Validation and Testing of a Suicide Prevention Program to Improve Mental Well-Being Among Adolescents in Gilgit Baltistan, Pakistan: A Pre/Post-Intervention Protocol

Summary

Background Globally, around 800,000 people die annually by committing suicide with a disproportionate burden of 77% of these deaths occurring in low- and middle income countries. Suicidal ideation is frequently observed among adolescents and is directly associated with suicidal attempts. Pakistan has witnessed a marked escalation in suicide rates in recent years, with Gilgit-Baltistan reporting the highest incidence. Extensive scholarly inquiry suggests the potential role of suicide prevention strategies in mitigating suicidal ideation, attempts, and related fatalities. This study aims to validate and evaluate the efficacy of a locally contextualized suicide prevention programs called RAAHI (the Guide) and safeTALK in improving the mental wellbeing of school-going adolescents in the Gilgit Baltistan, Pakistan.

Method and Analysis The investigation will evaluate the effectiveness of a locally contextualized suicide prevention intervention program called RAAHI based on internationally tested out program named safeTALK among 267 adolescents attending 4 private schools in Gilgit Baltistan, Pakistan, followed by its contextual validation. 'RAAHI', a suicide literacy module is designed to equip individuals with the knowledge and skills to recognize signs of suicidal ideation, engage them empathetically, and connect those in crisis with support. It promotes open discussions, combats stigma, and encourages preventive measures for widespread suicide literacy. The, safeTalk a 4-hour psychoeducational workshop, aimed to prevent adolescent suicide through presentations, videos, discussions, and interactive sessions. Participants learned to identify warning signs, engage in TALK steps (Tell, Ask, Listen, KeepSafe), and connect individuals with crisis support.

Employing an \& interrupted time-series design through a pre-post-test framework, the study will assess the impact of the intervention at various time points, post intervention (T2) and follow up after 8 weeks (T3). Descriptive and inferential analyses (paired t test, ANOVA) will be carried out to gauge alterations in each measured outcome (including knowledge, confidence, willingness, and help-seeking behaviors) during the course of the study.

Ethics and Dissemination The study protocol has been approved by the Ethical Review Committee of the Aga Khan University (registration number 2023-8509-24844). The study finding will be shared with the parents and school authorities through workshops conducted in Urdu. The study will be published in an open-access, peer-reviewed journal and presented at relevant conferences.

Strengths and Limitations

-Since there is no standard intervention available for suicide prevention for adolescents in Pakistani context, the current research will assist in up scaling contextualized suicide prevention intervention among school-going adolescents in Pakistan. However, due to time, budget and logistical constraints, this feasibility study will only be conducted In private schools of Gilgit Baltistan, Pakistan, limiting potentially diverse implementation experiences and outcomes in rural or public school settings. This may restrict the generalizability of the study findings. Moreover, employing a quasi-experimental design without an appropriate control group can potentially undermine the internal validity of the study.

Conditions

• Suicide Prevention

Interventions

BEHAVIORAL

Suicide prevention treatment

Intervention I:"RAAHI" RAAHI is a suicide literacy module that is specially designed to provide individuals with essential knowledge and skills by equipping them with tools to navigate the complexities of mental health and suicide prevention. This module aims to empower people to recognize signs of suicidal ideation, engage in empathetic communication through open discussion, combat stigma, and connect individuals in crisis with appropriate support and resources. The duration of the module will be of three hours. Intervention II: "safeTALK" The \"safeTalk\" program is a psychoeducational initiative designed for suicide prevention among adolescents, consisting of a 4-hour workshop that incorporates presentations, videos, discussions, and questions.The workshop is designed according to the standard practices of safeTALK, to assist participants in (a) identifying warning signs of suicide; (b) Avoiding frequent impulses to overlook, dismiss, or avoid discussions about suicide.

Sponsors & Collaborators

• Fogarty International Center of the National Institute of Health

  collaborator NIH

• Aga Khan University

  lead OTHER

Principal Investigators

• Yasmin Parpio, PhD · Aga Khan University

• Rozina Nuruddin, PhD · Aga Khan University

Study Design

Allocation

NA

Purpose

PREVENTION

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

12 Years

Max Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2024-01-30

Primary Completion

2025-03-30

Completion

2025-03-30

Countries

• Pakistan

Study Locations