Mental health among children and adolescents is a growing concern around the world. In North America, healthcare visits for suicide-related thoughts and behaviours among young people have surged in recent years. One commonly used support tool in hospitals is safety planning interventions – a structured plan developed with patients to help reduce suicide ideation and self-harm behaviours during a mental health crisis. Originally created for adults, safety plans are now used with children and adolescents in hospitals and various clinical settings across North America. But do they work for this age group?
A new meta-analysis, published in JAMA Pediatrics, takes a closer look at the effectiveness of safety planning interventions for suicide prevention in children and adolescents. The study, led by The Hospital for Sick Children (SickKids) in partnership with Nationwide Children’s Hospital, evaluated the impact of these interventions on reducing suicide ideation, self-harm behaviours, suicide attempts, and re-presentation to healthcare settings. The findings showed no significant association between safety planning interventions and reductions in these outcomes, when safety planning was the only intervention used.
“Children and adolescents who seek care for self-harm thoughts and behaviours are at increased risk for suicide attempts, so there is a pressing need for accessible and effective interventions to help these patients,” says Dr. Daphne Korczak, senior author, Staff Psychiatrist and Senior Scientist in the Neurosciences & Mental Health program at SickKids. “Despite the widespread use of safety planning interventions for suicide prevention, our study found limited evidence supporting their effectiveness for children and adolescents.”
Safety planning interventions are routinely used as treatments for children and adolescents in emergency departments, urgent treatment centres, and crisis hotlines. To help evaluate their efficacy in these settings, the authors conducted a comprehensive review of existing research and examined 10 studies involving more than 1,000 children and adolescents. The meta-analysis of these study findings assessed outcomes including suicide ideation, suicide-related behaviour, suicide attempts, and return visits to healthcare settings.
“While safety planning interventions have shown promise in adult populations, the needs of children and adolescents may differ. These findings highlight the importance of evaluating whether safety plans should be adapted or integrated with other supports to better meet the needs of younger individuals,” says Jeffrey Bridge, co-author, Epidemiologist and Director of the Center for Suicide Prevention and Research at Nationwide Children’s Hospital.
The authors note that most of the included studies were pilot studies conducted in the United States and call for further research including those in other regions to identify which components of safety planning interventions are most effective in paediatric settings, and how they could be best implemented with other suicide prevention strategies.