Suicide prevention starts before the crisis: intervention guidelines for university students.

Background: Suicide among university students is a growing public health concern, particularly in low- and middle-income countries. The university setting presents unique challenges and opportunities for implementing effective suicide prevention strategies. Despite the availability of various interventions, these efforts often fail to address the contextual and systemic factors that influence their success.

Objective: Investigate the elements that can support implementing actions to prevent suicide among university students. Using interviews, focus groups, and questionnaires, the study was conducted at a university in the North of Brazil.

Participants: These are 20 undergraduate students, 12 undergraduate course coordinators, 6 technical-administrative staff, and 12 health professionals.

Method: Thematic analysis and the context and implementation of complex interventions (CICI) model were used to analyze the data.

Results: Thematic analysis revealed that political and socioeconomic contexts-such as underfunded mental health services, lack of institutional coordination, and limited financial aid-were critical barriers. Key facilitators included social participation, teacher-student relationships, and actions that promote a welcoming university environment. Implementation concerns included the risk of stigmatization and the need for role clarity among university staff. Stakeholders proposed a range of interventions distributed across ecological, proactive, early, and crisis zones, emphasizing the need for mental health promotion, intersectoral collaboration, and collective program design.

Conclusions: Effective suicide prevention in universities requires a systemic approach that addresses prevention and treatment actions of suicidality. By leveraging the insights of multiple stakeholders and applying context-sensitive frameworks, universities can implement sustainable interventions. This study provides a road map for advancing suicide prevention efforts and illustrates ongoing and comprehensive actions to promote the mental health of university students.