Systematic review and narrative synthesis of suicide prevention in high-schools and universities : a research agenda for evidence-based practice
Date
2021-06-10
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: Youth suicide prevention in high-schools and universities is a public health priority. Our aim was to
propose a research agenda to advance evidence-based suicide prevention in high-schools and universities by
synthesizing and critically reviewing the research focus and methodologies used in existing intervention studies.
Methods: Fourteen databases were systematically searched to identify studies which evaluate suicide prevention
interventions delivered on high-school or university campuses, with before and after measures. Data from included
studies (n = 43) were extracted to identify what, where, how and for whom interventions have been tested.
Narrative synthesis was used to critically evaluate research focus and methodology. Study quality was assessed.
Results: Research has focused primarily on selective interventions, with less attention on indicated and universal
interventions. Most evidence comes from North America and high-income countries. The target of interventions
has been: non-fatal suicidal behaviour; confidence and ability of staff/students to intervene in a suicidal crisis;
suicide-related knowledge and attitudes; and suicide-related stigma. No studies included suicide deaths as an
outcome, evaluated eco-systemic interventions, explored how context influences implementation, used multisite
study designs, or focused explicitly on LGBTQ+ youth. Two studies evaluated digital interventions. Quality of the
majority of studies was compromised by lack of methodological rigour, small samples, and moderate/high risk of
bias. Interventions often assume the existence of an external well-functioning referral pathway, which may not be
true in low-resource settings.
Conclusion: To advance evidence-based suicide prevention in educational settings we need to: conduct more
high-quality clinical and pragmatic trials; promote research in low- and middle-income countries; test targeted
interventions for vulnerable populations (like LGBTQ+ youth), evaluate interventions where death by suicide is the
primary outcome; include translational studies and use implementation science to promote intervention uptake;
evaluate the potential use of digital and eco-systemic interventions; and conduct multisite studies in diverse
cultural settings.
Description
CITATION: Breet, E., et al. 2021. Systematic review and narrative synthesis of suicide prevention in high-schools and universities : a research agenda for evidence-based practice. BMC Public Health, 21:1116, doi:10.1186/s12889-021-11124-w.
The original publication is available at https://bmcpublichealth.biomedcentral.com/
The original publication is available at https://bmcpublichealth.biomedcentral.com/
Keywords
Suicide prevention
Citation
Breet, E., et al. 2021. Systematic review and narrative synthesis of suicide prevention in high-schools and universities : a research agenda for evidence-based practice. BMC Public Health, 21:1116, doi:10.1186/s12889-021-11124-w