Using telemedicine to reduce suicide ideation and behavior: A systematic literature review

Objective: To review the published research for reported effectiveness of telemedicine in reducing suicide ideation and behavior in patients already diagnosed with a psychiatric disorder.

Design: A thorough literature search on the PubMed, Web of Science, PsycInfo, Cochrane Library, and TRIP (Turning Research Into Practice) Medical Database was conducted. Phrases such as “telemedicine,” “telehealth,” “remote consultation,” “mobile health,” “psychiatric disorders,” “suicide,” “suicide, attempted or ideation,” and “telepsychiatry” were employed in a variety of combinations. The primary inclusion criteria encompassed peer-reviewed articles published in the past 5 years. Secondary inclusion criteria comprised: (1) the diagnosis of any psychiatric disorder for all patients included in the study, (2) the absence or presence of use of telepsychiatry to offer consultation and communication, and (3) reported outcomes involving suicide rates or attempted suicide rates. The research publications passing inclusion criteria were assessed, and all their corresponding outcome measures were included in a meta-analysis.

Results: A total of 705 studies were identified by applying the initial search strategy to the electronic databases described. Of these, 205 passed the primary inclusion criteria. After excluding duplicates and non-English articles, 105 articles were screened using the secondary inclusion criteria. Nine articles remained, including three systematic reviews that were excluded. Finally, a total of six independent, non-overlapping studies were included in this meta-analysis, encompassing data for 576 participants.

The 18 outcome measures in this meta-analysis included five “positive” measures: perceived ability to cope with suicidal ideation, optimism, gratitude, positive affect, and the Mini Mental State Exam. The “negative” measures included: suicidal ideation intensity, hopelessness, depression, suicidality, HAMD (Hamilton Depression Rating Scale) score, HAMD score without suicide item, medical admissions, number of days of medical hospitalizations, number of psychiatric hospitalizations, number of emergency room visits, suicide ideation questionnaire (SIQ) from baseline to posttreatment, and SIQ from baseline to follow-up. Overall, this review found support for the hypothesis that telemedicine can reduce suicide ideation and behavior. There was a moderate effect size for the 18 measures analyzed. Based on the four different forest plots presented in this analysis, all average effect sizes calculated showed that the intervention of telemedicine has a small-to-moderate effect on the measures studied, which translates loosely to a small-to-moderate effect on the patient’s suicide ideation and behavior.

Conclusions: Telemedicine appears to be a promising way to reduce suicidal ideation, although how this translates into reductions in self-harm and/or suicide attempts is unclear from this review alone.