Safety Planning Interventions for Suicide Prevention in Children and Adolescents : A Systematic Review and Meta-Analysis

Importance  Suicide ideation and suicide-related behavior (eg, suicide attempts) are increasingly prevalent among adolescents. Evidence supports safety planning interventions for adults at risk for suicide; the effectiveness for adolescents is unknown.

Objective  To evaluate the effectiveness of safety planning as a standalone intervention for adolescents with suicide ideation and/or suicide-related behavior.

Data Sources  Ovid MEDLINE, OVID PsycINFO, EBSCO CINAHL, and Scopus (Elsevier) from January 1, 2008, to March 26, 2024.

Study Selection  Included were all studies that examined safety planning as a standalone treatment for adolescents and assessed suicide ideation, suicide-related behavior including suicide attempts, and/or re-presentations to health care settings. Included were peer-reviewed studies evaluating intervention effectiveness or efficacy, with or without a control condition. Nonempirical studies, gray literature, and studies not available in English were excluded.

Data Extraction and Synthesis  Two reviewers performed data extraction and quality assessment independently. Meta-analytic random-effects models were used to calculate effect size estimates. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal tools.

Main Outcomes and Measures  The outcomes planned for extraction were suicide ideation, suicide-related behavior (eg, attempts; planning with intent to act), and re-presentation to health care settings (ie, emergency department visit; inpatient admission) during the follow-up period.

Results  Ten studies including 1002 adolescents (mean [SD] age, 15.0 [0.4] years; 76.0% female) met inclusion criteria; 5 were included (n = 619) in the meta-analysis. There was no significant association between safety planning interventions and suicide ideation (Hedges g = 0.11; 95% CI, 0.01-0.21), behavior (Hedges g = −0.09; 95% CI, −0.20 to 0.02), attempts (risk ratio [RR], 1.03; 95% CI, 0.12-8.88) or suicide-related re-presentation (RR, 0.99; 95% CI, 0.29-3.35) at follow-up. Risk of bias for the majority of studies was moderate to high.

Conclusions and Relevance  This systematic review and meta-analysis found limited research evaluating safety planning with adolescents. Although available data do not support safety planning as a standalone treatment for reducing suicide-related outcomes among children and adolescents, well-powered studies are needed to address this common intervention for suicide prevention in adolescents.

Key Points

Question  What is the effectiveness of safety planning as a standalone intervention for suicide prevention in children and adolescents?

Findings  In this systematic review and meta-analysis of the 5 studies that evaluated interventions, safety planning was not associated with reductions in suicide ideation, suicide-related behavior, suicide attempts, or suicide-related re-presentation to health care settings (eg, emergency departments; inpatient units) at follow-up. There was moderate to high risk of bias in the included studies.

Meaning  Current evidence to support safety planning as an effective intervention for children and adolescents at increased risk of suicide is limited.