View in EDS

Acute‐Phase Interventions After Self‐Harm for Preventing Suicide and Recurrence: A Systematic Review and Meta‐Analysis.

Saved in:
Bibliographic Details
Title: Acute‐Phase Interventions After Self‐Harm for Preventing Suicide and Recurrence: A Systematic Review and Meta‐Analysis.
Authors: Roncete, Guilherme Pimenta (AUTHOR), Farhat, Luis C. (AUTHOR), Beiram, Loren (AUTHOR), Damiano, Bianca Besteti Fernandes (AUTHOR), Bryan, Craig J. (AUTHOR), Ramirez, Karina L. (AUTHOR), Miguel, Euripedes Constantino (AUTHOR), Damiano, Rodolfo Furlan (AUTHOR)
Source: Acta Psychiatrica Scandinavica. Jun2026, Vol. 153 Issue 6, p610-626. 17p.
Subjects: Suicide prevention, Problem-solving therapy, Early medical intervention, Clinical trials, Self-injurious behavior, Psychiatric hospital care
Abstract: Introduction: Suicide risk is markedly elevated following presentation after self‐harm, yet the evidence base for interventions initiated in the immediate post‐presentation period has not been synthesized with specific attention to this high‐risk window. Clarifying which early interventions may reduce adverse outcomes is essential for informing psychiatric care and prevention strategies. Methods: We conducted a systematic review and meta‐analysis of randomized clinical trials enrolling individuals presenting to clinical services after self‐harm, with interventions initiated within 1 month of the index episode. PubMed, Embase, PsycINFO, the WHO International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov were searched from inception through April 24, 2025. Two reviewers independently screened studies and extracted data using standardized forms. Risk of bias was assessed using the Cochrane RoB 2 tool, and certainty of evidence was evaluated with GRADE. Random‐effects meta‐analyses with Hartung–Knapp adjustment were conducted for intervention categories with at least three trials, and prediction intervals were calculated. Prespecified meta‐regressions examined participant‐ and intervention‐level moderators. Results: Sixty randomized clinical trials, including 22,654 participants, met the inclusion criteria. Across pooled analyses, no intervention category was associated with a statistically significant reduction in repeat self‐harm at any follow‐up interval. For suicide deaths, problem‐solving therapy was associated with lower mortality at medium‐term follow‐up (6–12 months; OR 0.45, 95% CI 0.29–0.70; I2 = 0%), and brief intervention and contact was associated with lower mortality at long‐term follow‐up (> 12 months; OR 0.34, 95% CI 0.15–0.79; I2 = 0%). Meta‐regression analyses indicated that younger mean sample age and trial inclusion based on suicidal intent moderated effects on repeat self‐harm at > 6–12 months. Conclusions: Among trials initiating treatment within 1 month of self‐harm presentation, effects on repeat self‐harm were small and not statistically significant, likely reflecting outcome heterogeneity in the acute post‐presentation period. In contrast, structured problem‐solving and brief contact‐based interventions were associated with lower suicide mortality at medium‐ and long‐term follow‐up. These findings support the use of scalable early interventions in psychiatric services and highlight priorities for future trials powered to detect effects on suicide mortality. Trial Registration: PROSPERO: CRD42023458233 Key Points: Summations: ○Interventions initiated within 1 month after a self‐harm presentation showed limited effects on repeat self‐harm, underscoring the challenges of this outcome in acute post‐presentation contexts.○Problem‐solving therapy and brief intervention and contact were associated with lower suicide mortality at medium‐ and long‐term follow‐up, highlighting the potential value of scalable early strategies.○Focusing on time‐restricted high‐risk periods offers a clinically relevant framework for evaluating preventive interventions in psychiatric services. Limitations: ○Suicide deaths were rare events across trials, limiting statistical power and contributing to uncertainty despite consistent directional effects.○Considerable heterogeneity in definitions, measurement, and follow‐up of repeat self‐harm may have reduced the ability to detect intervention effects on this outcome.○Many trials were not designed specifically for the acute post‐presentation period, constraining inference about optimal timing and sequencing of interventions. [ABSTRACT FROM AUTHOR]
Copyright of Acta Psychiatrica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
Description
Abstract:Introduction: Suicide risk is markedly elevated following presentation after self‐harm, yet the evidence base for interventions initiated in the immediate post‐presentation period has not been synthesized with specific attention to this high‐risk window. Clarifying which early interventions may reduce adverse outcomes is essential for informing psychiatric care and prevention strategies. Methods: We conducted a systematic review and meta‐analysis of randomized clinical trials enrolling individuals presenting to clinical services after self‐harm, with interventions initiated within 1 month of the index episode. PubMed, Embase, PsycINFO, the WHO International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov were searched from inception through April 24, 2025. Two reviewers independently screened studies and extracted data using standardized forms. Risk of bias was assessed using the Cochrane RoB 2 tool, and certainty of evidence was evaluated with GRADE. Random‐effects meta‐analyses with Hartung–Knapp adjustment were conducted for intervention categories with at least three trials, and prediction intervals were calculated. Prespecified meta‐regressions examined participant‐ and intervention‐level moderators. Results: Sixty randomized clinical trials, including 22,654 participants, met the inclusion criteria. Across pooled analyses, no intervention category was associated with a statistically significant reduction in repeat self‐harm at any follow‐up interval. For suicide deaths, problem‐solving therapy was associated with lower mortality at medium‐term follow‐up (6–12 months; OR 0.45, 95% CI 0.29–0.70; I2 = 0%), and brief intervention and contact was associated with lower mortality at long‐term follow‐up (> 12 months; OR 0.34, 95% CI 0.15–0.79; I2 = 0%). Meta‐regression analyses indicated that younger mean sample age and trial inclusion based on suicidal intent moderated effects on repeat self‐harm at > 6–12 months. Conclusions: Among trials initiating treatment within 1 month of self‐harm presentation, effects on repeat self‐harm were small and not statistically significant, likely reflecting outcome heterogeneity in the acute post‐presentation period. In contrast, structured problem‐solving and brief contact‐based interventions were associated with lower suicide mortality at medium‐ and long‐term follow‐up. These findings support the use of scalable early interventions in psychiatric services and highlight priorities for future trials powered to detect effects on suicide mortality. Trial Registration: PROSPERO: CRD42023458233 Key Points: Summations: ○Interventions initiated within 1 month after a self‐harm presentation showed limited effects on repeat self‐harm, underscoring the challenges of this outcome in acute post‐presentation contexts.○Problem‐solving therapy and brief intervention and contact were associated with lower suicide mortality at medium‐ and long‐term follow‐up, highlighting the potential value of scalable early strategies.○Focusing on time‐restricted high‐risk periods offers a clinically relevant framework for evaluating preventive interventions in psychiatric services. Limitations: ○Suicide deaths were rare events across trials, limiting statistical power and contributing to uncertainty despite consistent directional effects.○Considerable heterogeneity in definitions, measurement, and follow‐up of repeat self‐harm may have reduced the ability to detect intervention effects on this outcome.○Many trials were not designed specifically for the acute post‐presentation period, constraining inference about optimal timing and sequencing of interventions. [ABSTRACT FROM AUTHOR]
ISSN:0001690X
DOI:10.1111/acps.70085