Program Evaluation and Decision Analytic Modelling of Universal Suicide Prevention Training (safeTALK) in Secondary Schools
Background 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 sess...
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| Veröffentlicht in: | Applied health economics and health policy 2020-04, Vol.18 (2), p.311-324 |
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| creator | Kinchin, Irina Russell, Alex M. T. Petrie, Dennis Mifsud, Adrianne Manning, Laurence Doran, Christopher M. |
| description | Background
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.
Methods
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.
Results
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 |
| doi_str_mv | 10.1007/s40258-019-00505-3 |
| format | Article |
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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.
Methods
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.
Results
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.
Conclusion
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.</description><identifier>ISSN: 1175-5652</identifier><identifier>EISSN: 1179-1896</identifier><identifier>DOI: 10.1007/s40258-019-00505-3</identifier><identifier>PMID: 31410773</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adolescent ; Attitudes ; Education ; Female ; Health Administration ; Health Economics ; Health Promotion ; Help seeking behavior ; Humans ; Intervention ; Justice ; Knowledge ; Learning ; Male ; Markov analysis ; Markov chains ; Medicine ; Medicine & Public Health ; Original Research Article ; Pharmacoeconomics and Health Outcomes ; Population ; Prevention ; Program Evaluation ; Public Health ; Quality of Life Research ; Queensland ; Questionnaires ; Return on investment ; Risk Reduction Behavior ; School effectiveness ; Schools ; Secondary school students ; Secondary schools ; Self destructive behavior ; Self-efficacy ; Students ; Suicidal Ideation ; Suicide ; Suicide - prevention & control ; Suicide prevention ; Suicides & suicide attempts ; Surveys and Questionnaires ; Training</subject><ispartof>Applied health economics and health policy, 2020-04, Vol.18 (2), p.311-324</ispartof><rights>Springer Nature Switzerland AG 2019</rights><rights>Copyright Springer Nature B.V. Apr 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c452t-516c04e1314c4d816964e61c53b496e87e9383930978b089017c5ab2050950c33</citedby><cites>FETCH-LOGICAL-c452t-516c04e1314c4d816964e61c53b496e87e9383930978b089017c5ab2050950c33</cites><orcidid>0000-0003-0133-2763 ; 0000-0002-3685-7220</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40258-019-00505-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40258-019-00505-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27866,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31410773$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kinchin, Irina</creatorcontrib><creatorcontrib>Russell, Alex M. T.</creatorcontrib><creatorcontrib>Petrie, Dennis</creatorcontrib><creatorcontrib>Mifsud, Adrianne</creatorcontrib><creatorcontrib>Manning, Laurence</creatorcontrib><creatorcontrib>Doran, Christopher M.</creatorcontrib><title>Program Evaluation and Decision Analytic Modelling of Universal Suicide Prevention Training (safeTALK) in Secondary Schools</title><title>Applied health economics and health policy</title><addtitle>Appl Health Econ Health Policy</addtitle><addtitle>Appl Health Econ Health Policy</addtitle><description>Background
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.
Methods
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.
Results
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.
