Systematic Review of Interventions to Address Suicidal Behavior Among People with a History of Intimate Partner Violence: Promises and Gaps

Background and Purpose: Suicidal behavior, encompassing suicidal ideation, plans, and attempts, is a major contributor to death and disability worldwide. While multiple studies have explored the mechanisms that may explain the observed association between intimate partner violence (IPV) and suicidal behavior, there have been no review papers that examine interventions that address suicidal behavior among people with a history of IPV. The purpose of this paper is to systematically examine and describe interventions that address suicidal behavior among people with a history of IPV.

Methods: Adhering to 2020 PRISMA guidelines, eight electronic databases were searched including PubMed, PsychInfo, Academic Search Complete, CINAHL, Medline, Sociological Abstracts, and Social Work Abstracts. Intervention studies were included if they focused on IPV, reported quantitative findings related to suicidal behavior (e.g. self-harm, suicidal thoughts, attempts, contemplation), delivered an intervention or program, and were published in peer-reviewed journals in English. Data were extracted to examine intervention modalities, level of intervention, core components, target population, theoretical foundations, efficacy, as well as promises and gaps of current interventions.

Results: A total of 1,389 peer-reviewed papers were identified through the search (excluding duplicates). Twenty-six papers met the inclusion criteria for full-text review from a total of five interventions. All five studies targeted women, and most studies targeted explicitly women with a history of IPV (n=4); one study additionally included men. Studies were globally dispersed: United States, Spain, South Africa, and Iran. Sample sizes varied widely from n=42 to n=353. Three studies were randomized control trials. All but one intervention were individual level interventions; the remaining one targeted both individual and structural level factors, including employment and gender attitudes. Interventions were guided by a wide range of theories such as empowerment framework, theory of triadic influence, and cognitive model of psychopathology. Only three studies reported significant intervention effects on suicidal behavior (risk, thoughts, preparation/active ideation).

Conclusions and Implications: Despite evidence that shows a link between IPV and suicidal behavior, we found few interventions that address or measure changes in suicidal behavior among populations with a history of IPV. Although these few studies yielded through our systematic review suggested some potential promising effects, other studies found no changes. Given the wide range of sample sizes, designs, modalities, number of sessions, use of measures, theoretical foundations and content, findings from our review paper suggest the need for more robust designs, consistent use of measures, and work across more diverse populations and global locations. Additionally, this review suggests the need for more attention to suicidal behavior as part of mental health and risk focused interventions among populations with a history of IPV. Finally, findings suggest the need to explore alternative levels of interventions – potentially developing interventions that do not solely operate on the individual level, such as focusing on the relational level with sources of social support, and other networks.