoughts and behaviours among post-secondary students: A mixed methods study

Objective: This study aimed to generate recommendations regarding how to identify, prevent and respond to suicide thoughts and behaviors among post-secondary students. Methods: A convergent mixed-methods design with Nominal Groups Technique (NGT) was used. Post-secondary and high-school students and their caregivers generated and ranked recommendations. A Codebook Thematic Analysis approach guided analysis of the NGT-discussions and extended understanding of recommendations. Results: 88 individuals participated in 21 panels. Five key recommendations were identified: (1) increase student and staff education regarding suicide identification, prevention, and awareness of existing supports; (2) enhance rapid access to supports for those experiencing a crisis; (3) improve institutional academic supports for students following crisis; (4) reduce stigma; (5) improve communication regarding on-campus suicide. Common themes included perceived impact of attitudes, institutional barriers, and peer-support on suicide thoughts and behaviors. Conclusions: These recommendations can inform the development of student-centred interventions for improving mental health supports.

Prevalence of Suicidal Behavior Among Students in South-East Asia: A Systematic Review and Meta-Analysis

OBJECTIVES

Estimation of rates of suicidal behaviors (ideation, plan, and attempt) would help to understand the burden and prioritize prevention strategies. However, no attempt to assess suicidal behavior among students was identified in South-East Asia (SEA). We aimed to assess the prevalence of suicidal behavior (ideation, plan, and attempt) among students in SEA.

METHODS

We followed PRISMA 2020 guidelines and registered the protocol in PROSPERO (CRD42022353438). We searched in Medline, Embase, and PsycINFO and performed meta-analyses to pool the lifetime, 1-year, and point prevalence rates for suicidal ideation, plans, and attempts. We considered the duration of a month for point prevalence.

RESULTS

The search identified 40 separate populations from which 46 were included in the analyses, as some studies included samples from multiple countries. The pooled prevalence of suicidal ideation was 17.4% (confidence interval [95% CI], 12.4%-23.9%) for lifetime, 9.33% (95% CI, 7.2%-12%) for the past year, and 4.8% (95% CI, 3.6%-6.4%) for the present time. The pooled prevalence of suicide plans was 9% (95% CI, 6.2%-12.9%) for lifetime, 7.3% (95% CI, 5.1%-10.3%) for the past year, and 2.3% (95% CI, 0.8%-6.7%) for the present time. The pooled prevalence of suicide attempts was 5.2% (95% CI, 3.5%-7.8%) for lifetime and 4.5% (95% CI, 3.4%-5.8%) for the past year. Higher rates of suicide attempts in the lifetime were noted in Nepal (10%) and Bangladesh (9%), while lower rates were reported in India (4%) and Indonesia (5%).

CONCLUSIONS

Suicidal behaviors are a common phenomenon among students in the SEA region. These findings call for integrated, multisectoral efforts to prevent suicidal behaviors in this group.

Current evidence and opportunities in child and adolescent public mental health: a research review

BACKGROUND

A public mental health lens is increasingly required to better understand the complex and multifactorial influences of interpersonal, community and institutional systems on the mental health of children and adolescents.

METHODS

This research review (1) provides an overview of public mental health and proposes a new interactional schema that can guide research and practice, (2) summarises recent evidence on public mental health interventions for children and adolescents, (3) highlights current challenges for this population that might benefit from additional attention and (4) discusses methodological and conceptual hurdles and proposes potential solutions.

RESULTS

In our evidence review, a broad range of universal, selective and indicated interventions with a variety of targets, mechanisms and settings were identified, some of which (most notably parenting programmes and various school-based interventions) have demonstrated small-to-modest positive effects. Few, however, have achieved sustained mental health improvements.

CONCLUSIONS

There is an opportunity to re-think how public mental health interventions are designed, evaluated and implemented. Deliberate design, encompassing careful consideration of the aims and population-level impacts of interventions, complemented by measurement that embraces complexity through more in-depth characterisation, or 'phenotyping', of interpersonal and environmental elements is needed. Opportunities to improve child and adolescent mental health outcomes are gaining unprecedented momentum. Innovative new methodology, heightened public awareness, institutional interest and supportive funding can enable enhanced study of public mental health that does not shy away from complexity.

