Collaborative strategies for adolescent suicide prevention: insights from Slovakia and Kyrgyzstan

Abstract

Objective

The study aimed to gain insights about the collaborative efforts of various professionals involved in preventing adolescent suicide within multidisciplinary teams in Slovakia and Kyrgyzstan.

Materials and methods

A qualitative research method was employed, involving semi-structured interviews with 10 specialists from Slovakia and Kyrgyzstan.

Results

Despite differing levels of development and implementation of multidisciplinary team concepts, findings revealed a generally positive impact of collaborative efforts in both countries (more structured in Slovakia and less developed in Kyrgyzstan). Multidisciplinary teams in educational settings strive to create supportive environments for adolescents, contributing significantly to mitigating various issues during their formative years.

Conclusions

Prevention efforts require coordinated action among multiple social institutions with unified strategies. While progress has been made, there remains potential for further development, particularly in improving cooperation among specialists, national recognition of youth suicide as a critical issue, and institutionalizing procedures to elevate the status and education of multidisciplinary teams.

Significance

This research provides innovative insights into the effectiveness of multidisciplinary teams in suicide prevention among adolescents. By suggesting comprehensive strategies for team collaboration, it offers valuable contributions to reducing youth suicide rates in both Slovakia and Kyrgyzstan.

Introduction

Suicide is a critical global issue, with alarming rates reported in various countries worldwide. Despite efforts to address this challenge, many nations continue to grapple with high suicide rates among young people, underscoring the urgency for effective prevention strategies [1].

Studies have shown that mental illness is a cause of suicide as seen in Bertolote and Fleischmann [2] where they reported that about 90% of adult people who died by suicide suffered from mental illnesses such as depression and substance abuse. Schnyder et al. [3] also corroborated that most suicide attempters experience feelings of anxiety and panic prior to their suicidal act, and that a higher percentage reportedly lose control over themselves, thus indicating a state of emotional crisis. Conversely, due to the multifactorial causes of suicide, it is expedient to mention that intervention and prevention measures should be multi-faceted because it is necessary to take into consideration the social, physical, and environmental factors [2]. Consequently, Philip and McCullough [4] emphasized the importance of social factors in classifying persons who kill themselves. In their research, they showed that persons admitted to a hospital following a suicidal attempt manifested the variables of social pathology [5] to a high degree; meaning that it is important to assess the patients’ personal relationships and social background [4]. Essentially, ‘social pathology’ is known as a condition or phenomenon in society, which might often lead to a flood of social, economic, and psychological problems that can undermine overall well-being.

Emile Durkheim [6], known as the founder of modern sociology, developed a new perspective where the concept of suicide was viewed not just from a psychological concept but also from sociological standpoint, a social fact—a so-called “sui generis”. Emile Durkheim [6] defined suicide as social phenomenon that “is applied to all cases of death resulting directly or indirectly from a positive or negative act of the victim himself, which he knows will produce this result”. Although this definition has continued to raise several concerns from sociologists and psychologists, the focus of this definition by Durkheim is to reveal that suicide is a social action which has both internal and external influence [7].

Adolescence, characterized by significant biological, psychological, and social changes, presents a crucial developmental period where individuals may face heightened risk factors for suicidal behavior [8]. According to numerous studies [7, 9, 10], the following are risk factors for suicide in adolescence and young adulthood: mental illness, previous suicide attempts, hopelessness, poor relationship with parents/caregivers, parental divorce, child abuse, school issues, peer suicide, poor problem-solving skills, easy access to lethal means, conduct disorder in youth, strained parent–child relationships, and peer victimization are just a few of the risk factors that can contribute to suicidal behavior [1, 11]. In response to this public health crisis, suicide prevention efforts have been advocated by the World Health Organization [1], urging governments to prioritize comprehensive prevention strategies. According to Wasserman [10] it is essential to include prevention in all levels of interaction—societal, community, interpersonal, and individual with the strong intention to guide and assist countries in strengthening their suicide prevention efforts.

The World Health Organization's [11] framework states that a person may make up to 20 attempts before actually dying by suicide, hence prevention is thought to be one of the most effective approaches to fight suicide. However, adolescent suicide attempters may have a greater history of prior suicide attempts than adult suicide attempters, which explains both the method and the reason. Adolescents utilize more non-lethal techniques, such as poisoning by over-the counter medications [11, 12]. Because adolescent suicide attempts are generally less severe and fatal than adult suicide attempts, it is even more pertinent and essential to start prevention initiatives for young age groups.

