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Saving and Empowering young lives in PAKistan (SEPAK): An Exploratory Cluster Randomized Controlled Trial (cRCT)

Published online by Cambridge University Press:  19 July 2023

M. Panagioti
Affiliation:
1Division of Population Health, Health Services Research & Primary Care, Institute for Health Policy and Organisation /Alliance Manchester Business School, Manchester, United Kingdom
T. Kiran
Affiliation:
2Research, Pakistan Institute of Living and Learning, karachi, Pakistan
S. Irshad
Affiliation:
2Research, Pakistan Institute of Living and Learning, karachi, Pakistan
R. Sattar
Affiliation:
2Research, Pakistan Institute of Living and Learning, karachi, Pakistan
A. Hodkinson
Affiliation:
1Division of Population Health, Health Services Research & Primary Care, Institute for Health Policy and Organisation /Alliance Manchester Business School, Manchester, United Kingdom
S. Tofique
Affiliation:
2Research, Pakistan Institute of Living and Learning, karachi, Pakistan
N. Tyler
Affiliation:
1Division of Population Health, Health Services Research & Primary Care, Institute for Health Policy and Organisation /Alliance Manchester Business School, Manchester, United Kingdom
I. Angelakis
Affiliation:
3School of Psychology, University of South Wales, Wales, United Kingdom
Z. Zadeh
Affiliation:
2Research, Pakistan Institute of Living and Learning, karachi, Pakistan
A. Maqsood
Affiliation:
4Department of Behavioral Sciences, Fatima Jinnah Women University, Rawalpindi
S. Sultana
Affiliation:
5Department of Applied Psychology, Bahauddin Zakariya University, Multan
S. Dawood
Affiliation:
6Center for Clinical Psychology, University of Punjab, Lahore
M. Bhattia
Affiliation:
7Department of Psychiatry, Peoples University of Medical and Health Sciences for Women, Nawabshah
A. Tamiduddin Nizami
Affiliation:
8Department of Medicine, Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi
H. A. Khan
Affiliation:
9Baloshistan Institute of Psychiatry & Behavioral Sciences, Bolan Medical College, Quetta
I. B. Chaudhry
Affiliation:
2Research, Pakistan Institute of Living and Learning, karachi, Pakistan
N. Husain
Affiliation:
10Division of Psychology and Mental Health, University of Manchester, Manchester, Pakistan
N. Chaudhry*
Affiliation:
2Research, Pakistan Institute of Living and Learning, karachi, Pakistan
*
*Corresponding author.

Abstract

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Introduction

Suicide is a leading cause of death among young people and most deaths by suicide occur in low and middle-income countries. School is the best place where we can identify and respond to youth suicide risk. School-based interventions for suicide prevention in young people have been successful across US, Europe and Australia, but require adaptations to be acceptable and feasible in Pakistan.

Objectives

To develop and test culturally adapted preventative interventions for suicidal behaviours among pupils in secondary schools in Pakistan. The qualitative component aimed at exploring the views of students, parents, teachers and general practitioners on cultural adaptation, experience of participation, areas of improvement and suggestions for scale-up of the school-based suicide prevention program (SEPAK).

Methods

A clustered randomised controlled trial. The four culturally modified interventions 1) Linking Education and Awareness of Depression and Suicide Awareness (LEADS) Training for pupils (students=260) 2) the Question, Persuade, and Refer (QPR) for teachers (students=203) 3) QPR for parents (students=445); 4) Screening by Professionals (Profscreen) (students=260) were compared against control intervention (educational posters) (students=227). Structured questionnaires were administered at baseline and 1-month post-intervention to assess suicidal behaviours, psychological well-being and quality of life. A total of 8 focus groups (FGs) were conducted at pre and post intervention stage with each stakeholders.

Results

Patient and public involvement and Engagement (PPIE) was strongly embedded in the project to ensure meaningful benefits for participants. A total of 40 schools were recruited from 8 cities across Pakistan. A total of 243 students attended LEADS intervention, 92 teachers and 304 parents completed QPR training, and 9 general practitioners were trained in ProfScreen. The retention rate at follow-up was 99% that shows feasibility of delivering intervention package in Pakistan. All participants marked SEPAK as effective in identifying risk of and preventing self-harm and suicide in young people and in improving pathways to treatment. Interventions were perceived as helpful in improving knowledge about mental health, impact of mental health difficulties on functioning, reducing stigma, equipping stakeholders to identify and signpost at-risk people. Improvement in clinical and teaching practice as well as understanding others behaviors were also reported.

Conclusions

This study suggest feasibility of integrating a suicide prevention program in existing educational system and highlights positive role of creating awareness about suicide in youth, introduction of school-based mental health programs, parental counseling and strengthening of the health system by training general practitioners in early identification of suicide risk and promoting suicide prevention strategies

Disclosure of Interest

None Declared

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association
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