Assessing Communicative Resilience in Suicide Prevention for LGBTQ+ Communities: A Qualitative Analysis of Community Conversations

PURPOSE

Since LGBTQ + communities experience disproportionate rates of suicidality; it is important to identify strategies for suicide prevention. Research shows that supportive interpersonal communication and identity affirmation helps prevent suicide. The purpose of this analysis is to explore the role of communicative resilience in suicide prevention among LGBTQ + communities.

APPROACH

This analysis is part of a community-based participatory research project.

SETTING

In November 2021, a Community-Academic Partnership hosted a virtual town hall, via Zoom, immediately followed by five Community Conversation (CC) groups.

PARTICIPANTS

Participants were aged 18 years or older and identified as an LGBTQ + community member or active ally. We define active ally as an individual who, through their personal relationships, service to the community, or professional work, actively advocates for and supports members of LGBTQ + communities.

METHOD

CC groups were audio-recorded and transcribed (n= 25 participants). Transcripts were inductively coded for thematic analysis and identified themes were deductively coded using Communication Theory of Resilience (CTR) to identify observations of communicative resilience (MaxQDA2020).

RESULTS

Themes aligned with CTR, including importance of peer and professional support, affirming identities, reducing stigma, cultivating hope, and advocating for equitable policies.

CONCLUSION

Findings demonstrate that through communication, members of LGBTQ + communities enact processes of resilience that support and promote suicide prevention. These findings support community mobilization, communicative resilience, and advocacy to help save lives.

Pathways from childhood trauma to suicidal ideation: mediating through difficulties in emotion regulation and depressive symptoms

OBJECTIVE

Suicidal ideation is a clinical exigency heightening the risk of suicide at different levels of suicidal behavior. This study sought to explore crucial correlates of this phenomenon with a structural equation modeling approach. Accordingly, the mediating role of depressive symptoms and difficulties in emotion regulation between childhood trauma and suicidal ideation were explored.

METHOD

The sample consisted of 372 university students (57.3% females, M = 20.75, SD = 2.25) who completed self-report measures examining experiences of childhood trauma, depressive symptoms, difficulties in emotion regulation, and suicidal ideation. Structural equation modeling was employed, and mediation analysis was conducted. Confirmatory factor analysis was used to test the measurement model of each construct before evaluating the conceptual mediated model.

RESULTS

Findings indicate that depressive symptoms with difficulties in emotion regulation had the strongest association (r = 0.60, P = 0.001), then depressive symptoms and suicidal ideation (r = 0.58, P = 0.001), suicidal ideation with difficulties in emotion regulation (r = 0.45, P = 0.001) then suicidal ideation with childhood trauma (r = 0.39, P = 0.001), difficulties in emotion regulation with childhood trauma (r = 0.36 P = 0.001) and finally depressive symptoms and childhood trauma (r = 0.35, P = 0.001). Regarding indirect paths, difficulties in emotion regulation and depression function together (in a sequential path) to mediate the association between childhood trauma and suicidal ideation ( χ²(68) = 216.86, P < 0.01, CFI = 0.95, TLI = 0.93, RMSE = 0.077, CI [0.066 to 0.089], SRMR = 0.049).

CONCLUSION

Results demonstrate that childhood trauma, depressive symptoms, and difficulties in emotion regulation are linked to suicidal ideation, highlighting the necessity of recognizing and addressing suicidal ideation as well as the factors that contribute to suicidal ideation. Emotion regulation interventions can be effective in reducing the negative effects of childhood trauma and lowering the risk of suicide. These interventions can help in reducing depressive symptoms and improve overall mental well-being, leading to a lower risk of suicide.

Prevalence and correlates of 30-day suicidal ideation and intent: Results of the South African National Student Mental Health Survey

