A systematic overview of the effectiveness of public health nursing interventions: an overview of adolescent suicide prevention programs (Structured abstract)

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn. The findings of this review must be considered in light of the serious methodological limitations of the studies reviewed. The evidence suggests there may be both beneficial and harmful effects of suicide prevention programmes for adolescents. The literature suggests that more broadly-based comprehensive school-based health programmes should be evaluated for their effectiveness in addressing the determinants of adolescent risk behaviour.XCM: The review uses a sound search strategy, it is clear in its methodology and provides good detail on the primary studies included. To summarise the evidence on the effectiveness of adolescent suicide prevention curricula programmes.XSI: The majority of studies used some form of educational programme based on a suicide prevention curriculum provided by teachers, counsellors or psychologists. One study evaluated post-suicide group counselling.XPA: Adolescents, most frequently high-school students in Grades 9 and 10, were included.XOA: The outcomes assessed included suicide risk, knowledge, attitudes, coping, hopelessness and empathy. Measurement tools are listed.XSD: Prospective intervention studies with a control group were included.XSS: MEDLINE, CINAHL, PsycINFO and the Social Sciences Citation Index were searched from 1980 to 1995 using the keywords 'adolescents' and 'suicide prevention', 'stress management', 'assertiveness', 'aggression', 'depression', 'community mental health' and 'evaluation'. Eighteen key journals were handsearched back 5 years, and reference lists of identified articles were examined to locate other potentially relevant articles (post-1980).XVC: The validity of the articles was assessed using a measurement tool described by Ciliska et al. (see Other Publications of Related Interest no 1). The validity criteria examined included: method of allocation to study groups; level of agreement to participate in the study; control for confounding variables; method of data collection including pre-testing of data collection tools; and percenaget of participants available for follow-up. Criteria were rated pass, moderate or fair, and articles were then judged strong, moderate or weak, depending on the ratings of the 5 criteria. The included trials were independently assessed for validity by two readers. Any discrepancies were resolved through discussion.XDC: All articles were reviewed by a primary reader and a subset reviewed by a second reader. The level of agreement was calculated (kappa = 0.80).XDE: The authors do not state how the data were extracted for the review, or how many of the authors performed the data extraction.XCS: The results of the studies were combined qualitatively, according to the outcome measured.XDS: No statistical test of heterogeneity was conducted.XRR: Eleven studies (n=4,221) were included: 3 quasi-random controlled trials, 5 cohort studies, 1 retrospective matched cohort and 2 trials of Solomon Four Group Design.Of the 3 studies examining changes in suicide risk, 2 showed a significantly greater reduction in suicide risk, specifically depression, anxiety and emotionality, than the control groups. There were no differences in suicide risk between counselled and control participants in the third study.The reviewed studies demonstrated a relatively consistent, positive impact of programmes on knowledge related to suicide. Of the 8 studies that evaluated changes in knowledge, 6 found that knowledge increased.Nine studies examined the effects of the suicide prevention programmes on students' attitudes relating towards disclosure of suicidal intention, seeking help from adults and professionals, and helping suicidal peers. Both beneficial and harmful effects of the programmes were found for these measures.Four studies examined the effects of the suicide prevention programmes on self-rated measures of coping. Results were inconsistent, with 2 studies showing a significant positive change in coping skills, 1 showing no significant difference between intervention and control groups, and another showing a reduction in maladaptive coping in girls but an increase in boys.Three studies included measures of hopelessness. Two studies showed no significant differences between intervention and control groups, the third study demonstrated a decrease in hopelessness for girls but an increase for boys.One study evaluated empathy. An increase in empathy was demonstrated for girls undergoing a suicide prevention programme, but not for boys.