Suicide Prevention and Intervention With Military Personnel and/or Veterans: An Overview of Systematic Reviews

Background Suicide prevention among military personnel and veterans is a public health priority, yet evidence regarding effective interventions is dispersed across systematic reviews of varying scope and quality. Objectives To systematically identify, appraise, and synthesize reviews of suicide prevention and treatment interventions for military personnel and veterans and assess the applicability and quality of the evidence. Methods We searched eight bibliographic databases, organizational websites, reference lists, and forward citations and consulted subject-matter experts for reviews published from 2004 onward. Searches were completed in June–July 2024. Eligible reviews synthesized interventions intended to prevent or treat suicidal ideation or behavior and either focused on military personnel or veterans or included an identifiable subset of studies involving these populations. Two reviewers independently conducted full-text screening and data extraction. Findings were synthesized narratively. Review quality was assessed using AMSTAR 2 and primary-study overlap using the Corrected Covered Area Index. Results Twenty-three reviews met eligibility criteria. Across reviews, findings regarding intervention effectiveness were mixed, with some favorable findings for particular approaches, but the evidence did not support confident conclusions about the effectiveness of specific suicide prevention interventions for military personnel or veterans. Review quality was poor: 22 reviews were rated critically low quality and one low quality. Heterogeneity in interventions, populations, study designs, and outcomes, along with inconsistent assessment and incorporation of risk of bias, further limited interpretation. The reviews contained 323 unique primary studies; however, only 48 specifically evaluated a suicide prevention or treatment intervention in a military or veteran population and reported a suicide-specific outcome, and only 18 (38%) of these were randomized controlled trials. Conclusions Despite a substantial review literature, directly applicable, methodologically trustworthy evidence remains limited. More rigorous primary studies and systematic reviews focused specifically on suicide prevention in military and veteran populations are needed. Registration PROSPERO CRD42024549878.