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Cited by 222Suicide and Self-Harm StudiesPsychiatric care and mental health servicesOpioid Use Disorder Treatment

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

Open access
Doupnik, Stephanie K., Rudd, Brittany, Schmutte, Timothy, Worsley, Diana, Bowden, Cadence F., McCarthy, Erin, Eggan, Elliott, Bridge, Jeffrey A. +1 more·2020·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2020.1586PMC PMC7301305
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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.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis of 14 brief acute care suicide prevention interventions found that the pooled intervention effect was associated with fewer subsequent suicide attempts and greater linkage to follow-up mental health care, but not with significantly reduced depression symptoms at follow-up. The authors conclude these brief interventions may improve key outcomes after an acute care encounter, though suicide deaths were not examined.

Key findings

  • Subsequent suicide attempts: pooled OR, 0.69 (95% CI, 0.55-0.87); Hedges g = 0.21 (95% CI, 0.08-0.33); I² = 0%; P = .72. The paper reports this corresponds to a risk difference of -0.035, a 3.5% reduction, or 78 fewer suicide attempts in 2241 patients in the pooled intervention groups.
  • Linkage to follow-up care: pooled OR, 2.74 (95% CI, 1.80-4.17); Hedges g = 0.55 (95% CI, 0.32-0.78); I² = 55.4%; P = .02. The paper reports this corresponds to a 22.5% absolute increase in completed follow-up.
  • Depression symptoms at follow-up: Hedges g = 0.28 (95% CI, -0.02 to 0.59), not statistically significant; I² = 72.2%; P = .003. Excluding Asarnow et al resulted in a statistically significant pooled effect (Hedges g = 0.38 [95% CI, 0.05-0.71]).
  • Intervention components among 14 studies: brief contact in 6 (42.9%), care coordination in 3 (21.4%), Safety Planning Intervention in 5, and all but 1 study provided a brief therapeutic intervention. For linkage to follow-up care, the Peter test showed statistically significant evidence of small study effects (regression coefficient, 53.07 [95% CI, 10.47-95.66]; P = .02).

Methods

  • Systematic review and meta-analysis conducted per PRISMA, registered with PROSPERO (CRD42019114964). Searched Ovid MEDLINE, Scopus, CINAHL, PsychINFO, and Embase for English-language studies published January 1, 2000, to December 31, 2019.
  • Eligible studies examined an intervention delivered in a single in-person encounter to patients with identified suicide risk, included a comparison group, measured patient outcomes, and were available in English; interventions consisting solely of brief follow-up contact were excluded.
  • Random-effects models pooled outcomes for subsequent suicide attempts, linkage to follow-up care, and depression symptoms at follow-up. Analyses used pooled ORs and Hedges g, converted ORs to standardized mean differences, assessed heterogeneity with I², and conducted sensitivity and subgroup analyses; risk of bias was assessed with the Cochrane Risk of Bias tool.

Limitations

  • Paper-stated: the literature search was limited to published English-language articles and reports; unpublished findings were not included; only 14 studies were identified, with only subsets included in each meta-analysis; one large study (Miller et al, 2017) accounted for a large proportion of participants and was heavily weighted; and most studies did not include death as an outcome, so the review could not examine whether interventions reduced suicide deaths.
  • Evident from the text: several meta-analyses included few studies, heterogeneity was statistically significant for linkage to follow-up care and depression symptoms, and the linkage-to-follow-up analysis showed statistically significant evidence of small study effects, which the authors note could be a false positive or could reflect publication bias, selective reporting, or true heterogeneity.
  • Evident from the text: risk of bias was commonly high for incomplete outcome data, especially in studies that did not describe how missing data were analyzed.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1001/jamapsychiatry.2020.1586

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 56 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    Every included study had enough data to assess intervention effects on at least one outcome.

    “All studies reported sufficient data to examine intervention effects on at least 1 outcome.”
    Quote in the paperSubstantial claim
  • Findingown data

    The outcomes reported most often by the included studies were later suicide attempts, attendance at follow-up care, and depression symptoms at follow-up.

