The effectiveness of middle and high school-based suicide prevention programmes for adolescents: a systematic review.
OBJECTIVE
To assess the effectiveness of middle and high school-based suicide prevention curricula.


METHODS
The following were searched: Ovid MEDLINE(R) in-process and other non-indexed citations and Ovid MEDLINE(R), Ovid Healthstar, CINAHL, PsycINFO, all EBM reviews-Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED, and the ISI Web of Science, until October 2009; government web pages for statistics and other demographic data in countries where they were available; citation lists of relevant articles.


METHODS
Randomised controlled studies, interrupted time series analyses with a concurrent comparison group, studies with follow-up examinations (post-test questionnaires and monitoring suicide rates), and middle to high school-based curriculum studies, including both male and female participants, were included.


RESULTS
36 potentially relevant studies were identified, eight of which met the inclusion criteria. Overall, statistically significant improvements were noted in knowledge, attitude, and help-seeking behaviour. A decrease in self reported ideation was reported in two studies. None reported on suicide rates.


CONCLUSIONS
Although evidence exists that school-based programmes to prevent suicide among adolescents improve knowledge, attitudes, and help-seeking behaviours, no evidence yet exists that these prevention programmes reduce suicide rates. Further well designed, controlled research is required before such programmes are instituted broadly to populations at risk.
Injury Prevention Research Office, Keenan Research Centre, St Michael's Hospital, Toronto, Ontario, Canada. injuryprevention@smh.toronto.on.ca
Michael D
MD
Cusimano
Mojib
M
Sameem
D000293:Adolescent; D002648:Child; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D012572:School Health Services / Q000592:standards*; D013334:Students / Q000523:psychology*; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology*; D000092864:Suicide Prevention