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

Journal article

Background: Liaison psychiatry services play a central role in self-harm care and suicide prevention byproviding specialist mental health input in general hospitals. Psychosocial interventions, includingbrief 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 riskbut 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 systematicreviews evaluating interventions in liaison psychiatry contexts (including emergency departments,wards in general hospitals, outpatient/follow-up clinics for acute care patients receiving treatment forself-harm/suicidal behaviour), in adults or mixed adult/adolescent populations. Review quality(AMSTAR-2), primary study overlap in reviews, and evidence certainty (adapted GRADE) wereassessed. Findings were narratively synthesised and tabulated, with input from experts-by-experiencethroughout. PROSPERO: CRD42023442639.Results: Twenty-three systematic reviews (including 12 meta-analyses; >450,000 participants), wereincluded. Person-centred brief contact interventions, particularly those incorporating safety planningand follow-up, were most consistently associated with reduced suicide attempt rates. However,methodological limitations including heterogeneity, limited generalisability, lack of self-harm specificoutcomes, 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 limitedby the lack of setting-specific trials, limited patient involvement, and suboptimal quality trials. Reviewquality varied. Primary trial overlap was slight overall, but high for some pairs of reviews of briefinterventions.Conclusion: Current evidence for self-harm and suicide prevention interventions in liaison psychiatryservices is methodologically suboptimal. Given widescale implementation of psychosocialinterventions, there is an urgent priority to ensure they are safe, effective, and acceptable withinliaison psychiatry services

Authors: Quinlivan, L; Westhead, J; Graney, J; Su, F; Steeg, S

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BioMed Central
• Journal: BMC Psychiatry
• Volume: 25
• Issue: 1
• Pages: 1127-1127
• Publication date: 2025-11-27
• DOI: 10.1186/s12888-025-07142-2
• EISSN: 1471-244X
• ISSN: 1471-244X
• Language: English