Evaluating Primary Suicide Prevention in Adolescents With Risk Factors (ESPAIR)

Suicide is one of the main causes of death among teenagers. Because it is preventable, primary prevention of suicide has become a public health priority, with encouraging results in promoting suicide awareness and reducing suicidal thoughts among adolescents. However, the lack of studies conducted among vulnerable populations (i.e., marginalised, disengaged and disadvantaged) is a major gap, even though these populations present an increased risk of suicidal behaviour.

The aim of this project is to test the effectiveness of a brief primary suicide prevention intervention for vulnerable adolescents, using a randomised controlled trial. Vulnerable adolescents include those 1) detained in juvenile detention centres, 2) at risk of dropping out of school, 3) undergoing treatment for psychiatric disorders, 4) belonging to a sexual or gender diversity, 5) affected by chronic conditions, or 6) with relational/familial problems. The main aim is to test the effectiveness of the intervention on a composite measure of suicide awareness, psychological distress and suicidal thoughts. The project will also explore other issues that present challenges for vulnerable populations: access to primary suicide prevention and non-response bias. The study will provide relevant results to address the current lack of high-quality evidence for primary suicide prevention in adolescents.

Study Overview

• Status: Recruiting
• Conditions: Suicide Prevention
• Intervention / Treatment: Behavioral: Primary suicide prevention intervention; Behavioral: Art-based control intervention

• Study Type: Interventional
• Enrollment (Estimated): 240
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Stéphanie Baggio, Prof.; Phone Number: +41316846774; Email: stephanie.baggio@unibe.ch

