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Universal school-based suicide awareness & education programs

Evidence Rating

Some Evidence

Health Factors

Universal school-based suicide awareness and education programs deliver a curriculum-based approach to suicide prevention to all students (), usually in middle or high school settings. Students learn to recognize warning signs of suicide in themselves and others (, ). Programs are often based on a psychoeducational curriculum and use multimedia presentations, lectures, classroom discussion, interactive activities, and role-play ().

Expected Beneficial Outcomes (Rated)

  • Reduced suicide

  • Increased knowledge of suicide

  • Improved coping skills

Other Potential Beneficial Outcomes

  • Increased help-seeking behavior

Evidence of Effectiveness

There is some evidence that universal school-based suicide awareness and prevention programs reduce suicide attempts among middle and high school students (, , ). Such programs can also improve students’ knowledge and coping mechanisms to address suicidal thoughts and depression (, , ). However, additional evidence is needed to confirm effects.

The SOS Signs of Suicide Prevention program is a school-based program that has been shown to reduce self-reported suicide attempts as well as increase knowledge and coping mechanisms to address suicidal thoughts and poor mental health among middle and high school students (SAMHSA-NREPP, , ). Students participating in the Youth Aware of Mental Health Program (YAM), in place in various European countries, report fewer suicide attempts and less suicidal ideation than nonparticipating peers (). Good Behavior Game, a classroom behavior management program for elementary school students, has been shown to improve peer relationships and is associated with decreases in the risk of later suicide attempts (). Universal education programs appear to increase middle and high school students’ help-seeking behaviors in some cases (, , ).

Experts suggest that lack of school administrative support and concerns that suicide education may lead to increases in suicide attempts can be barriers to implementing suicide prevention programs in schools (YSP school guide, ).

Impact on Disparities

No impact on disparities likely

Implementation Examples

There are many specific suicide prevention programs, particularly at the middle and high school level. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a toolkit to help high schools and districts around the country implement suicide prevention programs (SAMHSA-High school toolkit). SAMHSA also awards grants in support of state and tribal youth suicide prevention efforts (GLS suicide prevention). The Suicide Prevention Resource Center outlines many approaches to suicide prevention programs, including school curriculums (SPRC).

Washington state recently piloted Riding the Waves, a suicide prevention curriculum for 5th grade elementary school students (YSPP-Riding the Waves).

Implementation Resources

SPRC - Suicide Prevention Resource Center (SPRC). Effective suicide prevention requires multiple approaches.

SAMHSA-High school toolkit - Substance Abuse and Mental Health Services Administration (SAMHSA). Preventing suicide: A toolkit for high schools. HHS Publication No. SMA-12-4669. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration; 2012.

SOS - Screening for Mental Health. Prevention and education: The SOS Signs of Suicide (SOS).

YSPP - Youth Suicide Prevention Program (YSPP). Reduce suicidal behaviors in Washington State.

YSP school guide - Lazear KJ, Roggenbaum S, Blasé K. Youth suicide prevention school-based guide (YSP school guide). Tampa, FL: University of South Florida, College of Behavioral & Community Sciences, Louis de la Parte Florida Mental Health Institute, Department of Child & Family Studies; 2012.

TX-Steps for schools - Poland S, Poland D. Recommendations for Suicide Safer Schools Texas school district action steps. Texas Department of State Health Services, Texas Suicide Prevention Council, & Mental Health America of Texas; 2015.

Citations - Evidence

* Journal subscription may be required for access.

SAMHSA-NREPP - SAMHSA's National Registry of Evidence-based Programs and Practices (NREPP).

Calear 2016* - Calear AL, Christensen H, Freeman A, et al. A systematic review of psychosocial suicide prevention interventions for youth. European Child and Adolescent Psychiatry. 2016;25(5):467-482.

Cusimano 2011* - Cusimano MD, Sameem M. The effectiveness of middle and high school-based suicide prevention programmes for adolescents: A systematic review. Injury Prevention. 2011;17(1):43-49.

Katz 2013* - Katz C, Bolton S-L, Katz LY, et al. A systematic review of school-based suicide prevention programs. Depression and Anxiety. 2013;30(10):1030-1045.

Klimes-Dougan 2013* - Klimes-Dougan B, Klingbeil DA, Meller SJ. The impact of universal suicide-prevention programs on the help-seeking attitudes and behaviors of youths. Crisis. 2013;34(2):82-97.

Robinson 2013b* - Robinson J, Cox G, Malone A, et al. A systematic review of school-based interventions aimed at preventing, treating, and responding to suicide-related behavior in young people. Crisis. 2013;34(3):164-182.

Wasserman 2015* - Wasserman D, Hoven CW, Wasserman C, et al. School-based suicide prevention programmes: The SEYLE cluster-randomised, controlled trial. Lancet. 2015;385(9977):1536-1544.

Newcomer 2016* - Newcomer AR, Roth KB, Kellam SG, et al. Higher childhood peer reports of social preference mediates the impact of the good behavior game on suicide attempt. Prevention Science. 2016;17(2):145-156.

YSP school guide - Lazear KJ, Roggenbaum S, Blasé K. Youth suicide prevention school-based guide (YSP school guide). Tampa, FL: University of South Florida, College of Behavioral & Community Sciences, Louis de la Parte Florida Mental Health Institute, Department of Child & Family Studies; 2012.

Stein 2010* - Stein BD, Kataoka SH, Hamilton AB, et al. School personnel perspectives on their school’s implementation of a school-based suicide prevention program. The Journal of Behavioral Health Services & Research. 2010;37(3):338-349.

Citations - Implementation Examples

* Journal subscription may be required for access.

SPRC - Suicide Prevention Resource Center (SPRC). Effective suicide prevention requires multiple approaches.

SAMHSA-High school toolkit - Substance Abuse and Mental Health Services Administration (SAMHSA). Preventing suicide: A toolkit for high schools. HHS Publication No. SMA-12-4669. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration; 2012.

GLS suicide prevention - Suicide Prevention Resource Center. Garrett Lee Smith (GLS) Suicide Prevention grantees.

YSPP-Riding the Waves - Youth Suicide Prevention Program (YSPP). Riding the Waves elementary school curriculum.

Date Last Updated

Feb 6, 2017