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Global systematic review of the effects of suicide prevention interventions in Indigenous peoples
  1. Stuart Leske1,2,
  2. Elise Paul3,
  3. Mandy Gibson1,2,
  4. Brock Little1,2,
  5. Mark Wenitong4,5,6,
  6. Kairi Kolves1,2
  1. 1 Australian Institute for Suicide Research and Prevention, School of Psychology, Griffith University, Mt Gravatt Campus, Qld, Australia
  2. 2 WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Qld, Australia
  3. 3 Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
  4. 4 Apunipima Cape York Health Council, Bungalow, Australia
  5. 5 School of Public Health, Queensland University of Technology, Brisbane, Qld, Australia
  6. 6 College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Qld, Australia
  1. Correspondence to Kairi Kõlves, Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt Campus, Queensland, Australia; k.kolves{at}


Objective Suicide rates are often higher in Indigenous than in non-Indigenous peoples. This systematic review assessed the effects of suicide prevention interventions on suicide-related outcomes in Indigenous populations worldwide.

Methods We searched CINAHL, Embase, PubMed, PsycINFO, ProQuest Dissertations & Theses and Web of Science from database inception to April 2020. Eligible were English language, empirical and peer-reviewed studies presenting original data assessing the primary outcomes of suicides and suicide attempts and secondary outcomes of suicidal ideation, intentional self-harm, suicide or intentional self-harm risk, composite measures of suicidality or reasons for life in experimental and quasi-experimental interventions with Indigenous populations worldwide. We assessed the risk of bias with the Cochrane Risk of Bias Tool and the Risk of Bias Assessment for Non-randomised Studies.

Findings We included 24 studies from Australia, Canada, New Zealand and the USA, comprising 14 before–after studies, 4 randomised controlled trials (RCTs), 3 non-randomised controlled trials, 2 interrupted time-series designs and 1 cohort study. Suicides decreased in four and suicide attempts in six before–after studies. No studies had a low risk of bias. There was insufficient evidence to confirm the effectiveness of any one suicide prevention intervention due to shortage of studies, risk of bias, and population and intervention heterogeneity. Review limitations include language bias, no grey literature search and data availability bias.

Conclusion For the primary outcomes of suicides and suicide attempts, the limited available evidence supports multilevel, multicomponent interventions. However, there are limited RCTs and controlled studies.

  • Suicide
  • prevention
  • systematic reviews

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  • Contributors EP and KK conceived the study. SL designed and ran searches. SL, KK and MG screened records, conducted risk of bias assessments and extracted data. BL and SL extracted data for Indigenous involvement and SL and MG checked these extractions. All authors made substantial intellectual contributions and revisions to the draft manuscript.

  • Funding The WHO funded this review. The funding body had no role in the study design, execution or analysis or the decision to publish the paper.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.