Danuta Wasserman [12] emphasizes the importance of preventive measures because “suicide does not occur at random, but rather is considered an ongoing process; from suicidal thoughts to suicide attempts and in some cases a completed suicide”. The World Health Organization [1, 11] states that typical national strategies may include a variety of prevention measures, including training for health professionals, educators, police, and other stakeholders in the health and education sectors. These measures also include surveillance, means restriction, media guidelines, stigma reduction, and public awareness raising. These programs typically also involve postvention and crisis intervention services for both adults and children [1, 13]. Non-specialized health and social professionals can be employed to enhance the assessment and management of suicidal behaviors in children and adolescents to provide effective practical assistance.

However, implementing effective prevention programs, particularly in educational settings, remains a challenge due to the complexities involved [14, 15]. Despite these challenges, there is growing recognition of the importance of multidisciplinary approaches involving social service providers in addressing adolescent suicide [10, 16].

The multidisciplinary approach is widely used in a health system where mental health professionals work as a part of a team to promote high-quality care and best practice in delivering mental health services [17]. Since the concept of health incorporates a complex and holistic system where all spheres such as biological, psychological, physical, socioeconomic, cultural, and environmental factors function as interconnected and interacting determinants of one another, it is noted that health and social issues are characteristically broad and complex and are most appropriate examined from a multidisciplinary perspective [18]. With increasing specialisation in healthcare and expansion of knowledge about mental health and health conditions in general having a forum of different groups that reflect various areas of specialization is increasingly necessary. The benefits of a multidisciplinary team include improved clients’ health outcomes, which leads to strengthened quality of life, as well as reduction of costs and utilization of medical services [19]. Grant and Lusk [20] consider that a multidisciplinary approach allows professionals and clients to come together with sound procedures and solutions with an adequate number of interventions. It is based on the connection and coordination of experts from one or more institutions and the client’s active involvement. They say, that the experience of success from multidisciplinary collaboration strengthens the team and simultaneously allows it to solve more challenging tasks [20].

For the general prevention of suicide among young people, it is especially essential to implement a collaborative team approach because it targets the general population of adolescents who might be at risk for developing suicidal ideation at the initial stage when influenced by different social stressors. Leeb et al. [21] strongly emphasize the connection of suicide with other forms of violence. For example, it is reported that young people who have experienced violence, including child abuse, bullying, or sexual violence tend to have a higher suicide risk [21]. Consequently, when the multidisciplinary team is comprised of different professionals involved in the matter, the interests of a child are especially considered. Together with Kutash et al. [19] they also point out that the success of a case is more likely to be complete if there is a strong connection with a child’s family, school personnel, community leaders, social workers, psychologists, as well as a provision of adequate support and easy access to health care [19, 21].

This study encompasses two countries—Slovakia and Kyrgyzstan for a few reasons. Firstly, the WHO stats show Slovakia remains the medium with a suicide rate of 4.02 among adults and young people in Europe [11] performing its prevention measures as helpful for suicide mitigation. Among the Central Asian countries, Kyrgyzstan (8.3) competes with Uzbekistan (8.3) for the second place while Kazakhstan (18.1) takes the leading position [11, 22]. Countries like Kyrgyzstan, despite being relatively small in population compared to others, face disproportionately high rates of adolescent suicide [11, 23]. These two countries represent a contrasting picture of suicide rates, with Slovakia showing a moderate rate compared to Kyrgyzstan’s disproportionately high adolescent suicide rate, underscoring the urgent need for targeted and context-specific interventions.

Secondly, Slovakia has vividly progressed in advancing multidisciplinary teams into prevention interventions through School Support Teams (SST) [24, 25]. This is a relatively new program (NP POP II) launched with the help of the Ministry of Education and have been implemented by the Methodological and Pedagogical Center from September 2020. The program assists the professional and pedagogical staff of the school, who actively participate in creating an inclusive school culture and work not only with school students, but also with teachers, parents, their community, and other professionals in the education sector and beyond. Through multidisciplinary cooperation, they effectively support school children and maximize their chances of success in a safe and productive environment [26]. It is noted that the standards are well-prescribed and ready to use [32]. Since the initiative is very fresh, the application has not been implemented fully; therefore, we cannot fully tell about what impact it brings to preventing risky behaviors including suicide attempts and acts. However, this crucial information can still help spread the word about the effectiveness of the interventions that have been offered in Slovakia.