    “Among included studies, the most commonly reported outcomes were subsequent suicide attempts, linkage to follow-up care, and depression symptoms at follow-up.”
    Quote in the paperSubstantial claim
  • Findingcitation

    Ten studies provided brief therapeutic approaches that were not Safety Planning Intervention.

    “Ten studies delivered brief therapeutic interventions other than a Safety Planning Intervention. 15,18,20,[22]][23][24][25][26][27][28]”
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  • Findingown data

    Seven studies (50%) assessed subsequent suicide attempts.

    “Seven studies (50%) examined subsequent suicide attempts as an outcome, [16][17][18]21,23,24,28”
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  • Findingown data

    All but one of the 14 studies provided a brief therapeutic intervention.

    “Of the 14 included studies, all but 1 study 19 provided a brief therapeutic intervention.”
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  • May combine two claims. 32
  • Classified as probably not a substantial claim. 40

  • May combine two claims.

    Findingown data

    The pooled effect of the included interventions on linkage to follow-up mental health care was an increase, with pooled OR 2.74 (95% CI 1.80-4.17) and Hedges g 0.55 (95% CI 0.32-0.78).

    “We found that the pooled effect size of included interventions was toward an increase in linkage to follow-up mental health care (pooled OR, 2.74 [95% CI, 1.80-4.17];Hedges g = 0.55 [95% CI, 0.32-0.78]).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Improving linkage to follow-up mental health care is beneficial for patients, for example by reducing suicide risk.

  • May combine two claims.

    Findingown data

    Fourteen studies were eligible for the narrative synthesis, covering outcomes for 4270 patients.

    “Ultimately, we identified 14 studies eligible for inclusion in the narrative synthesis (Figure 1), representing outcomes for 4270 patients.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Studies with complete data received a low risk rating.

    “Studies reporting complete data were assigned a low risk score.27,28”
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    Findingown data

    Full articles were reviewed for 125 studies.

    “After removing duplicates, we screened titles and abstracts for 2235 records, and of those, we reviewed the full article for 125 studies.”
    Quote in the paperNot a substantial claim

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    Findingown data

    Three of the 14 studies (21.4%) included care coordination.

    “Of the 14 included studies, 3 (21.4%)included care coordination.17,19,20”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Five studies (35.7%) used telephone calls as brief contact, and their patients also got handwritten notes by mail.

    “In 5 studies (35.7%), the brief contact included telephone calls, and of those studies, patients also received handwritten mailed notes.22”
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  • May combine two claims.

    Findingcitation

    The studies tracked participants for 2 months to 1 year after intervention and ascertained later suicide attempts through medical records or validated self-report.

    “Studies followed up study participants for 2 months to 1 year after the intervention to identify subsequent suicide attempts and used either medical record review 28 or validated patient self-report measures [16][17][18]21,23,24 to ascertain suicide attempts.”
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    Findingown data

    The database searches yielded 3968 articles.

    “Database searches returned 3968 articles.”
    Quote in the paperNot a substantial claim

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    Findingown data

    Four main components were identified: brief contact, care coordination, safety planning, and other brief therapeutic approaches.

    “We identified 4 main components of interventions delivered in the study: brief contact interventions, care coordination, safety planning interventions, and other brief therapies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The included studies tested brief suicide prevention interventions intended to encourage ongoing mental health care and lower later suicide attempts.

    “Included studies evaluated brief suicide prevention interventions to promote ongoing mental health care and reduce subsequent suicide attempts.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    A single study used a brief therapeutic intervention together with care coordination and brief contact.

    “One study included a brief therapeutic intervention, care coordination, and a brief contact intervention.20”
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Brief contact was part of the intervention in 6 of 14 studies (42.9%).

    “Brief contact was included as a component of a suicide prevention intervention for 6 of 14 included studies (42.9%).”
    Quote in the paperNot a substantial claim

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    Findingown data

    Three studies (21.4%) used both a brief therapeutic intervention and a brief contact intervention.

