This review concluded that the current scientific foundation regarding school-based suicide prevention programmes was very limited and all studies had considerable methodological weaknesses. The review suffered from a number of limitations (in particular in terms of the analysis) and the conclusions are unlikely to be reliable.

To provide a comprehensive review of school-based suicide prevention programmes from a public health perspective.

PsycINFO and ERIC were searched from 1967 to February 2008. Search terms were reported. Reference lists of retrieved studies were screened. Four relevant journals were handsearched. Journals in which identified studies were published were screened between 2007 and 2008. The review was restricted to published English-language studies.

Studies that reported on the effectiveness of a school-based programme designed to address suicidal behaviour among children and youths and that reported outcome data were eligible for inclusion. Studies had to report details of methods and results.

Most universal suicide prevention programmes focused on curriculum programmes presented to students, mostly embedded within the context of health education classes. Selected suicide intervention programmes varied across studies. Details of control interventions were lacking. Students were in grades 9 to 12, where reported. A variety of different outcomes were assessed by the included studies.

Two reviewers independently assessed studies for inclusion. Decisions were reviewed by a third reviewer.

Two reviewers independently assessed study quality according to the following criteria developed by the Task Force on Evidence-Based Intervention in School Psychology Procedural and Coding Manual: measurement; comparison group; statistically significant outcomes; educational/clinical significance; identifiable components; implementation fidelity; replication; and site of implementation. Each item was assigned a score from 0 to 3 based on the strength of the evidence and an average score was calculated for each study. Disagreements were resolved through consensus.

Two reviewers independently coded studies into one of the following three groups: universal prevention programmes (targeted an entire population); selected prevention programmes (focused on an at-risk group of students); and indicated prevention programmes (focused on students who had already engaged in suicidal behaviour).

A narrative synthesis was presented based mainly on the results of the validity assessment.

Thirteen studies were included (n= 336,948, range 128 to 330,000).

Universal suicide prevention programmes (10 studies, n=334,209):

Most studies suffered from consistent methodological weaknesses: only 30% included reliable and valid measures; 10% demonstrated educational/clinical significant; 20% documented programme implementation fidelity; and none replicated the effects of the programmes. Eleven studies included a control group.

Most studies provided either weak (50%) or promising evidence (30%) for statistically significant outcomes.

Selected suicide prevention programmes (three studies, n=2,739):

All three studies included a control group, but suffered from consistent methodological weaknesses similar to those in the universal suicide prevention programmes. Only one study documented intervention adherence and used analytical techniques to identify which identifiable components of prevention programmes were related to statistical significance.

None of the studies showed promising or strong evidence for educational/clinical significance or the replication of effects.

The scientific foundation regarding school-based suicide prevention programmes was very limited. All studies suffered from consistent and considerable methodological weaknesses.

The review addressed a clear question supported by defined, although broad, inclusion criteria. The literature search was adequate for published studies, but restriction of the review to published English-language studies meant that there was a possibility of language and publication biases. Appropriate steps were taken to minimise bias and errors at all stages of the review. A formal validity assessment was conducted, but this combined assessment of the reliability of results with details on statistical significance of the findings and details of how the gradings were reached was unclear. Appropriate study details were provided in tables, but no numerical or statistical data related to the results of the individual studies were reported in these or in the text. Most studies included a control group, but details on control interventions were lacking and it was unclear whether results refered to as statistically significant related to within-group or between-group comparisons. In addition, gradings of statistical significance were made at the study level instead of looking at the effects of the interventions on specific outcome measures. Limitations in the analysis made it almost impossible to interpret the results of the review. The authors' recommendations for practice did not appear to be supported by the review findings.

Although the authors' cautious conclusions were supported by the results, a more in-depth analysis may have provided more informative results. Based on the possibility of missing studies and limitations in the quality assessment and analysis, the authors' conclusion may not be reliable.

Practice: The authors stated that there was some evidence that prevention programmes may lead to improvements in students' problem-solving skills and self-efficacy as well as reductions in self-reported suicide vulnerability. Such prevention programmes included provision of: information to students regarding suicide awareness and intervention; teaching of coping and problem-solving skills; and teaching and reinforcing strength and protective factors while addressing risk-taking behaviours.

Research: The authors stated that future studies should attempt to address the key methodological features outlined in the Task Force on Evidence-Based Intervention in School Psychology Procedural and Coding Manual. Research was needed to identify long-term behavioural outcomes among students who were recipients of school-based suicide prevention programmes, particularly among those students with identifiable risk factors. There was also a need for researchers to develop and evaluate school-based suicide prevention programmes that emphasised greater interdisciplinary partnerships with families and communities.

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.