Economic evaluations of preventive interventions for self-harm and suicide: a systematic review

Self-harm and suicide are major public health concerns and leading causes of mortality worldwide, highlighting a pressing need for policymakers to identify and implement cost-effective interventions. This systematic review (PROSPERO registration #CRD42023460339) followed the PRISMA guidelines and aimed to synthesize the available cost-effectiveness evidence for the prevention of self-harm and suicide. Systematic searches were performed in MEDLINE, Embase, PsycINFO, CINAHL, Econlit, and ProQuest to identify full economic evaluations and return-on-investment studies on preventive interventions for self-harm and suicide published up to January 15, 2026. Methodological quality was assessed using Drummond's 10-item checklist, and findings were synthesized narratively. A total of 69 eligible studies evaluated 22 types of interventions: three universal, five selective, five indicated, and nine multi-level. Most studies were rated as high-quality (n = 61/69) and conducted in high-income countries (HICs) (n = 63/69), primarily assessing the cost-effectiveness of universal interventions like means restriction (n = 6), selective and indicated interventions like psychotherapy (n = 30), support services (n = 15), and medication (n = 5). Evidence consistently found that interventions for self-harm and suicide prevention were generally cost-effective or cost-saving. Strong evidence supported the cost-effectiveness of several universal (e.g. awareness training), selective (e.g. psychotherapy, support services), indicated (e.g. suicide risk screening, support services, psychotherapy for adults in HICs like Australia, US, Canada), and multi-level interventions. However, more economic evaluations are needed for interventions targeting older adults and children in all countries, especially in low- and middle-income countries, where evidence is lacking.