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Cited by 187Suicide and Self-Harm StudiesPersonality Disorders and PsychopathologyBipolar Disorder and Treatment

Treatments for the Prevention and Management of Suicide: A Systematic Review

D'Anci, Kristen E., Uhl, Stacey, Giradi, Gina, Martin, Constance·2019·Annals of Internal Medicine
DOI 10.7326/m19-0869
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Abstract

Background: Suicide is a growing public health problem, with the national rate in the United States increasing by 30% from 2000 to 2016. Purpose: To assess the benefits and harms of nonpharmacologic and pharmacologic interventions to prevent suicide and reduce suicide behaviors in at-risk adults. Data Sources: MEDLINE, EMBASE, PsycINFO, and other databases from November 2011 through May 2018. Study Selection: Systematic reviews (SRs) and randomized controlled trials (RCTs) that assessed nonpharmacologic or pharmacologic therapies for adults at risk for suicide. Data Extraction: One investigator abstracted data and assessed study quality, and a second investigator checked abstractions and assessments for accuracy. Data Synthesis: Eight SRs and 15 RCTs were included. The evidence for psychological interventions suggests that cognitive behavioral therapy (CBT) reduces suicide attempts, suicidal ideation, and hopelessness compared with treatment as usual (TAU). Limited evidence suggests that dialectical behavior therapy (DBT) reduces suicidal ideation compared with wait-list control or crisis planning. The evidence for pharmacologic treatments suggests that ketamine reduces suicidal ideation with minimal adverse events compared with placebo or midazolam. Lithium reduces rates of suicide among patients with unipolar or bipolar mood disorders compared with placebo. However, no differences were observed between lithium and other medications in reducing suicide. Limitation: Qualitative synthesis of new evidence with existing meta-analyses, methodological shortcomings of studies, heterogeneity of nonpharmacologic interventions, and limited evidence for pharmacologic treatments and harms. Conclusion: Both CBT and DBT showed modest benefit in reducing suicidal ideation compared with TAU or wait-list control, and CBT also reduced suicide attempts compared with TAU. Ketamine and lithium reduced the rate of suicide compared with placebo, but there was limited information on harms. Limited data are available to support the efficacy of other nonpharmacologic or pharmacologic interventions. Primary Funding Source: U.S. Department of Veterans Affairs Veterans Health Administration. (PROSPERO: CRD42018104978).

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  • D'Anci et al. systematically reviewed treatments for suicide prevention, reporting that cognitive-behavioural and mindfulness-based interventions were among the most frequently supported approaches.

    “D’Anci et al. [53] systematically reviewed treatments for suicide prevention, reporting that cognitive-behavioural and mindfulness-based interventions were among the most frequently supported approaches.”

    From Targeting Psychological Pain After a Suicide Attempt: Scoping Review and Intervention Protocol (2026) · cites this paper as [53]

  • Prior reviews indicate the relevance of cognitive-behavioural and mindfulness-based strategies for psychological pain and identify psychological pain as both a state and trait phenomenon.

    “Overall, prior reviews [53,54,55,56,57] indicate the relevance of cognitive-behavioural and mindfulness-based strategies and identify psychological pain as both a state and trait phenomenon, supporting psychological pain as a meaningful intervention target.”

    From Targeting Psychological Pain After a Suicide Attempt: Scoping Review and Intervention Protocol (2026) · cites this paper as [53]

  • Psychological pain domains-states and traits-are clinically relevant and modifiable through psychotherapeutic intervention.

    “domains—states and traits—are clinically relevant and modifiable through psychotherapeutic intervention, underscoring the centrality of psychological pain in suicide risk and the need for targeted interventions aimed at broadening emotional and behavioural coping repertoires.”

    From Targeting Psychological Pain After a Suicide Attempt: Scoping Review and Intervention Protocol (2026) · cites this paper as [53]

  • 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 [3]

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Authors
D'Anci, K. E., Uhl, S., Giradi, G., & Martin, C.
Affiliations
  • ECRI Institute, Plymouth Meeting, Pennsylvania (K.E.D., S.U., G.G., C.M.)
  • ECRI Institute (US)
ORCID
Uhl, Stacey
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
2019-09-03
Volume
171
Issue
5
Pages
334-342
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/m19-0869
OpenAlex
W2971153040
Cited by
187
References
25
Citations by year
2026: 19 · 2025: 27 · 2024: 33 · 2023: 38 · 2022: 35 · 2021: 17 · 2020: 14 · 2019: 4
FWCI
20.45
Type
journal article
Language
en
Open access
closed
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
suicide prevention, suicide attempts, suicidal ideation, cognitive behavioral therapy, dialectical behavior therapy, ketamine, lithium, bipolar disorder, unipolar mood disorders, non-pharmacological treatment, pharmacological interventions, at-risk adults, hopelessness
MeSH terms
Dialectical Behavior Therapy, Suicide Prevention, Antidepressive Agents, Crisis Intervention, Humans, Ketamine, Patient Education as Topic, Risk Factors, Suicide, United States, Cognitive Behavioral Therapy, Lithium Compounds, Suicidal Ideation

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