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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 accessAbstract
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.
Overview
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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.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“All studies reported sufficient data to examine intervention effects on at least 1 outcome.”
§ 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 > Study Selection
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In the paper
“Among included studies, the most commonly reported outcomes were subsequent suicide attempts, linkage to follow-up care, and depression symptoms at follow-up.”
§ 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 > Study Selection
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In the paper
“Ten studies delivered brief therapeutic interventions other than a Safety Planning Intervention. 15,18,20,[22]][23][24][25][26][27][28]”
§ 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 > Description of Brief Suicide Prevention Interventions
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Seven studies (50%) examined subsequent suicide attempts as an outcome, [16][17][18]21,23,24,28”
§ 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 > Meta-analysis Results
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Of the 14 included studies, all but 1 study 19 provided a brief therapeutic intervention.”
§ 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 > Description of Brief Suicide Prevention Interventions
What the sources say
- Not checked yetcites [19] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“The most common brief therapeutic intervention was the Safety Planning Intervention, which was delivered in 5 studies.16,18,24,27,28”
§ 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 > Description of Brief Suicide Prevention Interventions
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We found that the pooled effect of the interventions was consistently toward a reduction in subsequent suicide attempts regardless which study was excluded, suggesting that no individual study disproportionately affected findings.”
§ 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 > Meta-analysis Results
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All 14 contributed data to a meta-analysis of at least 1 outcome.”
§ 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 > Evidence Synthesis
Strength:plain· not yet calibratedn = 4,270Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We found that heterogeneity between studies was statistically significant (I 2 = 55.4%;P = .02),suggesting that the included interventions varied in their associations with patients' likelihood of linkage to follow-up care.”
§ 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 > Meta-analysis Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We did not find statistically significant heterogeneity in the studies' associations with subsequent suicide attempts (I 2 = 0%; P = .72),suggesting that included interventions had a similar effect in reducing subsequent suicide attempts.”
§ 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 > Meta-analysis Results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
- It may state two separate claims as one. 32
- Probably not a substantial claim. 40
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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]).”
§ 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 > Meta-analysis Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: Improving linkage to follow-up mental health care is beneficial for patients, for example by reducing suicide risk.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Ultimately, we identified 14 studies eligible for inclusion in the narrative synthesis (Figure 1), representing outcomes for 4270 patients.”
§ 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 > Evidence Synthesis
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Studies reporting complete data were assigned a low risk score.27,28”
§ 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 > Risk of Bias
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“After removing duplicates, we screened titles and abstracts for 2235 records, and of those, we reviewed the full article for 125 studies.”
§ 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 > Evidence Synthesis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Of the 14 included studies, 3 (21.4%)included care coordination.17,19,20”
§ 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 > Description of Brief Suicide Prevention Interventions
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“In 5 studies (35.7%), the brief contact included telephone calls, and of those studies, patients also received handwritten mailed notes.22”
§ 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 > Description of Brief Suicide Prevention Interventions
What the sources say
- Not checked yetcites [22] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ 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 > Meta-analysis Results
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Database searches returned 3968 articles.”
§ 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 > Evidence Synthesis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We identified 4 main components of interventions delivered in the study: brief contact interventions, care coordination, safety planning interventions, and other brief therapies.”
§ 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 > Description of Brief Suicide Prevention Interventions
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Included studies evaluated brief suicide prevention interventions to promote ongoing mental health care and reduce subsequent suicide attempts.”
§ 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 > Description of Brief Suicide Prevention Interventions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“One study included a brief therapeutic intervention, care coordination, and a brief contact intervention.20”
§ 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 > Description of Brief Suicide Prevention Interventions
What the sources say
- Not checked yetcites [20] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Brief contact was included as a component of a suicide prevention intervention for 6 of 14 included studies (42.9%).”
§ 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 > Description of Brief Suicide Prevention Interventions
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“For example, 3 studies (21.4%) included a brief therapeutic intervention plus a brief contact intervention.16,23,26”
§ 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 > Description of Brief Suicide Prevention Interventions
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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.”
