Comparative Effects of Psychosocial and Behavioral Interventions to Prevent or Reduce Suicidal Ideation and Suicidal Behavior: A Network Meta-Analysis.

BACKGROUND

Previous meta-analyses combined treatment with prevention interventions and there was a lack of comparative studies on preventive interventions for suicide.

AIMS: To evaluate and rank the effects of prevention interventions on self-harm, suicidal ideation, suicidal behavior, and depression.

METHODS

We searched PubMed, HINARI, CENTRAL and ResearchGate until November 2025 to identify randomized controlled trials that reported suicidal ideation and suicidal behavior among adolescents and adults. Eligible studies were selected through systematic screening, and data were synthesized using a network meta-analysis with a random-effects model to assess and rank effects of psychosocial and behavioral interventions in January 2026.

RESULTS

This study included 94 trials (27,242 participants). Compared with control group, psychotherapy (Odds ratio [OR] = 0.60; 95% CI [0.47, 0.76]), active outreach (OR = 0.73; 95% CI [0.59, 0.90]), and other psychosocial and behavioral interventions (hereafter, "other type"; OR = 0.53; 95% CI [0.33, 0.86]) were the three most effective interventions in preventing suicidal behavior (moderate-quality evidence). Psychotherapy (Standardized mean difference [SMD] = -0.18; 95% CI [-0.31, -0.05]; moderate-quality evidence) and other type (SMD = -0.60; 95% CI [-0.86, -0.33]; moderate-quality evidence) were the two most effective interventions in preventing suicidal ideation. Only psychotherapy was significantly more effective than control group (OR = 0.66; 95% CI [0.48, 0.91]; moderate-quality evidence) in reducing self-harm. Only skills showed effectiveness in reducing depression with very low-quality evidence (SMD = -0.67; 95% CI: [-1.07, -0.28]).

CONCLUSIONS

Psychotherapy consistently improved several suicide-related outcomes, indicating that clinical and community settings should prioritize this intervention. Healthcare policymakers and practitioners should integrate psychotherapy into regular mental health services and expand active outreach activities to improve conditions and use of the beneficiaries.