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.
- 1.World Health Organisation. Preventing suicide: a global imperative. Geneva: WHO; 2014.Google Scholar
- 2.AIHW National Mortality Database [database on the Internet]. AIHW. 2016. Available from: http://www.aihw.gov.au/deaths/leading-causes-of-death/. Accessed 06 Aug 2018.
- 4.Australian Institute of Health and Welfare. Suicide and hospitalised self-harm in Australia: trends and analysis. Canberra: AIHW; 2014.Google Scholar
- 7.Australian Bureau of Statistics. National survey of mental health and wellbeing. Canberra: ABS; 2007.Google Scholar
- 8.Barker E, Novic A, Houweling H, McPhedran S, De Leo D. Suicide research: selected readings. Brisbane: Australian Institute for Suicide Research and Prevention; 2013.Google Scholar
- 11.Mo PKH, Ko TT, Xin MQ. School-based gatekeeper training programs in enhancing gatekeepers’ cognitions and behaviours for adolescent suicide prevention: a systematic review. Child Adolesc Psychiatry Ment Health. 2018;12:29. https://doi.org/10.1186/s13034-018-0233-4.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Headspace. Suicide intervention in schools: an evidence summary. Sydney: Headspace.Google Scholar
- 13.Australian Bureau of Statistics. 2016 Census of Population and Housing. Canberra: ABS; 2017.Google Scholar
- 14.National Coronial Information System (NCIS). Suicide mortality data. NCIS. http://www.ncis.org.au/. Accessed 03 Oct 2016.
- 16.Niagara Suicide Prevention Coalition and Distress Centre Niagara. Evaluation of SafeTALK Training in a Convenience Sample of 500 Niagara Region Residents, Health Professionals and Volunteers. Canada: Niagara Region; 2015.Google Scholar
- 17.Eynan R. Preventing suicides in the Toronto subway system: a program evaluation. Toronto: University of Toronto; 2011.Google Scholar
- 18.McLean J, Schinkel M, Woodhouse A, Pynnonen AM, McBryde L. Evaluation of the Scottish SafeTALK Pilot. Edinburgh: Scottish Development Centre for Mental Health; 2007.Google Scholar
- 19.McKay K, Hawgood J, Kavalidou K, Kolves K, O’Gorman J, De Leo D. A review of the operation life suicide awareness workshops. Report to the Department of Veterans’ Affairs. Brisbane: Australian Institute for Suicide Research and Prevention; 2012.Google Scholar
- 21.McDavid D. Making an economic case for investing in suicide prevention In: O’Connor R, Pirkis J, editors. The international handbook of suicide prevention. 2nd ed. Wiley-Blackwell; 2016. p. 775–90.Google Scholar
- 22.Kirkpatrick DL, Kirkpatrick JD. Evaluating training programs: the four levels. 3rd ed. San Francisco: Berrett-Koehler Publishers; 2006.Google Scholar
- 23.Wyman PA, Brown CH, Inman J, Cross W, Schmeelk-Cone K, Guo J, et al. Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. J Consult Clin Psychol. 2008;76(1):104–15. https://doi.org/10.1037/0022-006X.76.1.104.CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Australian Bureau of Statistics (ABS). Consumer Price Index, Australia, March 2019. Canberra: ABS; 2019.Google Scholar
- 27.The Allen Consulting Group. Police, Ambulance and Clinical Early Response (PACER) Evaluation. Melbourne: Report to Department of Health; 2012.Google Scholar
- 28.Independent Hospital Pricing Authority. National hospital cost data collection. Australian Public Hospitals Cost Report 2013–2014. Canberra: IHPA; 2014.Google Scholar
- 29.Kinchin I. Cost of hospital management per incident of self-harm in three cohorts of Australians: 15–19 years, 20–24 years and 25–29 years. In: Australian Institute of Health and Welfare, editor. Canberra: AIHW; 2014.Google Scholar
- 30.Clements C, Turnbull P, Hawton K, Geulayov G, Waters K, Ness J, et al. Rates of self-harm presenting to general hospitals: a comparison of data from the Multicentre Study of Self-Harm in England and Hospital Episode Statistics. BMJ Open. 2016;6(2):e009749. https://doi.org/10.1136/bmjopen-2015-009749.CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Commission National Mental Health. The National Review of Mental Health Programs and Services. Sydney: National Mental Health Commission; 2014.Google Scholar
- 33.O’Dea D, Tucker S. The Cost of Suicide to Society. Wellington: Ministry of Health; 2005.Google Scholar
- 34.Australian Security and Investments Commission. Paying for your funeral. ASIC. 2017. https://www.moneysmart.gov.au/life-events-and-you/over-55s/paying-for-your-funeral. Accessed 19 Feb 2018.
- 40.Committee Pharmaceutical Benefits Advisory. Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee. Canberra: Department of Health and Ageing; 2008.Google Scholar