A Narrative Review on the Impact of Teachers’ Support in the Prevention of Death by Suicide Among Young People

Abstract

Purpose of the Review:

Death by suicide among young people is a growing issue worldwide. Every year, 46000 children (10–19 years old) take their lives. Lack of social support is one of the causes of suicide in young people. This narrative review aims to highlight the impact of teachers’ support in the prevention of death by suicide among young people.

Collection and Analysis of Data:

A literature search was conducted in Scopus, PubMed, Embase, and Web of Science to find out the relevant studies using the keywords and synonyms of “social support,” “young,” “suicide,” and “teacher.” The original articles published in indexed and peer-reviewed English language journals in the last 10 years (2014–2023) were included in this review. The included articles were focused on teachers’ support in terms of the prevention of suicide among young people. After screening the title-abstract and full-text articles, the review findings revealed that support from teachers has a positive impact on the prevention of suicide among young people. Young people who have higher teachers’ support show lower suicidal behaviors. Hence, teachers’ support acts as a protective factor against suicide in young people.

Conclusion:

The review concludes that teachers’ support has shown a positive impact on reducing suicidal behaviors among young people. Teachers are important sources of support in understanding suicidal behaviors in young people. Holistic support from each one of us is the enormous need to reduce the number of suicides. Studies have recommended that teachers’ support should be the focus of intervention, for example, school-based psychoeducation on young people’s suicide.

Keywords

Young people social support suicide teachers

Worldwide, death by suicide is a growing issue among young people. Every year, more than 7,00,000 people take their lives, and it is the fourth major cause of death in people aged between 15 and 29 years.¹ In Bangladesh, death by suicide among students is more common than in the general population.²

There are many social and cultural risk factors for suicide among adolescents in Asia.³ Involving teachers in school-based programs on suicide prevention along with life skills training and problem-solving techniques has created a positive awareness among students in other countries.⁴ Adolescence is a significant phase for acquiring emotional and social behaviors that contribute to mental well-being.

A protective and supportive environment in the family, school, and community is very important. Due to a lack of quality support from significant others, many adolescents are at risk for developing mental health issues. The existing study reported that the number of suicides in girls who were between the ages of fifteen and nineteen doubled from 2007 to 2015, while among boys who were between the ages of fifteen and nineteen, it increased by 30% during the same period.⁵ According to the National Crime Records Bureau (NCRB) of India, every hour one student dies by suicide, and from 2013 to 2016, Maharashtra, Madhya Pradesh, Tamil Nadu, and Karnataka had the highest number of student deaths by suicide.⁶ The United Nations Sustainable Development Goal, SDG3.4.2, talks about the suicide mortality rate.⁷

Since ancient times, it has been believed that social support has an important role in suicide risk.⁸ The interpersonal theory of suicide and the sociological theory of suicide describe a lack of social support that increases the risk of suicide.^9,10 The interpersonal theory of suicide also explains that social support strengthens feelings of belongingness in reducing the risk of suicide.¹¹ Studies have shown that social support is associated with reducing the risk of suicidal ideation and suicidal attempts in adolescents,^12,13 and adults.¹⁴

Existing systematic review,^15,16 and meta-analysis¹⁷ showed that individuals who have higher social support show lesser depressive symptoms. Social support acts as a protective factor in students’ lives. Social support lessens the negative impact of stressful situations by improving coping abilities.¹⁸ Students spend most of their time at school with teachers and peers. Teachers are the people who can identify the symptoms of suicide among students at an early stage and support them. Earlier literature has demonstrated that social support from teachers has a profound impact on mental health. It has been co-related negatively with depression, suicidal ideation, and suicidal attempts.^19–22 The National Suicide Prevention Strategy, 2022 (NSPS) introduced by the Government of India has focused on suicide prevention among students.^23,24 The NSPS also focused on stress management training for students by teachers.^23,24 By reviewing existing literature, it is understandable that training teachers, students,²⁴ and school staff²⁵ may be helpful in the prevention of suicide.