    “For example, 3 studies (21.4%) included a brief therapeutic intervention plus a brief contact intervention.16,23,26”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    A single study delivered brief caring contacts by text at day 1, week 1, and nine additional points across 12 months, with trained counselors responding to replies.

    “One study 18 used text messaging to provide brief caring contacts at 1 day, 1 week, and 9 other times throughout 12 months, and trained counselors responded to recipients' replies either with supportive statements or to ensure the recipient engaged with mental health treatment.”
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    Findingown data

    Six studies (42.9%) assessed depression.

    “and 6 (42.9%) examined depression as an outcome.15,16,[19][20][21][22]”
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    Findingown data

    Nine studies (64.3%) assessed linkage to follow-up care.

    “9 (64.3%)examined link to follow-up care as an outcome, 16,[19][20][21][24][25][26][27][28]”
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    Findingown data

    After duplicates were removed, 2235 records were screened by title and abstract.

    “After removing duplicates, we screened titles and abstracts for 2235 records, and of those, we reviewed the full article for 125 studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Incomplete outcome data was the domain most often rated high risk, sometimes because of missing-data handling.

    “The most common domain in which studies were assigned a high risk of bias was in incomplete outcomes data, in some cases owing to handling of missing data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Four more eligible articles were found by checking references of included studies.

    “We identified 4 additional eligible articles from review of references of included studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    If a study did not say how missing data were handled, it was rated high risk for incomplete outcome data.

    “Studies that did not mention how missing data were analyzed were assigned a high risk score on the incomplete outcome data domain.17,[20][21][22][23]26”
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    Findingcitation

    Three studies (21.4%) delivered Safety Planning Intervention plus an additional brief therapeutic component, for example treatment engagement.

    “Finally, 3 studies (21.4%) included the Safety Planning Intervention enhanced with another brief therapeutic intervention such as treatment engagement.24,27,28”
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  • May combine two claims.

    Findingown data

    Excluding any single study from the pooled analysis did not change the finding that interventions were associated with higher odds of linkage to follow-up care, indicating no individual study had an outsize influence.

    “The pooled effect of the interventions consistently showed higher odds of linkage to follow-up care regardless of which study was excluded from the analysis, suggesting that no individual study had an outsize influence on the findings.”
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    Findingcitation

    Studies reporting a standard approach to missing data, including multiple imputation or last observation carried forward, were rated medium risk.

    “Studies that described a standard method for handling missing data during analysis, such as multiple imputation or last observation carried forward, were assigned a medium risk score. 15,16,18,19,24,25”
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  • May combine two claims.

    Findingown data

    The pooled OR for subsequent suicide attempts was 0.69, corresponding to a risk difference of -0.035, a 3.5% reduction or 78 fewer suicide attempts in 2241 patients in the pooled intervention groups.

    “The pooled OR for subsequent suicide attempts was 0.69, corresponding to a risk difference of -0.035, a 3.5% reduction or 78 fewer suicide attempts in 2241 patients in the pooled intervention groups.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Reducing subsequent suicide attempts lowers the risk of suicide deaths.

  • May combine two claims.

    Findingown data

    The systematic review identified 14 brief suicide prevention interventions that included 4 main components: brief contact, care coordination, safety planning, and other brief therapies.

    “In this systematic review, we identified 14 brief suicide prevention interventions that included 4 main components: brief contact, care coordination, safety planning, and other brief therapies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    We were able to examine 3 important outcomes from the published literature, and for 2 of the 3 outcomes we found no evidence of publication bias using a conservative test.

    “Nevertheless, we were able to examine 3 important outcomes from the published literature, and for 2 of the 3 outcomes we found no evidence of publication bias using a conservative test.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In adolescent-only subgroup analysis, the effect size for linkage did not differ from the main analysis, but heterogeneity was not statistically significant (I2=39%; P=.18).

