Summary of findings 7. Comparison 9: remote contact interventions versus treatment as usual.

Remote contact interventions compared to treatment as usual
Patient or population: children and adolescents who engage in SH. Settings: outpatients. Intervention: remote contact interventions (emergency card). Comparison: treatment as usual.
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	Number of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Treatment as usual	Emergency card
Repetition of SH at 12 months	Study population		OR 0.5 (0.12 to 2.04)	105 (1 RCT)	⊕⊝⊝⊝ VERY LOW 1,2	Quality was downgraded as an open random numbers table was used to generate the allocation sequence and, as allocation was not concealed, there is possible selection bias. Quality was further downgraded as the nature of this intervention means it is unlikely participants and clinical personnel would have been blind to treatment allocation and, as no details on outcome assessor blinding were provided, performance and detection bias cannot be ruled out. Lastly, there was an error in the randomisation sequence such that five participants in the intervention group either did not receive emergency cards, or alternatively, received them only after a delay thereby invalidating follow‐up data for these five individuals.
	121 per 1000	64 per 1000 (16 to 219)
*The basis for the assumed risk (e.g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio; RCT: randomised controlled trial; SH: self‐harm.
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

¹ Risk of bias was rated as VERY SERIOUS as the nature of the intervention means that participants and clinical personnel could not have remained blind to treatment allocation suggesting that performance and detection bias may have been present. Additionally, as an open random numbers table was used to generate the allocation sequence and, as allocation was not concealed, there is possible selection bias. There was also an error in the randomisation sequence resulting in five participants in the intervention group either not receiving the cards, or alternatively, not receiving them until after a substantial delay thereby invalidating follow‐up data for these individuals.

2 Imprecision was rated as SERIOUS owing to the wide confidence interval associated with the estimate of treatment effect.