Background. Although suicide prevention is recognised as a priority among university students in South Africa (SA), it is unclear whatproportion of students require urgent indicated interventions and what the characteristics are of these students.Objective. To assess the prevalence and sociodemographic correlates of 30-day suicidal ideation, frequency of ideation and self-reported intention to act on ideation in the next year among a national sample of SA university students.Methods. Self-report cross-sectional data were collected online from students (N=28 268) at 17 universities across SA as part of the national student mental health survey. Students reported suicidal ideation in the past 30 days, frequency of ideation and intention to act on ideation in the next year. Data were weighted within institutions by gender and population group, and across the four main types of universities (historically white, historically disadvantaged, technical and distance learning) to correct for response rate discrepancies. Prevalence was estimated with these weighted in the total sample and across types of universities. Poisson regression with robust error variances was used to investigate associations of sociodemographic characteristics with ideation and intention to act on suicidal ideation. Results are reported as relative risks (RRs) with design-based 95% confidence intervals (CIs).Results. Thirty-day prevalence of suicidal ideation was 24.4% (standard error (SE) 0.3), with 2.1% (SE 0.1) and 4.1% (SE 0.1), respectively,reporting suicidal ideation all/almost all the time, or most of the time. A total of 1.5% (SE 0.1) of respondents reported being very likely to act on their suicidal ideation, while 3.9% (SE 0.2) were somewhat likely, 8.7% (SE 0.2) were not very likely and 85.8 (SE 0.5) either reported no suicidal ideation or that they were not at all likely to act on this ideation. Risk of suicidal ideation with high intent in the total sample was elevated among females (RR 1.9, 95% CI 1.3 - 2.7) and gender non-conforming students (RR 4.3, 95% CI 1.4 - 13.0) relative to males, black African students compared with white students (RR 3.6, 95% CI 1.9 - 7.1), students whose parents did not progress to secondary school compared with students whose parents had a university education (RR 1.6, 95% CI 1.0 - 2.5) and sexual minority students compared with heterosexual students (RR 1.9, 95% CI 1.3 - 2.6). Among students with 30-day ideation (controlling for frequency of ideation), only two of these predictors of high intent remained significant: identifying as black African (RR 2.7, 95% CI 1.4 - 5.1), and having parents with less than secondary education (RR 1.5, 95% CI 1.0 - 2.1).Conclusion. Scalable suicide prevention interventions are needed to reach the large number of SA students who report suicidal ideation with intent.

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

Suicide is the fourth leading cause of death among adolescents, globally. Though post-primary, school-based suicide prevention (PSSP) has the potential to be a key strategy for preventing adolescent suicidal thoughts and behaviours (STBs), there are persisting challenges to translating PSSP research to practice. Intervention and contextual factors relevant to PSSP are likely key to both PSSP effectiveness and implementation. As such, this systematic review aimed to summarise the effectiveness of PSSP for adolescent STBs and highlight important intervention and contextual factors with respect to PSSP. PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials were searched to identify randomised and non-randomised studies evaluating the effectiveness of interventions located in post-primary, school-based settings targeting adolescent STBs. PSSP effectiveness and intervention and contextual factors were synthesised narratively. Twenty-eight studies were retained, containing nearly 47,000 participants. Twelve out of twenty-nine trials comparing intervention and independent control comparators reported statistically significant reductions in STBs postintervention, and 5/7 trials comparing preintervention and postintervention scores demonstrated significant reductions in STBs over time. Reporting and analysis of intervention and contextual factors were lacking across studies, but PSSP effectiveness and intervention acceptability varied across type of school. Although school personnel commonly delivered PSSP interventions, their input and perspectives on PSSP interventions were lacking. Notably, adolescents had little involvement in designing, inputting on, delivering and sharing their perspectives on PSSP interventions. Twenty out of twenty-eight studies were rated as moderate/high risk of bias, with non-randomised trials demonstrating greater risks of bias and trial effectiveness, in comparison to cluster randomised trials. Future research should prioritise complete reporting and analysis of intervention and contextual factors with respect to PSSP, involving key stakeholders (including adolescents and school personnel) in PSSP, and investigating key stakeholders' perspectives on PSSP. Given the inverse associations between both study quality and study design with PSSP effectiveness, particular consideration to study quality and design in PSSP research is needed. Future practice should consider PSSP interventions with universal components and PSSP which supports and involves key stakeholders in engaging with PSSP.

An examination of theory-based suicidal ideation risk factors in college students with multiple marginalized identities

