Strategies to prevent death by suicide: meta-analysis of randomised controlled trials.

Abstract

<b>Background</b>Few randomised controlled trials (RCTs) have shown decreases in suicide.<b>Aims</b>To identify interventions for preventing suicide.<b>Method</b>We searched EMBASE and Medline from inception until 31 December 2015. We included RCTs comparing prevention strategies with control. We pooled odds ratios (ORs) for suicide using the Peto method.<b>Results</b>Among 8647 citations, 72 RCTs and 6 pooled analyses met inclusion criteria. Three RCTs (<i>n</i> = 2028) found that the World Health Organization (WHO) brief intervention and contact (BIC) was associated with significantly lower odds of suicide (OR = 0.20, 95% CI 0.09-0.42). Six RCTs (<i>n</i> = 1040) of cognitive-behavioural therapy (CBT) for suicide prevention and six RCTs of lithium (<i>n</i> = 619) yielded non-significant findings (OR = 0.34, 95% CI 0.12-1.03 and OR = 0.23, 95% CI 0.05-1.02, respectively).<b>Conclusions</b>The WHO BIC is a promising suicide prevention strategy. No other intervention showed a statistically significant effect in reducing suicide.