Emotion regulation-targeted interventions initiated during hospitalization for suicidal crisis: a systematic review and exploratory meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not specified in abstract

• Effect Size: Standardized mean differences (Hedges' g) favoring ER interventions

• Primary Outcome: Suicide attempts and suicidal ideation

• Nnt Or Sensitivity: Not calculable from available data

• Confidence Interval: Not specified in abstract

Clinical Application

High feasibility and acceptability reported across intervention modalities during psychiatric hospitalization Relevant to Australian mental health services given universal applicability of ER interventions; aligns with RANZCP guidelines for suicide prevention in inpatient settings Psychiatric inpatients with suicidal ideation or behavior across diagnostic categories, both adolescent and adult populations

Abstract

INTRODUCTION: Suicide is a leading cause of premature death, with risk peaking around psychiatric hospitalization. Emotion dysregulation (ED) is recognized as a key factor contributing to suicidal ideation and behavior across psychiatric diagnoses. The efficacy of interventions that target ED for suicidality reduction remains unclear, so we aimed to assess these interventions in psychiatric inpatients. METHODS: We conducted a PRISMA-compliant, PROSPERO-registered (CRD420251140949) systematic review and meta-analysis of randomized and non-randomized trials evaluating interventions targeting emotion regulation (ER) for psychiatric inpatients with suicidal ideation and/or behavior. Searches covered PubMed, Embase, and PsycINFO to September 18, 2025. Standardized mean differences (Hedges' g) were pooled under random-effects models and heterogeneity was assessed (Q, I2, τ2). Exploratory meta-regressions examined age, sex, and study quality; small-study effects were explored with funnel plots. RESULTS: Twelve studies met inclusion (n = 1708), spanning dialectical behavior therapy (DBT), mindfulness-based interventions, acceptance and commitment therapy (ACT), and other ER-related protocols. Across modalities, feasibility and acceptability were high and interventions consistently improved suicide-related outcomes in transdiagnostic adolescents and adult populations. Suicide attempts and ideation met outcome criteria for exploratory meta-analyses, and, for both, ER-targeted interventions outperformed usual care, despite heterogeneity and small samples. Exploratory meta-regressions were non-significant; funnel plots did not suggest marked publication bias, though power was limited. CONCLUSIONS: ER-targeted interventions delivered during psychiatric hospitalization are feasible and show promising benefits on suicide-related outcomes. Given heterogeneity and limited sample sizes, larger, well-powered randomized trials using standardized suicidality endpoints are needed to establish efficacy, refine inpatient protocols, and inform acute care pathways.

References

1. 1.Saccaro, L. F., Giff, A. E., Parincu, Z., Piguet, C., Greiner, C., & Prada, P. (2026). Emotion regulation-targeted interventions initiated during hospitalization for suicidal crisis: a systematic review and exploratory meta-analysis. Journal of Affective Disorders, 121375. https://doi.org/10.1016/j.jad.2026.121375