The study of effect moderation in youth suicide-prevention studies

  • Rashelle J. Musci
  • Hadi Kharrazi
  • Renee F. Wilson
  • Ryoko Susukida
  • Fardad Gharghabi
  • Allen Zhang
  • Lawrence Wissow
  • Karen A. Robinson
  • Holly C. Wilcox



Suicide is now the second leading cause of death among persons between the ages of adolescents and emerging adults and rates have increased despite more funding and broader implementation of youth suicide-prevention programs. A systematic review was conducted focusing on identifying youth suicide-prevention studies within the United States. This paper reports on the methods utilized for understanding possible moderators of suicide-prevention program outcomes.


We searched six databases from 1990 through August 2017 to identify studies of suicide-preventive interventions among those under age 26 years. Two independent team members screened search results and sequentially extracted information related to statistical methods of moderation analyses.


69 articles were included in the systematic review of which only 17 (24.6%) explored treatment effect heterogeneity using moderation analysis. The most commonly used analytic tool was regression with an interaction term. The moderators studied included demographic characteristics such as gender and ethnicity as well as individual characteristics such as traumatic stress exposure and multiple prior suicide attempts.


With a greater emphasis from the federal government and funding agencies on precision prevention, understanding which prevention programs work for specific subgroups is essential. Only a small percentage of the reviewed articles assessed moderation effects. This is a substantial research gap driven by sample size or other limitations which have impeded the identification of intervention effect heterogeneity.


Suicide prevention Moderation methods Systematic review 



This project was funded under Contract no. HHSA29020150000XI Task Order 290-2012-00007-I from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services (HHS). The authors of this manuscript are responsible for its content. Statements in the manuscript do not necessarily represent the official views of or imply endorsement by AHRQ or HHS. This topic a Pathways to Prevention Project and was nominated by the Office of Disease Prevention of the National Institutes of Health (NIH) and selected by AHRQ for systematic review by an EPC. A representative from AHRQ served as a Contracting Officer’s Technical Representative and provide technical assistance during the conduct of the full-evidence report and provided comments on draft versions of the full-evidence report. AHRQ did not directly participate in the literature search, determination of study eligibility criteria, data analysis or interpretation, or preparation, review, or approval of the manuscript for publication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2018

Authors and Affiliations

  • Rashelle J. Musci
    • 1
  • Hadi Kharrazi
    • 1
  • Renee F. Wilson
    • 1
  • Ryoko Susukida
    • 1
  • Fardad Gharghabi
    • 1
  • Allen Zhang
    • 1
  • Lawrence Wissow
    • 1
  • Karen A. Robinson
    • 1
  • Holly C. Wilcox
    • 1
  1. 1.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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