Collaborative care interventions to reduce suicidal behavior among patients with depression or at risk of suicide in primary-care settings: A systematic review and meta-analysis

Introduction: Suicide is a leading cause of preventable death worldwide. While Collaborative Care (CC) effectively treats depression in primary care led by general practitioners, its impact on reducing suicide behavior remains uncertain. Additionally, the optimal intensity and duration of CC interventions are unclear. Objective: This systematic review and meta-analysis aimed to evaluate the effect of CC interventions on suicidal behavior in patients with depression or at risk of suicide in primary care settings. Methods: We searched PubMed, Embase, and Cochrane databases from inception to April 2024. Two researchers independently performed data selection, extraction, and quality assessment. Data were pooled using the odds ratio (OR) and a random-effects model. The main outcome was suicidal behavior, including attempts and ideation. Subgroup analyses assessed the effectiveness of intensity and duration. A meta-analysis was conducted using the R "meta" package, and the protocol was registered with PROSPERO (CRD 42023477655). Results: From 3696 articles, 10 randomized controlled trials with 20,110 participants were included. CC interventions significantly reduced suicidal behavior compared to controls (pooled OR = 0.66; 95 % CI, 0.46-0.96). High-intensity interventions were particularly effective (pooled OR = 0.56; 95 % CI, 0.40-0.78). However, no significant relationship was found between intervention duration and suicidal behavior. There was no clear evidence of publication bias. Conclusions: CC interventions can reduce suicidal behavior in primary care settings, especially with high-intensity interventions. However, caution is needed due to study heterogeneity and low quality.