title: A systematic review of school-based suicide prevention programs.
abstract: OBJECTIVE
  Suicide is one of the leading causes of death among youth today. Schools are a cost-effective way to reach youth, yet there is no conclusive evidence regarding the most effective prevention strategy. We conducted a systematic review of the empirical literature on school-based suicide prevention programs.
  
  
  METHODS
  Studies were identified through MEDLINE and Scopus searches, using keywords such as "suicide, education, prevention and program evaluation." Additional studies were identified with a manual search of relevant reference lists. Individual studies were rated for level of evidence, and the programs were given a grade of recommendation. Five reviewers rated all studies independently and disagreements were resolved through discussion.
  
  
  RESULTS
  Sixteen programs were identified. Few programs have been evaluated for their effectiveness in reducing suicide attempts. Most studies evaluated the programs' abilities to improve students' and school staffs' knowledge and attitudes toward suicide. Signs of Suicide and the Good Behavior Game were the only programs found to reduce suicide attempts. Several other programs were found to reduce suicidal ideation, improve general life skills, and change gatekeeper behaviors.
  
  
  CONCLUSIONS
  There are few evidence-based, school-based suicide prevention programs, a combination of which may be effective. It would be useful to evaluate the effectiveness of general mental health promotion programs on the outcome of suicide. The grades assigned in this review are reflective of the available literature, demonstrating a lack of randomized controlled trials. Further evaluation of programs examining suicidal behavior outcomes in randomized controlled trials is warranted.
authors: Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Cara
authors: C
authors: Katz
authors: Shay-Lee
authors: SL
authors: Bolton
authors: Laurence Y
authors: LY
authors: Katz
authors: Corinne
authors: C
authors: Isaak
authors: Toni
authors: T
authors: Tilston-Jones
authors: Jitender
authors: J
authors: Sareen
mesh_terms: D000293:Adolescent; D057186:Comparative Effectiveness Research; D019317:Evidence-Based Medicine; D006801:Humans; D015397:Program Evaluation; D012572:School Health Services; D000092864:Suicide Prevention
keywords: child/adolescent; depression; dissemination/implementation; empirical supported treatments; suicide/self-harm