Breet Elsie, Matooane Matsie, Tomlinson Mark, Bantjes Jason
Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
BMC Public Health. 2021 Jun 10;21(1):1116. doi: 10.1186/s12889-021-11124-w.
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.
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.
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.
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.
高中和大学的青少年自杀预防是一项公共卫生重点工作。我们的目标是通过综合和批判性地审视现有干预研究中使用的研究重点和方法，提出一个研究议程，以推进高中和大学基于证据的自杀预防工作。
系统检索了14个数据库，以识别评估在高中或大学校园实施的自杀预防干预措施且有前后测量的研究。提取纳入研究（n = 43）的数据，以确定干预措施测试的内容、地点、方式和对象。采用叙述性综合分析来批判性地评估研究重点和方法。评估研究质量。
研究主要集中在选择性干预措施上，对指导性干预措施和普遍性干预措施的关注较少。大多数证据来自北美和高收入国家。干预措施的目标包括：非致命性自杀行为；工作人员/学生干预自杀危机的信心和能力；与自杀相关的知识和态度；以及与自杀相关的耻辱感。没有研究将自杀死亡作为结果纳入，没有评估生态系统干预措施，没有探讨背景如何影响实施，没有使用多地点研究设计，也没有明确关注 LGBTQ+ 青少年。两项研究评估了数字干预措施。大多数研究的质量因缺乏方法严谨性、样本量小以及中度/高度偏倚风险而受到影响。干预措施通常假定存在外部运作良好的转诊途径，而在资源匮乏的环境中可能并非如此。
为了推进教育环境中基于证据的自杀预防工作，我们需要开展更多高质量的临床和实用性试验；促进低收入和中等收入国家的研究；测试针对弱势群体（如 LGBTQ+ 青少年）的针对性干预措施，评估以自杀死亡为主要结果的干预措施；纳入转化研究并运用实施科学来促进干预措施的采用；评估数字和生态系统干预措施的潜在用途；以及在不同文化背景下开展多地点研究。
