Generalisability and Global Representation

Excluding at-risk participants can protect trial safety but limits generalisability. The geographic skew limits evidence for risk assessment frameworks suited to diverse cultural and socioeconomic settings. Trials that exclude young people with suicidal ideation may produce efficacy estimates that do not translate to real-world clinical use. Most included studies were conducted in high- or middle-income countries. The review recommends more research on adapting risk assessment frameworks for resource-constrained and culturally diverse contexts.