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Suicide is a persistent public health crisis among military personnel and veterans, who experience significantly higher rates of suicide than the general population. Despite legislative efforts such as the Joshua Omvig Veterans Suicide Prevention Act (2007), rates remain high. A variety of interventions—universal, selective, and indicated—have been implemented to reduce suicide risk among these populations. However, the effectiveness of these interventions remains unclear. This overview of reviews aims to synthesize findings from existing systematic reviews on suicide prevention and treatment interventions for military personnel and veterans, assess the quality and consistency of the evidence, and identify gaps to guide future research and policy.
Methods
We followed Cochrane’s methodological guidelines for conducting this overview of reviews. A protocol was published in PROSPERO prior to the start of the overview. We conducted a comprehensive search across eight bibliographic databases, relevant organizational websites, reference lists, and expert consultations to identify reviews published between 2004 and July 2024. Reviews were eligible if they examined suicide prevention interventions targeting suicide-specific outcomes in active-duty military personnel, National Guard/reserve members, or veterans. Two independent reviewers screened studies and extracted data using a structured form, resolving discrepancies by consensus. We examined study overlap across reviews and assessed quality included reviews using the AMSTAR 2 tool. Given the heterogeneity of review methods and findings, a narrative synthesis approach was used. Results were reported according to PRIOR standards.
Results
Twenty-three reviews encompassing 323 unique studies were included. Most of the included reviews used narrative synthesis (83%), did not indicate a geographical area of focus (65%), and were published in journal articles (74%). Interventions ranged from psychotherapy and multicomponent programs to the Collaborative Assessment and Management of Suicidality (CAMS) and safety/crisis planning. While some interventions, such as multicomponent universal programs and Cognitive Behavioral Therapy (CBT), showed promise, the overall findings were inconsistent. All but one of the included reviews were rated “critically low,” and one review was rated “low.” Many reviews lacked clear inclusion criteria, included low-quality studies, failed to assess the quality of included evidence, or lacked rigorous synthesis methods. There was substantial heterogeneity in study designs, intervention types, and outcome definitions. Meta-analyses were rare and often limited by methodological variability. Suicide-related outcomes were inconsistently defined and reported, with vague terms like "suicidality" often used without clarification, limiting the interpretability of findings.
Conclusion and Implications
Though findings should be interpreted with caution due to the quality of the reviews, interventions which showed the most promise included multicomponent universal programs, Cognitive Behavioral Therapy (CBT), and safety planning. Existing reviews have already laid a foundation by identifying a wide range of suicide prevention strategies available for military veterans. Looking ahead, future systematic reviews and primary studies have the power to meaningfully strengthen the evidence base by adopting standardized definitions, clearly outlining outcomes, and using robust synthesis methods. With continued effort and collaboration, we can identify the most effective suicide prevention strategies that deliver meaningful support to military personnel and veterans.