Psychosocial interventions for self-harm and suicide prevention in liaison psychiatry: An overview of systematic reviews

Background: Liaison psychiatry services play a central role in self-harm care and suicide prevention by providing specialist mental health input in general hospitals. Psychosocial interventions, including brief contact approaches (e.g., safety plans) and longer-term structured therapies (e.g., cognitive-behaviour therapy [CBT], dialectical behaviour therapy [CBT]), may reduce self-harm and suicide risk but their relevance and effectiveness within liaison psychiatry settings remains unclear.

 

Aims: To synthesise systematic evidence review on psychosocial interventions for preventing self-harm and suicide in liaison psychiatry settings through an umbrella review.

 

Methods: We searched Medline, Embase, CINAHL, PsycInfo, and CDSR (2013-2023) for systematic reviews evaluating interventions in liaison psychiatry contexts (including emergency departments, wards in general hospitals, outpatient/follow-up clinics for acute care patients receiving treatment for self-harm/suicidal behaviour), in adults or mixed adult/adolescent populations. Review quality (AMSTAR-2), primary study overlap in reviews, and evidence certainty (adapted GRADE) were assessed. Findings were narratively synthesised and tabulated, with input from experts-by-experience throughout. PROSPERO: CRD42023442639.

Results: Twenty-three systematic reviews (including 12 meta-analyses; >450,000 participants), were included. Person-centred brief contact interventions, particularly those incorporating safety planning and follow-up, were most consistently associated with reduced suicide attempt rates. However, methodological limitations including heterogeneity, limited generalisability, lack of self-harm specific outcomes, and mixed findings for remote only contact interventions warrant cautious interpretation. For longer-term psychological therapies, CBT was associated with reduced repeat self-harm, particularly with longer follow-up, whereas DBT reduced the rate of repetition. Evidence was limited by the lack of setting-specific trials, limited patient involvement, and suboptimal quality trials. Review quality varied. Primary trial overlap was slight overall, but high for some pairs of reviews of brief interventions.

Conclusion: Current evidence for self-harm and suicide prevention interventions in liaison psychiatry services is methodologically suboptimal. Given widescale implementation of psychosocial interventions, there is an urgent priority to ensure they are safe, effective, and acceptable within liaison psychiatry services.