Methods and Efficacy of Social Support Interventions in Preventing Suicide: A Systematic Review and Meta-Analysis

Abstract

Background: The objectives of this systematic review are to describe and summarize the suicide prevention approaches through offering social support, and to examine the efficacy of these interventions. Methods: Six electronic databses were searched. The inclusion criteria for the summary of intervention approaches were: (a) studies aimed at preventing suicide through approach(es) that offer social support directly; (b) suicide-related outcomes must be presented. The additional inclusion criteria for meta-analysis on the efficacy of these interventions included: (a) suicidal attempt or death was a outcome measure; (b) RCT design; and (c) using social support intervention as the main/only method. Findings: 17,645 articles were identified. In the 51 studies included in stage 1, the approaches were categorized into and Reciprocal based on the direction of support provided. Unidirectional support intervention were further classified as with and without interaction based on whether there were immediate interaction between support providers and receipients. For suicide attempt during a total of 10,095 person-years, there was a non-significant reduction in overall pooled odds ratio of 0·87 (95% CI: 0·69-1·11). However, the number of suicide during 14,834 person-years was significantly reduced in the intervention group (pooled odds ratio 0·48, 95% CI 0·30-0·77). Further sub-group analyses found that unidirectional interventions with interaction was significantly superior than those without interaction in preventing suicide (p=0·02), but not in preventing suicide attempt (p=0·70). Interpretation: Three types of approaches that provide support of different quality at different costs are identified. We recommend unidirectional intervention with interaction as a suicide prevention strategy for those with elevated suicide risk. Funding Statement: The authors stated: There was no funding source for this study. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was undertaken according to the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines.