Digital cognitive-behavioural therapy to reduce suicidal ideation and behaviours: a systematic review and meta-analysis of individual participant data

Authors

Rebekka Büscher, Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany rebekka.buescher@mps.uni-freiburg.de.
Marie Beisemann, Department of Statistics, TU Dortmund University, Dortmund, Germany.
Philipp Doebler, Department of Statistics, TU Dortmund University, Dortmund, Germany.
Hannah M. Micklitz, Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Ad Kerkhof, Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Pim Cuijpers, Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Philip J. Batterham, Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia.
Alison L. Calear

Document Type

Article

Publication Date

12-1-2022

Abstract

QUESTION: Digital interventions based on cognitive-behavioural therapy (iCBT) is associated with reductions in suicidal ideation. However, fine-grained analyses of effects and potential effect-moderating variables are missing. This study aimed to investigate the effectiveness of iCBT on suicidal ideation, effect moderators, effects on suicide attempts and predictors of adherence. STUDY SELECTION AND ANALYSIS: We systematically searched CENTRAL, PsycINFO, Embase and PubMed for randomised controlled trials that investigated iCBT for suicidal ideation or behaviours. Participants reporting baseline suicidal ideation were eligible. We conducted a one-stage individual participant data (IPD) meta-analysis. Suicidal ideation was the primary outcome, analysed as three indices: severity of suicidal ideation, reliable changes and treatment response. FINDINGS: We included IPD from nine out of ten eligible trials (2037 participants). iCBT showed significant reductions of suicidal ideation compared with control conditions across all indices (severity: b=-0.247, 95% CI -0.322 to -0.173; reliable changes: b=0.633, 95% CI 0.408 to 0.859; treatment response: b=0.606, 95% CI 0.410 to 0.801). In iCBT, the rate of reliable improvement was 40.5% (controls: 27.3%); the deterioration rate was 2.8% (controls: 5.1%). No participant-level moderator effects were identified. The effects on treatment response were higher for trials with waitlist-controls compared with active controls. There were insufficient data on suicide attempts. Human support and female gender predicted treatment adherence. The main source of potential bias was missing outcome data. CONCLUSIONS: The current evidence indicates that iCBT is effective in reducing suicidal ideation irrespective of age, gender and previous suicide attempts. Future studies should rigorously assess suicidal behaviour and drop-out reasons.

Publication Source (Journal or Book title)

Evidence-based mental health

First Page

e8

Last Page

e17

Recommended Citation

Büscher, R., Beisemann, M., Doebler, P., Micklitz, H. M., Kerkhof, A., Cuijpers, P., Batterham, P. J., & Calear, A. L. (2022). Digital cognitive-behavioural therapy to reduce suicidal ideation and behaviours: a systematic review and meta-analysis of individual participant data. Evidence-based mental health, 25 (e1), e8-e17. https://doi.org/10.1136/ebmental-2022-300540