Key Points

Question  What are the effects of suicide-focused (direct) and other (indirect) psychotherapies on suicidal ideation and suicide attempts?

Findings  In this systematic review and meta-analysis of 147 studies comprising 193 comparisons and 11 001 participants, direct and indirect interventions were associated with significant reductions in suicidal ideation and suicide attempts.

Meaning  The findings suggest that both direct and indirect psychotherapies can be used to reduce the severity of suicidal ideation and risk of suicide attempts.

Abstract

Importance  Suicidal ideation and suicide attempts are debilitating mental health problems that are often treated with indirect psychotherapy (ie, psychotherapy that focuses on other mental health problems, such as depression or personality disorders). The effects of direct and indirect psychotherapy on suicidal ideation have not yet been examined in a meta-analysis, and several trials have been published since a previous meta-analysis examined the effect size of direct and indirect psychotherapy on suicide attempts.

Objective  To investigate the effect sizes of direct and indirect psychotherapy on suicidal ideation and the incidence of suicide attempts.

Data Sources  PubMed, Embase, PsycInfo, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials were searched for articles published up until April 1, 2023.

Study Selection  Randomized clinical trials of psychotherapy for any mental health problem, delivered in any setting, compared with any control group, and reporting suicidal ideation or suicide attempts were included. Studies measuring suicidal ideation with 1 item were excluded.

Data Extraction and Synthesis  PRISMA guidelines were followed. Summary data were extracted by 2 independent researchers and pooled using 3-level meta-analyses.

Main Outcomes and Measures  Hedges g was pooled for suicidal ideation and relative risk (RR) was pooled for suicide attempts.

Results  Of 15 006 studies identified, 147 comprising 193 comparisons and 11 001 participants were included. Direct and indirect psychotherapy conditions were associated with reduced suicidal ideation (direct: g, −0.39; 95% CI, −0.53 to −0.24; I², 83.2; indirect: g, −0.30; 95% CI, −0.42 to −0.18; I², 52.2). Direct and indirect psychotherapy conditions were also associated with reduced suicide attempts (direct: RR, 0.72; 95% CI, 0.62 to 0.84; I², 40.5; indirect: RR, 0.68; 95% CI, 0.48 to 0.95; I², 0). Sensitivity analyses largely confirmed these results.

Conclusions and Relevance  Direct and indirect interventions had similar effect sizes for reducing suicidal ideation and suicide attempts. Suicide prevention strategies could make greater use of indirect treatments to provide effective interventions for people who would not likely seek treatment for suicidal ideation or self-harm.

Source: https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2824096