Systematic Review and Meta-Analysis: Effectiveness of Stand-Alone Digital Suicide Preventive Interventions for the Self-Management of Suicidality

Abstract

AbstractSuicide is a global issue accounting for more than 700,000 deaths annually, with low- and middle-income countries being disproportionally affected. Technology-enhanced interventions have been suggested as a preventive method with various benefits—e.g., increased scalability and sustainability, making them relevant for developed and especially for developing nations. However, despite the increasing number of such interventions, their effectiveness is seldom appropriately evaluated. The current review aims to tackle this need by synthetizing the evidence with the goal of answering whether these interventions can be recommended for the self-management of suicidality. A systematic review was carried out across multiple databases (PubMed/Medline, Global Index Medicus, PsychINFO, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Cumulative Index to Nursing and Allied Health Literature), identifying 4520 individual reports up to November 2021. Ten of these were deemed sufficient to inform the evaluation, but only four were included in the meta-analyses. Quality assessment via GRADE reveals some concerns, primarily regarding selection of reported results. Results suggest negligible effect on the outcomes of deaths by suicide, suicide attempts, and a small effect on suicidal ideation—favoring digital interventions over no intervention. Conclusively, there is not enough evidence to allow for the recommendation of digital interventions as stand-alone care, but they are promising if developed on the grounds of evidence-based practices. The review also highlights the challenges of evaluation, by discussing excessive safety procedures and considering parallelly ongoing treatment. Additionally, the need to involve low- and middle-income countries is emphasized as currently these regions are underrepresented, even though they have a high potential for benefiting from stand-alone digital interventions.