Conclusion
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.</description><subject>Adolescent</subject><subject>Attitudes</subject><subject>Education</subject><subject>Female</subject><subject>Health Administration</subject><subject>Health Economics</subject><subject>Health Promotion</subject><subject>Help seeking behavior</subject><subject>Humans</subject><subject>Intervention</subject><subject>Justice</subject><subject>Knowledge</subject><subject>Learning</subject><subject>Male</subject><subject>Markov analysis</subject><subject>Markov chains</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Research Article</subject><subject>Pharmacoeconomics and Health Outcomes</subject><subject>Population</subject><subject>Prevention</subject><subject>Program Evaluation</subject><subject>Public Health</subject><subject>Quality of Life Research</subject><subject>Queensland</subject><subject>Questionnaires</subject><subject>Return on investment</subject><subject>Risk Reduction Behavior</subject><subject>School effectiveness</subject><subject>Schools</subject><subject>Secondary school students</subject><subject>Secondary schools</subject><subject>Self destructive behavior</subject><subject>Self-efficacy</subject><subject>Students</subject><subject>Suicidal Ideation</subject><subject>Suicide</subject><subject>Suicide - prevention & control</subject><subject>Suicide prevention</subject><subject>Suicides & suicide attempts</subject><subject>Surveys and Questionnaires</subject><subject>Training</subject><issn>1175-5652</issn><issn>1179-1896</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7TQ</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9kctuUzEQhi1ERUvhBVggS2zK4oDvl2VUSosIolLSteX4TIKrE7vYOZEqXr5OUqjEoqvxyN_8c_kRekfJJ0qI_lwFYdJ0hNqOEElkx1-gE0q17aix6uX-LTupJDtGr2u9JYQpZcUrdMypoERrfoL-XJe8Kn6NL7Z-GP0m5oR96vEXCLHukknyw_0mBvwj9zAMMa1wXuKbFLdQqh_wbIwh9oCvC2wh7evnxce0A8-qX8J8Mv3-EceEZxBy6n25x7PwK-ehvkFHSz9UePsYT9HN14v5-VU3_Xn57Xwy7YKQbNNJqgIRQNvQQfSGKqsEKBokXwirwGiw3HDLidVmQYwlVAfpF6ydxEoSOD9FZwfdu5J_j1A3bh1raMv4BHmsjjHNGZXU6IZ--A-9zWNpJ2gUN0IaQY1pFDtQoeRaCyzdXYnrtpmjxO2scQdrXLPG7a1xuyneP0qPizX0_0r-etEAfgBq-0orKE-9n5F9AEwal5M</recordid><startdate>20200401</startdate><enddate>20200401</enddate><creator>Kinchin, Irina</creator><creator>Russell, Alex M. T.</creator><creator>Petrie, Dennis</creator><creator>Mifsud, Adrianne</creator><creator>Manning, Laurence</creator><creator>Doran, Christopher M.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>4T-</scope><scope>7TQ</scope><scope>7WY</scope><scope>7WZ</scope><scope>7X7</scope><scope>7XB</scope><scope>87Z</scope><scope>88C</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FL</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>BENPR</scope><scope>BEZIV</scope><scope>CCPQU</scope><scope>DHY</scope><scope>DON</scope><scope>DPSOV</scope><scope>DWQXO</scope><scope>FRNLG</scope><scope>FYUFA</scope><scope>F~G</scope><scope>GHDGH</scope><scope>K60</scope><scope>K6~</scope><scope>K9.</scope><scope>KC-</scope><scope>L.-</scope><scope>M0C</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2L</scope><scope>PQBIZ</scope><scope>PQBZA</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0133-2763</orcidid><orcidid>https://orcid.org/0000-0002-3685-7220</orcidid></search><sort><creationdate>20200401</creationdate><title>Program Evaluation and Decision Analytic Modelling of Universal Suicide Prevention Training (safeTALK) in Secondary Schools</title><author>Kinchin, Irina ; Russell, Alex M. T. ; Petrie, Dennis ; Mifsud, Adrianne ; Manning, Laurence ; Doran, Christopher M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c452t-516c04e1314c4d816964e61c53b496e87e9383930978b089017c5ab2050950c33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Attitudes</topic><topic>Education</topic><topic>Female</topic><topic>Health Administration</topic><topic>Health Economics</topic><topic>Health Promotion</topic><topic>Help seeking behavior</topic><topic>Humans</topic><topic>Intervention</topic><topic>Justice</topic><topic>Knowledge</topic><topic>Learning</topic><topic>Male</topic><topic>Markov analysis</topic><topic>Markov chains</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Research Article</topic><topic>Pharmacoeconomics and Health Outcomes</topic><topic>Population</topic><topic>Prevention</topic><topic>Program Evaluation</topic><topic>Public Health</topic><topic>Quality of Life Research</topic><topic>Queensland</topic><topic>Questionnaires</topic><topic>Return on investment</topic><topic>Risk Reduction Behavior</topic><topic>School effectiveness</topic><topic>Schools</topic><topic>Secondary school students</topic><topic>Secondary schools</topic><topic>Self destructive behavior</topic><topic>Self-efficacy</topic><topic>Students</topic><topic>Suicidal Ideation</topic><topic>Suicide</topic><topic>Suicide - prevention & control</topic><topic>Suicide prevention</topic><topic>Suicides & suicide attempts</topic><topic>Surveys and Questionnaires</topic><topic>Training</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kinchin, Irina</creatorcontrib><creatorcontrib>Russell, Alex M. T.