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Direct vs. indirect interventions to prevent suicide

Direct vs. indirect interventions to prevent suicide

Figure 2

Immediate post-treatment effect on suicide and attempted suicide of direct and indirect interventions versus controls

Direct interventions address suicidal thoughts and behaviours during treatment, whereas indirect interventions address symptoms associated with suicide only. Odds are listed for the intervention group and control group (suicides or individuals who attempted suicide over individuals who did not). P=psychotherapy (eg, cognitive behavioural therapy, dialectical behaviour therapy, mentalisation-based treatment). O=other type. AO=active outreach (eg, postcards, telephone calls, home visits). Su=non-directive support. Sk=skills (eg, problem solving, communication, adaptive coping). CM=case management. RE=random effects.

Direct vs. indirect interventions to prevent suicide

Figure 3

Longer-term follow-up effect on suicide and attempted suicide of direct and indirect interventions versus controls

Direct interventions address suicidal thoughts and behaviours during treatment, whereas indirect interventions address symptoms associated with suicide only. Odds are listed for the intervention group and control group (suicides or individuals who attempted suicide over individuals who did not). P=psychotherapy (eg, cognitive behavioural therapy, dialectical behaviour therapy, mentalisation-based treatment). O=other type. AO=active outreach (eg, postcards, telephone calls, home visits). Su=non-directive support. Sk=skills (eg, problem solving, communication, adaptive coping). CM=case management. RE=random effects.

Direct vs. indirect interventions to prevent suicide

Figure 4

Contour-funnel plots of studies reporting post-treatment data (31 studies) and follow-up data (29 studies) for direct and indirect interventions

Direct interventions address suicidal thoughts and behaviours during treatment, whereas indirect interventions address associated symptoms only. Studies depicted inside the inner isosceles triangle have non-significant effect sizes, whereas studies depicted outside the outer triangle are significant at the p=0·01 level. Studies depicted in between are significant at the p=0·05 level. Red circles depict studies included in the analysis. Open circles depict imputed studies estimated by the trim-and-fill method. 24 OR=odds ratio.

Direct vs. indirect interventions to prevent suicide

Figure 5

Risk of bias summary showing the percentages of interventions (44 studies) with low, unclear, or high risk of bias for selected criteria

The risk of bias due to selective reporting is high if suicides were not reported and the number of individuals who attempted suicide was ten or more. The risk of bias due to incomplete data is high if more than 10% of the baseline sample is not reported on. The risk of bias due to allocation is high if participants or investigators could have foreseen allocation. The risk of bias due to randomisation is high if sequence generation was not truly random.

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