Effects of positive psychological interventions on suicide-related outcomes: A systematic review and meta-analysis

Suicide remains a significant global public health issue. Positive psychological interventions (PPIs) have been proposed as approaches that may contribute to suicide prevention, although their effectiveness remains unclear.

We systematically searched 11 databases from inception to January 2026. Pooled effect sizes were synthesized primarily using random-effects models. Subgroup, sensitivity, and meta-regression analyses were conducted to explore heterogeneity and test robustness.

Sixteen studies were included in the systematic review, 12 in the meta-analysis. At post-treatment, PPIs were associated with reduced suicidal ideation (Hedges' g = -0.39, 95% CI: -0.74 to -0.04). Evidence for persistence at post-intervention assessment was limited because only three studies reported short-term post-intervention assessments (Hedges' g = -0.12, 95% CI: -0.40 to 0.17). Evidence on suicide attempts and death by suicide was sparse (n = 5), although one study reported superior outcomes with PPIs versus control (log-rank χ² = 4.85, p = 0.028). In subgroup analyses, PPIs showed greater effects versus waitlist/blank controls (Hedges' g = -0.63, 95% CI: -0.86 to -0.40). Preliminary evidence suggests greater reductions in suicidal ideation with PPIs combined with pharmacotherapy than with pharmacotherapy alone (Hedges' g = -1.06, 95% CI: -1.70 to -0.42). Larger pooled effects were observed in low- and middle-income countries than in high-income countries (p = 0.029). Meta-regression showed control type (β = -0.414, p < 0.001) and total number of intervention sessions (β = -0.061, p = 0.043) explained 73.84% and 29.40% of between-study heterogeneity, respectively.

PPIs may have supportive or adjunctive value for suicide-related psychological outcomes, but evidence for suicide attempts, death by suicide, and longer-term effects remains limited.