    “The subgroup analysis including only adolescent populations had no difference in effect size from the main analysis; however, there was no statistically significant heterogeneity (I 2 = 39%; P = .18).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The pooled effect of the interventions on depression symptoms at follow-up was not statistically significant (Hedges g=0.28, 95% CI -0.02 to 0.59), with intervention groups having nonsignificantly lower depression scores than control groups.

    “The pooled effect size of included interventions on depression symptoms at follow-up was not significantly significant (Hedges g = 0.28 [95% CI, -0.02 to 0.59]).”
    • Also stated in: § Meta-analysis Results · plain
      “The intervention groups had nonsignificantly lower depression scores (ie, fewer depression symptoms) at follow-up compared with the control groups at follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For depression at follow-up, the contour-enhanced funnel plot was asymmetrical but showed 4 studies with nonsignificant P values.

    “For depression at followup, although asymmetrical, the funnel plot shows 4 studies with nonsignificant P values.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For linkage to follow-up care, the pooled OR was 2.74, corresponding to a 22.5% absolute increase in rates of completed follow-up in patients receiving the intervention.

    “For linkage to follow-up care, the pooled OR was 2.74, which corresponds to a 22.5% absolute increase in rates of completed follow-up in patients receiving the intervention.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Improving linkage to follow-up mental health care is beneficial for patients, for example by reducing suicide risk.

  • May combine two claims.

    Findingown data

    For subsequent suicide attempts, the funnel plot appeared symmetrical and showed 2 studies with nonsignificant P values.

    “For subsequent suicide attempts, the funnel plot appears symmetrical and shows 2 studies with nonsignificant P values.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In adult-only subgroup analysis, the effect size and heterogeneity for linkage did not differ from the main analysis.

    “The subgroup analysis of adults showed no difference in effect size or heterogeneity compared with the main analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The review and meta-analysis were conducted and reported following PRISMA.

    “We conducted and reported the systematic review and metaanalysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.8”
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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    National best practices for suicide prevention recommend that people identified as at risk receive treatment aimed at lowering suicide risk and services that keep them engaged in mental health care.

    “National suicide prevention best practices recommend that individuals identified as being at risk of suicide receive treatment specifically directed to reduce their risk of suicide and services to ensure they remain engaged in mental health care.6”
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    Premisecitation

    Brief interventions can be given in one time-limited encounter by trained professionals and emphasize ongoing treatment.

    “Brief interventions can be delivered in a single time-limited encounter by trained professionals and include an emphasis on ongoing treatment.”
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    Study design and conductown data

    Two authors independently extracted data from each study using a structured form.

    “Two study authors (either E.M. or E.E. and either D.W. or C.F.B.) independently abstracted relevant data for each study using a structured form, including study setting, intervention description, characteristics of the sample, inclusion/exclusion criteria, and study outcomes.”
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    Study design and conductown data

    Sensitivity analyses were performed to see whether any single study strongly influenced the pooled effect estimates.

    “We conducted sensitivity analyses to determine whether any study had a large influence on the pooled-effect estimates and subgroup analyses to investigate sources of heterogeneity.”
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    Premisecitation

    Visits to emergency departments for suicidal ideation and attempts have doubled over recent decades.

    “Emergency department visits for suicidal ideation and suicide attempts have doubled in recent decades.4,5”
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    Study design and conductcitation

    Study design and threats to inference were assessed with the Cochrane Risk of Bias tool.

    “Study design and threats to inference were evaluated by applying the Cochrane Risk of Bias tool. 10”
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    Study design and conductown data

    The protocol was registered with PROSPERO under CRD42019114964.

    “Our protocol was registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42019114964).”
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    Study design and conductnone given

    Team meetings were held to discuss and resolve disagreements and reach consensus on inclusion decisions.

    “We held team meetings to discuss and resolve discrepancies and reach consensus on all inclusion decisions.”
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    Study design and conductown data

    Possible small-study effects, including publication bias, were checked using the Peter regression test for binary outcomes and the Egger test for the continuous depression outcome.

