ArticlesSchool-based suicide prevention programmes: the SEYLE cluster-randomised, controlled trial
Introduction
Worldwide, suicide is one of the three leading causes of death in young people.1, 2 Globally, in 2009, suicide accounted for 7·3% of all deaths in the age group 15–19 years, after road traffic accidents (11·6%), and preceding violence (6·2%), respiratory tract infections (5·4%), tuberculosis (4·8%), and HIV (2·3%).3 According to the latest data from WHO, figures are similar in 2014.4 The lifetime prevalence of suicide attempts in adolescents in the USA is 4·1%.5 In Europe, the lifetime self-reported prevalence for similar age groups is 4·2%.6
Suicide attempts and severe suicidal ideation have potentially serious consequences, including substantial psychological effects, increased risk of subsequent suicide attempt, and death.7, 8 Importantly, suicidal behaviour also has profound negative effects on relatives and other people in the person's life.9 The medical, financial, and emotional costs to communities affected by suicide are also substantial.10 Consequently, the prevention of suicidal behaviour should be a national health priority, with the development of existing11, 12, 13 and new evidence-based, suicide preventive interventions. Research lends support to the theory that the vast proportion of psychopathological changes has its onset in childhood and adolescence,14 and therefore young people are an especially important target.15, 16 Most children and adolescents attend school, which makes these an appropriate setting for reaching young people.17 The authors of two systematic reviews of school-based suicide preventive interventions18, 19 concluded that assessments of school-based intervention programmes tested in randomised controlled trials are needed. The theoretical framework of suicide prevention programmes generally acknowledges universal, selective, or indicated approaches.20, 21, 22 School-based universal programmes include all pupils, whereas selective and indicated efforts focus on those regarded at high risk or presenting suicidal behaviour. The few randomised trials based on a universal or a selective approach have focused almost exclusively on generating change in knowledge and attitudes.19 Very few trials, all from the USA and none from Europe, have investigated changes in the reduction of severe suicidal ideation or suicide attempts.23, 24, 25, 26 In this Article, we report the results of the Saving and Empowering Young Lives in Europe (SEYLE) study, the first large-scale, multicountry, European randomised controlled trial of school-based prevention of suicidal behaviour in adolescents.27 The main hypothesis is that preventive interventions are more effective than a control condition in reducing new cases of suicide attempt and severe suicidal ideation between baseline and follow-up assessments.
Section snippets
Trial design and participants
SEYLE was a multicentre, cluster-randomised trial designed to investigate the efficacy of school-based preventive interventions for suicidal behaviour. Pupils were recruited from 168 schools in ten European Union countries (Austria, Estonia, France, Germany, Hungary, Ireland, Italy, Romania, Slovenia, and Spain). Schools were deemed eligible if they were public, contained at least 40 pupils aged 15 years, had more than two teachers for pupils aged 15 years, and had no more than 60% of pupils of
Results
Of 232 schools that were approached and randomly assigned to one of four study groups, 168 schools (72%) accepted to participate. 27 099 pupils were approached: 14 267 were not enrolled because parental consent or pupils' assent were not given, and 1722 pupils were absent from school on the day of baseline assessment. We recruited 11 110 pupils (median age 15 years [IQR 14–15], mean age 14·8 years [SD 0·8]; 59% girls). Of the 11 110 pupils with baseline assessment, 9798 (88%) were available at
Discussion
This study represents the first European, multicountry, randomised controlled trial of the prevention of suicidal behaviour in adolescents (panel). The results show that the YAM, a universal, school-based intervention of short duration (5 h in 4 weeks),29 was significantly more effective in preventing new cases of suicide attempts and severe suicidal ideation, including planning, than no intervention (the control group). The reported reduction in incident suicide attempts was more than 50% with
References (48)
- et al.
Global patterns of mortality in young people: a systematic analysis of population health data
Lancet
(2009) - et al.
Premature death after self-harm: a multicentre cohort study
Lancet
(2012) - et al.
The European Psychiatric Association (EPA) guidance on suicide treatment and prevention
Eur Psychiatry
(2012) - et al.
Health of the world's adolescents: a synthesis of internationally comparable data
Lancet
(2012) - et al.
Common adolescent mental disorders: transition to adulthood
Lancet
(2014) - et al.
Awareness in nine countries: a public health approach to suicide prevention
Leg Med (Tokyo)
(2009) - et al.
The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts
Drug Alcohol Depend
(2008) - et al.
The prognosis of common mental disorders in adolescents: a 14-year prospective cohort study
Lancet
(2014) - et al.
Service use by at-risk youths after school-based suicide screening
J Am Acad Child Adolesc Psychiatry
(2009) - et al.
Suicide and suicidal behavior
Epidemiol Rev
(2008)
Global suicide rates among young people aged 15–19
World Psychiatry
Preventing suicide: a global imperative
Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement
JAMA Psychiatry
A newly identified group of adolescents at “invisible” risk for psychopathology and suicidal behavior: findings from the SEYLE study
World Psychiatry
Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys
J Clin Psychiatry
Essential questions on suicide bereavement and postvention
Int J Environ Res Public Health
Is it worth investing in mental health promotion and prevention of mental illness? A systematic review of the evidence from economic evaluations
BMC Public Health
Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries
Bull World Health Organ
Suicide prevention strategies: a systematic review
JAMA
Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication
Arch Gen Psychiatry
The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement
Cochrane Database Syst Rev
Mapping the evidence of prevention and intervention studies for suicidal and self-harming behaviors in young people
Crisis
A systematic review of school-based suicide prevention programs
Depress Anxiety
Reducing risks for mental disorders: frontiers for preventive intervention research
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