Study Locations

• Switzerland
  • Geneva, Switzerland, 1205
    • Recruiting
    • CAP Formations, Cité des Métiers
    • Contact: Nadejda Lambert; Phone Number: +41223205567; Email: nadejda@stopsuicide.ch
  • Geneva, Switzerland, 1205
    • Recruiting
    • Unité de Liaison Ambulatoire et Hospitalière, Service de psychiatrie de l'enfant et de l'adolescent, HUG
    • Contact: Santiago Peregalli; Phone Number: +41223724800; Email: santiago.peregalli@hug.ch
  • Grand-Lancy, Switzerland, 1212
    • Recruiting
    • Foyers de Gilly
    • Contact: Patrick Heller, MD; Phone Number: +41223055218; Email: patrick.heller@hug.ch
  • Lausanne, Switzerland, 1012
    • Recruiting
    • Foyer de Chailly
    • Contact: Patrick Heller, MD; Phone Number: +41223055218
  • Lausanne, Switzerland, 1018
    • Recruiting
    • Ren'Fort
    • Contact: Nadejda Lambert; Phone Number: +41223205567; Email: nadejda@stopsuicide.ch
  • Lonay, Switzerland, 1027
    • Recruiting
    • Foyer La Pommeraie
    • Contact: Patrick Heller, MD; Phone Number: +41223055218; Email: patrick.heller@hug.ch
  • Onex, Switzerland, 1213
    • Recruiting
    • Service des Parcours Individualisé
    • Contact: Nadejda Lambert; Phone Number: +41223205567; Email: nadejda@stopsuicide.ch
  • Petit Lancy, Switzerland, 1213
    • Recruiting
    • Le Repuis
    • Contact: Nadejda Lambert; Phone Number: +41223205567; Email: nadejda@stopsuicide.ch
  • Thônex, Switzerland, 1226
    • Recruiting
    • Astural, Parcours A2mains
    • Contact: Nadejda Lambert; Phone Number: +41223205567; Email: nadejda@stopsuicide.ch
  • Canton of Geneva
    • Geneva, Canton of Geneva, Switzerland, 1201
      • Recruiting
      • Dialogai et Totem
      • Contact: Nadjeda Lambert; Phone Number: +41223205567; Email: nadejda@stopsuicide.ch
    • Plan-les-Ouates, Canton of Geneva, Switzerland, 1228
      • Recruiting
      • Programme ForMe (anciennement SEMO) et dispositif ProPULSE
      • Contact: Nadejda Lambert; Phone Number: +41223205567; Email: nadejda@stopsuicide.ch
    • Vernier, Canton of Geneva, Switzerland, 1214
      • Recruiting
      • Programme Intégration et Formation Professionnelle
      • Contact: Nadejda Lambert; Phone Number: +41223205567; Email: nadejda@stopsuicide.ch
    • Vernier, Canton of Geneva, Switzerland, 1214
      • Recruiting
      • Centre de Détention et d'Observation La Clairière
      • Contact: Patrick Heller, MD; Phone Number: +41223055218; Email: patrick.heller@hug.ch
  • Canton of Vaud
    • Lausanne, Canton of Vaud, Switzerland, 1003
      • Recruiting
      • Agnodice
      • Contact: Nadejda Lambert; Phone Number: +41223205567; Email: nadejda@stopsuicide.ch
    • Lausanne, Canton of Vaud, Switzerland, 1003
      • Recruiting
      • Vogay
      • Contact: Nadejda Lambert; Phone Number: +41223205567; Email: nadejda@stopsuicide.ch
    • Lausanne, Canton of Vaud, Switzerland, 1005
      • Recruiting
      • Centre Thérapeutique de Jour pour Adolescents
      • Contact: Sébastien Urben, Dr.; Phone Number: +41213147492; Email: Sebastien.Urben@chuv.ch
    • Lausanne, Canton of Vaud, Switzerland, 1008
      • Recruiting
      • Unité de Soins Psychiatriques Fermée pour Mineurs
      • Contact: Sébastien Urben, Dr.; Phone Number: +41213147492; Email: Sebastien.Urben@chuv.ch
    • Palézieux, Canton of Vaud, Switzerland, 1607
      • Recruiting
      • Établissement de Détention pour mineurs et jeunes adultes Les Léchaires
      • Contact: Patrick Heller, MD; Phone Number: +41223055218; Email: patrick.heller@hug.ch
  • Valais
    • Sierre, Valais, Switzerland, 3977
      • Recruiting
      • Centre éducatif fermé de Pramont
      • Contact: Patrick Heller, MD; Phone Number: +41223055218; Email: patrick.heller@hug.ch
      • Contact: Stéphanie Baggio, PhD; Phone Number: +41316846774; Email: stephanie.baggio@unibe.ch
      • Sub-Investigator: Patrick Heller, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Vulnerable adolescents defined as being: 1) detained in juvenile detention centers, 2) disconnected from school, 3) in treatment for psychiatric disorders, 4) belonging to a sexual or gender minority, 5) affected by chronic conditions, or 6) with relational/familial problems.
• Age 14 to 25 years old.
• Good knowledge of French.
• Accepting to sign the informed consent.

Exclusion Criteria:

• The medical/educational staff considers that the intervention will interfere with appropriate management of acute psychiatric disorder or may cause harm to self or other.
• Being enrolled in another suicide prevention intervention during the study period.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Primary suicide prevention intervention; The framework of the primary suicide prevention intervention is psychoeducation. The intervention lasts for 90 minutes and is conducted in groups of 5 to 15 (on average 10) participants. It provides general information on suicidal behaviors, information about facts and myths about suicide, identification of risk factors and warning signs of suicidal behaviors, and information on ways to seek for help and get support for themselves and others in the canton. The intervention includes a lecture, group discussions based on case examples, and a quiz on facts and myths about suicide. It is conducted by a trained staff member with the support of a psychologist trained in suicide prevention for children and adolescents. It follows a standardized format.	Behavioral: Primary suicide prevention intervention; Psychoeducation workshop
Active Comparator: Art-based control intervention; The control intervention will be an art-based activity, a workshop on slam poetry. At the end of the study, participants will get a flyer containing information on suicide prevention with the participants of the control group. Therefore, they will have a low-threshold intervention.	Behavioral: Art-based control intervention; Slam poetry workshop

