Scaling Up a Blended Digital and Face-to-Face School-Based Suicide Prevention Program for Adolescents: A Quasi-Experimental Study of the Reframe-IT+ Intervention in Santiago, Chile

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 26^th, 2024. [https://clinicaltrials.gov/study/NCT06759441].