    “We examined for evidence of small study effects, such as publication bias, using the Peter regression test for binary outcomes (suicide attempt and linkage to follow-up care) and the Egger test for the continuous outcome of depression symptoms at follow-up.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Subgroup analyses were performed to explore sources of heterogeneity.

    “We conducted sensitivity analyses to determine whether any study had a large influence on the pooled-effect estimates and subgroup analyses to investigate sources of heterogeneity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In acute care, brief interventions help identify and initially manage various mental health and other problems and have practical advantages.

    “Brief interventions are used in acute care to identify and provide initial management for a number of mental health and other problems and offer several practical advantages.7”
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    Study design and conductown data

    Each study received a low, medium, or high risk-of-bias rating in each of the tool's nine domains.

    “Each study's risk of bias was assigned low, medium, or high risk in each of the tool's 9 domains.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Two authors independently screened titles and abstracts to find eligible studies.

    “Two study authors (E.M. and E.E.) independently reviewed titles and abstracts of retrieved studies to identify studies eligible for inclusion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Brief interventions focusing on immediate suicide risk reduction and transition to ongoing mental health care are well suited for acute settings that cannot provide ongoing longitudinal mental health care.

    “Brief interventions that focus on immediate suicide risk reduction and transition to ongoing mental health care are well suited for settings not equipped to offer ongoing, longitudinal mental health care.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Our study builds on previous findings by evaluating a broader range of interventions, including safety planning and care coordination, and a broader range of outcomes, including successful linkage to follow-up care.

    “Our study builds on these previous findings by evaluating a broader range of interventions, including those focused on safety planning and care coordination, and a broader range of outcomes, including successful linkage to follow-up care.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    For depression and suicide attempt outcomes, funnel plots do not show strong evidence of publication bias, consistent with the Egger test showing no evidence of small study effects.

    “Therefore, for the depression and suicide attempt outcomes, funnel plots do not show strong evidence of publication bias, which is consistent with the Egger test showing no evidence of small study effects.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A small meta-analysis of 2 studies of interventions involving active follow-up after emergency department discharge found that these interventions reduced subsequent suicide attempts.

    “Consistent with our findings, a small meta-analysis of 2 studies of interventions involving active follow-up after emergency department discharge found that these interventions reduced subsequent suicide attempts.32”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    If the small study effects finding for linkage is a true positive, it could be explained by publication bias, selective reporting, or true heterogeneity.

    “If a true positive, small study effects could be explained by publication bias (ie, studies with nonsignificant findings are not published in the literature), selective reporting (ie, studies only reported those outcomes with statistically significant differences), or true heterogeneity (ie, the interventions have a different effect in studies with small samples).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Brief contact interventions reduce the number of suicide attempts per person but not the total number of suicide attempts or suicide deaths.

    “Brief contact interventions reduce the number of suicide attempts per person but not the total number of suicide attempts or suicide deaths.9”
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    Interpretationown data

    Future efforts to implement brief suicide prevention interventions in acute care are likely to reduce patients' risk of future suicide attempts and improve their continuity of mental health care.

    “Future efforts to implement brief suicide prevention interventions in acute care are likely to reduce patients' risk of future suicide attempts and improve their continuity of mental health care.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Reducing subsequent suicide attempts lowers the risk of suicide deaths.
    • Rests on an assumption: Improving linkage to follow-up mental health care is beneficial for patients, for example by reducing suicide risk.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Premisereasoning

    In the US and many other countries, mental health care remains difficult to access, and care coordination was likely included as a component of many interventions due to the complexity of navigating mental health care systems.

    “Nevertheless, in the US and many other countries, mental health care remains difficult to access, and care coordination was likely included as a component of many interventions due to the complexity of navigating mental health care systems.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    The systematic review identified only 14 studies, and only the subsets with relevant outcomes were included in each meta-analysis.

