What works where and why? A systematic review and meta-analysis of digital interventions addressing suicide-related outcomes in community, education and clinical settings

Background: Digital suicide prevention interventions have previously been shown to be effective, however the field has rapidly developed. Aims: To undertake a contemporary review of the evidence and understanding where interventions may work best. Method: A meta-analysis following the PRISMA guidelines was conducted. PubMed/Medline, PsycINFO and Cochrane Central were searched for randomised controlled trials up to February 2024. Interventions were categorised according to their delivery setting, and as direct (directly targeting suicidality) or indirect (targeting depression), and effects on suicidal ideation and behaviours (plans, self-harm, attempts and suicide death) were calculated using Hedge’s g. Results: Forty-six papers reporting 48 unique trials were included. The majority of studies examined direct interventions (n = 27, 56.3%), and most were delivered in community settings (n = 31, 64.6%). There was a small and significant effect for suicidal ideation in clinical settings (g = −0.35, 95% CI [−0.59, −0.10], p = .006) and community settings (g = −0.10, 95% CI [−0.19, −0.01], p = .037), but not in education settings (g = −0.20, 95% CI [−0.55, 0.16], p = .283). Pairwise comparisons between settings were not significant, nor were there any significant effects for suicidal behaviours. Conclusions: The results show that digital interventions to reduce suicide ideation are effective when delivered in community and clinical settings. Fewer studies have been conducted in, and the evidence does not yet support the effectiveness in, education settings. Furthermore, there does not appear to be any evidence supporting the effectiveness of digital interventions in reducing suicidal behaviours. Design features (such as treatment modality) may account for less variance in effectiveness than previously thought.