Abstract
Safety planning-type interventions (SPTIs) for patients at risk of suicide are often used in clinical practice, but it is unclear whether these interventions are effective. This article reports on a meta-analysis of studies that have evaluated the effectiveness of SPTIs in reducing suicidal behaviour and ideation. We searched Medline, EMBASE, PsycINFO, Web of Science and Scopus from their inception to 9 December 2019, for studies that compared an SPTI with a control condition and had suicidal behaviour or ideation as outcomes. Two researchers independently extracted the data. To assess suicidal behaviour, we used a random-effects model of relative risk based on a pooled measure of suicidal behaviour. For suicidal ideation, we calculated effect sizes with Hedges' g. The study was registered at PROSPERO (registration number CRD42020129185). Of 1816 unique abstracts screened, 6 studies with 3536 participants were eligible for analysis. The relative risk of suicidal behaviour among patients who received an SPTI compared with control was 0.570 (95% CI 0.408-0.795, P = 0.001; number needed to treat, 16). No significant effect was found for suicidal ideation. To our knowledge, this is the first study to report a meta-analysis on SPTIs for suicide prevention. Results support the use of SPTIs to help preventing suicidal behaviour and the inclusion of SPTIs in clinical guidelines for suicide prevention. We found no evidence for an effect of SPTIs on suicidal ideation, and other interventions may be needed for this purpose.
Highlights
Safety planning-type interventions (SPTIs) for patients at risk of suicide are often used in clinical practice, but it is unclear whether these interventions are effective
The relative risk of suicidal behaviour among patients who received an SPTI compared with control was 0.570
To our knowledge, this is the first study to report a meta-analysis on SPTIs for suicide prevention
Summary
Safety planning-type interventions (SPTIs) for patients at risk of suicide are often used in clinical practice, but it is unclear whether these interventions are effective. Suicidal behaviour is a significant public health issue worldwide, resulting in an estimated 16 million suicide attempts and 800 000 suicides per year.[1] For every person who dies by suicide, more than 20 others make a non-fatal attempt,[2] and many more have serious thoughts about ending their life.[3] Suicidal ideation and suicidal behaviour (including both fatal and non-fatal suicide attempts) constitute a substantial disease burden. This underlines the importance of suicide prevention.[4]. There is an increasing body of evidence in support of several psychological treatments for suicide prevention, including cognitive–behavioural therapy and dialectical behaviour therapy.[5,6] In recent years, brief interventions, defined as up to three encounters between a patient and (para-)professional, have been linked to reduced risks of suicidal behaviour.[7,8]
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