Thirdly, developing countries like Kyrgyzstan can benefit from best practices because the issue remains under-prioritized in the country due to a lack of qualified specialists [27]; there is no holistic system of prevention either at local (including educational) or governmental levels; and social policies do not respond to the needs, but instead react post-factum [28]. Therefore, due to a lack of unified and systemization of support on government and local levels, practitioners in Kyrgyzstan jointly point to the significant need to work multidisciplinary to fasten the service provision to children and youth at risk or/and at crisis of risk and, as a result, contribute to suicide prevention in children and young people [28–30].

This study aims to investigate the role of multidisciplinary teams in suicide prevention among adolescents, with a focus on understanding their effectiveness and challenges, particularly in countries like Slovakia and Kyrgyzstan where the level of integration of multidisciplinary teams differ and, therefore, it might create a substantial discourse and analysis of experience and best practices exchange. By examining successful models of multidisciplinary collaboration and identifying strategies for improvement, this research seeks to contribute to the development of evidence-based interventions and policy recommendations for addressing adolescent suicide on a global scale.

Materials and methods

This study aimed to explore the role of multidisciplinary teams in suicide prevention within educational settings in Slovakia and Kyrgyzstan. A qualitative research design was chosen to explore the perspectives and experiences of professionals working in these teams.

The sample size consisted of ten specialists (n = 10), five from each country, selected through purposive sampling. The Researchers used their professional network to create rapport with each of the interview participants. This approach was complemented by job shadowing at their workplaces and participation in field visits. Participants included social workers, school psychologists, social pedagogues, police officers, and representatives from children's organizations, chosen based on their experience in working with youth at risk of suicide. Semi-structured interviews were conducted using an interview guide structured around four main research questions, with probing questions for further insight. The interviews were audio recorded and transcribed verbatim for analysis.

The model to analyze qualitative data in this study is a thematic analysis which is considered one of the most commonly used methods of identifying, analysing and reporting patterns (themes) with data [31]. A thematic analysis of this research was to help identify patterns of themes in the interview data. We highlighted statements and phrases from the interviews that were significant to the study. We went back and forth among transcripts until consistent and distinct codes existed. The original quotes related to each themes were brought together and looked into for relationships within and across data sources. This helped us arrange and refine categories of participants’ ideas until they were solidified. Codes were then arranged into subthemes, and they were brought into main discussions. ATLAS.ti software was utilized to organize the data and facilitate the analysis process. This software supported the systematic coding of data and the development of themes, enabling a rigorous and transparent analysis. As a result, this facilitated analysis which helped the study form around four (4) main themes and four (4) sub-theme clusters followed by additional components for discussion (Table 1):

Table 1.

Theme and subtheme cluster

Theme	Subtheme cluster
1. The contribution of the multidisciplinary team to the prevention of adolescent suicide	Views on the level of contribution: • safe environment, • capacity of the team, and • problem indication
2. The roles of social institutions in the prevention of adolescent suicide	Experience with participating institutions: • primary contact (schools), • secondary contact (social and medical support), and • follow-up (other organizations)
3. The activities on suicide prevention by the multidisciplinary teams	System of support: • relationship building, • school involvement, • challenges on local level, and • other approaches
4. Suggestions to improve the work of multidisciplinary teams in the prevention of adolescent suicide	Local and national levels: • local level improvements, and • national level improvements

Ethics Declarations

Ethical approval

This research was performed in line with the principles of the Declaration of Helsinki. Prior to the research, the corresponding University (Mykolas Romeris University, Lithuania) gave the Ethical Certificate to approve the conduction of the research. The sample size and qualification were preliminary agreed upon with the Master Thesis’s Supervisor and the Coordinating University. Also, all necessary documents were prepared and coordinated with the Supervisor and according to the Ethical Certificate. Before the interview, introductory meetings were conducted to clarify the qualifications for the study’s purpose.

