Challenges in Synthesising the Effects of Synchronous Remote-based Interventions on Suicidal Behaviours: A Systematic Review and Meta-Analysis

Introduction. Suicide is one of the leading causes of preventable death worldwide. Evidence reported in the literature seems to support the impact of providing active contact for people that have attempted suicide. The current systematic review and meta–analysis aim to investigate the effects of suicide prevention strategies implemented through remote and synchronous technology–based interventions. Methods. The systematic review and meta–analysis followed the PRISMA 2020 guidelines. The searches were conducted in PubMed, PsycInfo, Scopus, and Web of Science. Screening, selection process, data extraction, and risk of bias (RoB) assessment have been performed independently by two reviewers. A systematic review and narrative synthesis of the data has been performed. Data on adherence to treatment and suicide–related factors to explain heterogeneity were extracted. A meta–analysis was conducted to determine effect sizes (Hedge′s g) for suicidal ideation, odds ratios (OR) and 95% confidence intervals (95% CI) for lethal and non–lethal suicide behaviours. Data were pooled using a random–effects model. Subgroup analyses were performed by classifying the studies according to the evaluation period. Results. A total of 26 publications were finally included. Synchronous remote–based interventions were effective in preventing repeated suicide attempts (OR = 0.75; 95% CI 0.62 – 0.90) and suicide deaths (Peto OR = 0.37; 95% CI 0.18 – 0.77); however, considerable heterogeneity was reported. The effects on suicidal ideation were not confirmed (Hedge′s g = 0.23; 95% CI –1.54 – 1.07). Conclusions. The observed heterogeneity suggests that the effects should be considered under caution. Methodological and procedural guidelines are proposed to improve the quality of future research studies. ### Competing Interest Statement D.P. has received grants and also served as a consultant or advisor for Rovi, Angelini, Janssen, Lundbeck and Servier. The other authors declare no conflicts of interest. ### Clinical Protocols ### Funding Statement This research was funded by the Instituto de Salud Carlos III, Subdireccion General de Evaluacion y Fomento de la Investigacion (ISCIII) and Fondo Europeo de Desarrollo Regional (FEDER). The APC was funded by the Instituto de Salud Carlos III, Subdireccion General de Evaluacion y Fomento de la Investigacion (ISCIII) and Fondo Europeo de Desarrollo Regional (FEDER). The funders had no role in the design of the study; in the collection, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. The Department of Mental Health of Hospital Universitari Parc Tauli, Unitat Mixta de Neurociencia Traslacional I3PT-INc-UAB, is the sponsor. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.