10.14718/ACP.2026.29.6

Artículo School-Based Interventions for Suicidal Behavior Prevention in Adolescence: An Integrative Review Intervenciones escolares para la prevención de la conducta suicida en la adolescencia: revisión integrativa

Blanca Estela Barcelata Eguiarte¹
Laura Amada Hernández Trejo²*
María Emilia Lucio y Gómez Maqueo³
Verónica Guadalupe Vázquez-Cortés⁴

¹ Universidad Nacional Autónoma de México, Mexico City, Mexico
0000-0002-0122-372X

² Universidad Nacional Autónoma de México, Mexico City, Mexico
0000-0002-0991-3944

³ Universidad Nacional Autónoma de México, Mexico City, Mexico
0000-0002-6098-940X

⁴ Universidad Nacional Autónoma de México, Mexico City, Mexico
0009-0006-8977-1566

^* Contact information: Universidad Nacional Autónoma de México, Av. Universidad 3000, Copilco El Alto, Mexico City, Mexico.
laura.a.ht@gmail.com

Authors' Notes:

Conflict of Interest Statement: The authors declare no conflict of interest.

Funding: This study was funded by PAPIIT-IN301523-DGAPA, Universidad Nacional Autónoma de México.

Permission to Reproduce Material: The authors declare that no material from other sources was reproduced in this article.

Received: May 26, 2023;
Reviewed: June 03, 2025
Accepted: February 17, 2026

How to cite [APA]: Barcelata Eguiarte, B. E., Hernández Trejo, L. A., Lucio y Gómez-Maqueo, M. E., & Vázquez-Cortés, V. G. (2026). School-Based Interventions for Suicidal Behavior Prevention in Adolescence: An Integrative Review. Acta Colombiana de Psicología, 29, 1-24. https://doi.org/10.14718/ACP.2026.29.6

Abstract

Adolescent suicidal behavior is a major global public health concern. Although effective treatments have advanced, most have been developed in clinical rather than school settings. This review aimed to identify, evaluate, and synthesize school-based interventions for preventing and managing adolescent suicidal behavior, comparing their key characteristics. Following elements of PRISMA and PICO guidelines, studies published between January 2016 and June 2025 were searched in EBSCO, OVID, and PubMed. Of 2,549 records, 33 met the inclusion criteria. Most interventions were conducted in English-speaking countries, with few in Latin America, and primarily used psychoeducational or cognitive-behavioral approaches within pre- or quasi-experimental designs; randomized trials were less common. Overall, studies reported improvements in knowledge, help-seeking, and suicide risk indicators, although effect sizes were reported inconsistently. Findings suggest school-based interventions are promising, but highlight the need for more rigorous, culturally adapted research in Latin America.

Keywords: Suicidal behavior; adolescents; intervention; school-based; integrative review.

Resumen

La conducta suicida en adolescentes es un problema de salud pública de gran importancia a nivel global. Aunque los tratamientos han avanzado, la mayoría se ha desarrollado en contextos clínicos más que escolares. La presente revisión tuvo como objetivo identificar, evaluar y sintetizar intervenciones escolares para prevenir y manejar la conducta suicida en adolescentes, comparando sus características principales. Siguiendo los elementos de PRISMA y PICO, se buscaron estudios publicados entre enero de 2016 y junio de 2025 en EBSCO, OVID y PubMed. De 2549 registros, 33 cumplieron los criterios de inclusión. La mayoría de las intervenciones se realizaron en países angloparlantes, con pocas en Latinoamérica, y emplearon enfoques psicoeducativos o cognitivo-conductuales en diseños preexperimentales o cuasiexperimentales; los ensayos aleatorizados fueron menos frecuentes. En general, se observaron mejoras en conocimiento, búsqueda de ayuda e indicadores de riesgo suicida, aunque los tamaños del efecto se reportaron de forma inconsistente. Los hallazgos sugieren efectos prometedores, pero subrayan la necesidad de investigaciones más rigurosas y culturalmente adaptadas en América Latina.

Palabras clave: Conducta suicida; adolescentes; intervención; ámbito escolar; revisión integrativa.

