Effects of suicide prevention programs on suicidal ideation and attempts in military personnel: a systematic review and meta-analysis.

BACKGROUND: Suicide among military personnel is a pervasive and urgent issue. AIMS: This study analyzed the effects of suicide prevention programs on suicidal ideation and attempts among military personnel and identified program characteristics associated with greater efficacy. METHODS: PsycINFO, PubMed, Web of Science, EMBASE, and Google Scholar were searched for randomized controlled trials involving active-duty or retired military personnel. Fourteen studies were included in the systematic review, and 10 in the meta-analysis. Primary outcomes were suicidal ideation and attempts. Data were analyzed using a random-effects model, with subgroup analyses based on program type, delivery method, and implementation site. RESULTS: Suicide prevention programs significantly reduced suicidal ideation and suicide attempts (Hedges's g = -0.33, 95% CI: -0.62 to -0.03, p = .029; I2 = 73). Cognitive behavioral therapy (CBT)-based interventions showed a small effect on ideation (Hedges's g = -0.33) and a moderate effect on attempts (Hedges's g = -0.67). Face-to-face and blended programs were the most effective, whereas non-face-to-face programs were ineffective. Furthermore, military base-based interventions outperformed those at healthcare institutions. CONCLUSIONS: Suicide prevention programs, particularly CBT-based and multi-component interventions delivered face-to-face or blended within military units, are effective. Future research should optimize remote strategies and enhance long-term effectiveness. PRISMA/PROSPERO: Regarding registration in PROSPERO, while we did attempt the registration for this systematic review, it was ultimately not possible for two primary reasons. First, the PROSPERO registration review at the time we applied prioritized COVID-19-related research. This, therefore, delayed the review process for this study's suicide-related topic. Second, a systematic review protocol with a similar title had already been registered. Consequently, we never received a registration number. Notably, while a similarly titled protocol exists, our study specifically employs a comprehensive meta-analysis approach to address this topic, thus ensuring a distinct methodology.