Many studies have been done on the impact of family support, peer support, or many sources of social support (parents, close friends, community leaders, teachers, etc.) together on young suicide, but very few cross-sectional studies have been conducted, mainly focusing on teachers’ support. The authors could not locate any review on this topic, so this will be the first narrative review of its kind. Thus, the authors intend to highlight the impact of teachers’ support in the prevention of death by suicide among youth.

Review Question

Does the teachers’ support have an impact on the prevention of death by suicide among youth?

Methods

Search Strategy

A comprehensive literature search was conducted in Scopus, PubMed, Web of Science, and EMBASE to find relevant studies using the MESH terms and keywords and synonyms “social support,” “young,” “suicide,” and “teacher.” The Boolean operators (OR, AND) were used to create the search strategy.

Study Selection

The inclusion criteria for the present reviews are as follows:

The full-text articles are published in an indexed and peer-reviewed journal.

The articles were published in the English language in the last 10 years (2014–2023).

The articles focused on the impact of teachers’ support in terms of young suicide.

Young people: Age 10–24 years

The exclusion criteria for the present reviews are as follows:

Conference proceedings, reviews, commentary, letters to the editor, and study protocols are excluded from the present review.

Published articles on the impact of social support from other sources, for example, parents, family members, and peers, are excluded in the present review.

Data Extraction

The initial search yielded 145 articles (PubMed = 18, Embase = 30, Scopus = 33, Web of Science = 64). Retrieved articles were screened on RAYYAN software, and thirteen articles were included in the preset narrative review based on the inclusion criteria.

Results

After screening the title-abstract and full-text articles, 13 cross-sectional articles were analyzed, and study details are explained in Table 1. The results are analyzed in the context of the geographical location (setting), income category, and sample characteristics. All the studies assessed teachers’ support as an outcome variable. Out of 13 reviewed articles, nine articles concluded that support from teachers could reduce suicidal behaviors among young people.

Table 1.

Summary of Articles Included on the Impact of Teachers’ Support in the Prevention of Death by Suicide Among Young People.