Introduction

Suicidal behavior is a major public health concern among adolescents worldwide. The World Health Organization (WHO, 2025) reported that in 2021, suicide was the third leading cause of death among youth aged 15-24. Adolescence spans ages 10-19, and "young people" includes ages 10-24; nonetheless, youth statistics are typically reported for ages 15-24. It ranks second among females and third among males, with the highest rates observed in adolescents aged 13-18. Suicide is the most severe expression of suicidal behavior, and 73% of cases occur in low- and middle-income countries. Although rare in childhood, suicide rates increase with age: from .5 (females) and .9 (males) per 100,000 children to 12.0 and 14.2 in adolescents (Castellví et al., 2017). In Mexico, overall rates are lower than in other countries (Borges et al., 2012), but adolescents aged 15-19 are the most affected group (Sánchez-Cervantes et al., 2015). Thus, suicide remains a critical mental health issue in Mexico and a leading cause of death among youth globally (Instituto Nacional de Estadística y Geografía [INEGI], 2022; Nock et al., 2013).

Despite the current discussion about the suicidal behavior definition from different perspectives, such as the Diagnostical and Statistical Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association, 2018) and the International Classification of Diseases, eleventh edition (ICD-11; WHO, 2023), there is a relative consensus that suicidal behavior includes a wide range of behaviors like purposefully self-inflicted injuries and suicide attempts (Iorfino et al., 2020; Klonsky et al., 2016; McHugh et al., 2019; Paul, 2018). Immediate outcomes (death, injury, or no harm) are the primary concern for care services, particularly in emergency settings (Rangel-Villafaña & Jurado-Cárdenas, 2022). Research shows that adolescent self-injury predicts later suicidal behaviors and mental health problems (Iorfino et al., 2020); therefore, prevention requires evidence-based early interventions in contexts where adolescents spend most of their time. Despite advances in effective treatments, suicidal behavior has increased in recent decades, particularly among adolescents (e.g., Morris-Perez et al., 2023). Most interventions rely on cognitive and behavioral approaches to reduce suicide ideation and attempts (e.g., Finlayson et al., 2023). Accordingly, WHO (2021) recommends comprehensive, school-based prevention for children and adolescents.

"School-based programs" have been shown to be successful (Chodkiewicz & Boyle, 2016), as they enable early intervention within adolescents' natural context and allow for targeted strategies based on school data. Given that adolescents spend a substantial portion of their time in school, this context can function as both a risk and protective factor in their development (Posamentier et al., 2023); either promoting positive youth de­velopment, academic achievement, and resilience (e.g., Lerner et al., 2016; Pearlman et al., 2018) or preventing emotional and behavioral problems such as bullying, aggression, and substance use (e.g., Taub & Pearrow, 2013). These interventions may include assertiveness training, social-emotional and coping skills, and decision making to prevent suicidal behavior (e.g., Gijzen et al., 2022; Posamentier et al., 2023).

Important meta-analyses on suicide have primarily examined community samples (ages 18-65), across diverse settings (clinical, school, social), and interventions (e.g., Fox et al., 2020; Hofstra et al., 2019; Schmeckenbecher et al., 2022). Reported approaches include systemic brief therapy (SBT; Finlayson et al., 2023), cognitive behavioral therapy (CBT; Tarrier et al., 2008), and dialectical behavior therapy (DBT; Linehan et al., 2006), as well as mindfulness and contextual therapies, implemented at different levels (e.g., psychoeducation, selective, and target interventions). However, relatively few studies focus specifically on school settings. Hence, this review aims to identify, evaluate, and summarize the findings of all relevant school-based studies for preventing and managing suicidal behavior in adolescents, comparing their key characteristics. Such evidence may inform better decision-making in intervention design.

Method

Study Type

This study is an integrative review conducted using a structured search strategy, guided by selected elements of the PRISMA statement (Page & Moher, 2017; Page et al., 2021). The review aimed to collect, evaluate, and synthesize available evidence addressing a specific research question using a transparent and reproducible method. The process was guided by the PICOS (Population, Intervention, Comparison, Outcome, Studies) framework and applied across multiple databases with predefined inclusion and exclusion criteria.

Procedure

A structured literature search was carried out in the EBSCO, OVID, and PubMed databases. It included studies published between January 2016 and June 2025 to capture the most recent evidence on school-based intervention programs.

The search strategy followed the PICOS framework (Huang et al., 2006): Population (P) included adolescents aged 13-18 years. Intervention (I) consisted of school-based psychological or psychoeducational interventions to prevent suicidal behavior. Comparison criteria (C) were based on pre- and post-assessments and study characteristics. Outcomes (O) included symptom reduction and increased knowledge of risk factors. Finally, for intervention designs (S), studies ranged from pre-experimental to randomized controlled trials, and the application settings were examined. Searches used MeSH terms and Boolean operators (e.g., suicide* OR parasuicide* OR self-harm) AND (intervention* OR treatment* OR psychoeducation*), adapted to each database (see Table 1).