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Composite measure of suicide awareness	Nine-item perceived suicide awareness scale (PSAS-9), assessed on a 5-point scale, score ranging from 0 to 36, with a higher score indicating a higher suicide awareness	One-week post-baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Access to primary suicide prevention	Self-developed scale on primary suicide prevention training, 3 questions combined in a binary indicator (yes/no)	Baseline
Composite measure of suicide awareness	Nine-item perceived suicide awareness scale (PSAS-9), assessed on a 5-point scale, score ranging from 0 to 36, with a higher score indicating a higher suicide awareness	Three-month post-baseline
Knowledge on suicide	Literacy of Suicide Scale (LOSS), 12 binary (true/false) questions, score ranging from 0 to 12, with a higher score indicating higher knowledge on suicide	One-week post-baseline; three-month post-baseline
Knowledge of local resources	Self-developed scale on local resources, 6 binary (true/false) questions, score ranging from 0 to 6, with a higher score indicating higher knowledge of local resources	One-week post-baseline; three-month post-baseline
Suicidal thoughts	Suicidal Ideation Attributes Scale (SIDAS), 10 questions assessed on a 5-point scale, with a score ranging from 0 to 50. A higher score indicates a higher level of suicidal thoughts.	One-week post-baseline; three-month post-baseline
Psychological distress	Kessler Psychological Distress scale (K-6), 6-item scale is assessed on a 5-point scale, with a score ranging from 0 to 24. A higher score indicates a higher level of psychological distress.	One-week post-baseline; three-month post-baseline
Attrition	Percentage of participants who drop out, continuous variable (0-100), with a higher percentage indicating a higher level of attrition	Three-month post-baseline

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of participants with serious adverse events (safety outcome)	Death, life-threatening event, and hospitalisation	One-month post baseline
Number of participants with adverse events (safety outcome)	Scarification, insomnia, appetite problems, substance use, and para-suicidal endangerment behaviors identified and reported by the local team	One-month post baseline
Self-reported distress (safety outcome)	Composite outcome with two questions from Bailey et al. (2017, https://https://doi.org/10.1027/0227-5910/a000465) related to the distressing and pleasurable nature of the intervention, assessed on a 5-point scale, score ranging from 0 to 8, a higher score indicating higher self-reported distress	One-week post-baseline

Collaborators and Investigators

• Sponsor: Stéphanie Baggio
• Investigators: Principal Investigator: Stéphanie Baggio, Prof., Institute of Primary Health Care (BIHAM), University of Bern

Publications and helpful links

General Publications

• Baggio S, Bailey E, Edan A, Heller P, Kapp C, Lambert N, Michaud L, Mundt AP, Nsingi N, Perez S, Peregalli S, Piguet C, Piotrowski C, Prutyanova Y, Rumley M, Sapin M, Urben S, Iglesias K. Evaluating primary suicide prevention in adolescents with risk factors (ESPAIR): study protocol for a cluster-randomized controlled trial. Trials. 2025 Nov 24;26(1):537. doi: 10.1186/s13063-025-09266-y.

Study record dates

Study Major Dates

• Study Start (Actual): March 11, 2025
• Primary Completion (Estimated): May 30, 2027
• Study Completion (Estimated): September 30, 2028

Study Registration Dates

• First Submitted: August 8, 2024
• First Submitted That Met QC Criteria: August 8, 2024
• First Posted (Actual): August 13, 2024

Study Record Updates

• Last Update Posted (Actual): December 18, 2025
• Last Update Submitted That Met QC Criteria: December 11, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Suicide; Primary prevention; Psychological distress; Vulnerable adolescents
• Additional Relevant MeSH Terms: Behavioral Symptoms; Self-Injurious Behavior; Behavior; Suicide Prevention; Suicide
• Other Study ID Numbers: 2024-01208

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Data will be shared on https://www.swissubase.ch.
• IPD Sharing Time Frame: After the publication of the main results of the study
• IPD Sharing Access Criteria: Upon approval from the principal investigator
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No