Sl No.	Authors and Years	Title of the Study	Setting and (Income Category)	Study Design	Sample and Sample Size	Objective of the Study	Results/Impact
1	Forster M, Grigsby TJ, Gower AL, Mehus CJ, McMorris BJ (2020)	The role of social support in the association between childhood adversity and adolescent self-injury and suicide: findings from a statewide sample of high school students	Minnesota (High income)	Cross-sectional	39,682 students from 9^th grade (14 years) and 33,966 students from 11^th grade (17 years)	To investigate the promotive and protective effects of peer and teacher-perceived social support individually and in combination.	Teachers’ support can promote a positive impact among youth even if they are living in stressful families.²⁶
2	Xiao Y, Chen Y, Chang W, Pu Y, Chen X, Guo J, Li Y, Yin F (2020)	Perceived social support and suicide ideation in Chinese rural left-behind children: a possible mediating role of depression	China (Upper middle income)	Cross-sectional	2,898 LBC* (10-17 years) (M_age= 13.95 years)	To explore the association between perceived social support and suicide ideation (SI) and to discuss the possible mediating role of depression in this association.	Support from teachers was not associated with suicide ideation among LBC*³⁶
3	Taliaferro LA, Muehlenkamp JJ (2017)	Non-suicidal self-Injury and suicidality among sexual minority youth: risk factors and protective connectedness factors	Minnesota (High income)	Cross-sectional	77,758 students in grades 9 and 11	To examine which types of social connections were associated with reduced risk of repetitive NSSI** and suicidality among youth who identified with a specific sexual minority group.	Teachers act as an important protective factor against suicidal ideation.²⁷
4	Fredrick SS, Demaray MK, Malecki CK, Dorio NB (2018)	Can social support buffer the association between depression and suicidal ideation in adolescent boys and girls?	Midwest (High income)	Cross-sectional	399 9th-grade students (13–16 years)	To investigate social support (from parents, classmates, teachers, and close friends) as a protective factor in the association between depression and suicidal ideation	Teachers’ support did not act as a protective factor in the association between depression and suicide.³⁴
5	Zhao Q, Gui H, Mao Y, Tam CC (2022)	Suicidal ideation, suicide attempts, parenting styles, social support and school conditions among college students in China	China (Upper middle income)	Cross-sectional	2,369 undergraduates (avg. age 20.10 years)	To explore the association between the socio-environmental factors and suicidality (suicidal ideation or suicide attempts).	Teachers’ support was significantly associated with reducing suicidality in females.³⁷
6	Galindo-Domínguez H, Losada Iglesias D (2023)	Bullying victimization and suicidal ideation in adolescents: the moderation effect of family, teachers, and peers support	Spain (High income)	Cross-sectional	898 adolescents (M_age = 13.55)	To analyze whether peer, family, and teacher support moderate the relationship between bullying victimization and suicidal ideation in adolescents based on their age, sex, or their condition of retaking a course.	Irrespective of any personal characteristics, teachers’ support helped in reducing suicidal ideation among adolescents.²⁸
7	Madjar N, Daka D, Zalsman G, Shoval G (2021)	Depression symptoms as a mediator between social support, non-suicidal self-injury, and suicidal ideation among Arab adolescents in Israel	Israel (High income)	Cross-sectional	276 Adolescents (mean age 15.1 years)	To explore whether depression symptoms mediate the relationships between perceptions of social support from three sources, namely parents, teachers, and peers, and NSSI** and suicidal ideation.	Teachers’ support was significantly associated with decreasing suicidal ideation.³⁰
8	Kim J, Ko Y. (2021)	Influence of experiencing bullying victimization on suicidal ideation and behaviours in Korean adolescents	Korea (High income)	Cross-sectional	5000 adolescents (14 to 18 years)	To identify the factors of the development of suicidal ideation and transition from suicidal ideation to action among Korean adolescents focused on the experience of bullying victimization, mental health, relationships with family, relationships with teachers and friends, and social support.	Relationships with teachers did not have any significant role in suicidal ideation, suicidal plans, and suicidal attempts.³²
9	Aguayo L, Beach LB, Wang X, Ruprecht MM, Felt D, Kershaw KN, Davis MM, Phillips G (2022)	Someone to talk to: The association of mentorship and cyberbullying with suicidality among U S high school students	U S A (High income)	Cross-sectional	25,527 students (14–18 years)	To examine the association of having a mentoring relationship with a teacher or adult in school with odds of suicidal ideation, planning, and attempts in a large sample of US high school students.	Having a mentoring relationship with a teacher was associated with less suicidal ideation, planning, and attempts.³⁵
10	Kim Y, Jeong W, Yang J, Lee SA, Park EC (2021)	Association of the type of counselor with suicidal ideation and suicide attempts: a survey of South Korean adolescents	South Korea (High income)	Cross-sectional	65,485 adolescents (middle and high school)	To examine whether suicidal ideation or suicide attempts of an adolescent are associated with a counselor who was near the adolescent.	The role of the teacher as a counselor helps in reducing suicidal ideation, especially when adolescents are having problems with academic/ career choices.³³
11	Madjar N, Walsh SD, Harel-Fisch Y (2018)	Suicidal ideation and behaviors within the school context: Perceived teacher, peer, and parental support	Israel (High income)	Cross-sectional	4241 (aged 15–17 years)	To address this issue, these factors are amalgamated into a single analytical model using a multilevel approach. Teacher, peer, and parental relations in understanding suicidal behavior	Teachers’ support was significantly associated with lowering suicidal behavior and suicidal ideation among students.³¹
12	Xiao Y, Ran H, Fang D, Che Y, Donald AR, Wang S, Peng JW, Chen L, Lu J (2022)	School bullying associated suicidal risk in children and adolescents from Yunnan, China: The mediation of social support.	Yunnan, China (Upper middle income)	Cross-sectional	6,063 children and adolescents (aged 10–18 years)	To investigate the mediation of social support in the association between school bullying and suicidal risk among a large group of Chinese children and adolescents.	Social support from teachers was not associated with suicidal risk.³⁸
13	Galindo-Domínguez H, Losada Iglesias D (2023)	Emotional intelligence and suicidal ideation in adolescents: The mediating and moderating role of social support	Spain (High income)	Cross-sectional	898 Spanish adolescents (M_Age = 13.55)	To discover the mediating and moderating effect of peer support, family support, and teacher support in the relationship between emotional intelligence and suicidal ideation in adolescents.	Social support from teachers helped in reducing suicidal ideation.²⁹

(*LBC- Left-Behind Children, **NSSI- Non-Suicidal Self-Injury)

The review findings revealed that support from teachers has a positive impact on young people’s suicide. Young people who have higher social support show lower suicidal behaviors. Hence, social support acts as a protective factor against suicide in young people.