</creatorcontrib><creatorcontrib>Petrie, Dennis</creatorcontrib><creatorcontrib>Mifsud, Adrianne</creatorcontrib><creatorcontrib>Manning, Laurence</creatorcontrib><creatorcontrib>Doran, Christopher M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection【Remote access available】</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>PAIS Index</collection><collection>ABI/INFORM Collection</collection><collection>ABI/INFORM Global (PDF only)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ABI/INFORM Collection</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ABI/INFORM Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Social Science Premium Collection (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest Central</collection><collection>ProQuest Business Premium Collection</collection><collection>ProQuest One Community College</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><collection>Politics Collection</collection><collection>ProQuest Central</collection><collection>Business Premium Collection (Alumni)</collection><collection>Health Research Premium Collection</collection><collection>ABI/INFORM Global (Corporate)</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Business Collection (Alumni Edition)</collection><collection>ProQuest Business Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Politics Collection</collection><collection>ABI/INFORM Professional Advanced</collection><collection>ABI/INFORM Global</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest Health Management</collection><collection>Medical Database</collection><collection>Political Science Database (Proquest)</collection><collection>ProQuest One Business</collection><collection>ProQuest One Business (Alumni)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Applied health economics and health policy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kinchin, Irina</au><au>Russell, Alex M. T.</au><au>Petrie, Dennis</au><au>Mifsud, Adrianne</au><au>Manning, Laurence</au><au>Doran, Christopher M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Program Evaluation and Decision Analytic Modelling of Universal Suicide Prevention Training (safeTALK) in Secondary Schools</atitle><jtitle>Applied health economics and health policy</jtitle><stitle>Appl Health Econ Health Policy</stitle><addtitle>Appl Health Econ Health Policy</addtitle><date>2020-04-01</date><risdate>2020</risdate><volume>18</volume><issue>2</issue><spage>311</spage><epage>324</epage><pages>311-324</pages><issn>1175-5652</issn><eissn>1179-1896</eissn><abstract>Background
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.
Methods
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.
Results
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.
Conclusion
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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31410773</pmid><doi>10.1007/s40258-019-00505-3</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0003-0133-2763</orcidid><orcidid>https://orcid.org/0000-0002-3685-7220</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Applied health economics and health policy, 2020-04, Vol.18 (2), p.311-324 |
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| source | MEDLINE; SpringerLink_现刊; PAIS Index |
| subjects | Adolescent Attitudes Education Female Health Administration Health Economics Health Promotion Help seeking behavior Humans Intervention Justice Knowledge Learning Male Markov analysis Markov chains Medicine Medicine & Public Health Original Research Article Pharmacoeconomics and Health Outcomes Population Prevention Program Evaluation Public Health Quality of Life Research Queensland Questionnaires Return on investment Risk Reduction Behavior School effectiveness Schools Secondary school students Secondary schools Self destructive behavior Self-efficacy Students Suicidal Ideation Suicide Suicide - prevention & control Suicide prevention Suicides & suicide attempts Surveys and Questionnaires Training |
| title | Program Evaluation and Decision Analytic Modelling of Universal Suicide Prevention Training (safeTALK) in Secondary Schools |
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