Evaluating the global landscape of suicide helpline services: a global survey across 105 countries

Background: Suicide helpline services (SHSs) are viewed as an essential part of suicide prevention. In the context of increased demand experienced by the services through the COVID-19 pandemic, as well as reduced funding, we aimed to evaluate such services to help assess their effectiveness and resilience. Methods: This multinational cross-sectional survey, conducted from Sept 1, 2022, to Feb 28, 2023, evaluated SHSs in 150 countries. Local collaborators created an SHS directory, and a 42-question questionnaire was distributed via Survey Monkey through Find A Helpline and local collaborators. A team of experts, including individuals with lived experience, helped shape the research questions and study design. We did descriptive statistical analysis of answers to the questions, and data were further analysed using the Bayesian Model Averaging method to predict managers’ or supervisors’ low overall satisfaction with the service (MS-LOSS). Findings: The study involved 446 responses from 105 countries for descriptive statistics. 354 (79·4%) of 446 services had insufficient funding, 249 (55·8%) had post-COVID-19 budget reductions, and 278 (62·3%) observed a sharp rise in suicide help requests during the COVID-19 pandemic. 420 responses were used for finding the optimal logistic model, which had an area under the curve of 0·679, indicating that pre-service training for volunteers was significantly associated with a reduction in MS-LOSS (odds ratio 0·16 [95% CI 0·07–0·31]; p<0·001), as was having a quality assurance structure (0·15 [0·02–0·70]; p=0·030). Higher MS-LOSS was associated with staff training only every 2–3 years instead of one or more times per year (2·87 [1·23–6·85], p=0.016) and with dilemmas with providing services in severe cases (1·68 [1·06–2·68]; p=0·028). Interpretation: Global SHS reports indicate that both pre-task and ongoing training for volunteers and staff, coupled with a quality assurance structure, could decrease MS-LOSS. Our findings emphasise the need for training for volunteers, continuous training programmes for staff, and on-site support for individuals at risk of suicide. Funding: RSTMH Small Grants Award 2021, UK NIHR, and MEXT.