scholarly journals Mobile Health Technology Interventions for Suicide Prevention: Systematic Review (Preprint)

2018 ◽  
Author(s):  
Ruth Melia ◽  
Kady Francis ◽  
Emma Hickey ◽  
John Bogue ◽  
Jim Duggan ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Suicide Prevention ◽  
Mobile Health ◽  
Cochrane Library ◽  
Outcome Variable ◽  
Controlled Trials ◽  
Safe Practice ◽  
Mhealth Intervention ◽  
Self Harm ◽  
Mhealth Technology

BACKGROUND Digital interventions are proposed as one way by which effective treatments for self-harm and suicidal ideation may be improved and their scalability enhanced. Mobile devices offer a potentially powerful medium to deliver evidence-based interventions with greater specificity to the individual when the intervention is needed. The recent proliferation of publicly available mobile apps designed for suicide prevention underlines the need for robust evidence to promote safe practice. OBJECTIVE This review aimed to examine the effectiveness of currently available mobile health (mHealth) technology tools in reducing suicide-specific outcomes. METHODS The following databases were searched: Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, and relevant sources of gray literature. All published and unpublished randomized controlled trials (RCTs), pseudo-RCTs, and pre-post observational studies that evaluated the effectiveness of mHealth technology in suicide prevention delivered via mobile computing and communication technology were included. Studies were included if they measured at least one suicide outcome variable (ie, suicidal ideation, suicidal intent, nonsuicidal self-injurious behavior, and suicidal behavior). A total of 2 review authors independently extracted data and assessed study suitability, in accordance with the Cochrane Collaboration Risk of Bias Tool, on July 31, 2018. Owing to the heterogeneity of outcomes found across studies, results were not amenable for pooled synthesis, and a meta-analysis was not performed. A narrative synthesis of the available research is presented here. RESULTS A total of 7 studies met criteria for inclusion . Four published articles that reported on the effectiveness of the following mobile phone apps were included: iBobbly, Virtual Hope Box, BlueIce, and Therapeutic Evaluative Conditioning. Results demonstrated some positive impacts for individuals at elevated risk of suicide or self-harm, including reductions in depression, psychological distress, and self-harm and increases in coping self-efficacy. None of the apps evaluated demonstrated the ability to significantly decrease suicidal ideation compared with a control condition. In addition, 3 unpublished and recently completed trials also met criteria for inclusion in the review. CONCLUSIONS Further research is needed to evaluate the efficacy of stand-alone mHealth technology–based interventions in suicide prevention. The small number of studies reported in this review tentatively indicate that such tools may have a positive impact on suicide-specific outcomes. Future mHealth intervention evaluations would benefit from addressing the following 3 main methodological limitations : (1) heterogeneity of outcomes: a lack of standardized measurement of suicide outcomes across studies; (2) ecological validity: the tendency to exclude potential participants because of the elevated suicide risk may reduce generalizability within clinical settings; and (3) app regulation and definition: the lack of a standardized classification system for mHealth intervention type points to the need for better definition of the scope of such technologies to promote safe practice.

scholarly journals Mobile Health Technology Interventions for Suicide Prevention: Systematic Review

10.2196/12516 ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. e12516 ◽  
Author(s):  
Ruth Melia ◽  
Kady Francis ◽  
Emma Hickey ◽  
John Bogue ◽  
Jim Duggan ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Suicide Prevention ◽  
Mobile Health ◽  
Cochrane Library ◽  
Outcome Variable ◽  
Controlled Trials ◽  
Safe Practice ◽  
Mhealth Intervention ◽  
Self Harm ◽  
Mhealth Technology

