Psychotherapy Interventions Reduce Suicidal Ideation and Suicide Attempts

Both direct and indirect psychosocial interventions are associated with reduced severity of suicidal ideation and suicide attempts, according to study findings published in JAMA Psychiatry.

Researchers sought to determine the effects of direct and indirect psychotherapy interventions on suicidal ideation and suicide attempts.

The team of researchers conducted a systematic review and meta-analysis of PubMed, Embase, PsycInfo, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials for articles published up to April 1, 2023. Included studies had a randomized design comparing groups, analyzed psychotherapy administered for any mental health condition in any setting, included a control group for comparison, and reported suicidal ideation, suicide attempts, or self-harm leading to hospitalization. Patients who passed from suicide were included in suicide attempts.

The literature search provided 7980 unique records, of which 147 studies were selected for inclusion reflecting 193 comparisons. A total of 103 of these examined the effect of psychotherapy on severity of suicidal ideation, with 64 using direct therapy and 39 using indirect therapy aimed towards other mental health conditions. The other 90 comparisons examined the effect of psychotherapy on suicidal attempts or self-harm leading to hospitalization, with 64 using direct therapy and 26 using indirect therapy.

In total, suicidal ideation and suicide attempts or self-harm leading to hospitalization were measured among 9812 and 14,443 participants, respectively. A total of 1905 participants attempted suicide. Under both direct and indirect conditions, participants exhibited similar levels of suicide ideation severity at baseline based on studies using the Beck Scale for Suicidal ideation. 

Both direct and indirect psychotherapy treatment showed declines in suicidal ideation severity (g, -0.39; 95% CI, ­-0.53 to -0.24 and g, -0.30; 95% CI, -0.42 to -0.18, respectively) and suicide attempts (relative risk [RR], 0.72; 95% CI, 0.62-0.84; and RR, 0.68; 95% CI, 0.48-0.95, respectively).

Subgroup analyses showed that Collaborative Assessment and Management of Suicidality (g, -0.46; 95% CI, -0.85 to -0.08) and cognitive behavioral therapy (g, -0.51; 95% CI, -0.91 to -0.12) were more effective forms of direct therapy targeting suicidal ideation than psychodynamic-oriented therapy (g, 0.01; 95% CI, -0.36 to 0.39; P = .03).

Additionally, dialectical behavior therapy (RR, 0.49; 95% CI, 0.50 to 0.83) and cognitive behavioral therapy (RR, 0.65; 95% CI, 0.50 to 0.83) were more effective forms of direct therapy targeting suicide attempts than were Collaborative Assessment Management of Suicidality (RR, 1.14; 95% CI, 0.34 to 3.81), family therapy (RR, 1.14; 95% CI, 0.87 to 1.49), and problem-solving therapy (RR, 0.99; 95% CI, 0.77 to 1.29; P <.001).

“[D]irect interventions may have additional merit for health care professionals, because they could provide tangible tools and strategies and enhance clinicians’ confidence when dealing with suicidal ideation and attempts,” the researchers noted.

Study limitations included a broad definition of direct treatment, a population mainly made up of young adults and adults, the absence of follow-up measurements, and the inability to determine if indirect treatment included discussions on suicidal ideation.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor