Rethinking post-primary school-based suicide prevention: understanding intrvention effectiveness, implementation requirements and youth voice

Globally, suicide is a leading cause of adolescent mortality. Although post-primary, school?based suicide prevention (PSSP) interventions are a promising preventive strategy, there are long-standing PSSP evidence-practice gaps. Adolescents typically engage with PSSP interventions in classrooms which are nested in schools and situated in diverse jurisdictions, yet consideration to contextual factors is lacking in PSSP research. A central aim of this programme of research is to enhance understanding of how PSSP interventions work and are effective, with a particular focus on youth voice and adolescents’ experiences with PSSP interventions and suicide prevention and mental health in schools.

The first review employing a multi-level meta-analysis (n=12) showed that PSSP interventions targeting suicidal thoughts and behaviours as both primary intervention and secondary outcomes were associated with 13–15% and 28–34% lower odds of suicidal ideation and suicide attempts, respectively. Moderator analyses were non-significant (ps>.05).

The second systematic review (n=28) employing narrative synthesis demonstrated PSSP intervention effectiveness and a lack of reporting and analysis of intervention and contextual factors. Notably, adolescents had little involvement in designing, inputting on, and delivering PSSP interventions.

The meta-ethnographic review employing reciprocal translations and lines-of-argument synthesis revealed the importance of the following aspects of adolescents’ engagement with PSSP interventions: (1) how adolescents were engaged, (2) trust in facilitators, school personnel and schools, and (3) the sharing of real-life experiences for connection. Ultimately, adolescents’ trust in and connection with individuals and schools involved in PSSP interventions was integral for sharing of the self and actively engaging in interventions.

The fourth and fifth studies explore the perspectives of adolescents who engaged with the Mental Health of Youth Story (MYSTORY) photovoice study, using reflexive thematic analysis (TA). Study four explored adolescents’ perspectives on school mental health and suicide prevention, with both the critical role of schools in adolescent mental health and the need to amplify youth voice evident. Study five demonstrates the MYSTORY study as a creative and youth-friendly study, which enabled reflection on and discussion of mental health, from personal mental health to school mental health and suicide prevention experiences. Participation in the MYSTORY study enhanced ability to express oneself and was associated with feelings of pride, accomplishment, and connection, which were central to perceptions of youth voice in the MYSTORY study.

These findings advance understanding of how PSSP effectiveness and implementation requirements are impacted by context, with the importance of youth voice and school contexts to both PSSP interventions and wider school mental health and suicide prevention evident. The overarching contribution of this programme of research is the re-thinking of the field of PSSP from a standpoint which focuses on effectiveness, implementation requirements, and youth voice.