    “The systematic review identified only 14 studies, and only the subsets with relevant outcomes were included in each meta-analysis.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The statistically significant small study effects finding for linkage could be a false positive given the known risk of false positives with few publications and substantial heterogeneity.

    “Given known risk of false positives when a small number of publications are included in the analysis and when there is substantial hetero-geneity of effects between studies, this finding could be a false positive.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    For linkage to follow-up mental health care, the funnel plot is asymmetrical and only 1 study had a nonsignificant P value, indicating there could be publication bias for this outcome.

    “For linkage to follow-up mental health care, the funnel plot is asymmetrical and only 1 study had a nonsignificant P value, indicating that there could be publication bias (ie, suppression of studies with nonsignificant findings) for this outcome.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Joint Commission's 2016 mandate to identify patients at risk of suicide has increased the number of health care settings screening for suicide risk, but the success of screening initiatives likely varies, particularly in settings with limited mental health expertise.

    “The Joint Commission's 2016 mandate to identify patients at risk of suicide 33 has increased the number of health care settings screening for suicide risk; however, the success of screening initiatives likely varies, particularly in settings with limited mental health expertise.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    One large study accounted for a large proportion of the study participants and was therefore heavily weighted in the meta-analyses.

    “One large study 23 accounted for a large proportion of the study participants and was therefore heavily weighted in the metaanalyses.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    We did not include unpublished findings about suicide prevention interventions, such as findings from local quality improvement initiatives or unpublished research.

    “We did not include unpublished findings about suicide prevention interventions, such as findings from local quality improvement initiatives or unpublished research.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Our literature search was limited to published articles and reports available in English.

    “Our literature search was limited to published articles and reports available in English.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Smartphone applications for self-management of suicide risk were associated with reduced suicide ideation but not subsequent suicide attempts or deaths.

    “Smartphone applications for selfmanagement of suicide risk were associated with reduced suicide ideation but not subsequent suicide attempts or deaths.31”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31]

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Suicide prevention interventions delivered during and after a single in-person acute care encounter may be effective at reducing subsequent suicide attempts and improving patients' odds of linkage to follow-up mental health care.

    “Suicide prevention interventions delivered during and after a single in-person acute care encounter may be effective at reducing subsequent suicide attempts and improving patients' odds of linkage to follow-up mental health care.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Reducing subsequent suicide attempts lowers the risk of suicide deaths.
    • Rests on an assumption: Improving linkage to follow-up mental health care is beneficial for patients, for example by reducing suicide risk.
63 of 63

  • The paper relies on this without support.

    Acute care settings, including hospitals, emergency departments, urgent care centers, jails, and shelters, lack enough specialty mental health clinicians and may be unable to provide continuous mental health care.

    “However, acute health care settings including hospitals, emergency departments, and urgent care centers as well as other settings that deliver acute suicide prevention services, such as jails and shelters, are not well staffed with specialty mental health clinicians and may not have the capacity to offer continuity of mental health care.”

  • The paper relies on this without support.

    Clinical teams require evidence-based interventions that directly address suicide risk and support patients' transition to continuing longitudinal mental health care.

    “To achieve these goals, clinical teams need evidence-based interventions to directly address suicide risk and to ensure that patients transition to ongoing, longitudinal mental health care.”

  • The paper relies on this without support.

    Acute care settings are on the front line of suicide prevention and need effective tools to lower patients' risk of suicide-related morbidity and death.

    “Nevertheless, these settings are at the front line of suicide prevention and require effective tools to reduce patients' risk of morbidity from suicide ideation and attempts and their risk of suicide death.”

  • The paper relies on this without support.

    Reducing subsequent suicide attempts lowers the risk of suicide deaths.

    “Our findings provide important evidence that brief suicide prevention interventions may be effective at targeting important end points that reduce risk of suicide deaths.”
    “Suicide prevention interventions delivered during and after a single in-person acute care encounter may be effective at reducing subsequent suicide attempts and improving patients' odds of linkage to follow-up mental health care.”

