Controlled interventions to improve suicide prevention in educational settings: A systematic review and network meta-analysis

Background: Suicidal thoughts and behaviors (STBs) in young people is a major public health problem, which is on the rise globally. Aims: We applied the first network meta-analyses to examine the effectiveness of existing intervention types and contents to reduce STBs and improve suicide prevention competencies in educational settings. Method: We searched Medline, PsycInfo, and CENTRAL until April 2021. Quantitative studies focused on young people aged between 12 and 25 years which evaluated interventions at educational settings and contained comparator groups were included. Results: Overall, we identified 49 studies comprising 42,039 participants. Regarding the type of intervention, universal interventions (OR = 1.85, 95% confidence interval [CI] [1.43–2.38]) were associated with almost two-fold reductions in the odds of STBs. Selective (standardized mean difference [SMD] = 0.51, 95% CI [0.32–0.70]) and universal interventions (SMD = 0.40, 0.26–0.54) were moderately effective in increasing suicide prevention competencies. Regarding the content of the intervention, education/awareness programs (OR = 1.59, 95% CI [1.23–2.04]) and psychotherapy programs (OR = 2.22, [1.25–3.33]) were associated with 1.5- and two-fold reductions in the odds of STBs. Gatekeeper universal interventions (SMD = 1.04, 95% CI [0.73–1.34]) and gatekeeper selective interventions (SMD = 0.52, [0.26–0.77]) were strong-to-moderately more effective in increasing suicide prevention competencies when compared to no-treatment. Education/awareness interventions were also modestly effective (SMD = 0.28, 95% CI [0.12–0.44]). The quality of 81% of the included studies was low. Conclusions: Important policy actions should be taken with a focus on offering universal mental health/suicide awareness training programs and/or selective treatments to reduce STBs and improve suicide prevention competencies in educational settings.