Suicide Prevention Interventions in Schools: Assessing the Evidence Base

OBJECTIVE: Rates of suicide among youths, both in the United States and globally, remain high. Schools can serve as an important intervention setting for suicide prevention efforts because youths spend a great deal of time in school. This systematic review aimed to examine the level of evidence of specific school-based suicide prevention interventions by using established rating criteria. METHODS: A search of major databases, gray literature, and evidence-based registries was conducted to identify individual studies that focused on suicide prevention interventions within school settings and that were published between 2008 and 2022. The authors rated suicide prevention intervention as having high, moderate, or low levels of evidence; ratings were based on the number and rigor of studies with positive outcomes. RESULTS: Of the 14 different interventions identified across 14 studies, no intervention had enough studies to be rated as having a high level of evidence; one intervention, Signs of Suicide, was rated as having moderate evidence. Improved outcomes were found for 10 interventions, including reduced suicidal ideation, suicide attempts, suicide planning, and suicidal behavior. Four studies of three interventions found positive effects on mental health outcomes such as depression, anxiety, and psychological distress. No cost data were found for Signs of Suicide to complete a cost analysis. CONCLUSIONS: More research is needed to build the evidence base for school-based suicide prevention interventions that demonstrate positive impacts on suicide-related and mental health outcomes. Future research should also examine the cost-effectiveness of interventions.