Background Digital interventions are proposed as one way by which effective treatments for self-harm and suicidal ideation may be improved and their scalability enhanced. Mobile devices offer a potentially powerful medium to deliver evidence-based interventions with greater specificity to the individual when the intervention is needed. The recent proliferation of publicly available mobile apps designed for suicide prevention underlines the need for robust evidence to promote safe practice. Objective This review aimed to examine the effectiveness of currently available mobile health (mHealth) technology tools in reducing suicide-specific outcomes. Methods The following databases were searched: Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, and relevant sources of gray literature. All published and unpublished randomized controlled trials (RCTs), pseudo-RCTs, and pre-post observational studies that evaluated the effectiveness of mHealth technology in suicide prevention delivered via mobile computing and communication technology were included. Studies were included if they measured at least one suicide outcome variable (ie, suicidal ideation, suicidal intent, nonsuicidal self-injurious behavior, and suicidal behavior). A total of 2 review authors independently extracted data and assessed study suitability, in accordance with the Cochrane Collaboration Risk of Bias Tool, on July 31, 2018. Owing to the heterogeneity of outcomes found across studies, results were not amenable for pooled synthesis, and a meta-analysis was not performed. A narrative synthesis of the available research is presented here. Results A total of 7 studies met criteria for inclusion . Four published articles that reported on the effectiveness of the following mobile phone apps were included: iBobbly, Virtual Hope Box, BlueIce, and Therapeutic Evaluative Conditioning. Results demonstrated some positive impacts for individuals at elevated risk of suicide or self-harm, including reductions in depression, psychological distress, and self-harm and increases in coping self-efficacy. None of the apps evaluated demonstrated the ability to significantly decrease suicidal ideation compared with a control condition. In addition, 3 unpublished and recently completed trials also met criteria for inclusion in the review. Conclusions Further research is needed to evaluate the efficacy of stand-alone mHealth technology–based interventions in suicide prevention. The small number of studies reported in this review tentatively indicate that such tools may have a positive impact on suicide-specific outcomes. Future mHealth intervention evaluations would benefit from addressing the following 3 main methodological limitations : (1) heterogeneity of outcomes: a lack of standardized measurement of suicide outcomes across studies; (2) ecological validity: the tendency to exclude potential participants because of the elevated suicide risk may reduce generalizability within clinical settings; and (3) app regulation and definition: the lack of a standardized classification system for mHealth intervention type points to the need for better definition of the scope of such technologies to promote safe practice. Trial Registration PROSPERO CRD42017072899; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72899 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.8635

scholarly journals Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis

2021 ◽  
pp. 1-11
Author(s):  
Oswald D. Kothgassner ◽  
Andreas Goreis ◽  
Kealagh Robinson ◽  
Mercedes M. Huscsava ◽  
Christian Schmahl ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Suicidal Ideation ◽  
Dialectical Behavior Therapy ◽  
Meta Analysis ◽  
Adolescent Psychopathology ◽  
Cochrane Library ◽  
Behaviour Therapy ◽  
Clinical Consequences ◽  
Self Harm

Abstract Background Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical. Methods We conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12–19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7. Results Overall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = −0.44; 95% CI −0.81 to −0.07) and suicidal ideation (g = −0.31, 95% CI −0.52 to −0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = −0.98, 95% CI −1.15 to −0.81; suicidal ideation: g = −1.16, 95% CI −1.51 to −0.80; BPD symptoms: g = −0.97, 95% CI −1.31 to −0.63). Conclusions DBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

scholarly journals An Analysis of Depression, Self-Harm, and Suicidal Ideation Content on Tumblr

Crisis ◽  
2017 ◽  
Vol 38 (1) ◽  
pp. 44-52 ◽  
Author(s):  
Patricia A. Cavazos-Rehg ◽  
Melissa J. Krauss ◽  
Shaina J. Sowles ◽  
Sarah Connolly ◽  
Carlos Rosas ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Social Networking ◽  
Risk Behaviors ◽  
Suicide Prevention ◽  
Research Team ◽  
Median Number ◽  
Self Harm