Consent to participate

The chosen participants were informed about the study’s objectives and their rights, as well as about their voluntary participation and their rights to withdraw from the study at any time. The Informed Consent forms were signed by all participants after the purpose of the study had been explained to them. In addition, participants’ data were kept confidential and no names were used. The participants were assured of the confidentiality of their responses, and their identities were kept anonymous throughout the study. With the permission of the participants, all interviews were recorded to avoid misinterpretation and cross-checking of the information.

Results analysis

Theme 1: the contribution of the multidisciplinary approach to the prevention of adolescent suicide

Participants viewed the level of contribution of the multidisciplinary team from a few angles –safe environment, capacity of the team, and problem indication (Fig. 1).

Fig. 1.

Subtheme Cluster: Views on the level of contribution

Safe environment

“We must be very careful to approach this topic because we must always understand that the forbidden fruit is sweet. When we start talking about suicide, we may touch people who have never had it. And a child may go for it. And it may seem to be our fault.” (KG juvenile inspector)

“Well, I try not to talk about suicide too much. I try to avoid the word “suicide”. I try to substitute it. For example, was there a desire to go away, to leave life? was there and is there such a thing that you do not want to live? or just close your eyes and not to wake up?” (KG psychologist)

Nearly all participants underscored the critical role of establishing trust and a safe environment for children as a cornerstone of the multidisciplinary team’s work. This emphasis on safety is not merely procedural but deeply rooted in the cultural and social context, particularly in Kyrgyzstan. The participants' reluctance to use the word “suicide” reflects a culturally sensitive approach, driven by the belief that discussing suicide openly could inadvertently encourage the behavior. For example, the juvenile inspector's comment, “the forbidden fruit is sweet,” suggests an awareness of the psychological impact of language and the potential for suggestion. Even though, it is an applicable practice in Kyrgyzstan, Wasserman [10, 33] considers that this might hinder the implementation of preventive methods and slow down the recognition of the problem by the government. The methods vary from country to country, however, the emphasis on creating a systematic care for a child remains equally the same. This also aligns with the study of Andrews et al. [34] which says that despite behavior can be influenced by observing others, this highlights a nuanced understanding of cultural and psychological factors in suicide prevention, where the team's actions are informed by a delicate balance in their best to create a safe environment for a child.

Team capacity

“It is very important that people in the first contact are informed and educated about warning signs in children and know how to notice their tightness, sadness, depression, self-harm and respond to them adequately” (SV social worker)

The importance of the multidisciplinary team's competence was highlighted, particularly by participants from Slovakia, who noted the significance of diverse activities performed by the team members. The statement from the Slovak social worker, emphasizing the need for professionals to be “informed and educated about warning signs in children,” reflects a broader theoretical framework of professional competence and its impact on outcomes. This is consistent with the concept of Reflective Practice [35], where continuous learning and adaptability are critical to effective service provision. The emphasis on early detection and appropriate response ties into this concept suggesting that the team’s success is contingent upon their ability to act preemptively rather than reactively. This aligns with Carpenter et al. [7], who believe a multidisciplinary approach allows professionals and clients to collaborate on meaningful procedures and solutions with adequate interventions. The integration of these theoretical perspectives underscores the role of a well-rounded, competent team as not just practitioners but as active agents in shaping the course of intervention and prevention strategies.

Problem indication

“I think, we need to pay attention to young people who are on social media all the time and talk about with specialists how to solve the issues. Because it’s really a problem.” (SV policeman)

The emergence of different adolescent problems, as highlighted by participants, provides insight into the broader social and cultural dynamics at play. Participants from Kyrgyzstan pointed out an increase in suicidal ideation among younger children and the high level of violence against children. This observation may be interpreted through the lens of Durkheim's theory of Social Integration [7], which posits that a lack of social cohesion and support can lead to higher rates of suicide. The increase in suicidal ideation could reflect a breakdown in social structures, where traditional forms of support are eroding, leaving children more vulnerable. On the other hand, Slovak participants raised concerns about extremism, drug use, and bullying, which in turn, creates societal pressure and a lack of legitimacy leading to deviant behavior. Key risk factors identified by international researchers [12, 36, 37] also include feelings of hopelessness or helplessness, acute loss or rejection, exposure to violence, impulsivity, aggressive behavior, access to firearms, and family histories of suicide attempts. Both groups' concern about emotional instability and social media overuse highlights the global nature of these issues, suggesting that while the specific problems may differ, the underlying challenges of modernity and technological impact are universally recognized. These are critical elements that underscore the importance of a collaborative approach to intervention and prevention, as they highlight the multifaceted nature of the problem and the need for diverse expertise and perspectives in effectively addressing these issues.

