Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Dec;28(1):2199469.
doi: 10.1080/10872981.2023.2199469.

Simulation training in suicide risk assessment and intervention: a systematic review and meta-analysis

Océane Richard  1 , Fabrice Jollant  2 , Grégoire Billon  3 , Chris Attoe  3 , Dominique Vodovar  4 , Marie-Aude Piot  5
Affiliations
Meta-Analysis

Simulation training in suicide risk assessment and intervention: a systematic review and meta-analysis

Océane Richard et al. Med Educ Online. 2023 Dec.

Abstract

Purpose: Suicide is a major cause of preventable death worldwide. Adequate training in risk assessment and intervention is key to suicide prevention. The use of simulation (role plays, simulated patients, virtual reality…) for practical training is a promising tool in mental health. The purpose of this study was to assess the effectiveness of simulation training in suicide risk assessment and intervention for healthcare professionals and gatekeepers.

Methods: We conducted a systematic review in Medline and PsycINFO up to 31 July 2021 of randomized controlled trials (RCTs), non-randomized controlled trials, and pre/post-test studies. RCTs were furthermore included in a meta-analysis. We assessed the methodological quality of all studies with the Medical Education Research Study Quality Instrument, and the Cochrane Risk of Bias tool 2.0 for RCTs. Primary outcomes were changes in Kirkpatrick criteria: attitudes, skills, knowledge, behaviors, and patient outcomes.

Results: We included 96 articles representing 43,656 participants. Most pre/post-test (n = 65) and non-randomized controlled (n = 14) studies showed significant improvement in attitudes, skills, knowledge, and behaviors. The meta-analysis of 11 RCTs showed positive changes in attitudes immediately after training and at 2-4 months post-training; in self-perceived skills at 6 months post-training; but not in factual knowledge. Studies assessing benefits for patients are still limited.

Conclusions: The heterogeneity of methodological designs, interventions, and trained populations combined with a limited number of RCTs and studies on patients' outcomes limit the strength of the evidence. However, preliminary findings suggest that simulation is promising for practical training in suicidal crisis intervention and should be further studied.

Keywords: Mental disorders; Suicide; simulation training; suicidal ideation; teaching.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Flow chart.
Figure 2.
Figure 2.
Forest plots on knowledge.
Figure 3.
Figure 3.
Forest plots on attitudes.
Figure 4.
Figure 4.
Forest plots on skills.
See this image and copyright information in PMC

References

    1. World Health Organization . Suicide worldwide in 2019: global health estimates. World Health Organization; 2021. Available from 2021 Sep15; https://apps.who.int/iris/handle/10665/341728
    1. Hawton K, Pirkis J.. Suicide is a complex problem that requires a range of prevention initiatives and methods of evaluation. Br J Psychiatry. 2017;210(6):381–14. - PubMed
    1. Zalsman G, Hawton K, Wasserman D, et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry. 2016;3(7):646–659. - PubMed
    1. Hawgood J, Woodward A, Quinnett P, et al. Gatekeeper training and minimum standards of competency: essentials for the suicide prevention workforce. Crisis. Published online. 2021. June 30;0227–5910/a000794. DOI:10.1027/0227-5910/a000794. - DOI - PMC - PubMed
    1. Pistone I, Beckman U, Eriksson E, et al. The effects of educational interventions on suicide: a systematic review and meta-analysis. Int J Soc Psychiatry. 2019;65(5):399–412. - PubMed