Social marginalization increases the risk of suicidal ideation (SI) among individuals with diverse identities, yet research examining the effects of marginalization has focused on one identity. Emerging adulthood is a critical period of identity development and the age group with the highest rates of SI. Considering the challenges of living in potentially heterosexist, cissexist, racist, and sizeist environments, we tested whether possessing multiple marginalized identities was associated with severity of SI through factors proposed in the interpersonal-psychological theory (IPT) and the three-step theory (3ST) of suicide and if mediation paths were moderated by sex. A sample of 265 college students completed a cross-sectional online survey assessing SI and constructs related to IPT and 3ST. The number of marginalized identities was generated by adding minoritized sexual orientation, race/ethnicity other than non-Hispanic White, body mass index >25 kg/m2, sexual attraction to same sex but identified as heterosexual, and gender-fluid identity. In IPT multiple mediation analyses, possessing more marginalized identities was associated with SI severity through burdensomeness and hopelessness, but not belonging. Indirect paths through burdensomeness and belonging were moderated by sex. For 3ST, possessing more marginalized identities was associated with SI severity through hopelessness and psychological pain, but not social connection or meaning in life. Future research should consider intersecting social identities and test mechanisms by which multiply marginalized college students develop resilience to SI risk factors, such as support within their marginalized groups, to inform suicide assessment and intervention efforts on college campuses. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Implementation strategies and outcomes of school-based programs for adolescent suicide prevention: A scoping review protocol

OBJECTIVE

This scoping review aims to identify and map the empirical literature on the implementation strategies and outcomes of school-based programs for adolescent suicide prevention (SBASP).

INTRODUCTION

School-based programs are preferred interventions for preventing suicide in adolescents, and their effectiveness has been well-systematized in several reviews. Implementation research is a growing field for prevention programs, making it possible to understand the nature of success or failure outcomes and maximize intervention benefits. However, there is a knowledge gap in the implementation research applied to adolescent suicide prevention in the educational context. We conduct a scoping review to provide the first overview of the scope of implementation research applied to adolescent suicide prevention programs in the school setting to know what implementation strategies and outcomes are reported by these programs and how they are evaluated.

METHODS

The proposed scoping review will be conducted following six stages, including the definition of objectives. Studies must be empirical and address implementation strategies or implementation outcomes of school-based programs for adolescent suicide prevention. Studies that focused exclusively on clinical efficacy or effectiveness evaluation will be excluded. A preliminary search of PubMed was conducted to refine the initial search strings, followed by a final search of several other electronic databases. Finally, a gray literature search will identify unpublished literature and reduce location bias. There will be no limits to a specific date. Two independent reviewers will screen, select, and extract the retrieved records. The results will be presented using tabular forms and a narrative summary with attention to the review objectives and research questions and their implications for research and practice of school-based programs for adolescent suicide prevention.

Public Health Approaches to Promoting University Students' Mental Health: A Global Perspective

PURPOSE OF REVIEW

Provide a critical overview of recent global advances in student mental health from a public health perspective, highlighting key challenges and gaps in the literature.

RECENT FINDINGS

Mental disorders and suicidality are common among university students globally. However, there is a significant treatment gap even though evidence-based treatments are available. To overcome barriers to treatment, public health interventions should be conceptualized within a developmental paradigm that takes cognizance of the developmental tasks of young adulthood. Traditional one-on-one treatment approaches will not be a cost-effective or sustainable way to close the treatment gap among students. A range of evidence-based interventions is available to promote students' mental health; however, novel approaches are needed to scale up services and adapt intervention delivery to suit student specific contexts. Digital interventions and peer-to-peer interventions could be a cost-effective way to scale-up and expand the range of services.

Awareness and preferences about suicide crisis support service options among college students in India: A cross sectional study

BACKGROUND

Our objective was to explore the awareness about suicide support services and preferred service options during a suicide crisis among college going young adults.

METHODS

Between September 2016 and February 2017, we invited students from colleges affiliated to three major universities in a coastal district of South India to participate in a cross-sectional survey.

RESULTS

A total of 1890 usable responses were obtained. Most participants (n = 1633, 86.4%) were unaware of any suicide crisis support options. Most commonly listed options were support from family members, peer groups, counselling and psychiatric consultation. These were also endorsed as most preferred support options.

CONCLUSION

There is a low level of awareness about suicide support services among young Indian adults. There is a need for coordinated efforts to raise awareness and promote uptake of suicide support services in this group.

Research Review: The effect of school-based suicide prevention on suicidal ideation and suicide attempts and the role of intervention and contextual factors among adolescents: a meta-analysis and meta-regression

BACKGROUND

Globally, suicide is the fourth highest cause of adolescent mortality (Suicide: https://www.who.int/news-room/fact-sheets/detail/suicide). The effects of post-primary school-based suicide prevention (PSSP) on adolescent suicidal thoughts and behaviours (STBs) have not been comprehensively synthesised. We aim to estimate the population effect for PSSP interventions on adolescent STBs and explore how intervention effects vary based on intervention and contextual moderators.

