Abstract

The safety planning intervention (SPI) is gaining momentum in suicide prevention practice and research. This systematic review sought to determine the effectiveness of the SPI for adults experiencing suicide-related distress. Systematic searches of international, peer-reviewed literature were conducted in six databases (Cochrane Trials, Embase, Emcare, Medline, PsycINFO and Web of Science), including terms for safety planning, suicide, and suicide-related outcomes. A total of 565 results were included for screening. Result screening (title/abstract and full-text), data extraction and critical appraisal were conducted in duplicate. Twenty-six studies met the inclusion criteria. Studies were primarily quantitative (n = 20), largely with general adult or veteran samples; a small number of studies explored the perspectives of staff and significant others. Half of the studies included the SPI as a standalone intervention, while the other half examined the SPI in combination with other interventions. Most interventions were delivered in-person, with a hard-copy safety plan created, while a smaller number explored internet-based interventions. Primary measures included: suicidality (ideation, behavior, deaths; 10 studies), suicide-related outcomes (depression, hopelessness; 5 studies) and treatment outcomes (hospitalizations, treatment engagement; 7 studies). The evidence supports improvements in each of these domains, with complementary findings from the remaining quantitative and qualitative studies suggesting that the SPI is a feasible and acceptable intervention. While positive, these findings are limited by the heterogeneity of interventions and study designs, making the specific impact of the SPI difficult to both determine and generalize. Conversely, this also points to the flexibility of the SPI.

• Highlights

• The Safety Planning Intervention (SPI) is a valuable indicated intervention for general adult and veteran populations experiencing suicide-related distress, primarily in face-to-face, clinical settings.

• Quantitative findings indicate associations between the SPI and improvements in suicidal ideation and behavior, decreases in depression and hopelessness, along with reductions in hospitalizations and improvements in treatment attendance.

• Qualitative studies suggest the SPI is acceptable and feasible, with areas for development.

• SPIs have been shown to be adaptable to the clinical area in its modality (digital or paper-based), delivery (face-to-face or online), facilitation (clinician or self-administered) and multiplicity (as stand-alone or combined intervention).

摘要

安全计划干预 (SPI) 在自杀预防实践和研究中的势头越来越猛。本系统评价旨在确定 SPI 对经历自杀相关痛苦的成年人的有效性。在六个数据库（Cochrane Trials、Embase、Emcare、Medline、PsycINFO 和 Web of Science）中进行了国际同行评审文献的系统搜索，包括安全计划、自杀和自杀相关结果的术语。共有 565 个结果被纳入筛选。结果筛选（标题/摘要和全文）、数据提取和批判性评估一式两份进行。26 项研究符合纳入标准。研究主要是定量的（n = 20)，主要是一般成人或退伍军人样本；少数研究探讨了工作人员和其他重要人士的观点。一半的研究将 SPI 作为一项独立的干预措施，而另一半研究将 SPI 与其他干预措施相结合。大多数干预措施都是亲自进行的，并创建了硬拷贝安全计划，而少数人则探索了基于互联网的干预措施。主要措施包括：自杀（意念、行为、死亡；10 项研究）、自杀相关结果（抑郁、绝望；5 项研究）和治疗结果（住院、治疗参与；7 项研究）。证据支持每个领域的改进，其余定量和定性研究的补充结果表明 SPI 是一种可行且可接受的干预措施。虽然是积极的，但这些发现受到干预措施和研究设计的异质性的限制，使得 SPI 的具体影响难以确定和概括。反过来，这也指向了 SPI 的灵活性。

• 强调

• 安全计划干预 (SPI) 是一种有价值的指示干预，适用于经历自杀相关痛苦的普通成人和退伍军人，主要是在面对面的临床环境中。

• 定量研究结果表明 SPI 与自杀意念和行为的改善、抑郁和绝望的减少以及住院治疗的减少和治疗出勤率的改善之间存在关联。

• 定性研究表明，SPI 是可以接受和可行的，有待开发的领域。

• SPI 已被证明在其形式（数字或纸质）、交付（面对面或在线）、便利（临床医生或自我管理）和多样性（作为独立或组合）方面适用于临床领域干涉）。