Validation and Testing of a Suicide Prevention Program in Improving the Mental Well-being of School-going Adolescents in Gilgit Baltistan, Pakistan: A Pre/Post-intervention Study Protocol
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 267
- 试验地点
- 1
- 主要终点
- Suicidal Ideation
研究概览
简要总结
Background Globally, around 800,000 people die annually by committing suicide with a disproportionate burden of 77% of these deaths occurring in low- and middle income countries. Suicidal ideation is frequently observed among adolescents and is directly associated with suicidal attempts. Pakistan has witnessed a marked escalation in suicide rates in recent years, with Gilgit-Baltistan reporting the highest incidence. Extensive scholarly inquiry suggests the potential role of suicide prevention strategies in mitigating suicidal ideation, attempts, and related fatalities. This study aims to validate and evaluate the efficacy of a locally contextualized suicide prevention programs called RAAHI (the Guide) and safeTALK in improving the mental wellbeing of school-going adolescents in the Gilgit Baltistan, Pakistan.
Method and Analysis The investigation will evaluate the effectiveness of a locally contextualized suicide prevention intervention program called RAAHI based on internationally tested out program named safeTALK among 267 adolescents attending 4 private schools in Gilgit Baltistan, Pakistan, followed by its contextual validation. 'RAAHI', a suicide literacy module is designed to equip individuals with the knowledge and skills to recognize signs of suicidal ideation, engage them empathetically, and connect those in crisis with support. It promotes open discussions, combats stigma, and encourages preventive measures for widespread suicide literacy. The, safeTalk a 4-hour psychoeducational workshop, aimed to prevent adolescent suicide through presentations, videos, discussions, and interactive sessions. Participants learned to identify warning signs, engage in TALK steps (Tell, Ask, Listen, KeepSafe), and connect individuals with crisis support.
Employing an & interrupted time-series design through a pre-post-test framework, the study will assess the impact of the intervention at various time points, post intervention (T2) and follow up after 8 weeks (T3). Descriptive and inferential analyses (paired t test, ANOVA) will be carried out to gauge alterations in each measured outcome (including knowledge, confidence, willingness, and help-seeking behaviors) during the course of the study.
Ethics and Dissemination The study protocol has been approved by the Ethical Review Committee of the Aga Khan University (registration number 2023-8509-24844). The study finding will be shared with the parents and school authorities through workshops conducted in Urdu. The study will be published in an open-access, peer-reviewed journal and presented at relevant conferences.
Strengths and Limitations
-Since there is no standard intervention available for suicide prevention for adolescents in Pakistani context, the current research will assist in up scaling contextualized suicide prevention intervention among school-going adolescents in Pakistan. However, due to time, budget and logistical constraints, this feasibility study will only be conducted In private schools of Gilgit Baltistan, Pakistan, limiting potentially diverse implementation experiences and outcomes in rural or public school settings. This may restrict the generalizability of the study findings. Moreover, employing a quasi-experimental design without an appropriate control group can potentially undermine the internal validity of the study.
详细描述
Introduction Suicide is a notable worldwide public health issue, resulting in a staggering number of fatalities annually (Milbourn et al., 2022). It ranks among the five leading causes of death, representing over one-third of all fatalities (Kinchin et al., 2020). The rising global suicide rate, surpassing 800,000 deaths annually, underscores the urgency of addressing this critical public health concern (WHO, 2024). In Australia, suicide is the leading cause of death among individuals aged 15-24 years, with an annual rate of 11.6 deaths per 100,000 population (Kinchin & Doran, 2018). Moreover, each suicide case potentially corresponds with over 20 attempted suicides, emphasizing the urgent need for suicide prevention interventions. WHO (2024) suggests an alarmingly high prevalence of suicidal ideation, encompassing non-fatal suicide attempts and self-harm. This tragic occurrence is widespread across the globe, with 77% of suicides taking place in low and middle-income countries (Kinchin et al., 2020).
Additionally, on a global scale, suicide is the fourth most common cause of mortality, for individuals between the ages of 15 and 29 (Organization, 2021). Over the past five years, the United Arab Emirates has recorded the highest rate of suicides globally, (11.4%), followed by the United Kingdom (10.80%), Nepal (10.33%), the United States of America (8.9%), and Pakistan (7%) (CDC, 2020). Within the spectrum of mental health disorders, suicide emerges as the foremost cause of violent death, even among the economically active age group of 15-44 years, (CDC, 2020). According to a meta-analysis, 22.3% of college students at some point in their lives had had suicidal thoughts, plans, or made attempt(Mortier et al., 2018). In addition, a survey of 8,113 high school students in Hawaii found that 16.4% of the adolescents reported having suicidal thoughts, and nearly 10% acknowledged having attempted suicide at least once in their lives (Ivey-Stephenson, 2020).
Adolescents are highly vulnerable to mental health problems due to academic stress, interpersonal issues, and the transition to adulthood; all these factors exert substantial influence on their physical, emotional, social, and mental well-being (Broad, Sandhu, Sunderji, & Charach, 2017). In Pakistan, these challenges are exacerbated by social and cultural pressures, mental health being considered as a stigma, and limited access to treatment, which impacts social functioning and academic success, with long-term consequences (Bibi, Blackwell, & Margraf, 2021).
Increasing evidence suggests that school-based suicide prevention interventions are effective in their approach (Kinchin et al., 2017). Such interventions span various levels of prevention, encompassing primary efforts, like public awareness campaigns; secondary approaches, such as gatekeeper training programs; tertiary interventions, like psychotherapy and postvention strategies, including survivor support groups.
Similarly, expanding the conventional classification of mental health interventions, suicide prevention strategies can be categorized into universal (targeting the general public) or selective (aimed at specific high-risk groups with elevated lifetime risk, such as adolescent and psychiatric inpatients) (Zalsman et al., 2016).
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Prevention
- 盲法
- None
盲法说明
Not any
入排标准
- 年龄范围
- 12 Years 至 18 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Both male and female adolescents enrolled in grades IX and X who can comprehend English and Urdu languages will be included. In addition, they and their parents consent to participate in the study.
排除标准
- •Adolescents who will be absent or sick on the day of data collection and intervention will not be included in the study.
研究组 & 干预措施
Single arm
This is single arm pretest post-test, behavioural Suicide prevention intervention, so all the participants will be given the intervention
干预措施: Suicide prevention treatment (Behavioral)
结局指标
主要结局
Suicidal Ideation
时间窗: Pre test, post test I and post test II after 8 weeks
The degree of suicidal ideation among the participants will be measured through the Modified Scale of Suicidal Ideation by Miller et al. (1991), comprising 21 items. It was translated and used in the Urdu language by Bakht, Saeed, Noushad2, 3, and Shamoon (2017). The MSSI has shown strong internal consistency, with coefficient α ranging from 0.87 to 0.94
次要结局
- Attitude Toward Seeking Professional Psychological Help Scale (ATSPPHS)(Pre test, post test I and post test II after 8 weeks)
- Depression, Anxiety and Stress level.(Pre test, post test I and post test II after 8 weeks)
- Adaptive Coping strategies(Pre test, post test I and post test II after 8 weeks)
研究者
Yasmin Parpio
Principal
Aga Khan University