Suicide Safety Planning: A Systematic Review Supporting OT Research & Practice

PURPOSE: Suicide is a leading cause of mortality worldwide. At least 700,000 individuals die by suicide annually and many more try suicide (WHO, 2021). Occupational therapists support persons who are at risk of suicide in a range of practice areas including community and inpatient mental health, home care, in traumatic brain injury programs, and with persons living in challenging psychosocial circumstances, including homelessness. Suicide safety planning is an evidence-based approach that is frequently used in mental health care, and has been encouraged for used by occupational therapists (Hewitt et al., 2019). We conducted this systematic review to synthesize effectiveness studies on suicide safety planning interventions and to identify their various components.

METHOD: We conducted a systematic review of effectiveness studies (quasi-experimental and randomized controlled trial designs) using the method advanced by the Joanna Briggs Institute (JBI) following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines (Moher et al., 2010). We used Covidence to conduct a title and abstract screening and full-text review. Included studies were subjected to a narrative synthesis and critical appraisal using JBI checklists for quasi-experimental and randomized controlled trial studies. To synthesize this body of literature, we identified the components of a range of safety planning interventions, and summarized the effectiveness reported in included studies on five outcomes: suicide ideation; suicide behaviour; mental health symptoms; resilience and service use.

FINDINGS: The heterogeneity of outcomes in the included studies precluded a meta-analysis. A total of 5897 titles and abstracts remained following the removal of duplicates, of which 76 were subjected to full-text review. A total of 22 studies were included in our analyses and narrative synthesis. Critical appraisal scores ranged from 38.5-92.3 (m=63.7) out of a possible score of 100, representing moderate to high quality evidence. Three intervention categories were identified: 1) standard and enhanced safety planning interventions (n=11); 2) electronically delivered safety planning interventions (n=5); and 3) safety planning integrated with other approaches (n=6). Only three studies identified an occupational element of suicide safety planning. With regard to effectiveness, seven studies demonstrated effectiveness for suicide ideation; six for suicide behaviour; five for mental health symptoms; two for indices of resilience; and four for improving service use.

IMPLICATIONS: Evidence suggests that suicide safety planning is effective for mitigating suicide risk, but more research is needed. Occupational therapists may consider incorporating this approach in their practice as an evidence-based strategy for supporting individuals who are at risk of suicide. Suicide safety plans that include occupational elements may enhance the effectiveness of these approaches and should be developed and evaluated in future research. A collaboration between researchers and occupational therapy practitioners would help to develop such approaches. Organizational policymakers may consider incorporating suicide safety planning in their staff orientation and professional development plans for occupational therapy staff in all areas of practice, particularly practice areas where occupational therapists are more likely to encounter individuals who are at risk of suicide. These practice areas include inpatient and community mental health, home care, and practice areas where occupational therapists may encounter persons who have experienced recent losses or who are exposed to a high degree of psychosocial stress and trauma.

References

Aromataris, E., & Munn, Z. (2017). Chapter 1: JBI Systematic Reviews (E. Aromataris & Z. Munn, Eds.). The Joanna Briggs Institute. https://reviewersmanual.joannabriggs.org/

Hewitt, K., Hébert, M. L., & Vrbanac, H. (2019). CAOT role paper: Suicide prevention in occupational therapy. Canadian Association of Occupational Therapists. https://caot.ca/document/7445/Role%20Paper-Suicide%20Prevention_ENG_Sept5_2019.pdf

Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Group, P. (2010). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg, 8(5), 336-341. https://doi.org/10.1016/j.ijsu.2010.02.007

World Health Organization (WHO). (2021). Suicide. Retrieved March 5, 2022 from https://www.who.int/news-room/fact-sheets/detail/suicide