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).