Both direct and indirect psychotherapies equally effective inReducing Suicidal Ideation and Suicide Attempts: JAMA

Most successful suicide prevention interventions are indirect mental health interventions targeted toward depression or personality disorders, as opposed to directly targeting suicidal thoughts or behaviors themselves. Although indirect intervention methods have been found to be efficacious, compared with direct intervention methods, in which actual suicidal ideation has actually been targeted, no previous study has conducted a comprehensive comparison of the efficacy of direct and indirect intervention methods.

The main aim is to identify the effect sizes of direct and indirect psychotherapy for lessened suicidal ideation and attempts. The analysis will be based on the data retrieved from the six major databases: PubMed, Embase, PsycInfo, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials, as of April 1, 2023.

The researchers did a systematic search of six databases for randomized clinical trials comparing psychotherapy for any mental disorder with control groups and reporting outcomes that included suicidal ideation or suicide attempts. Only any setting trial was included if it was psychotherapy-based and reported using validated scales on suicidal behaviors or ideation; those conducted with single-item measures of suicidal ideation were left out. Two independent researchers extracted the data and pooled it with 3-level meta-analyses according to the PRISMA guidelines. Summary of the Effect Sizes Used The effect sizes for suicidal ideation were Hedges g, while relative risk (RR) was used for suicide attempts.

The meta-analysis consisted of 147 studies involving 193 comparisons from a total number of 11,001 participants.

The studies found that direct and indirect psychotherapy reduced suicidal ideation and attempts.

Direct psychotherapy also had a medium-sized effect, with a Hedges g of -0.39 (95% CI, -0.53 to -0.24; I2, 83.2), indicating a moderate reduction in suicidal ideation.

Indirect psychotherapy was once more equivalent, with a Hedges g of -0.30 (95% CI, -0.42 to -0.18; I2, 52.2).

Relative risk for direct psychotherapy was at 0.72 (95% CI, 0.62 to 0.84; I2, 40.5), showing that individuals exposed to direct psychotherapy were 28% less likely to attempt suicide than the control groups.

The relative risk for indirect psychotherapy was at 0.68 (95% CI, 0.48 to 0.95; I2, 0), showing that individuals who received indirect psychotherapy would be 32% less likely to attempt suicide.

In conclusion, the meta-analysis confirmed that both direct and indirect psychotherapy effectively reduce suicidal ideation and the incidence of attempts to commit suicide. Such findings go on to support the provision of both therapeutic strategies in efforts towards prevention of suicide. The outcomes further suggest indirect treatment could provide an essential alternative for people who do not seek explicit help for suicidal thoughts or behaviors. If mental health services can offer a variety of intervention pathways, then it would indeed be possible to reach at-risk individuals and support them in the prevention of suicide.

Reference:

van Ballegooijen, W., Rawee, J., Palantza, C., Miguel, C., Harrer, M., Cristea, I., de Winter, R., Gilissen, R., Eikelenboom, M., Beekman, A., & Cuijpers, P. (2024). Suicidal ideation and suicide attempts after direct or indirect psychotherapy: A systematic review and meta-analysis. JAMA Psychiatry (Chicago, Ill.). https://doi.org/10.1001/jamapsychiatry.2024.2854