School-based suicide prevention programmes

The SEYLE cluster-randomised, controlled trial

Danuta Wasserman, Christina W. Hoven, Camilla Wasserman, Melanie Wall, Ruth E. Eisenberg, Gergö Hadlaczky, Ian Kelleher, Marco Sarchiapone, Alan Apter, Judit Balazs, Julio Bobes, Romuald Brunner, Paul Corcoran, Doina Cosman, Francis Guillemin, Christian Haring, Miriam Iosue, Michael Kaess, Jean Pierre Kahn, Helen Keeley & 8 others George J. Musa, Bogdan Nemes, Vita Postuvan, Pilar Saiz, Stella Reiter-Theil, Airi Varnik, Peeter Varnik, Vladimir Carli

Research output: Contribution to journalArticle

155 Citations (Scopus)

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. Findings 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. Interpretation 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. Funding Coordination Theme 1 (Health) of the European Union Seventh Framework Programme.

Original languageEnglish (US)
Pages (from-to)1536-1544
Number of pages9
JournalThe Lancet
Volume385
Issue number9977
DOIs
StatePublished - Apr 18 2015
Externally publishedYes

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Pupil
Suicide
Randomized Controlled Trials
Suicidal Ideation
Control Groups
European Union
Attempted Suicide
Adolescent Behavior
Registries
Mental Health
Referral and Consultation
Public Health
Odds Ratio
Outcome Assessment (Health Care)
Clinical Trials
Health

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wasserman, D., Hoven, C. W., Wasserman, C., Wall, M., Eisenberg, R. E., Hadlaczky, G., ... Carli, V. (2015). School-based suicide prevention programmes: The SEYLE cluster-randomised, controlled trial. The Lancet, 385(9977), 1536-1544. https://doi.org/10.1016/S0140-6736(14)61213-7

School-based suicide prevention programmes : The SEYLE cluster-randomised, controlled trial. / Wasserman, Danuta; Hoven, Christina W.; Wasserman, Camilla; Wall, Melanie; Eisenberg, Ruth E.; Hadlaczky, Gergö; Kelleher, Ian; Sarchiapone, Marco; Apter, Alan; Balazs, Judit; Bobes, Julio; Brunner, Romuald; Corcoran, Paul; Cosman, Doina; Guillemin, Francis; Haring, Christian; Iosue, Miriam; Kaess, Michael; Kahn, Jean Pierre; Keeley, Helen; Musa, George J.; Nemes, Bogdan; Postuvan, Vita; Saiz, Pilar; Reiter-Theil, Stella; Varnik, Airi; Varnik, Peeter; Carli, Vladimir.

In: The Lancet, Vol. 385, No. 9977, 18.04.2015, p. 1536-1544.

Research output: Contribution to journalArticle

Wasserman, D, Hoven, CW, Wasserman, C, Wall, M, Eisenberg, RE, Hadlaczky, G, Kelleher, I, Sarchiapone, M, Apter, A, Balazs, J, Bobes, J, Brunner, R, Corcoran, P, Cosman, D, Guillemin, F, Haring, C, Iosue, M, Kaess, M, Kahn, JP, Keeley, H, Musa, GJ, Nemes, B, Postuvan, V, Saiz, P, Reiter-Theil, S, Varnik, A, Varnik, P & Carli, V 2015, 'School-based suicide prevention programmes: The SEYLE cluster-randomised, controlled trial', The Lancet, vol. 385, no. 9977, pp. 1536-1544. https://doi.org/10.1016/S0140-6736(14)61213-7
Wasserman, Danuta ; Hoven, Christina W. ; Wasserman, Camilla ; Wall, Melanie ; Eisenberg, Ruth E. ; Hadlaczky, Gergö ; Kelleher, Ian ; Sarchiapone, Marco ; Apter, Alan ; Balazs, Judit ; Bobes, Julio ; Brunner, Romuald ; Corcoran, Paul ; Cosman, Doina ; Guillemin, Francis ; Haring, Christian ; Iosue, Miriam ; Kaess, Michael ; Kahn, Jean Pierre ; Keeley, Helen ; Musa, George J. ; Nemes, Bogdan ; Postuvan, Vita ; Saiz, Pilar ; Reiter-Theil, Stella ; Varnik, Airi ; Varnik, Peeter ; Carli, Vladimir. / School-based suicide prevention programmes : The SEYLE cluster-randomised, controlled trial. In: The Lancet. 2015 ; Vol. 385, No. 9977. pp. 1536-1544.
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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. Findings 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. Interpretation 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. Funding Coordination Theme 1 (Health) of the European Union Seventh Framework Programme.",
author = "Danuta Wasserman and Hoven, {Christina W.} and Camilla Wasserman and Melanie Wall and Eisenberg, {Ruth E.} and Gerg{\"o} Hadlaczky and Ian Kelleher and Marco Sarchiapone and Alan Apter and Judit Balazs and Julio Bobes and Romuald Brunner and Paul Corcoran and Doina Cosman and Francis Guillemin and Christian Haring and Miriam Iosue and Michael Kaess and Kahn, {Jean Pierre} and Helen Keeley and Musa, {George J.} and Bogdan Nemes and Vita Postuvan and Pilar Saiz and Stella Reiter-Theil and Airi Varnik and Peeter Varnik and Vladimir Carli",
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TY - JOUR

T1 - School-based suicide prevention programmes

T2 - The SEYLE cluster-randomised, controlled trial

AU - Wasserman, Danuta

AU - Hoven, Christina W.

AU - Wasserman, Camilla

AU - Wall, Melanie

AU - Eisenberg, Ruth E.

AU - Hadlaczky, Gergö

AU - Kelleher, Ian

AU - Sarchiapone, Marco

AU - Apter, Alan

AU - Balazs, Judit

AU - Bobes, Julio

AU - Brunner, Romuald

AU - Corcoran, Paul

AU - Cosman, Doina

AU - Guillemin, Francis

AU - Haring, Christian

AU - Iosue, Miriam

AU - Kaess, Michael

AU - Kahn, Jean Pierre

AU - Keeley, Helen

AU - Musa, George J.

AU - Nemes, Bogdan

AU - Postuvan, Vita

AU - Saiz, Pilar

AU - Reiter-Theil, Stella

AU - Varnik, Airi

AU - Varnik, Peeter

AU - Carli, Vladimir

PY - 2015/4/18

Y1 - 2015/4/18

N2 - 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. Findings 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. Interpretation 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. Funding Coordination Theme 1 (Health) of the European Union Seventh Framework Programme.

AB - 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. Findings 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. Interpretation 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. Funding Coordination Theme 1 (Health) of the European Union Seventh Framework Programme.

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