Program Evaluation and Decision Analytic Modelling of Universal Suicide Prevention Training (safeTALK) in Secondary Schools
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Universal suicide education and awareness training in schools are promising suicide prevention initiatives. This study aims to evaluate a suicide awareness training (safeTALK) and to model potential return on investment (ROI) on a population basis. SafeTALK, comprises a 3-h education session, and has been delivered to secondary school students (aged 15–16 years) in Mackay, located in the Australian state of Queensland.
Evaluation consisted of two phases, ex-post and ex-ante. Phase I was a pre-post, follow-up analysis using a mixed-method questionnaire administered immediately prior (Time 1), immediately after (Time 2), and 4 weeks after training (Time 3). Phase II involved decision analytic modelling comparing safeTALK to the status quo. ROI was modelled using Markov chains for a hypothetical population of students aged 15–19 years in Mackay (n = 2561; suicide rate 78.1 per 100,000), Queensland (n = 296,287; 10.2) and Australia (n = 1,421,595; 8.3). Model parameters, including rates of hospitalised self-harm and suicide, cost implications and effectiveness of safeTALK were drawn from published literature. The baseline model adapted a health and justice system’s perspective, with an alternative model incorporating a societal perspective. All costs were adjusted to reflect AU$2017–2018.
Students reported seeking help mostly from friends (79%) or parents (68%); in the last 6 months 61% considered another student’s behaviour as suicidal, but only 21% reported asking about this. The main barriers to help-seeking were (i) being too embarrassed, (ii) shy or (iii) being judged. Students who attended safeTALK gained suicide-related knowledge (p < 0.001), confidence (p < 0.001), willingness (p = 0.006), and likelihood of seeking help (p = 0.044) and retained these up until follow-up assessment 4 weeks later with the exception of seeking help. From a health and justice system’s perspective, the model estimated a cumulative return of AU$1.45 per AU$1 invested in safeTALK in Mackay; AU$0.19 in Queensland; AU$0.15 across Australia. From a societal perspective, ROI increased to AU$31.21, AU$4.05 and AU$3.28, respectively.
Results strengthen the premise that safeTALK is feasible to implement within a school setting. The economic case for implementation of safeTALK is promising on a population basis, especially in high-risk communities, but further research is required to confirm the study results.
We wish to acknowledge the Department of Justice and Regulation for proving access to the Australian National Coronial Information System (NCIS) and the Australian Institute of Health and Welfare for providing self-harm hospitalisation data. The model used in this study was provided to the journal’s peer reviewers for their reference when reviewing the manuscript.
IK and CMD conceived the study. IK designed the analytical framework and wrote the manuscript. AM delivered safeTALK at Mercy College and contributed to the interpretation of results. LM oversaw all aspects of the study execution. AMTR ran statistical analyses and drafted the interpretation of output data and results. DP oversaw the Markov model construction. All authors commented, reviewed and approved the final manuscript.
Compliance with Ethical Standards
This work was supported by Grapevine Group Mackay and Central Queensland University.
Conflict of interest
AM is Midas House Coordinator at Mercy College Mackay. LM is the president of Grapevine Group Inc., a non-profit organisation. All other authors have no conflicts of interest to declare. The study was approved by the appropriate institutional research ethics committees and has been performed in accordance with the ethical standards of the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study. The views and opinions expressed in this manuscript are those of the authors and do not necessarily reflect the official policy or position of any other agency, organisation, employer or company.
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