Inpatient Treatment of Suicidality: A Systematic Review of Clinical Trials

Objective: Psychiatric inpatients represent an acutely vulnerable population with high rates of suicidality (ie, suicidal ideation, attempts, and completed suicide). This systematic review aimed to evaluate treatments for suicidality delivered within inpatient settings.

Data Sources: MEDLINE, Embase, APA PsycInfo, CINAHL, and The Cochrane Library were systematically searched using 3 concepts: suicidality, inpatient population/setting, and treatment/ interventions. Searches were limited to years 2001-2024, with no language restrictions.

Study Selection: Of 19,921 articles identified, 11,519 were screened, and 179 underwent full-text review. We included clinical trials on pharmacologic and nonpharmacologic interventions for suicidality in psychiatric inpatients aged 18-65 with moderate to high levels of suicidality that measured changes in suicidality.

Data Extraction and Synthesis: Studies were organized into tables by study design, treatments, participants, suicide measure, outcomes, and key findings. Due to heterogeneity, a meta-analysis was not conducted; instead, a narrative synthesis was used for qualitative analysis.

Results: Forty-nine studies were included. Of 14 pharmacologic trials, intravenous ketamine showed most consistent rapid reduction in suicidality. Thirty-five nonpharmacologic trials, covering a broad spectrum of treatments including chronotherapy, neurostimulations, and psychotherapies, were reviewed. The results were mixed, with some interventions showing potential in reducing suicidality, particularly in the mood, personality, and trauma-related disorders. Many studies had methodological concerns including nonrandomized designs, lack of control arms, and retrospective assessments.

Conclusion: A range of interventions for treating suicidality in inpatient settings have been evaluated, with mixed results. The current review underscores the need for larger, well-designed trials to assess the effectiveness of these treatments in inpatient settings.