Interventions to prevent repeat suicidal behavior in patients admitted to an emergency department for a suicide attempt: a meta-analysis.
Abstract
Background A huge number of patients with self-harm and suicide attempt visit emergency departments (EDs). We systematically reviewed studies and examined the effect of interventions to prevent repeat suicidal behavior in patients admitted to EDs for a suicidal attempt.Method We searched the databases of MEDLINE, PsychoINFO, CINAHL, and EMBASE through August 2013. Eligible studies were randomized controlled trials assessing the effects on repeat suicidal behavior of interventions initiated in suicidal patients admitted to EDs. Interventions in each trial were classified into groups by consensus. Meta-analyses were performed to determine pooled relative risks (RRs) and 95% confidence intervals (CIs) of repetition of suicide attempt for interventions in each group.Results Out of 5390 retrieved articles, 24 trials were included and classified into four groups (11 trials in the Active contact and follow-up, nine in the Psychotherapy, one in the Pharmacotherapy, and three in the Miscellaneous). Active contact and follow-up type interventions were effective in preventing a repeat suicide within 12 months (n=5319; pooled RR=0.83; 95% CI: 0.71 to 0.97). However, the effect at 24 months was not confirmed (n=925; pooled RR=0.98; 95% CI: 0.76-1.22). The effects of the other interventions on preventing a repetition of suicidal behavior remain unclear.Limitation Caution is needed regarding the heterogeneity of the effects.Conclusion Interventions of active contact and follow-up are recommended to reduce the risk of a repeat suicide attempt at 12 months in patients admitted to EDs with a suicide attempt. However, the long-term effect was not confirmed.
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Multiple interventions have evidence of efficacy in reducing suicide risk, including cognitive behavioral therapy, dialectical behavioral therapy, and active contact and follow-up interventions.
“Multiple interventions have evidence of efficacy in reducing suicide risk, including cognitive behavioral therapy,3,4 dialectical behavioral therapy,3 and active contact and follow-up interventions.5,6”
From Accuracy requirements for cost-effective suicide risk prediction among primary care patients in the US (2021) · cites this paper as [5]
Active contact and follow-up (ACF) has a relative risk of suicide attempt of 0.83 (95% CI, 0.71-0.97).
“a 2015 meta-analysis5 of 9 randomized clinical trials found a relative risk of suicide attempts of 0.83 (95% CI, 0.71-0.97)”
From Accuracy requirements for cost-effective suicide risk prediction among primary care patients in the US (2021) · cites this paper as [5]
Although this study evaluates risk prediction in an outpatient population, most data on the efficacy of risk reduction interventions are based on individuals seeking help at an emergency department, often after a suicide attempt.
“although this study evaluates risk prediction in an outpatient population, most data on the efficacy of risk reduction interventions are based on individuals seeking help at an emergency department, often after a suicide attempt.4,5”
From Accuracy requirements for cost-effective suicide risk prediction among primary care patients in the US (2021) · cites this paper as [5]
Previous meta-analyses have estimated varying effect sizes for primary benefits of risk reduction interventions, with not all showing statistically significant benefits.
“previous meta-analyses4,5,6,45 have estimated varying effect sizes, with not all showing statistically significant benefits”
From Accuracy requirements for cost-effective suicide risk prediction among primary care patients in the US (2021) · cites this paper as [5]
Studies with complete data received a low risk rating.
“Studies reporting complete data were assigned a low risk score.27,28”
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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Self-citation
- Authors
- Inagaki, M., Kawashima, Y., Kawanishi, C., Yonemoto, N., Sugimoto, T., Furuno, T., Ikeshita, K., Eto, N., Tachikawa, H., Shiraishi, Y., & Yamada, M.
- Affiliations
- Okayama University Hospital (JP)
- National Center of Neurology and Psychiatry (JP)
- Yokohama City University (JP)
- Tokyo Metropolitan Matsuzawa Hospital (JP)
- National Hospital Organization Yokohama Medical Center (JP)
- Nara Medical University (JP)
- Fukuoka University (JP)
- University of Tsukuba (JP)
- Corresponding author
- Inagaki, Masatoshi
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2015-04
- Volume
- 175
- Pages
- 66-78
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2064971250
- Cited by
- 137
- References
- 74
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 14 · 2023: 11 · 2022: 19 · 2021: 9 · 2020: 21 · 2019: 11 · 2018: 16 · 2017: 10 · 2016: 11 · 2015: 3
- FWCI
- 1.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Mochida Pharmaceutical Company
- Japan Society for the Promotion of Science (26461771)
- Japan Science and Technology Agency
- 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 › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- suicide attempts, suicide prevention, emergency department, follow-up intervention, psychotherapy, pharmacotherapy, self-harm, long-term outcomes
- MeSH terms
- Suicide Prevention, Emergency Service, Hospital, Humans, Suicide, Suicide, Attempted, Randomized Controlled Trials as Topic, Treatment Outcome, Protective Factors
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