Geographical Location and Economic Setting

A greater number of the studies (n = 10) were from high-income countries, including two studies each from Minnesota, Spain, Israel, the United States, and Korea.^26-35 Three studies are from China, an upper-middle-income country.^36–38

Characteristics of Study Participants

Out of 254,258 participants (in 13 included studies), two studies were done among both 9^th graders and 11^th graders,^26,27 and one study was done only among 9th-grade students.³⁴ One study was among undergraduate students,³⁷ and another was conducted among middle and high school students.³³ Left-behind children (LBC)³⁶ participated as well. The minimum age of the study participants was 10 years, and males, females, and sexual minority youth participated in the included studies.

Tools/ Instruments Used to Assess Teachers Support

Teachers’ support was measured by the Teacher–Student Relationships Scale from the Student Engagement Instrument developed by Appleton et al., 2006.²⁶ Yes/No questions^35,36 and Likert scale type question were given to measure the support from teachers.^27,37,32 The interpersonal social climate dimension was also used to measure the support received from teachers.²⁹ Among the included articles in this review, most of the articles used different Likert scales to assess the teachers’ support, such as different versions of the Child and Adolescent Social Support Scale (CASSS) developed by Malecki, Demaray, & Elliott, 2000,^34,38 the Scale of Positive Support developed by Richards & Branch, 2012,³⁰ and the Teacher Support Scale developed by Torsheim et al., 2000.³¹

Impact of Teachers’ Support

Teachers’ support can promote a positive impact among youth even if they are living in stressful families²⁶ or with achievements/ career choice-related problems.³³ Higher support from teachers was associated with a lower level of suicidal behaviors among students.^{26,28,29,30,31,35} Literature also showed that teachers’ support was not associated with suicidal ideation^34,36 and was not associated with bullying victimization and the risk of suicide among adolescents.³⁸ Teachers’ support acts as a protective factor against suicidal ideation among youth.²⁷ A higher level of teacher support was associated with a lower level of suicidality in females.³⁷ Another study revealed that support from teachers helps in reducing suicidal ideation irrespective of sex and age.²⁸ A study also showed that relationships with teachers did not have a protective role in suicidal plans, suicidal ideation, and suicidal attempts.³²

Discussion

From the results of the current review, it is highlighted that very limited studies have focused on teachers’ support against suicidal behaviors among young people. Though the support from teachers helps in reducing suicidal behaviors among students, it varies across grades. Once the students adjust to the classes, the protective effect increases with the number of sources of support.²⁶ Support from teachers was not associated with suicide ideation among left-behind children. It may be due to the smaller number of items used to assess the outcome variable.³⁶ Another study also highlighted that teachers’ support did not act as a protective factor. This may be due to the lower number of classes taken by a teacher, which may limit the building of a strong relationship between student and teacher,³⁴ different school cultures, and system.³² Females are more inclined to accept the support that is available to them. It may act as a protective against suicidality.³⁷ Adolescents spend most of their time at school with teachers; therefore, counseling by teachers was helpful to lessen career-related issues, which helped to prevent death by suicide.³³ The teacher supports students through active listening, empathy, encouragement, and respect, which act as a key factor in reducing suicidal ideation among students.²⁹

Limitation

This narrative review was restricted to articles published only in English between 2014 and 2023 and aged between 10 and 24, which may need to be revised to generalize the study’s findings.

Conclusion

The review concludes that support from teachers has shown a positive impact on reducing suicidal behaviors among young people. Teachers are important sources of support in understanding suicidal behaviors in young people. Holistic support from each one of us is the enormous need to reduce the number of suicides among young people. Studies have recommended that teachers’ support should be the focus of intervention, for example, school-based psychoeducation on adolescent suicide. More research studies and clinical work need to be conducted on the same topic to strengthen the evidence for awareness among students, sexual minority youth, as well as in the community.

