Safety planning interventions to address suicidality in adults: A systematic review of the methodological characteristics of safety planning effectiveness research

Objective: This review aimed to synthesize and critically examine the methodological characteristics of research on Safety Planning Intervention (SPI) effectiveness for adults experiencing suicidality. Method: Six databases were systematically searched for studies examining the efficacy/effectiveness of SPIs in adults, following PRISMA guidelines (Cochrane Trials, PubMed, Embase, PsycINFO, Web of Science, Medline). Search terms included terms related to suicidality and self-harm, and safety planning and crisis interventions. Screening was completed independently by two researchers. Study Design, Participants, Study Settings, Types of Safety Planning Interventions, Modalities of Intervention Delivery, Recruitment Methods, Monitoring Periods, Outcomes and Measures used, Results Reported and Guiding Theories were extracted. Results: Twenty articles were eligible for inclusion. Participants were predominantly veterans (n = 7) and emergency department patients (n = 4). Ten studies used a randomized controlled design, and seven were quasi-experimental. Studies took place in hospital settings (n = 8), mental health crisis care facilities (n = 2), refugee camps (n = 1) and online (n = 4). Interventions included SPI alone, SPI with structured follow-up, or SPI combined with other interventions. Suicide-specific outcomes included suicidal ideation, suicidal behaviour, suicide-related coping and hospitalization/ service use. Three studies referenced guiding theories. There was heterogeneity in outcomes studied and measures used. Results reported generally supported the effectiveness of SPI in reducing suicidal ideation and behaviours, reducing hospitalization and increasing outpatient treatment engagement. Conclusions: Studies varied in intervention setting, intervention procedures and modalities, outcomes assessed and measures used. There was a lack of theory-driven research and research targeting at-risk groups.