A systematic review of clinical practice guidelines for suicide and self-harm prevention in adults.
Oskar Flygare, Ana Portillo Van Diest, Kine Johansen Dymbe et al.
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In 30 seconds
This systematic review evaluated clinical practice guidelines for assessing, managing and treating adults who self-harm, with or without suicidal intent. Searches of 14 databases and repositories identified guidelines published from January 1, 2000, to January 10, 2024; 22 were included and rated by two reviewers using AGREE-II. Thirteen guidelines met the review’s high-quality threshold of at least 60% in three or more domains, including rigour of development. Applicability was a notable weakness: only three guidelines adequately addressed how recommendations could be implemented. Higher-quality guidelines commonly endorsed comprehensive psychosocial assessment, initial aftercare planning and means restriction, and cautioned against relying on risk tools alone.
Key findings
- Of 22 included guidelines, 13 met the high-quality threshold of ≥60% in at least three of six AGREE-II domains, including Rigour of development.
- Only three guidelines effectively addressed Applicability, or how recommendations could be put into practice.
- High-quality guidelines commonly recommended comprehensive psychosocial assessment, planning initial aftercare and means restriction.
- Guidelines cautioned against using risk-calculation tools as the sole basis for assessment.
Why it matters
Guidelines can help structure care where evidence for suicide prevention is limited. The review found recurring recommendations across higher-quality documents, while also identifying a gap between recommendations and their implementation in routine practice. This distinction matters when interpreting guidance: a sound recommendation may be difficult to apply unless the guideline explains how to operationalise it.
What to keep in mind
The review describes guideline quality and recommendations; it does not establish whether following them improves patient outcomes. The abstract also notes that the evidence base for suicide prevention remains limited.