A school-wide health intervention was associated with a reduction in teen suicide attempts, compared to programs that aimed to identify only at-risk students, according to a large study of teenagers in 10 European countries. The research was conducted by the Mailman School of Public Health’s department of epidemiology and department of biostatistics with colleagues from the New York State Psychiatric Institute, and several institutions abroad. Findings are published in the Lancet.
“This study provides much-needed empirical evidence of the effectiveness of a universal school-based public health intervention,” according to co-author Dr. Christina Hoven, professor of epidemiology in psychiatry.
Suicide is one of the three leading causes of death for young people globally. According to a 2013 study from JAMA, about four percent of American and European teenagers will commit suicide. Several suicide prevention interventions based at schools have been tested before, but this is the first randomized controlled trial of such programs. Suicide prevention programs differ in their approaches, with some aiming to identify at-risk individuals—known as selective or indicated prevention interventions— while “universal prevention interventions” try to raise awareness across a whole population.
In this study, called Saving and Empowering Young Lives in Europe or SEYLE, investigators tested the effects of three interventions—two of which were selective and one of which was universal—and compared each to a control situation. They recruited over 11,000 students from 168 schools in Austria, Estonia, France, Germany, Hungary, Ireland, Italy, Romania, Slovenia, and Spain and divided the schools into one of the four intervention groups.
The researchers measured the number of suicide attempts and instances of suicide ideation—thoughts of suicide—in all four groups after the interventions ended. After three months, none of the interventions had a significant effect on suicide attempts when compared to the control group, but after 12 months the universal intervention, called the Youth Aware of Mental Health Program or YAM, was associated with a reduction in suicide attempts and “severe” suicide ideation. For every 167 students reached by the program, one suicide attempt could be prevented each year. The absolute risk of suicide fell by 0.6 percent, or six out of 1,000 students attempting suicide, and the relative risk fell nearly 55 percent, meaning that in the control group, 11 students out of 1,000 attempted suicide versus five out of 1,000 who attempted in the universal intervention group.