Inclusion criteria were: (1) peer-reviewed articles published in English or Spanish; (2) studies involving adolescents aged 13-18 years; (3) interventions conducted in school settings; (4) studies aimed to examine school-based suicide prevention interventions from any theoretical approach.

Exclusion criteria included studies not focused on suicide prevention, studies with samples outside the 13-18 age range, and interventions targeting academic staff or adults who interact with adolescents rather than adolescents themselves.

Table 1. MeSH Words and Boolean Operators

Extraction process: Data were recorded using a structured screening form that included country of origin, sample size, intervention objectives and description, measures of change, outcomes, and study design. The selection process involved sequential filtering by (1) population, (2) type of intervention, and (3) additional criteria (e.g., year, language). Four psychologists reviewed and analyzed the search results, determining which studies met the inclusion criteria and should be synthesized in line with the review's objectives (Booth et al., 2012).

Ethical Considerations

This integrative review was based exclusively on previously published studies and did not involve primary data collection or direct interaction with human participants; therefore, ethical approval was not required. All sources were appropriately cited and accessed through open-access platforms. The authors have no conflicts of interest.

Results

A total of 2,549 records were identified in the previously established databases (EBSCO = 793, OVID = 1,010, and PubMed = 746); 1,172 of these records were removed prior to screening (19 due to unavailable full text, 78 duplicates, and 1,075 unrelated to the topic of this review). We screened 1,377 records, of which 1,269 were excluded due to low relevance to the purpose of this review.

The process of identification, screening, assessment, and selection of the studies is outlined according to PRISMA flow chart procedures (Page et al., 2021), as shown in Figure 1.

Figure 1. Flow Diagram of the Study Selection Process Based on PRISMA Guidelines

A total of 108 records were screened at the full-text stage for their eligibility. Of these, 75 records were excluded based on the predefined criteria. Finally, 33 studies were included in this review; their characteristics are described in the following sections.

Table 2 shows the frequency of articles by country, year, and language of publication, as reported by the databases used. Most articles were retrieved from PubMed and EBSCO, with fewer from OVID. The majority were conducted in English-speaking countries (mainly the United States and Australia), with limited representation from Latin America and Europe. Most studies were published in 2019 and in English.

Table 2. Distribution of Articles by Country, Year of Publication, and Language of Publication According to Databases

The essential features of each research study are presented in Table 3. Analysis categories included publication year, sample size, age range (13-18 years), inclusion criteria, intervention name and objectives, key characteristics (e.g., theoretical approach, number of sessions, and duration), research design, and outcomes (e.g., measures of change). Regarding age, 33.33% did not report the age range or mean age; in the remaining studies, participants were primarily high school students. Most interventions aimed to reduce suicide risk from a preventive perspective; however, some involved small-group therapeutic interventions led by trained professionals and therapists. Besides, 63.64% of studies used psychoeducational techniques, 24.24% used therapeutic interventions, and around 12.12% used mixed procedures (psychoeducation and psychotherapy). Concerning the outcomes, 72.73% of studies used specific psychometric measures to assess suicide and related factors such as depression or anxiety, as well as mood states, before and after treatment, to compare pre-test and post-test scores (e.g., Columbia Suicide Scale, CDRSR, Suicide Risk Scale, BDI-II). These studies used different analytical methods and statistical procedures (e.g., χ², ANOVA, MANOVA, linear and logistic regression); however, only 12.12% of the papers reported effect sizes for changes. Regarding design, most large-group preventive interventions used either psychoeducation or psychotherapy, whereas small-group studies often employed experimental or quasi-experimental designs (72.73%). Of these, 24.24% were experimental, including 18.18% randomized trials. Few studies (12.12%) were descriptive.

Table 3. Studies Regarding Interventions. Overview of Participants, Interventions, Comparisons, Outcomes, and Study Design (PICOS)

Additionally, peer-led interventions such as Hope Squad (Wright-Berryman et al., 2019) and the Rhode Island Suicide Prevention Initiative (Pearlman et al., 2018) were identified, with a focus on peer nomination and referral systems. Crisis-response protocols, including the PEACE Protocol (Capps et al., 2019) and the LEARN Training Program (Walsh et al., 2024), were reported as strategies to reinforce immediate response capacities in schools. Furthermore, innovative approaches such as Death Education (Testoni et al., 2020) and Stop Suicide (Baggio et al., 2022) introduced existential and awareness-raising perspectives. Culturally tailored programs, such as Project Yarn Circle (Gibson et al., 2024) for Aboriginal youth and HEYLIFE (Grosselli et al., 2024) in Germany, were also documented, along with technology-based interventions such as Text4Strength (Pisani et al., 2024), although the latter did not demonstrate significant outcomes.

