Efficacy of internet-based interventions to reduce suicidal ideation: a systematic review and meta-analysis.

Abstract

<h4>Background</h4>Suicide prevention remains a critical public health priority, with internet-based interventions offering accessible and scalable solutions. These digital approaches provide anonymity and flexibility, potentially improving mental health outcomes. The aim of this systematic review was to assess the efficacy of such interventions in reducing suicidal ideation and to explore sources of heterogeneity through subgroup analysis and meta-regression.<h4>Methods</h4>This systematic review was conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, ProQuest, PsycINFO, EMBASE, Scopus, Web of Science, and CINAHL was performed from inception to March 2025 using MeSH terms and Boolean operators. Eligible studies included randomized controlled trials involving adults (≥ 18 years) with suicidal ideation or attempts. Internet-based interventions (guided, unguided, and hybrid approaches) were compared to various control conditions. Primary outcomes focused on reductions in suicidal ideation, with secondary outcomes assessing mental health improvements. Given substantial heterogeneity observed across studies, we employed narrative synthesis as the primary approach, supplemented by subgroup analyses and meta-regression to explore sources of variability. Statistical analyses were conducted using STATA 17.0.<h4>Results</h4>The systematic review included 18 studies from 10 countries. Substantial heterogeneity precluded a meaningful overall meta analysis. Narrative synthesis revealed mixed findings, with some studies showing promising results for guided interventions while others demonstrated minimal effects. Subgroup analyses and meta regression examining age, gender, intervention type, and digital platform revealed no significant moderators of efficacy. The high heterogeneity (I² >78% across most comparisons) suggests important unexplained variability in intervention effects. Limited data on suicide attempts precluded robust analysis of this outcome.<h4>Conclusion</h4>Internet-based interventions show inconsistent effects on reducing suicidal ideation, with substantial heterogeneity across studies. While some guided approaches demonstrate potential, the evidence remains inconclusive due to methodological limitations and variability in intervention characteristics. Future research should prioritize standardized outcome measures, long-term follow-ups, and tailored intervention approaches to better understand which components work for specific populations.<h4>Clinical trial number</h4>Not applicable.