  • The paper relies on this without support.

    Improving linkage to follow-up mental health care is beneficial for patients, for example by reducing suicide risk.

    “For linkage to follow-up care, the pooled OR was 2.74, which corresponds to a 22.5% absolute increase in rates of completed follow-up in patients receiving the intervention.”
    “Suicide prevention interventions delivered during and after a single in-person acute care encounter may be effective at reducing subsequent suicide attempts and improving patients' odds of linkage to follow-up mental health care.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Previous meta-analyses of studies including SPTIs focused on brief interventions more broadly.

    “whereas meta-analyses of studies that included SPTIs have focused on brief interventions more broadly.7,8”

    From Safety planning-type interventions for suicide prevention: meta-analysis (2021) · cites this paper as [8]

  • Previous meta-analyses did not report on the effectiveness of SPTIs specifically.

    “Although the latter have made an important contribution to the literature, they did not include all published trials on SPTIs, and did not report on the effectiveness of SPTIs specifically.7,8”

    From Safety planning-type interventions for suicide prevention: meta-analysis (2021) · cites this paper as [8]

  • Previous meta-analyses did not include all published trials on SPTIs.

    “Although the latter have made an important contribution to the literature, they did not include all published trials on SPTIs, and did not report on the effectiveness of SPTIs specifically.7,8”

    From Safety planning-type interventions for suicide prevention: meta-analysis (2021) · cites this paper as [8]

    The Evidence Synthesis reports 14 eligible studies, and the Description of Brief Suicide Prevention Interventions says five delivered a Safety Planning Intervention. Neither section establishes that this or another previous meta-analysis omitted published SPTI trials; searches for comparisons with prior reviews did not resolve that point. (LLM, conf=0.70)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Database-search count differs from the flow diagram

    Minor

    The results say database searches returned 3968 articles, whereas the flow diagram assigns 3964 records to database searching and 4 to other sources.

  • Care-coordination count omits a study marked in the table

    Minor

    The text identifies only studies 17, 19, and 20 as including care coordination, but the table also marks study 21 as having that component. That makes four studies rather than three.

  • Forest-plot caption calls Hedges g an odds ratio

    Minor

    The figure labels its plotted effects as Hedges g, but its caption says the vertical line shows a pooled odds ratio across all three outcomes. Depression is reported as Hedges g rather than an odds ratio.

  • Currier study has conflicting publication years

    Minor

    The depression forest plot labels Currier et al as 2019, while the study table labels the same cited study as 2010.

4 of 4

Cites

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Cited by

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Related

Authors
Doupnik, S. K., Rudd, B., Schmutte, T., Worsley, D., Bowden, C. F., McCarthy, E., Eggan, E., Bridge, J. A., & Marcus, S. C.
Affiliations
  • Children's Hospital of Philadelphia (US)
  • University of Illinois Chicago (US)
  • Yale University (US)
  • Nationwide Children's Hospital (US)
  • Leonard Davis Institute of Health Economics (US)
Corresponding author
Doupnik, Stephanie K.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2020-10-01
Volume
77
Issue
10
Pages
1021
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2020.1586
PMC
PMC7301305
OpenAlex
W3036411432
Semantic Scholar
5e81eede4b1796d0b27a56d623f9df935000a79d
Cited by
222
References
33
Citations by year
2026: 24 · 2025: 45 · 2024: 46 · 2023: 38 · 2022: 30 · 2021: 33 · 2020: 6
FWCI
2.11
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (K23MH115162, R01MH107452, T32MH109433)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
suicide prevention interventions, suicide attempts, depressive symptoms, acute care settings, access to mental health care
MeSH terms
Suicide Prevention, Aftercare, Clinical Trials as Topic, Depression, Depressive Disorder, Follow-Up Studies, Humans, Psychotherapy, Brief, Recurrence, Suicide, Suicide, Attempted, Odds Ratio, Risk Assessment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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