title: School-based suicide prevention programmes: the SEYLE cluster-randomised, controlled trial.
abstract: BACKGROUND
  Suicidal behaviours in adolescents are a major public health problem and evidence-based prevention programmes are greatly needed. We aimed to investigate the efficacy of school-based preventive interventions of suicidal behaviours.
  
  
  METHODS
  The Saving and Empowering Young Lives in Europe (SEYLE) study is a multicentre, cluster-randomised controlled trial. The SEYLE sample consisted of 11,110 adolescent pupils, median age 15 years (IQR 14-15), recruited from 168 schools in ten European Union countries. We randomly assigned the schools to one of three interventions or a control group. The interventions were: (1) Question, Persuade, and Refer (QPR), a gatekeeper training module targeting teachers and other school personnel, (2) the Youth Aware of Mental Health Programme (YAM) targeting pupils, and (3) screening by professionals (ProfScreen) with referral of at-risk pupils. Each school was randomly assigned by random number generator to participate in one intervention (or control) group only and was unaware of the interventions undertaken in the other three trial groups. The primary outcome measure was the number of suicide attempt(s) made by 3 month and 12 month follow-up. Analysis included all pupils with data available at each timepoint, excluding those who had ever attempted suicide or who had shown severe suicidal ideation during the 2 weeks before baseline. This study is registered with the German Clinical Trials Registry, number DRKS00000214.
  
  
  RESULTS
  Between Nov 1, 2009, and Dec 14, 2010, 168 schools (11,110 pupils) were randomly assigned to interventions (40 schools [2692 pupils] to QPR, 45 [2721] YAM, 43 [2764] ProfScreen, and 40 [2933] control). No significant differences between intervention groups and the control group were recorded at the 3 month follow-up. At the 12 month follow-up, YAM was associated with a significant reduction of incident suicide attempts (odds ratios [OR] 0·45, 95% CI 0·24-0·85; p=0·014) and severe suicidal ideation (0·50, 0·27-0·92; p=0·025), compared with the control group. 14 pupils (0·70%) reported incident suicide attempts at the 12 month follow-up in the YAM versus 34 (1·51%) in the control group, and 15 pupils (0·75%) reported incident severe suicidal ideation in the YAM group versus 31 (1·37%) in the control group. No participants completed suicide during the study period.
  
  
  CONCLUSIONS
  YAM was effective in reducing the number of suicide attempts and severe suicidal ideation in school-based adolescents. These findings underline the benefit of this universal suicide preventive intervention in schools.
  
  
  BACKGROUND
  Coordination Theme 1 (Health) of the European Union Seventh Framework Programme.
authors.affiliation: National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden. Electronic address: danuta.wasserman@ki.se.
authors.forename: Danuta
authors.initials: D
authors.lastname: Wasserman
authors.affiliation: Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Christina W
authors.initials: CW
authors.lastname: Hoven
authors.affiliation: Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Wasserman
authors.affiliation: Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Wall
authors.affiliation: Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Eisenberg
authors.affiliation: National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Gergö
authors.initials: G
authors.lastname: Hadlaczky
authors.affiliation: National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ian
authors.initials: I
authors.lastname: Kelleher
authors.affiliation: Department of Medicine and Health Science, University of Molise, Campobasso, Italy; National Institute for Health, Migration and Poverty, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Sarchiapone
authors.affiliation: Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Alan
authors.initials: A
authors.lastname: Apter
authors.affiliation: Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary; Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.
authors.forename: Judit
authors.initials: J
authors.lastname: Balazs
authors.affiliation: Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Bobes
authors.affiliation: Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Romuald
authors.initials: R
authors.lastname: Brunner
authors.affiliation: National Suicide Research Foundation, Cork, Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: Corcoran
authors.affiliation: Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Doina
authors.initials: D
authors.lastname: Cosman
authors.affiliation: Inserm CIC-EC, Nancy University Hospital, Nancy, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Guillemin
authors.affiliation: Institute for Clinical Evaluation, Department for Psychiatry and Psychotherapy B, State Hospital Hall, Tyrol, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Haring
authors.affiliation: Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
authors.forename: Miriam
authors.initials: M
authors.lastname: Iosue
authors.affiliation: Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Kaess
authors.affiliation: Department of Psychiatry, Nancy University Hospital, Nancy, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Kahn
authors.affiliation: National Suicide Research Foundation, Cork, Ireland.
authors.forename: Helen
authors.initials: H
authors.lastname: Keeley
authors.affiliation: Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
authors.forename: George J
authors.initials: GJ
authors.lastname: Musa
authors.affiliation: Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Nemes
authors.affiliation: Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia.
authors.forename: Vita
authors.initials: V
authors.lastname: Postuvan
authors.affiliation: Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Saiz
authors.affiliation: Department of Clinical Ethics, Psychiatric Hospitals of the University of Basel, University Hospital Basel, Basel, Switzerland.
authors.forename: Stella
authors.initials: S
authors.lastname: Reiter-Theil
authors.affiliation: Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia; Tallinn University, Tallinn, Estonia.
authors.forename: Airi
authors.initials: A
authors.lastname: Varnik
authors.affiliation: Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia; Tallinn University, Tallinn, Estonia.
authors.forename: Peeter
authors.initials: P
authors.lastname: Varnik
authors.affiliation: National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Carli
mesh_terms: D000293:Adolescent; D016000:Cluster Analysis; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D012572:School Health Services; D057566:Self Report; D013405:Suicide / Q000706:statistics & numerical data; D000092864:Suicide Prevention