A Systematic Review and Meta-Analysis of Telehealth Aftercare Interventions to Reduce Suicidal Behavior or Suicide Following Hospital Treatment in the Emergency Department.

Background: The relative risk of subsequent suicidal behaviors (and suicide mortality) is high following an episode of hospital-treatment for suicidal behavior. This study evaluated the effectiveness of telehealth aftercare interventions in reducing suicidal behaviors. Methods: A systematic review was conducted using 13 online databases (from inception until July 2024). Analyses included narrative synthesis and random effects meta-analyses based on study design. Risk of bias was assessed by Cochrane tools. Results: We identified n = 14 studies involving n = 14,420 participants. Pooled effect estimates compared to usual treatment showed nonsignificantly reduced suicidal behavior in nonrandomized controlled trials (RR, 0.676 [CI 95% 0.453-1.008]), (7 studies), but no difference in randomized controlled trials (RR, 0.929 [CI 95% 0.734-1.175]) (6 studies, one study precluded analysis). The overall risk of bias was high across studies. Limitations: Many studies were underpowered, telehealth was often delivered in combination with other interventions, and the mode of telehealth was limited to telephone. Conclusions: Telehealth does not appear to confer benefit above usual treatment for suicidal behavior during follow-up, although the small number of studies and high risk of bias limits confidence in the precision of estimates of effect size. Further research might use well-designed studies to examine different clinical end points for suicidal behavior (number of or time to events) or other outcomes (retention in aftercare or other healthcare treatment).