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Effectiveness of universal programmes for the prevention of suicidal ideation, behaviour and mental ill health in medical students: a systematic review and meta-analysis
  1. Katrina Witt1,2,
  2. Alexandra Boland2,
  3. Michelle Lamblin2,
  4. Patrick D McGorry2,3,
  5. Benjamin Veness4,
  6. Andrea Cipriani5,
  7. Keith Hawton5,
  8. Samuel Harvey6,
  9. Helen Christensen6,
  10. Jo Robinson2
  1. 1 Turning Point, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
  2. 2 Orygen, The National Centre for Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
  3. 3 Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Alfred Health, Melbourne, Victoria, Australia
  5. 5 Department of Psychiatry, University of Oxford, Oxford, UK
  6. 6 Black Dog Institute, Sydney, New South Wales, Australia
  1. Correspondence to Dr Katrina Witt, Turning Point, Eastern Health Clinical School, Monash University, Richmond, VIC 3121, Australia; katrina.witt{at}


Question A growing body of work suggests that medical students may be particularly at risk of mental ill health, suicidal ideation and behaviour, resulting in recent calls to develop interventions to prevent these outcomes. However, few reviews have synthesised the current evidence base regarding the effectiveness of these interventions and provided guidance to improve future intervention efforts.

Study selection and analysis The authors conducted a systematic review to identify studies of any design reporting the effectiveness of any universal intervention to address these outcomes in medical students. Embase, MEDLINE and PsycINFO databases were searched from their respective start dates until 1 December 2017.

Findings Data from 39 studies were included. Most investigated the effectiveness of relatively brief interventions designed to reduce stress; most commonly using mindfulness-based or guided meditation approaches. Only one implemented an intervention specifically designed to address suicidal ideation; none investigated the effectiveness of an intervention specifically designed to address suicidal behaviour. Five investigated the effects of curriculum-level changes. Overall, there was limited evidence of an effect for these programmes at both the postintervention and longest follow-up assessment on depression, anxiety and stress.

Conclusions Relatively brief, individually focused, mindfulness-based interventions may be effective in reducing levels of anxiety, depression and stress in medical students in the short term. Effects on suicidal ideation and behaviour, however, remain to be determined. There has been a significant lack of attention on organisational-level stressors associated with medical education and training.

  • suicide & self-harm
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  • Contributors All authors approved the manuscript.

  • Funding The study was funded by the Commonwealth of Australia Department of Health and was part funded by the Prevention Hub, Department of Health. Individual authors also wish to acknowledge the following sources of funding: KW is funded by a postdoctoral fellowship awarded by the American Foundation for Suicide Prevention (PDF-0-145-16), HC is funded by APP1155614 and JR is funded by a National Health and Medical Research Council Career Development Fellowship (ID1142348).

  • Competing interests One of the authors, AC, is editor-in-chief of Evidence-Based Mental Health.

  • Ethics approval The data presented in this review were obtained from previously published reports available within the public domain. Specific institutional approval was therefore not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at Preliminary data relating to this review were presented by AB on 30 November 2018 at the 40th Annual Society for Mental Health Research Conference, Noosa Heads, Queensland, Australia.

  • Patient consent for publication Not required.

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