Validation of a handbook on suicide prevention among students: talking is the best solution

Objective: to validate the content and face of a manual on suicide prevention for university students of the health area. Methods: a methodological research involving two steps: content validation with participation of 13 experts; and semantic validation with participation of 82 health students. Two questionnaires with a Likert scale were used. The quantitative analysis was based on descriptive statistics to obtain the Content Validity Index and the Semantic Agreement Index. Results: the manual was considered valid by experts and university students, with a content validity index of 0.91 and semantic agreement index of 0.96. However, the manual underwent a textual and illustrative restructuring in the aspects of objectives, relevance, structure and presentation. Conclusion: after validation, the manual proved to be an appropriate tool for educational actions to be distributed to health university students. Descriptors: Educational Technology; Health Education; Suicide; Validation Studies. RESUMO Objetivo: validar o conteúdo e a aparência de um manual sobre prevenção do suicídio para universitários da área da saúde. Métodos: pesquisa metodológica, realizada em duas etapas: validação de conteúdo com 13 juízes especialistas na primeira e validação semântica com 82 universitários da área da saúde na segunda. Foram utilizados dois questionários com escala Likert. A análise quantitativa pautou-se na estatística descritiva para obter o Índice de Validade de Conteúdo e o Índice de Concordância Semântica. Resultados: o manual foi considerado válido pelos juízes especialistas e pelos universitários, pois obteve o índice de validade de conteúdo de 0,91 e índice de concordância semântica de 0,96. No entanto, passou por uma reestruturação textual e ilustrativa nos aspectos dos objetivos, relevância, estrutura e apresentação. Conclusão: o manual, após a validação, revelou-se um dispositivo adequado para mediar ações educativas e ser distribuído a universitários da área da saúde. Descritores: Tecnologia Educacional; Educação em Saúde; Suicídio; Estudos de Validação. 1Universidade do Estado do Amazonas. Manaus, AM, Brazil. 2Sociedade Brasileira de Estudos da Cannabis Sativa. São Paulo, SP, Brazil. Corresponding author: Elizabeth Teixeira Avenida Maceió 618/1204, Adrianópolis. CEP: 69057-010. Manaus, AM, Brazil. E-mail: etfelipe@hotmail.com Anelys Feitoza Siqueira1 Darlisom Sousa Ferreira1 Wagner Ferreira Monteiro1 Elizabeth Teixeira1 Iury Pedro Bento Barbosa2 How to cite this article: Siqueira AF, Ferreira DS, Monteiro WF, Teixeira E, Barbosa IPB. Validation of a handbook on suicide prevention among students: talking is the best solution. Rev Rene. 2020;21:e42241. DOI: https://doi.org/10.15253/2175-6783.20202142241 Siqueira AF, Ferreira DS, Monteiro WF, Teixeira E, Barbosa IPB Rev Rene. 2020;21:e42241. 2 Introduction Suicidal behavior includes suicidal ideation, planning, attempting, and suicide itself(1). The latter can be defined as “a deliberate act of consciously and intentionally causing one’s own death, albeit ambivalently, using a means he believes to be lethal”(2:9) or as a “relentless pursuit to solve an unexplained pain, taking one’s own life would be an impulsive, intentional, self-exterminating action”(3:11). This pain has a social origin(3), and is influenced by several factors biological, psychological, social, economic, cultural and spiritual; it is almost always impossible to define only one single factor as the cause(4-5). Mental disorders and previous suicide attempts are considered the main risk factors for suicide(2). Others factors, observed in the general population, are male sex, age over 45 years, unemployment, poverty, divorced or widowed marital status, conflicting interpersonal and family relationships, chronic physical illness, substance abuse, hopelessness, grief, and access to firearms, pesticides or medicines(2,5-6). College students have higher prevalence of anxiety and depression symptoms when compared to the general population(7), besides being more susceptible to suicidal behavior(1). Stress experienced during academic training gym is the major cause of depressive disorders(7), anxiety, Burnout syndrome and suicidal ideation among college students, which may result from high workload, pressure to learn a large amount of information, lack of leisure time and social activities, financial problems, lack of social support, residence far from the affective nucleus of origin, high demands within and outside the academic environment, demands associated with the completion of the course, and expectations with the world of work(7-9). Among all stressors, it has been observed that some are specifically risk factors for suicide, namely, anxiety and mood disorders, traffic accidents, fights involving physical aggression, poor confidence in the communication with parents, alcohol and tobacco consumption, and sexual abuse(10). Between 2011 and 2016, about 48,000 people attempted suicide in Brazil, and by 2015, 56,000 people died for this reason(4). It is estimated that 15 to 25.0% of those who attempted suicide will do so again the following year, and 10.0% will succeed in a 10-year period(4). The suicide rate in the population aged between 15 and 29 years increased by 40.0% in the last 10 years(7) and, in 2010, 47.7% of university students complained of psychological distress(7). It was found in a study that 9.9% of Brazilian university students had had suicidal ideation in the month prior to data collection, and the negative feelings score is proportional to the semester of the course in which the student is enrolled(11). Considering that college students have difficulty sharing their suffering regarding suicide because of the stigma against weakness and madness, and also the lack of knowledge and unpreparedness of undergraduate or already graduated professionals to deal with suicidal behavior(11), it is imperative that universities create more centers of psychological support to students(7), spaces that could be environments to talk about suicide, enabling healthy dialogues based on scientific knowledge(1,11). In this sense, educational technologies in printed format, such as guides and handbooks, stand out by their potential to mediate discussions and dialogues, allowing the target audience to broaden the reading and knowledge about the subject, promoting a reflection on behaviors and actions, and fostering the development of decision autonomy, thus characterizing health promotion(12). Thus, in view of the above, the team produced a printed educational technology, a handbook, with a view to favoring health promotion and mediating health education actions, as well as sensitizing the target audience, ie health students, regarding the theme, making them to reflect on it. From the production of this instrument, the following questions emerged: Is the handbook a valid