Abstract. Background: Social networking about depression can be indicative of self-reported depression and/or can normalize risk behaviors such as self-harm and suicidal ideation. Aim: To gain a better understanding of the depression, self-harm, and suicidal content that is being shared on Tumblr. Method: From April 16 to May 10, 2014, 17 popular depression-related Tumblr accounts were monitored for new posts and engagement with other Tumblr users. A total of 3,360 posts were randomly selected from all historical posts from these accounts and coded based on themes ascertained by the research team. Results: The 17 Tumblr accounts posted a median number of 185 posts (range = 0–2,954). Content was engaged with (i.e., re-blogged or liked) a median number of 1,677,362 times (range = 0–122,186,504). Of the 3,360 randomly selected posts, 2,739 (82%) were related to depression, suicide, or self-harm. Common themes were self-loathing (412, 15%), loneliness/feeling unloved (405, 15%), self-harm (407, 15%), and suicide (372, 14%). Conclusion: This study takes an important first step at better understanding the displayed depression-related references on Tumblr. The findings signal a need for suicide prevention efforts to intervene on Tumblr and use this platform in a strategic way, given the depression and suicidal content that was readily observed on Tumblr.

scholarly journals Design Features for Improving Mobile Health Intervention User Engagement: Systematic Review and Thematic Analysis

10.2196/21687 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e21687
Author(s):  
Yanxia Wei ◽  
Pinpin Zheng ◽  
Hui Deng ◽  
Xihui Wang ◽  
Xiaomei Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Mobile Health ◽  
Thematic Analysis ◽  
High Rate ◽  
Cochrane Library ◽  
User Engagement ◽  
Design Features ◽  
Unhealthy Lifestyle ◽  
Mhealth Intervention

Background Well-designed mobile health (mHealth) interventions support a positive user experience; however, a high rate of disengagement has been reported as a common concern regarding mHealth interventions. To address this issue, it is necessary to summarize the design features that improve user engagement based on research over the past 10 years, during which time the popularity of mHealth interventions has rapidly increased due to the use of smartphones. Objective The aim of this review was to answer the question “Which design features improve user engagement with mHealth interventions?” by summarizing published literature with the purpose of guiding the design of future mHealth interventions. Methods This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. Databases, namely, PubMed, Web of Science, Cochrane Library, Ovid EMBASE, and Ovid PsycINFO, were searched for English and Chinese language papers published from January 2009 to June 2019. Thematic analysis was undertaken to assess the design features in eligible studies. The Mixed Methods Appraisal Tool was used to assess study quality. Results A total of 35 articles were included. The investigated mHealth interventions were mainly used in unhealthy lifestyle (n=17) and chronic disease (n=10) prevention programs. Mobile phone apps (n=24) were the most common delivery method. Qualitative (n=22) and mixed methods (n=9) designs were widely represented. We identified the following 7 themes that influenced user engagement: personalization (n=29), reinforcement (n=23), communication (n=20), navigation (n=17), credibility (n=16), message presentation (n=16), and interface aesthetics (n=7). A checklist was developed that contained these 7 design features and 29 corresponding specific implementations derived from the studies. Conclusions This systematic review and thematic synthesis identified useful design features that make an mHealth intervention more user friendly. We generated a checklist with evidence-based items to enable developers to use our findings easily. Future evaluations should use more robust quantitative approaches to elucidate the relationships between design features and user engagement.

scholarly journals mHealth Interventions for Self-Harm: A Scoping Review (Preprint)

2020 ◽  
Author(s):  
Bethany Cliffe ◽  
Jessica Tingley ◽  
Isobel Greenhalgh ◽  
Paul Stallard
Keyword(s):  
Scoping Review ◽  
Evidence Base ◽  
Cochrane Library ◽  
Exclusion Criteria ◽  
Mhealth Intervention ◽  
Library Studies ◽  
Randomised Control Trials ◽  
Self Harm ◽  
Nuanced Understanding ◽  
Receive Treatment

