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      What Works in Youth Suicide Prevention? A Systematic Review and Meta-Analysis

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          Summary

          Background

          Young people require specific attention when it comes to suicide prevention, however efforts need to be based on robust evidence.

          Methods

          We conducted a systematic review and meta-analysis of all studies examining the impact of interventions that were specifically designed to reduce suicide-related behavior in young people.

          Findings

          Ninety-nine studies were identified, of which 52 were conducted in clinical settings, 31 in educational or workplace settings, and 15 in community settings. Around half were randomized controlled trials. Large scale interventions delivered in both clinical and educational settings appear to reduce self-harm and suicidal ideation post-intervention, and to a lesser extent at follow-up. In community settings, multi-faceted, place-based approaches seem to have an impact. Study quality was limited.

          Interpretation

          Overall whilst the number and range of studies is encouraging, gaps exist. Few studies were conducted in low-middle income countries or with demographic populations known to be at increased risk. Similarly, there was a lack of studies conducted in primary care, universities and workplaces. However, we identified that specific youth suicide-prevention interventions can reduce self-harm and suicidal ideation; these types of intervention need testing in high-quality studies.

          Highlights

          • This is the first systematic review and meta-analysis to synthesize the full spectrum of youth suicide prevention approaches.

          • Findings suggest that interventions designed to reduce suicide risk in young people can be effective.

          • Interventions delivered in clinical, educational and community settings appear to reduce self-harm and/or suicidal ideation.

          • The quantity and range of studies identified is encouraging, suggesting increased attention and investment in this area.

          Related collections

          Most cited references133

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

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            Importance of investing in adolescence from a developmental science perspective

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              Therapeutic interventions for suicide attempts and self-harm in adolescents: systematic review and meta-analysis.

              Suicidal behavior and self-harm are common in adolescents and are associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite recent advances in the understanding and treatment of self-harm and links between self-harm and suicide and risk of suicide attempt, progress in reducing suicide death rates has been elusive, with no substantive reduction in suicide death rates over the past 60 years. Extending prior reviews of the literature on treatments for suicidal behavior and repetitive self-harm in youth, this article provides a meta-analysis of randomized controlled trials (RCTs) reporting efficacy of specific pharmacological, social, or psychological therapeutic interventions (TIs) in reducing both suicidal and nonsuicidal self-harm in adolescents.
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                Author and article information

                Contributors
                Journal
                EClinicalMedicine
                EClinicalMedicine
                EClinicalMedicine
                Elsevier
                2589-5370
                28 October 2018
                Oct-Nov 2018
                28 October 2018
                : 4-5
                : 52-91
                Affiliations
                [a ]Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Vic 3052, Australia
                [b ]Turning Point, Eastern Health Clinical School, Monash University, 110 Church Street, Richmond, VIC 3121, Australia
                [c ]Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie Street, Vic 3010, Australia
                [d ]Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie Street, Vic 3010, Australia
                [e ]University Library, The University of Melbourne, Parkville, Vic 3010, Australia
                [f ]Department of Psychological Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Support Building Auckland Hospital, 2 Park Rd, Auckland 1142, New Zealand
                Author notes
                [* ]Corresponding author at: Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Vic 3052, Australia. jo.robinson@ 123456orygen.org.au
                Article
                S2589-5370(18)30041-5
                10.1016/j.eclinm.2018.10.004
                6537558
                31193651
                99adce60-9b3e-4199-b87e-c06fa1263557
                © 2018 Published by Elsevier Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 19 May 2018
                : 14 October 2018
                : 15 October 2018
                Categories
                Research Paper

                suicide prevention,self-harm,young people,systematic review,meta-analysis

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