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Original Investigation
June 17, 2020

Association of Suicide Prevention Interventions With Subsequent Suicide Attempts, Linkage to Follow-up Care, and Depression Symptoms for Acute Care Settings: A Systematic Review and Meta-analysis

Author Affiliations
  • 1PolicyLab, Center for Pediatric Clinical Effectiveness, Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 2Department of Pediatrics, University of Pennsylvania, Philadelphia
  • 3Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
  • 4Center for Mental Health, University of Pennsylvania, Philadelphia
  • 5now with Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, Chicago
  • 6Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
  • 7Department of Psychiatry, Massachusetts General Hospital, Boston
  • 8Research Institute at Nationwide Children’s Hospital, Department of Pediatrics, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus
JAMA Psychiatry. Published online June 17, 2020. doi:10.1001/jamapsychiatry.2020.1586
Key Points

Question  Are brief interventions delivered in a single encounter to individuals at risk of suicide effective at improving patient outcomes?

Findings  In this systematic review and meta-analysis of 14 studies, brief acute care suicide prevention interventions were associated with reduced subsequent suicide attempts and increased chances of linkage to follow-up care. Most interventions included multiple components; the most common components were care coordination, safety planning, brief follow-up contacts, and brief therapeutic interventions.

Meaning  The evidence supports incorporating brief suicide prevention interventions into routine acute care practice.

Abstract

Importance  To prevent suicide deaths, acute care settings need tools to ensure individuals at risk of suicide access mental health care and remain safe until they do so.

Objective  To examine the association of brief acute care suicide prevention interventions with patients’ subsequent suicide attempts, linkage to follow-up care, and depression symptoms at follow-up.

Data Sources  Ovid MEDLINE, Scopus, CINAHL, PsychINFO, Embase, and references of included studies using concepts of suicide, prevention, and clinical trial to identify relevant articles published January 2000 to May 2019.

Study Selection  Studies describing clinical trials of single-encounter suicide prevention interventions were included. Two reviewers independently reviewed all articles to determine eligibility for study inclusion.

Data Extraction and Synthesis  Two reviewers independently abstracted data according to PRISMA guidelines and assessed studies’ risk of bias using the Cochrane Risk of Bias tool. Data were pooled for each outcome using random-effects models. Small study effects including publication bias were assessed using Peter and Egger regression tests.

Main Outcomes and Measures  Three primary outcomes were examined: subsequent suicide attempts, linkage to follow-up care, and depression symptoms at follow-up. Suicide attempts and linkage to follow-up care were measured using validated patient self-report measures and medical record review; odds ratios and Hedges g standardized mean differences were pooled to estimate effect sizes. Depression symptoms were measured 2 to 3 months after the encounter using validated self-report measures, and pooled Hedges g standardized mean differences were used to estimate effect sizes.

Results  A total of 14 studies, representing outcomes for 4270 patients, were included. Pooled-effect estimates showed that brief suicide prevention interventions were associated with reduced subsequent suicide attempts (pooled odds ratio, 0.69; 95% CI, 0.53-0.89), increased linkage to follow-up (pooled odds ratio, 3.04; 95% CI, 1.79-5.17) but were not associated with reduced depression symptoms (Hedges g = 0.28 [95% CI, −0.02 to 0.59).

Conclusions and Relevance  In this meta-analysis, breif suicide prevention interventions were associated with reduced subsequent suicide attempts. Suicide prevention interventions delivered in a single in-person encounter may be effective at reducing subsequent suicide attempts and ensuring that patients engage in follow-up mental health care.

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