Discussion and Conclusions

The aim of the current review study was to identify, evaluate, and summarize the findings of all relevant school-based studies to prevent and manage adolescent suicide behavior, comparing the characteristics of various treatments of suicidal behavior in adolescents in school settings. Additionally, the level of treatment was examined regarding the target, selective, and universal interventions. The review using the PICOS strategy (Huang et al., 2006) summarized 33 papers. PICOS proved to be a helpful algorithm for identifying samples of interest, the names and purposes of interventions, outcomes, methods of data analysis, and study designs; however, data in some papers were incomplete.

The choice of intervention depends largely on its availability in scientific articles. Most of the articles were obtained in PubMed, EBSCO, and OVID; however, EBSCO and OVID provided overlapping records, reducing the final number of papers. PubMed yielded the largest number of studies related to suicide interventions. Despite conducting a secondary search, only a limited number of studies met the established inclusion criteria. Moreover, the restriction to articles published in English and Spanish further limited the scope of the search.

Based on the reviews consulted, this paper demonstrates how studies have developed research to test the influence of diverse methods and procedures,  many of them derived from cognitive-behavioral approaches and psychoeducation (Asarnow et al., 2017; Robinson et al., 2016; Wienke et al., 2019a, 2019b) to reduce the suicide risk in adolescents from a preventive and evidence-based perspective. Most studies report sa­tisfactory results, demonstrating that school programs can be successfully implemented in the natural school environment of adolescents using various theoretical approaches and well-known measures with adequate psychometric properties, focusing on different issues related to suicidal behavior (e.g., bullying, violence), as previously reported (Evans et al., 2014; Gijzen et al., 2022; Posamentier et al., 2023).

These findings are consistent with the recommendations of the WHO (2021), which emphasize the importance of early, context-based preventive strategies given the high rates of suicidality among adolescents aged 15 to 19 years worldwide, including Latin American countries (Borges et al., 2016; Castellví et al., 2017; Sánchez-Cervantes et al., 2015), as well as the increase in self-harm with suicidal intentionality. From this perspective, school-based interventions represent a strategic setting for universal, selective, and indicated prevention efforts.

Methodological Limitations and Challenges

Regarding methodological characteristics, many interventions involve caregivers, parents, or teachers to reinforce program effects and ensure the physical integrity of at-risk adolescents, which is particularly relevant for selective and indicated interventions. Most studies employ well-known questionnaires, such as the Columbia-Suicide Severity Rating Scale, the CED, and the BIDI-II, and use quantitative measures of change while also incorporating subjective reports. Methodologically, most interventions rely on pre-experimental or quasi-experimental designs (pre-test/post-test) with a single intervention group, and only a few include control groups or randomized experimental designs. Consequently, although these studies contribute valuable preliminary evidence, their methodological variability limits direct comparisons of effectiveness.

Many studies do not report effect sizes; instead, they focus on changes, some of which are statistically significant based on bivariate and multivariate analyses.

Although main and interaction effects are sometimes assessed pre- and post-intervention, indicators of change are rarely specified in the methods or results.

In several interventions, the conceptual framework is not clearly described; nevertheless, attempts were made to identify theoretical foundations, ranging from humanistic and systemic models to approaches primarily focused on cognitive aspects. In addition, peer-led and community-oriented interventions highlight the potential of empowering adolescents and school staff as active agents of prevention, as observed in Hope Squad (Wright-Berryman et al., 2019), Sources of Strength (Williford et al., 2022), the Youth Aware of Mental Health (Kahn et al., 2020), and the Rhode Island Initiative (Pearlman et al., 2018). Models such as the PEACE Protocol (Capps et al., 2019) and LEARN Training (Walsh et al., 2024) emphasize the importance of clear procedures and teacher training to recognize suicide risk and facilitate timely referrals, which are essential components of indicated prevention.