METHODS

Searches of PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials identified cluster randomised trials examining the effectiveness of PSSP on adolescent STBs. The Cochrane Risk of Bias tool assessed bias. Crude and adjusted back-transformed odds ratios (ORs) were calculated. Multilevel random-effects models accounted for dependencies of effects. Univariate meta-regression explored variability of intervention and contextual moderators on pooled effects.

RESULTS

There were 19 and 12 effects for suicidal ideation (SI) and suicide attempts (SA). Compared with controls, interventions were associated with 13% (OR = 0.87, 95%CI [0.78, 0.96]) and 34% (OR = 0.66, 95%CI [0.47, 0.91]) lower crude odds reductions for SI and SA, respectively. Effects were similar for adjusted SI (OR = 0.85, 95%CI [0.75, 0.95]) and SA (OR = 0.72, 95%CI [0.59, 0.87]) models. Within-study (0.20-9.10%) and between-study (0-51.20%) heterogeneity ranged for crude and adjusted SA models and SI heterogeneity was 0%. Moderator analyses did not vary SA effects (ps > .05).

CONCLUSIONS

This meta-analysis contributes to the PSSP evidence-base by demonstrating that PSSP targeting STBs as both primary intervention outcomes and with other health and well-being outcomes reduced SI and SA among 33,155 adolescents attending 329 schools, compared to controls. The number needed to treat estimates suggests the potential of reducing the incidence of SA and SI in one adolescent by implementing PSSP in 1-2 classrooms, supporting PSSP as a clinically relevant suicide prevention strategy. Although moderator analyses were nonsignificant and contained a small number of trials, larger SA effect sizes support particular effectiveness for interventions of a duration of ≤1 week, involving multiple stakeholders and with a 12-month follow-up.

Scoping review of 30 years of suicide prevention in university students around the world: efficacy, effectiveness, and cost-effectiveness

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.

Equitable suicide prevention for youth impacted by the juvenile legal system

Suicide is the second leading cause of death for adolescents in the United States. Despite the already alarmingly high rates of suicide attempts among adolescents, youth involved in the juvenile legal system (JLS) are up to three times more likely to have suicide attempts than their peers not impacted by the JLS. This public health crisis is also a matter of health equity, knowing that ethnoracially minoritized youth, mainly Black and Latinx youth, have disproportionate contact with the JLS. In order to disrupt the current elevated rates of suicide among Black and Latinx youth involved in the JLS, there needs to be more concerted efforts to improve assessment and suicide prevention efforts in the JLS. There are various potential touch points of care for suicide prevention and the Sequential Intercept Model (SIM), which outlines community-based responses to the involvement of people with mental and substance use disorders in the criminal justice system, can be used as a strategic planning tool to outline possible equitable interventions across these various touch points. Our purpose is to provide a comprehensive picture of gaps and equitable opportunities for suicide prevention across each intercept of the SIM. We provide recommendations of priorities to promote health equity in suicide prevention for ethnoracially minoritized youth impacted by the JLS.

Borderline Personality Symptoms: What Not to Be Overlooked When Approaching Suicidal Ideation among University Students

Suicidal ideation is a serious condition antecedent to suicidal attempts and is highly related not only to depression but also other psychosocial factors. This study aimed to examine the predictive effects of these potential factors for suicidal ideation among young adult university students. A cross-sectional survey was conducted on a sample of university students in Thailand. An online questionnaire employed the perceived stress scale-10 (PSS-10), the patient health questionnaire-8 (PHQ-8), the multidimensional scale of perceived social support (MSPSS), and a screening instrument for borderline personality disorder. An ordinal regression analysis was applied to determine the predictive effects of the independent variables. Of 336 students, the mean age was 20.26 ± 1.3 years, 80.4% of whom were female; 14.3% had suicidal ideation. The significant predictors of suicidal thoughts were perceived stress (AOR 1.11, 95% CI 1.01 to 1.22); depressive symptoms (AOR 1.16, 95% CI 1.05 to 1.22); borderline personality symptoms (AOR 1.19, 95% CI 1.01 to 1.40); and perceived social support (AOR 0.97, 95% CI 0.94 to 1.00). Not only did depressive symptoms contribute to suicidal ideation but they also constituted important variables. Therefore, they should be included in intervention plans to prevent suicidality among university students.