Table 2 Main results of systematic reviews on suicide prevention interventions in university students

Harrod et al., 2014

To evaluate the effect on suicide and suicide-related outcomes of suicide prevention interventions targeting undergraduate students.

Psychoeducation and gatekeeper strategies increased knowledge related to suicide in the short term. Limited evidence suggested minimal long-term gatekeeper effects on suicide-related awareness. The studies identified did not evaluate the effect of intervention on suicide attempts, threats or suicidal ideation, or help-seeking behavior. Only one study evaluated the effect of the intervention on completed suicides. There is lacking evidence regarding the effects of universities’ institutional policy on suicide prevention. Some gatekeeper interventions involved training peer counselors in on-campus housing, which may have limited applicability to students living off-campus or on non-residential campuses. It is not known whether improved knowledge or attitudes towards suicide persist over time. There is a lack of data to analyze the effects of programs on student subgroups with respect to class, gender, on-campus or off-campus residency, among others. The generalization of results is limited because all studies were applied in high-income countries. There is insufficient evidence to support widespread implementation of the analyzed programs.

Kreuze et al., 2017

Identify how technology-enhanced interventions address the determinants of suicidal behavior.

Technology-enhanced programs have shown efficacy in reducing suicidal ideation and comorbidities. Large-scale research and evaluation initiatives are needed to measure the costs and long-term impact of these interventions on the population.

Kutcher et al., 2017

To analyze the most applied suicide prevention programs in Canada to determine the evidence of effectiveness and safety.

The localized programs (SOS, Yellow Ribbon and SafeTALK) did not show sufficient evidence regarding efficacy or safety. Although the programs are popular in Canada and widely marketed, they do not show evidence related to effectiveness, which may represent a misuse of public resources. Future studies should replace distal outcomes (such as improved social cohesion, self-confidence when discussing suicide, or better knowledge related to suicide) with proximal outcomes (suicide rates or hospital admissions for suicide attempts) to measure the impact of interventions. Research should evaluate what works, what does not, and what causes harm. In addition to evaluating and valuing interventions that deal with the phenomenon globally (better access to clinical care for young people with mental disorders and training of stakeholders [such as teachers and health professionals] to determine risk and intervene appropriately).

Robinson et al., 2018

Synthesize evidence from suicide prevention interventions in schools and universities.

The number of studies carried out in school environments far exceeds those carried out in universities. Overall, 70% of school studies and 50% of university studies showed positive effects on suicidal thoughts and/or behavior. Interventions that used writing showed no reduction in suicidality. New high-quality research must be conducted in university settings, because of the lack of studies in the area. Future research should consider whether the programs have iatrogenic effects.

Witt et al., 2019

Analyze studies that report universal interventions targeting mental health, suicidal ideation and behavior in medical students.

Brief mindfulness-based stress management interventions were effective in reducing levels of anxiety, depression, and stress in medical students in the short term. There should be more studies about the long-term effects on these outcomes, and particularly for suicidal ideation and behavior. Future studies should implement strategies that take into account organizational stressors such as the competitive culture that rewards overwork and permissive environments of intimidation and bullying.

Wolitzky-Taylor et al., 2019

Examine the effects of universal and indicated suicide prevention programs on college students.

Interventions using the gatekeeper strategy had especially large effect on knowledge about suicide and self-efficacy in coping with suicide risk and moderate effect on ability to cope with suicide risk. Online screening and counseling programs have produced promising changes in attitudes but have been limited in their effectiveness with regard to changing help-seeking behavior and linking it to treatment. The authors present 5 suggestions for standardizing the research methodology. And they highlight the importance of evaluating the effects in a multilevel context, such as the number of students with suicidal ideation who were assisted after implementing the gatekeeper training.

Yonemoto et al., 2019

Investigate evidence related to effectiveness of gatekeeper programs in suicide prevention.

The effects of gatekeeper programs are still unclear, even for knowledge, assessments, and self-efficacy after training, although the strongest evidence comes from uncontrolled studies. Only one study evaluated suicidal behavior in the target population as an outcome. Some programs were developed based on theoretical and standardized foundations (such as the QPR program), but others were developed in original contexts or were not clear in their theoretical foundations. In future studies, primary and secondary outcomes should be clearly identified and the referral of people at risk of suicide to appropriate medical resources should be evaluated. The methodology should be standardized so that randomization methods are more clearly described (e.g., generate random sequence and allocation concealment).

Zechmeister et al., 2008

Identify and analyze economic evaluations of mental health promotion and mental disorder prevention interventions.

Only some of the studies reviewed provide strong evidence that preventive interventions are cost-effective. The clearest evidence is in early intervention programs for children and adolescents. There are few studies that analyze the cost-effectiveness of suicide prevention programs. Interventions to promote mental health and prevent mental disorders have a high potential to bring economic benefits to society. However, as the evidence base is scarce, it is difficult to formulate recommendations about prioritizing interventions and transferring results to different contexts.