Programs adapted to specific cultural contexts, including Project Yarn Circle in Aboriginal communities (Gibson et al., 2024), PRONAPS in Mexico (Casas-Muñoz et al., 2024), and HEYLIFE in Germany (Grosselli et al., 2024), demonstrate how cultural adaptation improves acceptance and perceived effectiveness. Other innovative strategies, such as Death Education (Testoni et al., 2020) and Stop Suicide (Baggio et al., 2022), expand the range of school-based prevention approaches, although their effects appear limited. Finally, technology-based programs like Text4Strength (Pisani et al., 2024) demonstrate both the potential and the limitations of digital tools when they are not integrated with direct interpersonal interaction. Overall, these studies suggest that, beyond psychoeducation and cognitive-behavioral approaches, including cultural adaptation, peer leadership, and crisis-preparedness strategies may enhance the reach and relevance of suicide prevention efforts in school settings.

Implications for Future Interventions

Beyond the descriptive characterization of existing programs, the findings of this review identify several patterns with implications for the design, implementation, and evaluation of school-based suicide prevention interventions for adolescents. Although the heterogeneity of studies limits causal inferences, the convergence of certain methodological and conceptual features suggests a set of practical recommendations that future interventions may consider:

1)   Prioritize multi-level intervention models with school settings. The predominance of psychoeducational and cognitive-behavioral interventions, combined with the involvement of teachers, peers, and caregivers in several programs, suggests that interventions are more likely to be feasible and acceptable when they operate across multiple levels of prevention. Universal interventions appear to facilitate awareness and early detection, while selective and indicated strategies address higher-risk adolescents.

2)   Emphasize feasibility and sustainability over clinical intensity. The predominance of pre-experimental and quasi-experimental designs, as well as the frequent use of brief psychoeducational formats, reflects structural constraints inherent to school environments. Programs that rely on clear procedures, teacher training, and structured protocols appear better aligned with school routines and resources, supporting their potential for scalability.

3)   Strengthen conceptual clarity and theory-driven design. Although most interventions report positive changes, the lack of explicit conceptual frameworks in many studies limits interpretability and replicability. Future school-based interventions would benefit from clearly articulated theoretical models, linking specific components to targeted outcomes related to suicidal behavior, emotional regulation, or help-seeking.

4)   Incorporate peer leadership and relational components as active mechanisms. The consistent presence of peer-led and community-oriented programs across contexts highlights the importance of social connectedness and peer influence during adolescence. School-based programs should therefore incorporate structured peer leadership roles and relational components that foster a sense of belonging, support, and help-seeking behaviors.

5)   Ensure cultural adaptation as a core design principle. Programs developed or adapted to specific cultural, social, and community contexts demonstrate greater relevance and engagement. Future interventions, particularly in underrepresented regions such as Latin America, should prioritize cultural adaptation processes from the design phase, rather than applying modifications to imported models.

6)   integrate technology as a complementary component. Technology-based interventions show potential to increase reach and accessibility; however, their limited effects in practice suggest that digital tools should complement, rather than replace, interpersonal and school-based supports.

Study Limitations

Several limitations should be considered when interpreting the findings of this review. Many studies did not report on participants' age ranges, despite adolescence encompassing a broad developmental period with significant psychobiological differences (Kim et al., 2020; Lindow et al., 2020; Pearlman et al., 2018; Schilling et al., 2016; Torcasso & Hilt, 2017; Wienke et al., 2019a, 2019b; Wright-Berryman et al., 2019). This issue should be considered when designing interventions. Most interventions were carried out in school settings with high school adolescents and in small groups; however, reports of large samples from national surveys or programs were also observed. In addition, the lack of effectsize reporting and the heterogeneity of designs and outcome measures limit the ability to compare intervention effectiveness. Given the limitations of this integrative review, publication bias cannot be ruled out, as only articles from selected databases and within a defined time frame were included, excluding other potentially relevant sources. Furthermore, tools such as ROBIS or AMSTAR 2 were not used, which may have limited the assessment of methodological bias.

Given these limitations, the findings of this review should be considered preliminary, and no definitive conclusions regarding the intervention's effectiveness can be drawn. Nevertheless, by focusing on recent, peer-reviewed studies, this review provides an overview of existing school-based interventions, their theoretical orientations, and methodological characteristics. Despite the relatively small number of studies meeting the inclusion criteria, this article offers descriptive and organizational evidence to inform decision-makers, researchers, and practitioners in school settings. The review highlights the need for more systematic, methodologically rigorous, and culturally adapted intervention research, particularly in Latin America, to strengthen suicide prevention strategies for adolescents within the school context.

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