Suicide Prevention by Empowering Adolescents in Pakistan (SEPAK)
Condition: Self-harm
MeSH terms: Suicide; Suicide Prevention; Self-Injurious Behavior
Study type: Interventional

Summary: 
      Self-harm is now seen as an epidemic affecting young people across the world and particularly
      in low and middle-income countries (LMIC) such as Pakistan. Young people in Pakistan often
      come across many troubles such as mental health and family problems, stress at school and
      social and economic inequalities. A youth suicide prevention programme is needed in Pakistan.
      Such programme will be based on secondary schools (where most young people are) and will
      support schools to work together with many public agencies to tackle the full range of
      troubles that young people face. Our main research aim is to work together with multiple
      stakeholders to culturally adapt and test the feasibility of three SEPAK interventions to
      prevent suicide among students in secondary schools in Pakistan (aged 12 to 17 years).
    

Detailed description: 
      There will be two research phases. In the first phase,

        1. Four preventative interventions will be selected and translated after reviewing the
           international literature on youth suicide prevention programmes (e.g. SEYLE trial in
           Europe);

        2. Focus groups will be undertaken with multiple stakeholders (students, teachers/staff at
           secondary schools, parents and health professionals) to decide on adaptations needed to
           the four selected interventions;

        3. Adapted versions the four preventative SEPAK interventions will be produced after
           incorporating the modifications recommended by the focus groups with stakeholders.

      In the second phase, the feasibility and acceptability of the four preventative SEPAK
      interventions will be examined in 4 secondary schools (each site) and one control group (each
      site) across 8 cities in Pakistan. The four preventative interventions will involve i.
      Delivering workshops for students at secondary schools to raise awareness on mental health
      and stresses that students face.

      ii. Training school teachers/workers to act as facilitators and identify troubled students
      iii. Training parents to act as facilitators and identify and support troubled young people
      iv. Training of health professionals who work with young people to systematically use cut-off
      scores of established psychometric tools for referring young people to mental and social care
      services. Six posters on mental health awareness will display in the classrooms of the school
      allocated to the control group.
    

Intervention name(s): LEADS Plus educational posters; Question, Persuade, and Refer (Teachers) Plus educational posters; Screening by Professionals programme plus educational posters; educational posters; Question, Persuade, and Refer (Parents) Plus educational posters
Intervention type(s): Other; Other; Other; Other; Other
Intervention description(s): This intervention covers depression and its symptoms, the link between depression and suicide, the risk and protective factors associated with suicide, the warning signs of suicide, seeking help and overcoming barriers to seeking help, and school and community suicide prevention resources. Six educational posters will also be displayed in class rooms; It is a manualised programme for gatekeepers, originally developed in the USA which to train teachers/school staff to identify the suicide risk in students and encourage students at risk of suicide to seek professional help. Six educational posters will also be displayed in classrooms.; This is an indicated or selective intervention which is based on students' responses to the baseline questionnaires. Participating health professionals review students' responses to the questionnaires used in the study and students whose scores meet pre-established cutoff points will be invited to participate in a professional mental health clinical assessment and if needed, referred to clinical services. Six educational posters will also be displayed in classrooms.; Six educational posters will be displayed in all schools in this cluster.; It is a manualised programme for gatekeepers (parents), originally developed in the USA which to train parents to support the young people at risk of suicide. Six educational posters will also be displayed in classrooms.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: self-harm; suicide prevention; school-based intervention; Pakistan