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Scaling Up a Blended Digital and Face-to-Face School-Based Suicide Prevention Program for Adolescents: A
Objective:
Adolescent suicide remains a major public health concern in Chile. Reframe-IT+ is a culturally adapted, school-based program that integrates digital cognitive-behavioral therapy with face-to-face sessions. Following a pilot randomized trial and a cluster RCT in southern Chile, this study aimed to evaluate the preliminary effectiveness under scale-up conditions of Reframe-IT+ in a new region and educational context.
Methods:
A quasi-experimental, pre-post study without a control group was conducted between December 2023 and December 2024 in 11 schools in Santiago, Chile. A total of 75 adolescents with suicidal ideation were enrolled, and 71 completed the intervention and post-assessments. The intervention included 13 weekly sessions (8 digital and 5 face-to-face). Primary outcome measures assessed suicidal ideation and depression. Paired-samples t-tests and adjusted models were used to examine changes.
Results:
Significant improvements were observed across all primary outcomes, including reductions in suicidal ideation (C-SSRS: -2.7; SIQ-JR: -13.2; p < 0.001) and depressive symptoms (PHQ-9: -3.7; p < 0.001). Secondary outcomes also showed improvements: anxiety (-3.9), hopelessness (-3.2), and psychotic-like experiences (-8.6) all declined (p < 0.001). Expressive suppression decreased (-0.9; p = 0.028). Protective factors increased significantly, including problem-solving skills (+5.3), behavioral activation (+1.9), cognitive reappraisal (+2.0), and quality of life (+3.8).
Conclusions:
This study provides preliminary evidence for the effectiveness of Reframe-IT+ when scaled to a new educational and geographic context. The program significantly reduced suicidal ideation and emotional distress while enhancing protective factors. These findings support further implementation studies and potential integration into national school-based mental health policies. Trial Registration: Clinical Trials NCT06759441, December 26th, 2024. [https://clinicaltrials.gov/study/NCT06759441].
