Suicide prevention among college students before and during COVID-19 pandemic: Systematic review and meta-analysis protocol

Background: Suicide is the second leading cause of death for college-aged individuals worldwide and in the US. Recent studies
have identified preliminary evidence of widening disparities across sex, sexual orientation, race/ethnicity, age, and
socioeconomic status among college students. Yet few systematic reviews and meta-analyses are available to offer a
comprehensive understanding of on-campus and off-campus interventions with different types of screening, assessment,
treatment, and postvention plans. Further challenges have been identified since the COVID-19 pandemic, calling for costeffective and innovative interventions to address increased rates of suicidal behaviors among college students facing
unprecedented stressors.
Objective: This research protocol describes the first systematic review and meta-analysis to identify the most effective and costeffective intervention components for universal and targeted (indicated and selected) suicide prevention among college students.
Special attention is placed on disparities in suicide prevention across sociodemographic subgroups, inclusive interventions
beyond campus, global context, and intervention responses to the COVID-19 pandemic.
Methods: A sensitive search strategy will be executed across Medline (Ovid), EMBASE (Embase.com), PsycINFO (EBSCO),
ERIC (EBSCO), Cochrane Library (Cochranelibrary.com), Dissertations and Theses Global (ProQuest), Scopus (Scopus.com),
and Google Scholar. Data extraction and evaluation will be conducted by two independent researchers. Risk of bias will be
assessed. A multilevel meta-regression model and subgroup analysis will be used to analyze the data and estimate effect size.
Results: The search was completed in December 2020. We expect the results to be submitted for publication in mid-2021.
Conclusions: Despite increasing rates of suicidal behaviors among college students, there are few preventative efforts targeting
this population, and even less focus on health disparities and equity. The impact of COVID-19 on suicidal behaviors among
college students further calls for an urgent need for rapid and effective interventions that might differ from traditional
approaches. This equity-focused study will address these gaps and provide a valuable analysis of the effectiveness of suicide
preventions and interventions. Findings will inform clinicians, researchers, policymakers, families, and organizations about
evidence-based approaches to reducing the gaps in the suicide crisis among college students from different sociodemographic
groups.