Saving and Empowering Young Lives in Europe (SEYLE) is a randomized controlled trial (RCT) that aims to promote mental health among school-based adolescents in European schools.
The programme involves 12,395 pupils recruited from randomized schools in 11 European countries: Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain, with Sweden as the coordinating centre.
Several studies have shown the effectiveness of suicide preventive interventions in reducing the risk of suicidal behaviours; however, in most of those studies, the target populations were primarily adults; whereas few focused on adolescents.
Randomized controlled trials comparing the efficacy, cost-effectiveness and cultural adaptability of suicide prevention strategies are still lacking in Europe, particularly among youth.
The main objectives of SEYLE are: to lead adolescents to better mental health through decreased risk-taking and suicidal behaviours; to evaluate and compare the outcomes of three preventive interventions based on different approaches; and to recommend culturally-adjusted intervention models that effectively promote adolescent mental health and well-being in European countries.
Each country performed a RCT comprising three active interventions and one minimal intervention serving as a control. The active interventions comprised gatekeeper training (QPR), mental health awareness training (Awareness), and professional screening for at-risk adolescents (ProfScreen).
Structured questionnaires were developed and administered to pupils at baseline, with 3-month and 12-month follow-ups to examine and compare the effects of the interventions.
Longitudinal analyses of the SEYLE project indicated significant improvements in adolescent mental health. According to the Beck Depression Inventory, depressive symptoms significantly decreased in all intervention arms at 3-months follow-up; a significant decrease was also observed at the 12-months follow-up. Pupils in the active intervention arms showed significant improvements in emotional symptoms, conduct problems and hyperactivity.
At the 3-months follow-up, a significant decrease of suicide attempts was observed in the Awareness arm when compared to the control group; however, no significant reduction was found in the QPR and ProfSreen intervention arms. At the 12-months follow-up, the number of adolescents reporting to have attempted suicide, during the past two weeks, was significantly lower in the Awareness, QPR and ProfScreen interventions in comparison to the control group.
In the ProfScreen intervention, 12.4% of adolescents were identified as severely needing mental health care. Results suggest that the evaluation of risk-behaviours in addition to psychopathology provides an added value in facilitating early prevention and intervention.
In regards to teachers, the interesting finding was the positive correlation between well-being and preparedness to help pupils with mental health problems; however, teachers had very low mental health literacy. The majority of teachers felt that they lacked the knowledge and skills to address mental disorders and suicidal behaviours among pupils and wished for more education.
SEYLE is the first European RCT to evaluate school-based suicide preventive interventions among adolescents. The longitudinal findings of the SEYLE project allow for recommendations regarding intervention strategies for promoting mental health and well-being among adolescents. The best accepted intervention among pupils and school staff was the Awareness intervention, which also showed high efficacy and sustainability. The inclusion of mental health awareness programs in the syllabi of schools across Europe is highly recommended.
Results indicated that screening for risk-behaviours and psychopathology in schools is a valuable approach in detecting students with psychological problems that require subsequent mental health care. However, strategies to increase acceptance and compliance to the clinical evaluation need to be developed if screening procedures are expected to be used in schools.
Results showed that teachers in European schools are able and willing to act as gatekeepers for pupils’ mental health; the observed inadequacy of mental health literacy among teachers calls for programs that provide mental health education to teachers across EU countries.