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

ObjectivesSuicide is a leading cause of preventable death worldwide. Evidence supports the impact of providing active contact for individuals who have attempted suicide. The current systematic review and meta-analyses aim to investigate the effects of suicide prevention strategies implemented through remote and synchronous technology-based interventions. DesignSystematic review, narrative synthesis, and meta-analysis. Data sourcesElectronic databases (PubMed, PsycInfo, Scopus, and Web of Science) and grey literature sources (ClinicalTrials.gov and Google Scholar) were searched until December 2024. Eligibility criteria Eligible articles assessed suicide prevention interventions for participants over 12 years with prior suicidal behaviour. Eligible study design included randomised control trials and non-randomised clinical trials published in English or Spanish. Data extraction and synthesisScreening, selection process, data extraction, and risk of bias assessment were performed independently by two reviewers. Data on suicide-related factors and adherence to treatment were extracted. Meta-analyses were conducted to determine effect sizes (Hedges g) for suicidal ideation, risk ratios (RR) for suicide attempts, and Peto odds ratios (OR) for suicide. Heterogeneity was assessed using the Cochranes Q test, tau2 statistic, and I2 value. Publication bias was investigated employing funnel plots and Eggers test. ResultsA total of 28 studies, comprising 10,015 participants in the intervention group and 10,726 in the comparison group, were included in the systematic review and meta-analyses. Synchronous remote-based interventions were effective in preventing repeated suicide attempts at 1 month (RR 0.73, 95% CI 0.62 to 0.85, I2=0.0%, Q=0.70, tau2=0.00), 6 months (RR 0.56, 95% CI 0.34 to 0.95, I2=85.4%, Q=54.92, tau2=0.36), and 12 months (RR 0.68, 95% CI 0.49 to 0.96, I2=87.6%, Q=72.63, tau2=0.27). Additionally, these interventions were associated with a reduction in suicide-related deaths at 18 months (Peto OR 0.18, 95% CI 0.08 to 0.44, I2=0.0%, Q=0.03, tau2=0.00). Effects on suicidal ideation were not statistically significant at any time-point (Hedges g -0.07 to -0.28, I2=0.0 to 69.3%, Q=1.16 to 7.38, tau2=0.00 to 0.14). ConclusionsSynchronous remote-based interventions demonstrate a potential benefit in preventing suicide attempts and deaths by suicide, and may serve as an adjunct to usual treatment; however, the effect on suicidal ideation appears limited. The observed heterogeneity warrants caution when interpreting these findings. Future research should prioritise methodological enhancements to improve the quality and consistency of evidence, as well as investigate the mediating processes underlying their effectiveness in reducing suicidal behaviour. PROSPERO registration number CRD42021275044. STRENGTHS AND LIMITATIONS OF THIS STUDYO_LIThe protocol was registered in PROSPERO and published in a peer-reviewed journal, ensuring methodological transparency. C_LIO_LIData extraction, synthesis, and quality assessment are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-2020) guidelines. C_LIO_LIThe systematic review and meta-analyses used a comprehensive search strategy to avoid missing published articles. C_LIO_LIHeterogeneity in the methods makes it difficult to draw definitive conclusions about the effectiveness of interventions. C_LI