Theme 2: the roles of social institutions in the prevention of adolescent suicide

Participants described their experience with different organizations which participate in the prevention of adolescent suicide from the following perspectives – primary contact (schools), secondary contact (social and medical support), and follow-up (other organizations) (Fig. 2).

Fig. 2.

Subtheme Cluster: Experience with participating institutions

Primary contact – schools

“We directly work with the school to help identify kids who have some kind of social, psychological, or legal problems.” (KG social worker)

“In our school, we have our supporting team that consists of our social pedagogue, school psychologist, career counselor, and coordinator for prevention, assistants of principals and special pedagogue” (SV social pedagogue)

The majority of interviewees from both countries emphasized the crucial role of schools as the primary contact in preventing adolescent suicide. This central role aligns with the idea of schools as microcosms of society, where early signs of distress can be detected and addressed. The interviewees from Kyrgyzstan underscored the involvement of educational departments, pointing out the necessity of coordinating prevention activities with these departments despite the challenges posed by bureaucratic and formal processes. This suggests a tension between the need for swift, responsive action and the often slow-moving, rigid structures within educational institutions. Studies by Singer et al. [14] and Wasserman [10] highlight that school-based programs are among the most critical and influential evidence-based suicide prevention methods which can integrate awareness exercises, curriculum, and skill development focusing on healthy coping and protective factors for suicide, such as improving problem-solving skills and fostering connectivity. The insistence on coordination, despite these challenges, reflects a recognition of the school’s integral role in creating a unified front against adolescent suicide, where the educational environment is not just a place of learning but a critical site for early intervention. The majority of interviewees affirmed the high involvement of a school as a central focal point in preventing adolescent suicide. The interviewees from Kyrgyzstan specifically emphasized the involvement of educational departments and the necessity of coordinating any prevention activities with them even though it is sometimes very bureaucratic and formal.

Secondary contact – social and medical support

“There are also psychologists. We work with them if there is a bigger problem… I think professionals, like psychiatrists and psychologists, should be more involved” (SV policeman)

The involvement of primary health care providers, such as doctors, school/community nurses, and child therapists, was highlighted as essential due to the sensitive nature of suicide prevention. This multi-tiered approach, involving both primary and secondary levels of psychological and psychiatric support, underscores the complexity of addressing adolescent suicide. This correlates with the research of Wigdorowitz and Hassem [39] which states that the integration of psychological/psychiatric roles at multiple levels reflects a holistic approach to mental health care, where prevention and intervention are not seen as isolated tasks but as part of a continuum of care. The structured position of mental health professionals within specialized centers, such as Slovakia's SCPP, illustrates the institutionalization of suicide prevention within the broader health and education systems. Participants believe it is reasonable to refer a case to a professional with more experience in difficult situations. These specialists include psychiatrists, clinical psychologists, and medical personnel. This is not surprising because the work of multidisciplinary teams was initially formed in the health sectors, with “psychiatric teams” consisting of psychiatrists, psychiatric nurses, psychologists, social workers, and occupational therapists arranging comprehensive treatment and care for people with mental illness [38]. The emphasis on professional expertise and the need for reference in cases of suicidal ideation or behavior also resonates with the specialized knowledge of healthcare providers is crucial in managing complex health issues like suicide.

Follow-up – other organizations

“We work with the child's natural environment, especially with the parents if possible, and we exchange information with other experts who work with the child - teachers, special pedagogue, psychologist, social worker, child psychiatrist. …. work with the department of social and legal protection of children to ensure the protection and monitoring of the child’s family environment” (SV director of children’s organization)

