School, Child & Youth (SCY) Mental Health and Wellbeing Research Lab, National Institute of Studies in Education, Health Research Institute, University of Limerick, Limerick, Ireland.
Department of Psychology, University of Limerick, Limerick, Ireland.
J Child Psychol Psychiatry. 2022 Aug;63(8):836-845. doi: 10.1111/jcpp.13598. Epub 2022 Mar 15.
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.
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.
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).
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.
在全球范围内，自杀是导致青少年死亡的第四大主要原因（自杀：https://www.who.int/news-room/fact-sheets/detail/suicide）。中学后基于学校的自杀预防（PSSP）对青少年自杀意念和行为（STB）的影响尚未得到全面综合评估。我们旨在评估 PSSP 干预措施对青少年 STB 的人群效果，并探讨干预效果如何因干预措施和情境因素的调节而有所不同。
对 PsycINFO、Medline、Education Source、ERIC、Web of Science 和 Cochrane 对照试验中心注册数据库进行检索，以确定评估 PSSP 对青少年 STB 有效性的整群随机试验。采用 Cochrane 偏倚风险工具评估偏倚。计算了未调整和调整后逆转换比值比（OR）。多水平随机效应模型考虑了效果的相关性。单变量荟萃回归分析了干预措施和情境因素对汇总效果的可变性。
自杀意念（SI）和自杀企图（SA）分别有 19 和 12 项效应。与对照组相比，干预组 SI 的粗比值比（OR）为 0.87（95%CI [0.78, 0.96]），SA 的粗比值比为 0.66（95%CI [0.47, 0.91]），分别降低了 13%和 34%。调整后的 SI（OR=0.85, 95%CI [0.75, 0.95]）和 SA（OR=0.72, 95%CI [0.59, 0.87]）模型的效果相似。SA 模型的粗值和调整值以及 SI 的异质性范围在研究内（0.20-9.10%）和研究间（0-51.20%）。SA 效应的调节分析无差异（p>.05）。
本荟萃分析通过证明 PSSP 以 STB 为主要干预结果，并以其他健康和幸福感结果为目标，可降低 329 所学校的 33155 名青少年的 SI 和 SA，从而为 PSSP 证据基础做出了贡献，与对照组相比。需要治疗的人数估计表明，通过在 1-2 个教室中实施 PSSP，有可能减少一个青少年的 SA 和 SI 的发生率，支持 PSSP 作为一种具有临床相关性的自杀预防策略。尽管调节分析无统计学意义且试验数量较少，但较大的 SA 效应大小支持持续时间≤1 周、涉及多个利益相关者且具有 12 个月随访的干预措施的特别有效性。
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