Footnotes

Acknowledgements

The authors express their gratitude to all the authors of the original article that have been found useful in writing this review.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Declaration Regarding the Use of Generative AI

None used.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

References

World Health Organization. Suicide worldwide in 2019: Global Health Estimates [Internet]. World Health Organization, Geneva. 2019. 4–9 p. Available from: https://apps.who.int/iris/rest/bitstreams/1350975/retrieve

Arafat

SMY

, Mali

, Akter

. Characteristics, methods and precipitating events of suicidal behaviors in Bangladesh: A year-round content analysis of six national newspapers. Neurol Psychiatry Brain Res [Internet]. 2020; 36(January): 14–7. Available from: 10.1016/j.npbr.2020.02.005

Otsuka

, Anamizu

, Fujiwara

, . Japanese young adults’ attitudes toward suicide and its influencing factors. Asian J Psychiatr [Internet]. 2020; 47(August 2019): 101831. Available from: 10.1016/j.ajp.2019.10.011

Miller

, Eckert

and Mazza

. Suicide prevention programs in the schools: a review and public health perspective. School Psych Rev, 2009; 38(2): 168–188.

Liu

, Stevens

, Wong

SHM

, . The prevalence and predictors of mental health diagnoses and suicide among US college students: implications for addressing disparities in service use. Depress Anxiety, 2019; 36(1): 8–17.

National Crime Records Bureau. Accidental deaths and suicide in India. 2019. Available from: https://ncrb.gov.in/sites/default/files/ADSI-2021/ADSI_2021_FULL_REPORT.pdf

United Nations. The Sustainable Development Goals Report 2022. Available from: https://unstats.un.org/sdgs/report/2022/The-Sustainable-Development-Goals-Report-2022.pdf

Durkheim

. Suicide: a study in sociology. Glencoe, Ill: Free Press, 1897.

Joiner

. Why people die by suicide. Cambridge, MA: Harvard University Press. Public Health, 2005; 78(1): 78-80. doi: 10.2105/AJPH.78.1.78

10.

Durkheim

. Suicide: a study in sociology. London: Routledge; 2005 Aug 4.

11.

Van Orden Total

, Witte

, Cukrowicz

, . The interpersonal theory of suicide. Psychol Rev, 2010; 117(2): 575–600.

12.

Miller

, Esposito-Smythers

and Leichtweis

. Role of social support in adolescent suicidal ideation and suicide attempts. J Adolesc Heal [Internet]. 2015; 56(3): 286–292. Available from: 10.1016/j.jadohealth.2014.10.265

13.

MacKin

, Perlman

, Davila

, . Social support buffers the effect of interpersonal life stress on suicidal ideation and self-injury during adolescence. Psychol Med, 2017; 47(6): 1149–1161.

14.

Kleiman

and Liu

. Social support as a protective factor in suicide: Findings from two nationally representative samples. J Affect Disord [Internet]. 2013; 150(2): 540–545. Available from: 10.1016/j.jad.2013.01.033

15.

Gariépy

, Honkaniemi

and Quesnel-Vallée

. Social support and protection from depression: Systematic review of current findings in Western countries. Br J Psychiatry, 2016; 209(4): 284–293.

16.

Santini

, Koyanagi

, Tyrovolas

, . The association between social relationships and depression: a systematic review. J Affect Disord [Internet]. 2015; 175: 53–65. Available from: 10.1016/j.jad.2014.12.049

17.

Rueger

, Malecki

, Pyun

, . A meta-analytic review of the association between perceived social support and depression in childhood and adolescence. Psychol Bull, 2016; 142(10): 1017–1067.

18.

Cohen

and Wills

. Stress, social support, and the buffering hypothesis. Psychological Bulletin, 1985; 98(2): 310–357.

19.

Demaray

and Malecki

. Critical levels of perceived social support associated with student adjustment. Sch Psychol Q, 2002; 17(3): 213–241.

20.

Colarossi

and Eccles

. Differential effects of support providers on adolescents’ mental health. Social Work Res, 2003; 27(1): 19–30.

21.

