Safety planning-type interventions for suicide prevention: meta-analysis

• Published in: British journal of psychiatry Vol. 219; no. 2; pp. 419 - 426
• Main Authors: Nuij, Chani, van Ballegooijen, Wouter, de Beurs, Derek, Juniar, Dilfa, Erlangsen, Annette, Portzky, Gwendolyn, O'Connor, Rory C., Smit, Johannes H., Kerkhof, Ad, Riper, Heleen
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01-08-2021
• Subjects: Behavior; Behavior modification; Bias; Clinical medicine; Clinical practice guidelines; Confidence intervals; General Adult; Humans; Intervention; Meta-analysis; Number needed to treat; Patients; Planning; Prevention; Prevention programs; Psychiatry; Questionnaires; Review; Risk factors; Safety; Suicidal Ideation; Suicide; Suicide - prevention & control; Suicides & suicide attempts; Systematic review; United States > US; suicide prevention; meta-analysis; Suicide; safety planning
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.2021.50

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.