BACKGROUND Self-harm is a growing issue, for which individuals do not often receive treatment. mHealth interventions are a possible solution to some of the barriers individual face when seeking support that have also been found to be effective in improving mental health. Reviews of mHealth interventions for self-harm thus far have had limiting exclusion criteria, so a broader scoping review will provide a more exhaustive understanding of mHealth interventions that have been developed for self-harm. OBJECTIVE This scoping review aimed to (1) identify the mHealth interventions that have been developed for self-harm, (2) understand the types and features of interventions that have been developed, (3) establish the evidence base for mHealth interventions for self-harm, and (4) determine what outcomes are typically used to assess the efficacy of interventions. METHODS A search was conducted using Embase, PubMed, PsycINFO, PsycEXTRA, Web of Science, and the Cochrane Library. Studies were included if it described an mHealth intervention that may have had a treatment effect on self-harm either directly or indirectly, and if it was available in English. There were no exclusion criteria based on study design. RESULTS A total of 36 papers were included in the review, that were mostly randomised control trials published within the last four years. The interventions were mostly smartphone applications or calling/texting services. They were generally shown to be effective and appealing, but very few were widely available for use. Outcomes typically focussed on a reduction of self-harm, as well as suicidality, mood, and the users’ experiences of the intervention. Samples were typically non-diverse, and there was limited variety in study designs or in measurements of self-harm recovery. CONCLUSIONS Effective and appealing mHealth interventions have been developed but are not widely available. Research could also benefit from greater diversity, as well as a broader and more nuanced understanding of recovery from self-harm.

scholarly journals Value of mobile health in improving breastfeeding outcomes among perinatal or postpartum women: a systematic review and meta-analysis of randomized controlled trials (Preprint)

2020 ◽  
Author(s):  
Jiafen Qian ◽  
Tingting Wu ◽  
Meina Lv ◽  
Zongwei Fang ◽  
Mingrong Chen ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Usual Care ◽  
Mobile Health ◽  
Exclusive Breastfeeding ◽  
Health Problems ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Breastfeeding Rate ◽  
Significant Difference

BACKGROUND Breastfeeding is essential for maintaining the health of mothers and babies, but the global breastfeeding rate is low. Interventions based on mobile health (mhealth) may have the potential to facilitate the improvement of breastfeeding status. OBJECTIVE The aim of this study was to analyze the existing evidence to determine whether mhealth-based interventions can improve the status of breastfeeding. METHODS We systematically searched multiple electronic databases (PubMed, Web of Science, The Cochrane Library and Embase) to identify eligible studies published before October 29, 2020. Included studies were randomized controlled trials (RCTs) studying the influence of mhealth on breastfeeding. RevMan 5.3 was used to analyze the data. RESULTS A total of 17 RCTs with a total sample size of 4366 participates met the inclusion criteria. Compared with usual care, interventions based on mhealth can significantly increase the rate of postpartum exclusive breastfeeding rate (RR 3.03, 95% CI 2.12-4.33; P<0.00001), enhance breastfeeding self-efficacy (RR 7.74, 95% CI 2.76-12.71; P=0.002), and reduce health problems in infants (RR 0.62, 95% CI 0.43-0.90; P=0.01. There was no significant difference between the intervention group and the usual care group in terms of participants' attitudes towards breastfeeding (RR 2.54, 95% CI -1.18-5.70; P=0.20) or initiation of breastfeeding within an hour of birth (RR 1.26, 95% CI 0.55-2.90; P=0.59). CONCLUSIONS Interventions based on mhealth can significantly increase the rate of postpartum exclusive breastfeeding, breastfeeding efficacy and reduce health problems in infants. Therefore, mhealth can be used to promote the health of pregnant mothers and infants.

scholarly journals Associations Between Mobile Health Technology use and Self-rated Quality of Life: A Cross-sectional Study on Older Adults with Cognitive Impairment

2021 ◽  
Vol 7 ◽  
pp. 233372142110189
Author(s):  
Line Christiansen ◽  
Johan Sanmartin Berglund ◽  
Peter Anderberg ◽  
Selim Cellek ◽  
Jufen Zhang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Mobile Health ◽  
Technology Use ◽  
Technical Skills ◽  
Outcome Variable ◽  
Cross Sectional ◽  
Mhealth Technology