§ 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 > Description of Brief Suicide Prevention Interventions
What the sources say
- Not checked yetcites [18] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“and 6 (42.9%) examined depression as an outcome.15,16,[19][20][21][22]”
§ 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 > Meta-analysis Results
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“9 (64.3%)examined link to follow-up care as an outcome, 16,[19][20][21][24][25][26][27][28]”
§ 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 > Meta-analysis Results
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“After removing duplicates, we screened titles and abstracts for 2235 records, and of those, we reviewed the full article for 125 studies.”
§ 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 > Evidence Synthesis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Risk of Bias
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We identified 4 additional eligible articles from review of references of included studies.”
§ 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 > Evidence Synthesis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ 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 > Risk of Bias
What the sources say
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Finally, 3 studies (21.4%) included the Safety Planning Intervention enhanced with another brief therapeutic intervention such as treatment engagement.24,27,28”
§ 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 > Description of Brief Suicide Prevention Interventions
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Meta-analysis Results
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ 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 > Risk of Bias
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: Reducing subsequent suicide attempts lowers the risk of suicide deaths.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ 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 > Meta-analysis Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Meta-analysis Results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § Meta-analysis Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For depression at followup, although asymmetrical, the funnel plot shows 4 studies with nonsignificant P values.”
§ 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 > Small Study Effects and Publication Bias
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: Improving linkage to follow-up mental health care is beneficial for patients, for example by reducing suicide risk.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For subsequent suicide attempts, the funnel plot appears symmetrical and shows 2 studies with nonsignificant P values.”
§ 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 > Small Study Effects and Publication Bias
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The subgroup analysis of adults showed no difference in effect size or heterogeneity compared with the main analysis.”
§ 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 > Meta-analysis Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“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”
§ 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 > Methods
What the sources say
- Not checked yetcites [8] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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”
§ 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 > S
What the sources say
- Not checked yetcites [6] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
In the paper
“Brief interventions can be delivered in a single time-limited encounter by trained professionals and include an emphasis on ongoing 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 > S
What the sources say
- Not checked yetcites [7] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Data Abstraction, Evaluation, and Synthesis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Meta-analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Emergency department visits for suicidal ideation and suicide attempts have doubled in recent decades.4,5”
§ 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 > S
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Study design and threats to inference were evaluated by applying the Cochrane Risk of Bias tool. 10”
§ 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 > Data Abstraction, Evaluation, and Synthesis
What the sources say
- Not checked yetcites [10] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our protocol was registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42019114964).”
§ 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 > Methods
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We held team meetings to discuss and resolve discrepancies and reach consensus on all inclusion decisions.”
§ 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 > Study Selection
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Meta-analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Meta-analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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”
§ 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 > S
What the sources say
- Not checked yetcites [7] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Each study's risk of bias was assigned low, medium, or high risk in each of the tool's 9 domains.”
§ 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 > Data Abstraction, Evaluation, and Synthesis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Two study authors (E.M. and E.E.) independently reviewed titles and abstracts of retrieved studies to identify studies eligible for inclusion.”
§ 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 > Study Selection
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > S
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Small Study Effects and Publication Bias
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“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”
§ 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 > Discussion
What the sources say
- Not checked yetcites [32]
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ 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 > Small Study Effects and Publication Bias
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Brief contact interventions reduce the number of suicide attempts per person but not the total number of suicide attempts or suicide deaths.9”
§ 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 > Discussion
What the sources say
- Not checked yetcites [9] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Conclusions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- 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.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The systematic review identified only 14 studies, and only the subsets with relevant outcomes were included in each meta-analysis.”
§ 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 > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Small Study Effects and Publication Bias
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Small Study Effects and Publication Bias
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“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.”
§ 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 > Discussion
What the sources say
- Not checked yetcites [33]
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“One large study 23 accounted for a large proportion of the study participants and was therefore heavily weighted in the metaanalyses.”
