Background
Methods
Search strategy
Classification of studies
Step 1: Identification of studies for exclusion
Step 2: Classification of studies
Step 3: Identification of intervention evaluations
Data extraction from intervention studies
Methodological critique of intervention studies
1st author, year, publication type | Country, location | Intervention type | Intervention component/s (number of sessions) | Target group (n), age, % male | Design | Data collection methods | Outcomes | Effects | Follow-up months | Cost |
---|---|---|---|---|---|---|---|---|---|---|
La Fromboise, 1995, journal article [41] | US, rural New Mexico | Education | Culturally tailored school-based life skills curriculum, including manual and teacher raining. (3/week × 30 weeks) | Native Americans (n=128): age range= 14–19 years, mean age=15.9 years and 36% male. | Pre-post, with two control groups | Self-report survey Observational methods | Suicide vulnerability: hopelessness, depression and self-efficacy | Intervention group less hopelessness (P<0.05); less suicidal (P<0.07); not less depressed. | 8 months | NR |
Berman, 1999, journal article [42] | US, rural Alaska | Community prevention | Alcohol restrictions | Experimental: 29,000 Control: 21,000 | Interrupted time series with control group | Routinely collected population level data | Death rates from accidents, suicides and homicides | Significant reductions (P<0.05) in homicide for high level restrictions, and in suicide for low level restrictions. 21% reduction in overall injury deaths. | 1-13yrs | NR |
Tsey, 2000, journal article [43] | Australia, remote Qld | Community prevention | Four stage empowerment program (1 × 4hr session per week for 10 weeks per each stage) | Aboriginal community members (n=31): age range= 20–50 years, median age=early 40 years, and 10% male | Pre-post, no control | Self-report survey Participant observation Narrative interviews | Individual & community levels of empowerment | NR | 10, 20, 30, and 40 weeks | |
May, 2005, journal article [39] | US, rural New Mexico | Community prevention | Train youth as natural helpers | Native Americans (n=800): age range = 10–19 and 20–24 years. | Interrupted time series, no control | Self-report by health professionals and police and medical records | Suicide attempts, gestures & completions | Significant reductions (P<0.05) in rates of suicidal gestures and attempts. No change in suicidal completions. | 13yrs | NR |
Drug and suicide education | ||||||||||
Family outreach post-suicide | ||||||||||
Suicide-risk screening | ||||||||||
Community cultural events | ||||||||||
Reorientation of mental health services | ||||||||||
Australia, regional NSW | Gatekeeper training | Suicide awareness and skills Gatekeeper training (8 × 1 day workshops) | Aboriginal Australian community members (n=48): age range= 19–55 years, mean age=36 years and 9% male. | Pre-post, no control | Self-report survey Interviews | Knowledge | Significant increases (P<0.05) pre-post training in knowledge, intentions, confidence. Non-significant changes post training to 2 years follow-up. | 2yrs | NR | |
Confidence | ||||||||||
Intentions | ||||||||||
Haggarty, 2006, journal article [34] | Canada, rural | Education | Multi-media education (1 × 30 minute session) | Healthcare providers, teachers, students and elders (n=24) | Pre-post, no control | Self-report survey | Knowledge | Significant increases (P<0.05) in knowledge | NR | NR |
Westerman, 2007, grey report [38] | Australia, rural and remote Western Australia | Gatekeeper training | Training and information workshops | Aboriginal youth and community members (n=769): age range =15-25 years. | Pre-post, no control | Self-report survey Interviews | Knowledge Confidence Intentions | Significant improvements (P<.05) in knowledge and confidence in how to identify individuals at risk of suicide. | NR | NR |
Muehlenkamp, 2009, journal article [37] | US, Native American | Gatekeeper training | Gatekeeper training, education workshops, social activities, individual counselling and education seminars, student support team, social networking, spiritual ceremonies | Native American college students (n=90) | Pre-post, no control | Self-report survey | Knowledge Attitudes | Reported improvements in problem solving ability, and marginal improvements in communication skills and knowledge | NR | NR |
Skills | ||||||||||
Allen, 2009, journal article [40] | US, remote Alaska | Community prevention | Community module: 26 prevention activities (7 targeting community) in 32 sessions. Additional activities: increased alcohol control, suicide crisis response team & prayer walks (32 sessions over 12 months) | Alaskan Indigenous youth (n=61): age range=12-17 years, mean age= 14 years, and 30% male. | Pre-post, no control | Self-report survey | Community readiness | Significant (P<0.05) increase in number of protective behaviours in youth. | NR | NR |
Youth & adult protective behaviours | ||||||||||
Adults of youth (n=47): mean age=48 years and 42% male. | ||||||||||
Community informants (n=5) |
Results
Indigenous population and sample
Intervention strategies
Community prevention
Gatekeeper training
Education
Methodological adequacy
1st author, year | Selection bias (A) | Allocation Bias (B) | Confounders (C) | Blinding (|D) | Data collection Methods (E) | Withdrawal & drop-outs (F) | Analysis (G) | Intervention integrity (H) |
---|---|---|---|---|---|---|---|---|
La Fromboise 1995 [41] | Weak | Moderate | Moderate | N/A | Moderate | Moderate | -Citation for formula used in the analysis | -No consent rate reported, 76% follow-up rate. |
-High response rate | -Number of intervention sessions received by participants not reported. | |||||||
- Manual used with teacher training | ||||||||
-Random observations of intervention delivery by intervention co-ordinator | ||||||||
Berman, 1999 [42] | Strong | Strong | Strong | N/A | Strong | N/A | -Citations to justify analysis but no citations for analysis method | -Communities level of exposure to alcohol control reported and considered in analysis |
Tsey, 2000 [43] | Weak | Weak | Weak | N/A | Weak | Moderate | Citation to justify theory but not analysis | -No consent rate reported and follow-up rate only partially reported |
-Adaptation of existing Aboriginal-specific program, | ||||||||
-Components of each stage described | ||||||||
May, 2005 [39] | Moderate | Weak | Weak | N/A | Strong | N/A | -No citation for formula used in the analysis | - Number and type of prevention activities recorded but reported elsewhere |
- Staff growth for program delivery reported | ||||||||
Moderate | Weak | Weak | N/A | Moderate | Strong | - Citations to justify analysis but no citations for analysis method | -93% consent rate and 91% and 100% follow-up reported. | |
-Manual for tailored delivery, dependent on group's needs | ||||||||
-High response rate reported | ||||||||
Haggarty, 2006 [34] | Weak | Weak | Weak | N/A | Weak | Moderate | -No citation for analysis method | - 79% follow-up |
- length of time of participant’s exposed to multi-media resource recorded | ||||||||
Westerman, 2007 [38] | Weak | Weak | Weak | N/A | Moderate | Moderate | No description of analysis or citation. | -Consent rate not reported and 77% follow-up |
-Intervention delivered by Indigenous Psychological services | ||||||||
Muehlenkamp, 2009 [37] | Weak | Weak | Weak | N/A | Moderate | Weak | No citation for analysis method | -No consent rate reported and follow-up rate difficult to determine |
-Some report of intervention exposure | ||||||||
-Adaptation of existing intervention | ||||||||
Allen, 2009 [40] | Moderate | Weak | Strong | N/A | Moderate | Strong | -Citation for formula used in the analysis. | -61% consent rate reported for individual program component |
-Low to moderate response rates | Intervention toolkit for tailoring to local needs | |||||||
-Intervention exposure (number and type of activities) measured and considered in analyses |