Background: Quality of life (QoL) is affected even at early stages in older adults with cognitive impairment. The use of mobile health (mHealth) technology can offer support in daily life and improve the physical and mental health of older adults. However, a clarification of how mHealth technology can be used to support the QoL of older adults with cognitive impairment is needed. Objective: To investigate factors affecting mHealth technology use in relation to self-rated QoL among older adults with cognitive impairment. Methods: A cross-sectional research design was used to analyse mHealth technology use and QoL in 1,082 older participants. Baseline data were used from a multi-centered randomized controlled trial including QoL, measured by the Quality of Life in Alzheimer’s Disease (QoL-AD) Scale, as the outcome variable. Data were analyzed using logistic regression models. Results: Having moderately or high technical skills in using mHealth technology and using the internet via mHealth technology on a daily or weekly basis was associated with good to excellent QoL in older adults with cognitive impairment. Conclusions: The variation in technical skills and internet use among the participants can be interpreted as an obstacle for mHealth technology to support QoL.

scholarly journals Rethinking the Endpoints of mHealth Intervention Research in Diabetes Care

2017 ◽  
Vol 12 (2) ◽  
pp. 389-392 ◽  
Author(s):  
Katherine L. Modzelewski ◽  
Mary-Catherine Stockman ◽  
Devin W. Steenkamp
Keyword(s):  
Health Care ◽  
Mobile Health ◽  
Gold Standard ◽  
Text Messages ◽  
Controlled Trials ◽  
Web Portals ◽  
High Demand ◽  
Mhealth Intervention ◽  
Randomized Controlled ◽  
Continuous Glucose Monitors

Mobile health (mHealth) is an emerging branch of medicine that utilizes technology to impact health care. With increasing access to smartphones and mobile devices, there has been an increase in both the availability and use of mHealth resources, including the use of text messages, apps, and web portals. In diabetes, there is particular interest as technology has long been a mainstay of management through glucometers, insulin pumps and continuous glucose monitors, which are increasingly interconnected. Although there is high demand for mHealth interventions in diabetes, there is no clear consensus on the best way to monitor these interventions. While randomized controlled trials are considered the gold standard for most medical research, we propose that alternative trial designs may be more applicable in the ever-changing mHealth landscape.

scholarly journals Efficacy of a Self-Regulation–Based Electronic and Mobile Health Intervention Targeting an Active Lifestyle in Adults Having Type 2 Diabetes and in Adults Aged 50 Years or Older: Two Randomized Controlled Trials

10.2196/13363 ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. e13363 ◽  
Author(s):  
Louise Poppe ◽  
Ilse De Bourdeaudhuij ◽  
Maïté Verloigne ◽  
Samyah Shadid ◽  
Jelle Van Cauwenberg ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Mobile Health ◽  
Intervention Group ◽  
Sitting Time ◽  
Control Group ◽  
Controlled Trials ◽  
Active Lifestyle ◽  
Mhealth Intervention ◽  
Randomized Controlled

