A systematic review of clinical practice guidelines for suicide and self-harm prevention in adults

Clinical practice guidelines are used to guide clinical decision making but are rarely formally evaluated. As high-quality evidence for suicide prevention is scarce, partly due to limited understanding of underlying causes and low baseline rates, CPGs are important for guiding care in this area. This systematic review focused on clinical practice guidelines for the assessment, management and treatment of adults with self-harm, with or without suicidal intent. We searched 14 medical databases and repositories for guidelines to identify eligible documents published between Jan 1, 2000, and Jan 10, 2024. Of 4775 identified records, 55 were assessed for full-text eligibility and 22 guidelines were included. Two raters assessed guideline quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) instrument. 13 of 22 guidelines were assessed as high quality by scoring ≥60% in at least three of six AGREE-II domains, including Rigour of development. The domain Applicability, concerning how to put recommendations into practice, was effectively addressed by only three guidelines. High quality guidelines often recommended a comprehensive psychosocial assessment, planning the initial aftercare, means restriction, and cautioned against relying solely on risk-calculation tools in isolation. While the evidence base remains limited, the consistency of key recommendations across high-quality guidelines underscores their value in guiding clinical care. Future guideline development should focus on improving applicability by specifying how recommendations can be implemented in routine clinical practice. PROSPERO REGISTRATION NUMBER: CRD42023488333.