Scoping review of 30 years of suicide prevention in university students around the world: efficacy, effectiveness, and cost-effectiveness

Abstract

A scoping review of systematic reviews was carried out to identify evidence of efficacy, effectiveness, and cost-effectiveness of universal and selective suicide prevention programs among university students worldwide. Five databases were reviewed using terms in English, Spanish, and Portuguese. The following were the inclusion criteria: systematic review or meta-analysis or meta-synthesis, suicide prevention in college students, evaluation of the efficacy, effectiveness and/or cost-effectiveness of interventions, and peer-reviewed studies. The quality of reviews was assessed. The field of study features three decades of publication in high-income countries. The strategy used, the components of the program, and the target audience to which they are delivered interfere with efficacy. In the psychoeducation strategy, the experiential and didactic components are more efficacious in the knowledge about suicide. And the motivational enhancement component promotes greater self-efficacy in suicide prevention. Programs that take a multimodal approach are effective in increasing short-term attitudes related to suicide and reducing rates of completed suicide. The gatekeeper strategy delivered to peer counselors is the most effective one in the outcomes, including short-term and long-term knowledge about suicide and its prevention and self-efficacy in suicide prevention. A greater number of evaluated studies of gatekeeper interventions were identified, indicating a trend in this research field. No review addressed the effects on subgroups that were classified based on sex, racial or sexual minorities, and special (indigenous) populations. Only one study addressed cost-effectiveness, pointing out that the psychoeducation and gatekeeper strategies have relevant net benefit rates, but the gatekeeper strategy has a higher cost–benefit ratio compared to the psychoeducation strategy. The findings indicate that psychoeducation and gatekeeper interventions tend to be more efficacious when they combine education and skills training to intervene in suicidal behavior. The components of the intervention and the target audience to which it is delivered influence efficacy. Multimodal interventions evaluate completed suicide outcomes, but require greater implementation efforts, in terms of human and financial resources and more time for the evaluation.

Prevalence of suicidal behaviour among students living in Muslim-majority countries: systematic review and meta-analysis

“…123 A recent review of suicide prevention strategies among university students found that gatekeeper training of peer counsellors, combining education with skills training, is effective in improving knowledge about suicide and boosting self-efficacy in suicide prevention. 124 …”

Study Dropout Thoughts in Male University Students as Warning Sign for Suicidal Ideation and Mental Health Problems

“…Suicide is a major public health concern worldwide (Shoib et al, 2022). While suicide rates have declined globally (World Health Organization, 2021), suicide remains the second leading cause of death in university students (Cecchin et al, 2022) and the prevalence of suicidal ideation is increasing in this group (Sivertsen et al, 2019). Male university students and men in general have a higher risk to die by suicide (Gunnell et al, 2020;Hedegaard et al, 2020;McLaughlin & Gunnell, 2021) but are also less likely to report suicidal thoughts or behaviors (Booth et al, 2019;Brandstetter et al, 2017;Seidler et al, 2016;Vogel et al, 2014;.…”

“…TMI characterized by dominance, pursuit of status, and primacy of work contrast with the loss of social status that results from unemployment, involuntary job loss, or also dropping out of university. While research on gender differences in university student suicidality is lacking (Cecchin et al, 2022), findings on the relationship between job related problems, financial problems, status loss and male suicide underscore the serious consequences that career interruptions can have primarily for men (Blakely, 2003;Garcy & Vågerö, 2013;.…”