Prevention of suicide and reduction of self-harm among people with substance use disorder: A systematic review and meta-analysis of randomised controlled trials

Prianka Padmanathan; Katherine Hall; Paul A Moran; Hayley E Jones; David Gunnell; Vicky Carlisle; Anne R Lingford-Hughes; Matt Hickman

doi:10.1016/j.comppsych.2019.152135

Prevention of suicide and reduction of self-harm among people with substance use disorder: A systematic review and meta-analysis of randomised controlled trials

Prianka Padmanathan^*, Katherine Hall, Paul A Moran, Hayley E Jones, David Gunnell, Vicky Carlisle, Anne R Lingford-Hughes, Matt Hickman

^*Corresponding author for this work

Research output: Contribution to journal › Review article (Academic Journal) › peer-review

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Abstract

Background
People with substance use disorder (SUD) are at significantly greater risk of suicide compared with the general population. In recent years the number of suicides resulting from drug poisoning in England and Wales has increased. We sought to identify and evaluate the effect of interventions to prevent suicide or reduce self-harm among people with SUD.

Methods
We conducted a systematic review of randomised controlled trials (RCTs) of interventions for people with SUD that included suicide or self-harm-related primary outcomes. We searched Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, PubMed, Embase and Web of Science from inception until 13th January 2019. Studies were assessed for bias using the Cochrane Risk of Bias 2 tool. A random effects meta-analysis of standardised mean differences (SMD) was conducted.

Results
We identified six RCTs from four countries (Australia, Iran, the United States of America and the United Kingdom) comprising 468 participants in total. All but one study investigated psychosocial interventions. On average across studies, there was weak evidence of a small positive effect of interventions on suicide or self-harm outcomes (d = -0.20, 95% CI = -0.39-0.00).

Limitations
Studies were heterogeneous in terms of population, intervention, controls and outcome. There were some concerns regarding bias for all trials. All trials were liable to type II error.

Conclusions
Evidence is currently lacking regarding the effectiveness of interventions to prevent suicide and reduce self-harm amongst people with SUD.

Original language	English
Article number	152135
Number of pages	7
Journal	Comprehensive Psychiatry
Volume	96
DOIs	https://doi.org/10.1016/j.comppsych.2019.152135
Publication status	Published - 1 Jan 2020

Structured keywords

Physical and Mental Health
Tobacco and Alcohol

Keywords

suicide
substance use disorder
addiction
alcohol
drug

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10.1016/j.comppsych.2019.152135

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Revised: 'Excessive drinking and alcohol related harms in Adulthood: ALSPAC at 24 MR/L022206/1'
Hickman, M.
1/06/15 → 31/05/20
Project: Research

Professor Paul A Moran
- paul.moranbristol.acuk
- Bristol Medical School (PHS) - Professor of Psychiatry
- Bristol Population Health Science Institute
Person: Academic , Member

Cite this

Padmanathan, P., Hall, K., Moran, P. A., Jones, H. E., Gunnell, D., Carlisle, V., Lingford-Hughes, A. R., & Hickman, M. (2020). Prevention of suicide and reduction of self-harm among people with substance use disorder: A systematic review and meta-analysis of randomised controlled trials. Comprehensive Psychiatry, 96, [152135]. https://doi.org/10.1016/j.comppsych.2019.152135

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abstract = "BackgroundPeople with substance use disorder (SUD) are at significantly greater risk of suicide compared with the general population. In recent years the number of suicides resulting from drug poisoning in England and Wales has increased. We sought to identify and evaluate the effect of interventions to prevent suicide or reduce self-harm among people with SUD.MethodsWe conducted a systematic review of randomised controlled trials (RCTs) of interventions for people with SUD that included suicide or self-harm-related primary outcomes. We searched Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, PubMed, Embase and Web of Science from inception until 13th January 2019. Studies were assessed for bias using the Cochrane Risk of Bias 2 tool. A random effects meta-analysis of standardised mean differences (SMD) was conducted.ResultsWe identified six RCTs from four countries (Australia, Iran, the United States of America and the United Kingdom) comprising 468 participants in total. All but one study investigated psychosocial interventions. On average across studies, there was weak evidence of a small positive effect of interventions on suicide or self-harm outcomes (d = -0.20, 95% CI = -0.39-0.00).LimitationsStudies were heterogeneous in terms of population, intervention, controls and outcome. There were some concerns regarding bias for all trials. All trials were liable to type II error. ConclusionsEvidence is currently lacking regarding the effectiveness of interventions to prevent suicide and reduce self-harm amongst people with SUD. ",

keywords = "suicide, substance use disorder, addiction, alcohol, drug",

author = "Prianka Padmanathan and Katherine Hall and Moran, {Paul A} and Jones, {Hayley E} and David Gunnell and Vicky Carlisle and Lingford-Hughes, {Anne R} and Matt Hickman",

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doi = "10.1016/j.comppsych.2019.152135",

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Prevention of suicide and reduction of self-harm among people with substance use disorder : A systematic review and meta-analysis of randomised controlled trials. / Padmanathan, Prianka; Hall, Katherine; Moran, Paul A et al.