§ 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 > Limitations
What the sources say
- Not checked yetcites [23] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did not include unpublished findings about suicide prevention interventions, such as findings from local quality improvement initiatives or unpublished research.”
§ 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 > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our literature search was limited to published articles and reports available in English.”
§ 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 > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Smartphone applications for selfmanagement of suicide risk were associated with reduced suicide ideation but not subsequent suicide attempts or deaths.31”
§ 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 > Discussion
What the sources say
- Not checked yetcites [31]
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Conclusions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- 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.
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.”
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?
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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 check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
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
MinorThe results say database searches returned 3968 articles, whereas the flow diagram assigns 3964 records to database searching and 4 to other sources.
“Database searches returned 3968 articles.”
“3964 Records identified through database searching 4 Records identified through other sources”
Care-coordination count omits a study marked in the table
MinorThe 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.
“Of the 14 included studies, 3 (21.4%)included care coordination.17,19,20”
“Grupp-Phelan et al, 21 2019 2 Urban children's hospital EDs in the US 168 Adolescents (aged 12-17 y) with nonpsychiatric chief complaint and positive screening for suicide ideation or attempt; not receiving mental health services Yes Yes Yes No”
Forest-plot caption calls Hedges g an odds ratio
MinorThe 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.
“The vertical line shows the pooled odds ratio across all 3 outcomes.”
“Figure: 2 Figure 2 . Figure 2. Forest Plots for 3 Study Outcomes: Depression, Linkage to Follow-up Care, and Subsequent Suicide Attempts Weight, % Study Hedges g (95% CI)”
Currier study has conflicting publication years
MinorThe depression forest plot labels Currier et al as 2019, while the study table labels the same cited study as 2010.
“Currier et al, 19 2019 0.31 (-0.05 to 0.66)”
“Currier et al, 19 2010 1 Urban psychiatric ED in the US”
Citations
Cites
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The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
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Sterne, J. A. C., Sutton, A. J., Ioannidis, J. P. A., Terrin, N., Jones, D. R., Lau, J., Carpenter, J., Rucker, G., Harbord, R. M., Schmid, C. H., et al. (2011) · BMJ · doi:10.1136/bmj.d4002 · Cited by 7,709
Safety planning intervention: a brief intervention to mitigate suicide risk.
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Chapter 10: Addressing reporting biases
Egger, M., & Moher, D. (2011) · Cited by 977
Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., Chaudhury, S. R., Bush, A. L., & Green, K. L. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.1776 · Cited by 648
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Goldman-Mellor, S. J., & Qin, P. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.09.053 · Cited by 4
Mansfield, Y., Hamilton, S. J., Argus, J., Wyder, M., Macready, R., James, B., Stewart, C., & Meehan, T. (2021) · Crisis · doi:10.1027/0227-5910/a000803 · Cited by 4
Schuster, H., Jones, N. M., & Qadri, S. F. (2021) · Cureus · doi:10.7759/cureus.20648 · Cited by 4
Khazanov, G. K., Jager‐Hyman, S., Harrison, J. D., Candon, M. K., Buttenheim, A. M., Pieri, M. F., Oslin, D. W., & Wolk, C. B. (2022) · Pilot and Feasibility Studies · doi:10.1186/s40814-022-01131-y · Cited by 4
Investing in Suicide Prevention: Zero Suicide in a Pediatric System of Care
Thomas, G. V., Chapman, M. R., & Grumet, J. G. (2022) · SpringerBriefs in psychology · doi:10.1007/978-3-031-06127-1_15 · Cited by 4
Suicide risk following ED presentation with self-harm varies by hospital
Murphy, S., Ross, E., O’Hagan, D., Maguire, A., & O’Reilly, D. (2023) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-023-02561-6 · Cited by 4
Genetics of suicide ideation. A role for inflammation and neuroplasticity?
Turiaco, F., Iannuzzo, F., Bruno, A., & Drago, A. (2024) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-024-01836-6 · Cited by 4
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Metadata
- 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)
- 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
- bronze
- doi.org
- 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
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