Joyce

and Early

. The impact of school connectedness and teacher support on depressive symptoms in adolescents: A multilevel analysis. Child Youth Serv Rev[Internet]. 2014 Apr 1; 39: 101–107. Doi: 10.1016/j.childyouth.2014.02.005.

22.

Yang

, Wang

, Li

, . School climate and adolescents’ suicidal ideation and suicide attempts: The mediating role of self-esteem. Psychol Dev Edu, 2013; 3 (9): 541–551.

23.

Ministry of Health and Family Welfare. National suicide prevention strategy, https://main.mohfw.gov.in/sites/default/files/National%20Suicide%20Prevention%20Strategy.pdf

24.

Shoib

and Kar

. Student suicide prevention in India: Moving towards a feasible solution. Indian J Psychol Med, 2024; XX(X): 1–2.

25.

Arya

. Suicide prevention in India. Ment Heal Prev [Internet]. 2024; 33: 200316. Available from: 10.1016/j.mhp.2023.200316

26.

Forster

, Grigsby

, Gower

, . The role of social support in the association between childhood adversity and adolescent self-injury and suicide: Findings from a statewide sample of high school students. J Youth Adolesc [Internet]. 2020; 49(6): 1195–1208. Available from: 10.1007/s10964-020-01235-9

27.

Taliaferro

and Muehlenkamp

. Non-suicidal self-Injury and suicidality among sexual minority youth: risk factors and protective connectedness factors. Acad Pediatr [Internet]. 2017; 17(7): 715–722. Available from: 10.1016/j.acap.2016.11.002

28.

Galindo-Domínguez

and Losada

Iglesias D

. Bullying victimization and suicidal ideation in adolescents: The moderation effect of family, teachers, and peers support. J Soc Pers Relat, 2023; 40(12): 4050–4074.

29.

Galindo-Domínguez

and Losada Iglesias

. Emotional intelligence and suicidal ideation in adolescents: The mediating and moderating role of social support. Rev Psicodidáctica (English ed), 2023; 28(2): 125–134.

30.

Madjar

, Daka

, Zalsman

, . Depression symptoms as a mediator between social support, non-suicidal self-injury, and suicidal ideation among Arab adolescents in Israel. Sch Psychol Int, 2021; 42(4): 358–378.

31.

Madjar

, Walsh

and Harel-Fisch

. Suicidal ideation and behaviors within the school context: perceived teacher, peer, and parental support. Psychiatry Res [Internet]. 2018; 269(August 2018):185–90. Available from: 10.1016/j.psychres.2018.08.045

32.

Kim

and Ko

Influence of experiencing bullying victimization on suicidal ideation and behaviors in Korean adolescents. Int J Environ Res Public Health, 2021; 18(20).

33.

Kim

, Jeong

, Yang

, . Association of the type of counselor with suicidal ideation and suicide attempts: a survey of South Korean adolescents. Child Adolesc Psychiatry Ment Health [Internet]. 2021; 15(1): 1–11. Available from: 10.1186/s13034-021-00414-1

34.

Fredrick

, Demaray

, Malecki

, . Can social support buffer the association between depression and suicidal ideation in adolescent boys and girls?. Psychol Sch, 2018; 55(5): 490–505.

35.

Aguayo

, Beach

, Wang

, . Someone to talk to: the association of mentorship and cyberbullying with suicidality among US high school students. Soc Psychiatry Psychiatr Epidemiol, 2022; 57(1): 149–159.

36.

Xiao

, Chen

, Chang

, . Perceived social support and suicide ideation in Chinese rural left-behind children: A possible mediating role of depression. J Affect Disord, 2020; 261(February 2019): 198–203.

37.

Zhao

, Gui

, Mao

, . Suicidal ideation, suicide attempts, parenting styles, social support and school conditions among college students in China. Smith Coll Stud Soc Work [Internet]. 2022; 92(2): 133–149. Available from: 10.1080/00377317.2022.2077275

38.

Xiao

, Ran

, Fang

, . School bullying associated suicidal risk in children and adolescents from Yunnan, China: the mediation of social support. J Affect Disord [Internet]. 2022; 300(August 2021): 392–399. Available from: 10.1016/j.jad.2022.01.032