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).
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
1,350
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.
Public schools
Quetta, Balochistan, Pakistan
Public schools
Peshawar, KPK, Pakistan
Public Schools
Lahore, Punjab Province, Pakistan
Public schools
Multan, Punjab Province, Pakistan
Public schools
Rawalpindi, Punjab Province, Pakistan
Public schools
Hyderābād, Sindh, Pakistan
Public schools
Karachi, Sindh, Pakistan
Public Schools
Nawabshah, Sindh, Pakistan
Feasibility of undertaking a trial of the intervention
recruitment rate of the trial
Time frame: Change from baseline to 1-month post baseline
Therapy log
acceptability of the interventions that will be evident from the attendance of participants in each session on a therapy log
Time frame: Change from baseline to 1-month post baseline
The Global school-based student health survey (GSHS)
The is a self-administered questionnaire and covered ten key topics: alcohol use, dietary behaviors, drug use, hygiene, mental health, physical activity, protective factors, sexual behaviors, tobacco use, and violence and unintentional injury
Time frame: Change in scores from baseline to outcome (1-month post baseline)
Deliberate Self-Harm Inventory
DSHI will be used to collect information about episode of self-harm. Minimum score is 0 and maximum score is 34. Higher total score indicate the higher intensity of the problem.
Time frame: Change in scores from baseline to outcome (1-month post baseline)
Kessler Psychological Distress Scale
This will use to measure psychological distress. It's a 10 item scale measuring emotional states with a 5 level response scale. Minimum score is 10 and a maximum score is 50. Low scores indicate low levels of psychological distress and high scores indicate high levels of psychological distress.
Time frame: Change in scores from baseline to outcome (1-month post baseline)
Beck Scale for Suicidal Ideation (BSSI)
This scale is a 19-items instrument that evaluates the presence and intensity of suicidal thoughts in a week. Minimum total score is 0 and maximum total score can be 38. Higher scores indicate worse outcome.
Time frame: Change in scores from baseline to outcome (1-month post baseline)
Euro-Qol (EQ-5D-5L)
A standardised instrument to measure health status and associated population utility weights. It consists of a self-report questionnaire covering five dimensions of health (mobility, self-care, usual activities, pain/ discomfort and anxiety/ depression)
Time frame: Change in scores from baseline to outcome (1-month post baseline)
Client Service Receipt Inventory
We will collect information on the use of health services (including the informal sector such as faith healers/Imams)
Time frame: Change in scores from baseline to outcome (1-month post baseline)
Client Satisfaction Questionnaire
Participant satisfaction with services will be assessed using the Client Satisfaction. The total score ranges from 8 to 32. Higher scores indicate higher level of satisfaction. Questionnaire (CSQ)
Time frame: Scores reported by the participant on the scale after intervention at 1-month post baseline
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