Safety Planning Interventions for Suicide Prevention in Children and Adolescents

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.