Social service organizations, including police, public organizations, social work, and child protection offices, play a critical role in the follow-up phase of suicide prevention. Their involvement in identifying problems within young people's families, evaluating teenagers’ environments, and coordinating efforts among specialists highlights the importance of a collaborative approach. The description of these organizations working within the child’s natural environment, particularly with parents and other professionals, reflects the principles of Bronfenbrenner’s Ecological Systems Theory [40, 41]. This theory posits that a child's development is influenced by multiple systems, from immediate family and school environments (microsystem) to broader societal influences (macrosystem). The collaboration between these organizations can be seen as an effort to create a supportive mesosystem, where different parts of a child's life are interconnected and mutually reinforcing. A multidisciplinary team composed of different professionals ensures the interests of the child are considered. Notably, social workers are mentioned in responses from each country, despite not being employed in schools. Singer et al. [8] reveal that social workers' identification with teams is no weaker than that of their counterparts. Although less emphasized than educational staff, the social work institution still made a significant contribution. The study shows that school personnel refer to social workers for follow-up with families and community members, establishing grounded practice for support from different professionals. However, there is confusion about the roles of social workers, as the majority of work is done by school personnel, limiting the capacity of social workers. Slovakian and Kyrgyzstani experiences with social workers in education might differ from US practice, where social workers are allocated at schools. An exploratory study in the US found that school social workers intervened with students threatening suicide (88%), attempting suicide (50%), being hospitalized for suicide risk (64%), or dying by suicide (10%) [14]. Thus, the integration of diverse professional perspectives and robust community ties is crucial for the effective management of adolescent concerns and the promotion of their well-being.

Theme 3: the activities on suicide prevention by the multidisciplinary teams

In this theme, participants highlighted the following groups – relationship building, school involvement, challenges on local level and other approaches (Fig. 3).

Fig. 3.

Subtheme Cluster: System of support

Relationship building

“Relationship is the number one. Every child should have at least one person in their life that they can go to and talk to” (SV psychologist)

Participants unanimously identified relationship building as the most crucial element in preventing a range of issues, including suicide. The emphasis on relationships reflects a deep understanding of the protective factors that can mitigate risk. The statement, "Every child should have at least one person in their life that they can go to and talk to," posits that secure, supportive relationships are foundational to emotional well-being. The concept of a "trusted adult" is also central to many suicide prevention frameworks, which stress the importance of connectedness in reducing feelings of isolation and despair among at-risk youth. This relational focus can be further analyzed through the lens of Social Support Theory [42], which suggests that the presence of supportive relationships can buffer individuals against the negative effects of stress and trauma. By emphasizing relationship building, participants are advocating for a preventive approach that is deeply rooted in the principles of human connection and empathy. It was revealed that all participants considered relationship building is number one in the prevention of any kinds of issues, including suicide prevention.

School involvement

“On any of our preventive activities, we have to consult with the school administration first. They explain the situation and we come to the class activity prepared” (SV director of children’s organization)

The majority of participants considered schools to be key in creating a supportive environment for both preventive and interventive activities. The mention of existing prevention programs within schools, particularly in Slovakia, underscores the institutional role that educational settings play in suicide prevention. The need to consult with school administration before implementing preventive activities reflects the bureaucratic nature of schools, but it also highlights the importance of collaboration and coordination within these institutions. Krnáčová et al. [26] state that multidisciplinary collaboration enables school staff to provide appropriate support for schoolchildren, increasing their chances of success in a secure setting.

In this case, the consultation process ensures that preventive activities are aligned with the school's broader goals and policies, thereby increasing their effectiveness and acceptance. The role of school administration in building a cohesive support environment also suggests that leadership plays a pivotal role in shaping the norms and values that guide organizational behavior. A supportive school culture, therefore, is not just about the presence of programs but also about the underlying values that prioritize students' well-being.

Other approaches

Participants discussed other approaches, including parental involvement, legal representation, and resocialization. The Slovakian professionals' focus on resocialization as a means to help children with risky behaviors highlights the importance of rehabilitation and reintegration in preventing further harm. Arensman et al. [43] appeal for a locally coordinated, systematic service delivery response network to ensure at-risk youth receive prompt assessments, good care, effective follow-up, and thorough monitoring. In Kyrgyzstan, the Department for the Support of Families and Children is a specialized governmental body for children’s rights and protection, involved when supervisory functions are needed. The Children Support Center provides consistent support in reducing suicides among teenagers. In Slovakia, these functions are implemented by the Day Center for Children and Family and other non-governmental organizations. Police are more frequently included in teamwork in Kyrgyzstan, working closely with social protection services and schools to control crime and prevent risky behaviors among young people. By activating the internal abilities of children to overcome the consequences of their actions, resocialization aims to address the root causes of risky behavior rather than merely punishing it. Additionally, the Kyrgyz participants' emphasis on religion as a protective factor suggests a culturally informed approach to prevention.

