Community-based mental health interventions for reducing youth suicidal thoughts and behaviours: a systematic review and meta-analysis

Background: Rates of suicidal thoughts and behaviours (STB) and non-suicidal self-injury (NSSI) in children and young people (CYP) are on the rise globally. Community-based mental health interventions may offer accessible and scalable support, however there is a paucity of evidence on their effectiveness in this population. We aim to provide an up-to-date synthesis and evaluation of evidence on whether community-based mental health programs targeting CYP (< 18 years) reduce STB and NSSI. Methods: Four electronic databases (PsycINFO, EMBASE, PubMed, and CINAHL) and Google Scholar were searched from October 2013 to June 2024. Eligible studies included controlled trials of CYP (sample mean age < 18 years) conducted in community settings, examining at least one primary outcome of STB or NSSI. Methodological quality was assessed, and findings were summarised using narrative synthesis and, where appropriate, quantitatively through meta-analyses. Results: From 1553 records, 13 studies met inclusion criteria, spanning universal or targeted school-based, digital, family-focused, and community-based programs across 12 countries. Meta-analysis revealed significant reduction in suicidal ideation (Pooled OR = 0.57, 95% CI: 0.44–0.72, p <.00001) and suicide attempts (OR = 0.43, 95% CI: 0.24–0.76, p =.004) following intervention. Suicide planning and NSSI outcomes were less conclusive due to limited data and moderate to high heterogeneity. Conclusions: Community-based interventions are effective in reducing suicidal ideation and suicide attempts among CYP, however their effectiveness at reducing NSSI and suicide planning is unclear. These results support the integration of community-based suicide prevention programs into national mental health strategies. Further rigorous, long-term, and culturally inclusive research is necessary to inform efficacious and scalable suicide prevention strategies.