Interventions for self-harm and suicidality in paediatric emergency departments: a meta-review.

Paediatric emergency department (ED) presentations for self-harm and suicidality have significantly increased worldwide in the past decade, making paediatric EDs a key point of contact for young people experiencing suicidal ideation. Since 2022, four systematic reviews have been conducted on interventions for self-harm/suicidality in paediatric EDs, but findings were limited by small sample sizes and high heterogeneity. This meta-review provides recommendations to guide clinical practice and future research to enhance the quality of interventions in paediatric EDs for addressing self-harm and suicide related behaviours. Of 286 studies identified, five reviews synthesising 14 individual studies on ED-based interventions published up to May 2022 were included. Key themes and conclusions were synthesised. Three main themes emerged including: lack of informative trials, low levels of intervention effectiveness and common intervention elements. Informativeness of prior trials was limited by small sample sizes, lack of globally relevant research and limited stakeholder perspectives. Common intervention elements included: follow-up contact post-ED discharge, family involvement and psychoeducation with safety planning. Limited progress has been made in this field, likely due to challenges in conducting rigorous trials in paediatric EDs. Research has failed to incorporate voices of young people and their families, crucial for meeting their needs. Future research must prioritise co-design with youth, parents, and stakeholders as a critical next step in developing more effective paediatric ED interventions. Digital tools may offer promise for delivering interventions in the ED but should complement face-to-face professional contact.