Effectiveness of Suicide Safety Planning Interventions: A Systematic Review Informing Occupational Therapy.

The reviewers searched comprehensively but say any review may have missed studies. The evidence is mostly from the United States and only one included study was done in Canada, so the findings may not fit Canadian practice. Participants were almost all described as men or women; only 9 of 2,388 people were recorded as another gender, so the review says little about them. Race was not recorded for 57.4% of participants and the samples were largely White, and only 23 participants (1.0%) were identified as 2SLGBTQ+ with 99% unspecified, so the findings may not transfer to other groups. Only three of the 22 studies included any activity or occupation component, and it was framed as a distraction, so there is no evidence here that adding meaningful activity to a safety plan helps. Several studies were quasi-experimental rather than randomised, and some tested an intervention in very small groups (one mindfulness-based safety planning study had 10 participants). The review counts studies that showed benefit rather than pooling the data, so it cannot say how large the benefit is; even where trials report a percentage reduction, that comes from small numbers of events. Differences between some plans were tested against another version of a plan rather than against usual care, which makes it hard to see how much the planning itself contributes. The authors note that resilience and service use have not been studied enough for any conclusion. One author is developing a safety plan described in the paper and another occupational therapist has adapted it, but neither has been formally tested.

The authors declared no competing interests. The work was paid for by an internal grant from Western University to the principal investigator.

Do not read this review as evidence that adding meaningful activity or occupations to a safety plan makes it work better. Only three of the 22 studies included any activity component, they described it as a distraction rather than as something meaningful in itself, and the review states plainly that little is known about what it contributes.