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Publication - Professor David Gunnell

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

    A systematic review and meta-analysis of randomised controlled trials

    Citation

    Padmanathan, P, Hall, K, Moran, PA, Gunnell, D, Carlisle, V, Lingford-Hughes, AR & Hickman, M, 2019, ‘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.

    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.

    Full details in the University publications repository