Challenges at the local level

“Parents are very important because children should come first to their parents when they have got a problem. And they should help to solve it. But the children don’t find support in their parents” (SV policeman)

While discussing the system of support, participants from both countries highlighted several challenges at the local level. Issues such as staff turnover, burnout, and a lack of child psychiatrists indicate systemic weaknesses that undermine the effectiveness of suicide prevention efforts. The mention of poor family relationships and issues with parental involvement further complicates the picture, as these factors are critical to a child's support network. The Slovak participants' concern about the stigma associated with psychiatric assistance reveals a societal barrier to seeking help. The fear of being labeled with a mental illness can prevent individuals from accessing the care they need, exacerbating their risk. On the other hand, the Kyrgyz participants' observation of a lack of educated professionals and awareness of the psychologist's role points to gaps in both the education system and public understanding.

Theme 4: suggestions to improve the work of multidisciplinary teams in the prevention of adolescent suicide

Interview participants provided suggestions for improvement through two perspectives – at the local level and at the national level (Fig. 4).

Fig. 4.

Subtheme Cluster: Local and national levels

Local level improvements

“First of all, teachers, social workers must be equipped with information about up-to-date life situations. They must know what the reasons can be, what to pay attention to, how a child behaves, and whether there is any prone to suicidality. The specialists should be analytical!” (KG social pedagogue)

At the local level, nearly all participants emphasized the urgent need for education and guidance for specialists, parents, and teachers. This emphasis on education reflects an understanding of the critical role that knowledge and skills play in effective suicide prevention. The suggestion to educate specialists on up-to-date life situations and prevention methods indicates a recognition of the rapidly changing social environment and its impact on adolescents. The call for specialists to be “analytical” highlights the need for a deeper understanding of the signs and causes of suicidality, suggesting that a more nuanced, evidence-based approach is necessary. These findings align with previous studies where the US Youth Risk Behavior Survey [36] indicates that prevention plays a huge role in interventions with suicidal youth. Most existing school-based suicide prevention programs target the entire student population through “gatekeeper” training for school personnel and students, teaching risk factors, warning signs, and help-seeking behaviors [44]. This is the program where professionals are encouraged to critically analyze their own experiences and knowledge to improve their practice continually. Appropriate tools and methods are crucial for implementing prevention activities. Universal screening assessments for suicide risk, standardized tools, are essential components of comprehensive suicide prevention programs. Research by Stone & Crosby [45] shows that school-based screening detects more at-risk individuals than professional screening, with some programs lowering suicide attempt rates. For successful implementation, building a strong support system is important, including relationship building with young people, school involvement, and outside assistance, particularly from parents. This corresponds to the Interpersonal Theory of Suicide [46], emphasizing interpersonal connections, social support, and environmental factors in mitigating suicidal ideation risks. These connections can create a sense of belonging and reduce feelings of isolation, which are critical in preventing suicidal behaviors. The suggestion to control young people's social media usage, particularly highlighted by Kyrgyz specialists, reflects concerns about the negative impact of social media on mental health. This concern is supported by the growing body of research indicating a correlation between social media use and increased rates of anxiety, depression, and suicidality among adolescents. The recommendation to limit phone and internet usage can be viewed through the lens of digital detox strategies, which advocate for reducing screen time to improve mental well-being.

National level improvements

“There has to be vision and strategy. I see that it has to be like this. But then again, there has to be a person who does this practically. It’s just that when it's all assembled, it has a bigger picture of a sustainable mechanism.” (KG psychologist)

At the national level, the majority of participants from both countries agreed on the necessity of having a joint vision and strategy to ensure cohesive and coordinated actions in suicide prevention. The call for a unified strategy underscores the importance of a systems approach, where different sectors and levels of government work together to address complex issues like adolescent suicide. It correlates with the WHO [11, 37] agenda which stands out for advocating comprehensive strategies, including policy implementation, community-based interventions, and multi-sectoral collaboration to enhance mental health services and suicide prevention efforts globally. This emphasizes the alignment of policies across different sectors and levels of government to achieve common goals. The need for more communication and information exchange among experts, as well as more specialists in first-contact roles, points to the importance of interprofessional collaboration. The participants' call for more national campaigns to raise awareness of suicide in society suggests a need for broader public engagement and destigmatization of mental health issues. National campaigns can play a crucial role in changing public perceptions, encouraging help-seeking behavior, and reducing the stigma associated with mental illness. Specialists from Kyrgyzstan offered specific suggestions for improving the education and training of psychologists, including the development of additional university departments and incentives for graduates to work in schools and centers. This focus on expanding educational opportunities and improving working conditions reflects a recognition of the importance of building a strong, well-trained workforce to address mental health issues. The suggestion to extend preventative efforts to rural areas highlights the need for equity in service provision, ensuring that all regions, including those that are often underserved, have access to vital prevention services.

