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Systematic Review
The authors state: "Suicide is a leading cause of death among post‐secondary students worldwide. Suicidal thoughts and planning are common among post‐secondary students. Previous reviews have examined the effectiveness of interventions for symptomatic individuals; however, many students at high risk of suicide are undiagnosed and untreated. We evaluated the effect on suicide and suicide‐related outcomes of primary suicide prevention interventions that targeted students within the post‐secondary setting."
The authors state: "Eight studies met inclusion criteria. They were heterogeneous in terms of participants, study designs, and interventions. Five of eight studies had high risk of bias. In 3 RCTs (312 participants), classroom‐based didactic and experiential programs increased short‐term knowledge of suicide (SMD = 1.51, 95% CI 0.57 to 2.45; moderate quality evidence) and knowledge of suicide prevention (SMD = 0.72, 95% CI 0.36 to 1.07; moderate quality evidence). The effect on suicide prevention self‐efficacy in one RCT (152 participants) was uncertain (SMD = 0.20, 95% CI ‐0.13 to 0.54; low quality evidence). One CBA analysed the effects of an institutional policy that restricted student access to laboratory cyanide and mandated professional assessment for suicidal students. The incidence of student suicide decreased significantly at one university with the policy relative to 11 control universities, 2.00 vs. 8.68 per 100,000 (Z = 5.90; P < 0.05). Four CBAs explored effects of training 'gatekeepers' to recognize and respond to warning signs of emotional crises and suicide risk in students they encountered. The magnitude of effect sizes varied between studies. Gatekeeper training enhanced short‐term suicide knowledge in students, peer advisors residing in student accommodation, and faculty and staff, and suicide prevention self‐efficacy among peer advisors. There was no evidence of an effect on participants' suicide‐related attitudes or behaviors. One CBA found no evidence of effects of gatekeeper training of peer advisors on suicide‐related knowledge, self‐efficacy, or gatekeeper behaviors measured four to six months after intervention."
The authors state: "We found insufficient evidence to support widespread implementation of any programs or policies for primary suicide prevention in post‐secondary educational settings. As all evaluated interventions combined primary and secondary prevention components, we were unable to determine the independent effects of primary preventive interventions. Classroom instruction and gatekeeper training increased short‐term suicide‐related knowledge. We found no studies that tested the effects of classroom instruction on suicidal behavior or long‐term outcomes. Limited evidence suggested minimal longer‐term effects of gatekeeper training on suicide‐related knowledge, while no evidence was found evaluating its effect on suicidal behavior. A policy‐based suicide intervention reduced student suicide, but findings have not been replicated. Our findings are limited by the overall low quality of the evidence and the lack of studies from middle‐ and low‐income countries. Rigorously designed studies should test the effects of preventive interventions on important health outcomes, including suicidal ideation and behavior, in varying post‐secondary settings."