Background Adopting an active lifestyle plays a key role in the prevention and management of chronic diseases such as type 2 diabetes mellitus (T2DM). Web-based interventions are able to alter health behaviors and show stronger effects when they are informed by a behavior change theory. MyPlan 2.0 is a fully automated electronic health (eHealth) and mobile health (mHealth) intervention targeting physical activity (PA) and sedentary behavior (SB) based on the Health Action Process Approach (HAPA). Objective This study aimed to test the short-term effect of MyPlan 2.0 in altering levels of PA and SB and in changing personal determinants of behavior in adults with T2DM and in adults aged ≥50 years. Methods The study comprised two randomized controlled trials (RCTs) with an identical design. RCT 1 was conducted with adults with T2DM. RCT 2 was performed in adults aged ≥50 years. Data were collected via face-to-face assessments. The participants decided either to increase their level of PA or to decrease their level of SB. The participants were randomly allocated with a 2:1 ratio to the intervention group or the waiting-list control group. They were not blinded for their group allocation. The participants in the intervention group were instructed to go through MyPlan 2.0, comprising 5 sessions with an interval of 1 week between each session. The primary outcomes were objectively measured and self-reported PA (ie, light PA, moderate-to-vigorous PA, total PA, number of steps, and domain-specific [eg, transport-related] PA) and SB (ie, sitting time, number of breaks from sitting time, and length of sitting bouts). Secondary outcomes were self-reported behavioral determinants for PA and SB (eg, self-efficacy). Separate linear mixed models were performed to analyze the effects of MyPlan 2.0 in the two samples. Results In RCT 1 (n=54), the PA intervention group showed, in contrast to the control group, a decrease in self-reported time spent sitting (P=.09) and an increase in accelerometer-measured moderate (P=.05) and moderate-to-vigorous PA (P=.049). The SB intervention group displayed an increase in accelerometer-assessed breaks from sedentary time in comparison with the control group (P=.005). A total of 14 participants of RCT 1 dropped out. In RCT 2 (n=63), the PA intervention group showed an increase for self-reported total PA in comparison with the control group (P=.003). Furthermore, in contrast to the control group, the SB intervention group decreased their self-reported time spent sitting (P=.08) and increased their accelerometer-assessed moderate (P=.06) and moderate-to-vigorous PA (P=.07). A total of 8 participants of RCT 2 dropped out. Conclusions For both the samples, the HAPA-based eHealth and mHealth intervention, MyPlan 2.0, was able to improve only some of the primary outcomes. Trial Registration ClinicalTrials.gov NCT03291171; http://clinicaltrials.gov/ct2/show/NCT03291171. ClinicalTrials.gov NCT03799146; http://clinicaltrials.gov/ct2/show/NCT03799146. International Registered Report Identifier (IRRID) RR2-10.2196/12413

scholarly journals Global systematic review of the effects of suicide prevention interventions in Indigenous peoples

2020 ◽  
pp. jech-2019-212368
Author(s):  
Stuart Leske ◽  
Elise Paul ◽  
Mandy Gibson ◽  
Brock Little ◽  
Mark Wenitong ◽  
...  
Keyword(s):  
Suicide Prevention ◽  
Indigenous Peoples ◽  
Randomised Controlled Trials ◽  
Suicide Attempts ◽  
Risk Of Bias ◽  
Indigenous Populations ◽  
Controlled Trials ◽  
Prevention Interventions ◽  
Self Harm ◽  
Randomised Controlled

ObjectiveSuicide rates are often higher in Indigenous than in non-Indigenous peoples. This systematic review assessed the effects of suicide prevention interventions on suicide-related outcomes in Indigenous populations worldwide.MethodsWe searched CINAHL, Embase, PubMed, PsycINFO, ProQuest Dissertations & Theses and Web of Science from database inception to April 2020. Eligible were English language, empirical and peer-reviewed studies presenting original data assessing the primary outcomes of suicides and suicide attempts and secondary outcomes of suicidal ideation, intentional self-harm, suicide or intentional self-harm risk, composite measures of suicidality or reasons for life in experimental and quasi-experimental interventions with Indigenous populations worldwide. We assessed the risk of bias with the Cochrane Risk of Bias Tool and the Risk of Bias Assessment for Non-randomised Studies.FindingsWe included 24 studies from Australia, Canada, New Zealand and the USA, comprising 14 before–after studies, 4 randomised controlled trials (RCTs), 3 non-randomised controlled trials, 2 interrupted time-series designs and 1 cohort study. Suicides decreased in four and suicide attempts in six before–after studies. No studies had a low risk of bias. There was insufficient evidence to confirm the effectiveness of any one suicide prevention intervention due to shortage of studies, risk of bias, and population and intervention heterogeneity. Review limitations include language bias, no grey literature search and data availability bias.ConclusionFor the primary outcomes of suicides and suicide attempts, the limited available evidence supports multilevel, multicomponent interventions. However, there are limited RCTs and controlled studies.

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