In: Comprehensive Psychiatry, Vol. 96, 152135, 01.01.2020.

Research output: Contribution to journal › Review article (Academic Journal) › peer-review

TY - JOUR

T1 - Prevention of suicide and reduction of self-harm among people with substance use disorder

T2 - A systematic review and meta-analysis of randomised controlled trials

AU - Padmanathan, Prianka

AU - Hall, Katherine

AU - Moran, Paul A

AU - Jones, Hayley E

AU - Gunnell, David

AU - Carlisle, Vicky

AU - Lingford-Hughes, Anne R

AU - Hickman, Matt

PY - 2020/1/1

Y1 - 2020/1/1

N2 - BackgroundPeople with substance use disorder (SUD) are at significantly greater risk of suicide compared with the general population. In recent years the number of suicides resulting from drug poisoning in England and Wales has increased. We sought to identify and evaluate the effect of interventions to prevent suicide or reduce self-harm among people with SUD.MethodsWe conducted a systematic review of randomised controlled trials (RCTs) of interventions for people with SUD that included suicide or self-harm-related primary outcomes. We searched Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, PubMed, Embase and Web of Science from inception until 13th January 2019. Studies were assessed for bias using the Cochrane Risk of Bias 2 tool. A random effects meta-analysis of standardised mean differences (SMD) was conducted.ResultsWe identified six RCTs from four countries (Australia, Iran, the United States of America and the United Kingdom) comprising 468 participants in total. All but one study investigated psychosocial interventions. On average across studies, there was weak evidence of a small positive effect of interventions on suicide or self-harm outcomes (d = -0.20, 95% CI = -0.39-0.00).LimitationsStudies were heterogeneous in terms of population, intervention, controls and outcome. There were some concerns regarding bias for all trials. All trials were liable to type II error. ConclusionsEvidence is currently lacking regarding the effectiveness of interventions to prevent suicide and reduce self-harm amongst people with SUD.

AB - BackgroundPeople with substance use disorder (SUD) are at significantly greater risk of suicide compared with the general population. In recent years the number of suicides resulting from drug poisoning in England and Wales has increased. We sought to identify and evaluate the effect of interventions to prevent suicide or reduce self-harm among people with SUD.MethodsWe conducted a systematic review of randomised controlled trials (RCTs) of interventions for people with SUD that included suicide or self-harm-related primary outcomes. We searched Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, PubMed, Embase and Web of Science from inception until 13th January 2019. Studies were assessed for bias using the Cochrane Risk of Bias 2 tool. A random effects meta-analysis of standardised mean differences (SMD) was conducted.ResultsWe identified six RCTs from four countries (Australia, Iran, the United States of America and the United Kingdom) comprising 468 participants in total. All but one study investigated psychosocial interventions. On average across studies, there was weak evidence of a small positive effect of interventions on suicide or self-harm outcomes (d = -0.20, 95% CI = -0.39-0.00).LimitationsStudies were heterogeneous in terms of population, intervention, controls and outcome. There were some concerns regarding bias for all trials. All trials were liable to type II error. ConclusionsEvidence is currently lacking regarding the effectiveness of interventions to prevent suicide and reduce self-harm amongst people with SUD.

KW - suicide

KW - substance use disorder

KW - addiction

KW - alcohol

KW - drug

U2 - 10.1016/j.comppsych.2019.152135

DO - 10.1016/j.comppsych.2019.152135

M3 - Review article (Academic Journal)

C2 - 31810026

VL - 96

JO - Comprehensive Psychiatry

JF - Comprehensive Psychiatry

SN - 0010-440X

M1 - 152135

ER -

Prevention of suicide and reduction of self-harm among people with substance use disorder: A systematic review and meta-analysis of randomised controlled trials

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Projects

Revised: 'Excessive drinking and alcohol related harms in Adulthood: ALSPAC at 24 MR/L022206/1'

Profiles

Professor Paul A Moran

Cite this