Depression and suicide prevention in schools can save lives

Moving stories

Complementing the existing STORM approach, teachers received training on conversation skills. Students attended a lesson with an expert by experience. Prior to the lesson, the pupils played 'Moving Stories' for five days. That is a serious game in which players can walk through a house just like the well-known game the 'Sims'. There, they meet Lisa, who struggles with gloomy thoughts. In the game, they work on their relationship score. "While playing, they learn that you can just start the conversation with someone who is gloomy. Lisa doesn't respond positively right away, but more so if you've talked to her. So they subconsciously learn that it is good for the relationship when you ask someone what they need," says Gijzen.

In the lesson with the expert by experience, students can ask questions, including about something they noticed about Lisa from the game. That way, they learn what depression looks like and how best to deal with it. Think about how to start the conversation, but also when it is wiser to call in an adult. Gijzen attended these classes and it made an impression: "Young people are very unfiltered and dare to ask extremely personal questions. One girl asked: How can you still be here if you used to want to die? That took me by surprise, but it was very special to be at those conversations."

Ask the question

The most important thing is to break the stigma around depression and suicide and make it discussable. This is also the focus of the 'gatekeepers training' for teachers. There, teachers learn how to start the conversation when they suspect depression or suicidal thoughts. It also dispenses with some common myths. "Teachers are afraid of giving young people ideas when they start talking about it. That's really not the case. You can just ask: do you ever think about suicide?"

The PhD candidate also analysed 11 other studies on the effect of similar prevention programmes. Those effects are relatively small, but significant. For Gijzen, this shows that investing in prevention pays off. "Every human life you can save is one life saved. Moreover, depression often has more impact on young people and the effects last longer than in adults. Even programmes that focused on depression rather than suicidality have been found to reduce the number of suicides. That's a great new finding from my study."

Cooperation improved

The study in East Brabant shows that the STORM approach greatly improved the cooperation between schools, municipalities and healthcare parties (GGD, GGZ and social workers). Also, 306 young people with suicidal thoughts were referred within 48 hours thanks to the GGD's screening (among about 3,000 schoolchildren). "Through STORM, parties were required to work together to jointly consider potential bottlenecks. That collaboration is still ongoing now, which is great to see," says Gijzen.

The PhD candidate also investigated which characteristics and symptoms are central to depression and suicidality using a network analysis. She used GGD questionnaires for this purpose. This showed that loneliness is most central in both depression and suicidality. "It does not automatically mean that loneliness is most common, but it does mean that it has the most impact on other symptoms and that loneliness has a strong link with suicidal thoughts. So prevention does not have to specifically target suicide, but you can better address depression and suicide prevention together."