Conclusion

Suicide prevention is a critical public health priority worldwide, demanding comprehensive and multidisciplinary team collaboration. This approach must encompass early identification, skill-building, and access to appropriate support services for young people at risk. Today’s multidisciplinary teams may vary due to changes in social policies, society’s needs, innovations, and the development of specialists' professional backgrounds. The roles of each team member may also include additional duties and responsibilities. Participants generally defined a multidisciplinary team as a cohesive organization that works jointly and cooperatively to address a problem.

The team becomes more potent due to multidisciplinary teamwork, enabling it to tackle more difficult tasks. The opinions of interview participants supported the notion that teamwork is helpful in identifying and resolving a wide range of adolescent concerns. Participants frequently mentioned issues such as bullying, drug and alcohol misuse, excessive social media use, and parent–child relationships as main contributors to risky behaviors in both countries.

In a school setting, multidisciplinary teams play a crucial role in this endeavor, facilitating collaboration among specialists to ensure holistic care and intervention. Our study confirmed that a successful Multidisciplinary Team in a school setting should consist of social services actors such as social pedagogues, social workers, school/child psychologists, police, and children’s centers. Other social elements identified during interviews include school administration, teachers, psychiatrists, medical facilities, the child protection office, and family members. This multi-tiered approach is necessary and beneficial for dealing with complex cases. A multidisciplinary team composed of different professionals ensures the interests of the child are considered.

However, the practical implementation of multidisciplinary teams varies between countries, as evidenced by the case of Slovakia and Kyrgyzstan. Slovakia demonstrates a more formalized approach through the robust work of SST supported by Interviewees from Slovakia who report it as the effective operation of the SST, established to support the professional and pedagogical staff of the school. These staff members contribute to an inclusive school culture and collaborate with students, teachers, parents, the local community, other professionals in the field of education, and professionals outside the educational setting. Kyrgyzstan's efforts are less structured but equally impactful through the collaboration of an informal network of professionals. Each interviewed specialist viewed their contribution to the team’s mission based on their roles, knowledge level, experience, and cultural specifics. Despite different approaches to prevention, the word “suicide” is preferred to be often avoided or masked positively.

Nevertheless, challenges such as budget constraints and the need for clearer roles persist in both contexts. For suggestions on improvement of the systems, the interview participants emphasized the need for education on prevention methods, building trusting relationships with children, limiting phone and internet usage, updating teachers and social workers on current issues, fostering collaboration in national events, and securing explicit and consistent government support. To enhance suicide prevention efforts, it is imperative to integrate multidisciplinary teams into existing mental health, education and social services, provide adequate resources and training, and strengthen collaboration within school settings and across community organizations. Moreover, further research is needed to better understand the risk factors for adolescent suicide and develop effective prevention strategies tailored to the unique contexts of different countries.

Overall, this study sheds light on the significance of multidisciplinary teams in suicide prevention and underscores the importance of innovative approaches to address this pressing public health issue.

Author contributions

Author Contributions Statement: Leila Salimova contributed to the conceptualization, design, and implementation of the empirical research, as well as the analysis and interpretation of the data. Leila Salimova also took the lead in writing the manuscript. Marketa Rusnakova provided supervision, guidance, and direction throughout the research process. Marketa Rusnakova contributed to the conceptualization of the study, provided critical feedback on the research design and methodology, and approved the final version of the manuscript. Leila Salimova is designated as the corresponding author, responsible for communication with the journal and addressing any inquiries related to the manuscript.

Funding

The authors declare that they have no sponsorship or funding related to this research.

Data availability

Data is provided within the manuscript.

Declarations

Competing interests

The authors declare no competing interests.