The Effects of Internet-Based Cognitive Behavioral Therapy for Suicidal Ideation or Behaviors on Depression, Anxiety, and Hopelessness in Individuals With Suicidal Ideation: Systematic Review and Meta-Analysis of Individual Participant Data (Preprint)-Reference-Cited by-同舟云学术

The Effects of Internet-Based Cognitive Behavioral Therapy for Suicidal Ideation or Behaviors on Depression, Anxiety, and Hopelessness in Individuals With Suicidal Ideation: Systematic Review and Meta-Analysis of Individual Participant Data (Preprint)

Published:2023-02-26 Issue: Volume: Page:
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Author:

Sander Lasse B^ORCID,Beisemann Marie^ORCID,Doebler Philipp^ORCID,Micklitz Hannah Moon^ORCID,Kerkhof Ad^ORCID,Cuijpers Pim^ORCID,Batterham Philip^ORCID,Calear Alison^ORCID,Christensen Helen^ORCID,De Jaegere Eva^ORCID,Domhardt Matthias^ORCID,Erlangsen Annette^ORCID,Eylem-van Bergeijk Ozlem^ORCID,Hill Ryan^ORCID,Mühlmann Charlotte^ORCID,Österle Marie^ORCID,Pettit Jeremy^ORCID,Portzky Gwendolyn^ORCID,Steubl Lena^ORCID,van Spijker Bregje^ORCID,Tighe Joseph^ORCID,Werner-Seidler Aliza^ORCID,Büscher Rebekka^ORCID

Abstract

BACKGROUND

Suicide is a global public health problem. Digital interventions are considered a low-threshold treatment option for people with suicidal ideation or behaviors. Internet-based cognitive behavioral therapy (iCBT) targeting suicidal ideation has demonstrated effectiveness in reducing suicidal ideation. However, suicidal ideation often is related to additional mental health problems, which should be addressed for optimal care. Yet, the effects of iCBT on related symptoms, such as depression, anxiety, and hopelessness, remain unclear.

OBJECTIVE

We aimed to analyze whether digital interventions targeting suicidal ideation had an effect on related mental health symptoms (depression, anxiety, and hopelessness).

METHODS

We systematically searched CENTRAL, PsycInfo, Embase, and PubMed for randomized controlled trials that investigated guided or unguided iCBT for suicidal ideation or behaviors. Participants reporting baseline suicidal ideation were eligible. Individual participant data (IPD) were collected from eligible trials. We conducted a 1-stage IPD meta-analysis on the effects on depression, anxiety, and hopelessness—analyzed as 2 indices: symptom severity and treatment response.

RESULTS

We included IPD from 8 out of 9 eligible trials comprising 1980 participants with suicidal ideation. iCBT was associated with significant reductions in depression severity (b=−0.17; 95% CI −0.25 to −0.09; <i>P</i><.001) and higher treatment response (ie, 50% reduction of depressive symptoms; b=0.36; 95% CI 0.12-0.60; <i>P</i>=.008) after treatment. We did not find significant effects on anxiety and hopelessness.

CONCLUSIONS

iCBT for people with suicidal ideation revealed significant effects on depression outcomes but only minor or no effects on anxiety and hopelessness. Therefore, individuals with comorbid symptoms of anxiety or hopelessness may require additional treatment components to optimize care. Studies that monitor symptoms with higher temporal resolution and consider a broader spectrum of factors influencing suicidal ideation are needed to understand the complex interaction of suicidality and related mental health symptoms.

CLINICALTRIAL

Open Science Framework; https://osf.io/mvnjk

Publisher

JMIR Publications Inc.

Reference49 articles.

1. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research.

2. The Internal Struggle Between the Wish to Die and the Wish to Live: A Risk Factor for Suicide

3. Is psychotherapy effective for reducing suicide attempt and non-suicidal self-injury rates? Meta-analysis and meta-regression of literature data

4. Psychosocial interventions following self-harm in adults: a systematic review and meta-analysis

5. Psychosocial interventions for self-harm in adults