Challenges in Synthesising the Effects of Synchronous Remote-based Interventions on Suicidal Behaviours: A Systematic Review and Meta-Analysis

Abstract

ABSTRACTIntroductionSuicide is one of the leading causes of preventable death worldwide. Evidence reported in the literature seems to support the impact of providing active contact for people that have attempted suicide. The current systematic review and meta-analysis aim to investigate the effects of suicide prevention strategies implemented through remote and synchronous technology-based interventions.MethodsThe systematic review and meta-analysis followed the PRISMA 2020 guidelines. The searches were conducted in PubMed, PsycInfo, Scopus, and Web of Science. Screening, selection process, data extraction, and risk of bias (RoB) assessment have been performed independently by two reviewers. A systematic review and narrative synthesis of the data has been performed. Data on adherence to treatment and suicide-related factors to explain heterogeneity were extracted. A meta-analysis was conducted to determine effect sizes (Hedge’sg) for suicidal ideation, odds ratios (OR) and 95% confidence intervals (95% CI) for lethal and non-lethal suicide behaviours. Data were pooled using a random-effects model. Subgroup analyses were performed by classifying the studies according to the evaluation period.ResultsA total of 26 publications were finally included. Synchronous remote-based interventions were effective in preventing repeated suicide attempts (OR = 0.75; 95% CI 0.62 – 0.90) and suicide deaths (Peto OR = 0.37; 95% CI 0.18 – 0.77); however, considerable heterogeneity was reported. The effects on suicidal ideation were not confirmed (Hedge’sg= 0.23; 95% CI −1.54 – 1.07).ConclusionsThe observed heterogeneity suggests that the effects should be considered under caution. Methodological and procedural guidelines are proposed to improve the quality of future research studies.