Written by Hannah Harp
Spoon Feed
Safety planning intervention (SPI) for youth in an acute-care setting with suicidal ideation (SI), suicide attempt (SA), or self-harm (SH) did not impact future SI/SA/SH or re-presentation for any of these issues.
Plans are just the beginning
This decade has seen a surge in acute care visits for suicide-related behaviors for pediatric patients, on the order of a 160% increase.1,2 We need evidence-based interventions at the point of care to reduce risk of suicide for these patients. SPIs help patients identify triggers that they need help and connect them with activities and supports they can use in a crisis. SPIs have been validated for adults, but there is very little research around how helpful they can be for adolescents.
This systematic review and meta-analysis assessed whether safety planning interventions (SPIs) reduce SI, SA, or healthcare re-presentation in adolescents. Ten studies (n = 1002) met inclusion, with five eligible for meta-analysis. SPIs showed no significant effect on SI (Hedges g = 0.11; 95%CI 0.01–0.21), SH behavior (g = −0.09; 95%CI −0.20–0.02), SA (RR = 1.03; 95%CI 0.12–8.88), or re-presentation (RR = 0.99; 95%CI 0.29–3.35). The ten studies used different formats of SPIs and follow-up intervals, and there was no indication whether patients received other interventions between presentation and follow-up. Likely some kids were connected to psych services after their ER visit or hospital stay, so these numbers may be a bit off if we are looking at the SPI as a standalone intervention.
How does this change my practice?
In theory, an SPI tells us exactly what we need to know when a kid is in crisis. In practice…I sometimes see SPIs from a hospital or mental health worker – in a language the parents can’t read, signed by an eight-year-old, listing a Medicaid PCP that isn’t actually their PCP, or with no information about where the form even came from. It seems clear to me that SPI should never be a standalone, even if it does mitigate risk of suicide a little bit. We need accessible psychotherapy and psychiatry services, or more hand-holding to help parents access services.
Source
Safety Planning Interventions for Suicide Prevention in Children and Adolescents: A Systematic Review and Meta-Analysis. JAMA Pediatr. 2025 May 19:e251012. doi: 10.1001/jamapediatrics.2025.1012. Epub ahead of print. PMID: 40388177
Works Cited
- Pediatric mental health hospitalizations at acute care hospitals in the US, 2009-2019. JAMA. 2023;329(12):1000-1011.doi:10.1001/jama.2023.1992
- Centers for Disease Control and Prevention. Youth Risk Behavior Survey Data Summary & Trends Report: 2013–2023. U.S. Department of Health and Human Services; 2024.
