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

IF 6.6 2区医学 Q1 PSYCHIATRY Evidence Based Mental Health Pub Date : 2022-12-01 DOI:10.1136/ebmental-2022-300540

Rebekka Büscher, Marie Beisemann, Philipp Doebler, Hannah M Micklitz, Ad Kerkhof, Pim Cuijpers, Philip J Batterham, Alison L Calear, Helen Christensen, Eva De Jaegere, Matthias Domhardt, Annette Erlangsen, Ozlem Eylem van Bergeijk, Ryan Hill, Anita Lungu, Charlotte Mühlmann, Jeremy W Pettit, Gwendolyn Portzky, Lena S Steubl, Bregje A J van Spijker, Joseph Tighe, Aliza Werner-Seidler, Chelsey R Wilks, Lasse B Sander

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引用次数: 8

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.

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数字认知行为疗法减少自杀意念和行为:个体参与者数据的系统回顾和荟萃分析。

问题:基于认知行为疗法(iCBT)的数字干预与自杀意念的减少有关。然而，缺乏对影响和潜在影响调节变量的细粒度分析。本研究旨在探讨iCBT对自杀意念的影响、效果调节因子、对自杀企图的影响以及依从性的预测因子。研究选择和分析:我们系统地检索了CENTRAL、PsycINFO、Embase和PubMed中调查iCBT治疗自杀意念或行为的随机对照试验。报告基线自杀意念的参与者符合条件。我们进行了一期个体参与者数据(IPD)荟萃分析。自杀意念为主要结局，以自杀意念严重程度、可靠改变及治疗反应三个指标进行分析。结果:我们纳入了10项符合条件的试验中9项的IPD(2037名受试者)。与对照组相比，iCBT在所有指标上均显示自杀意念显著降低(严重程度:b=-0.247, 95% CI -0.322至-0.173;可靠变化:b=0.633, 95% CI 0.408 ~ 0.859;治疗反应:b=0.606, 95% CI 0.410 ~ 0.801)。在iCBT中，可靠改善率为40.5%(对照组:27.3%);恶化率为2.8%(对照组为5.1%)。未发现参与者水平的调节效应。与主动对照相比，候补对照对治疗反应的影响更高。关于自杀企图的数据不足。人类支持和女性性别预测治疗依从性。潜在偏倚的主要来源是缺少结果数据。结论:目前的证据表明，iCBT在减少自杀意念方面是有效的，与年龄、性别和以前的自杀企图无关。未来的研究应该严格评估自杀行为和退学原因。

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来源期刊

Evidence Based Mental Health PSYCHIATRY-

CiteScore

18.10

自引率

7.70%

发文量

期刊介绍： Evidence-Based Mental Health alerts clinicians to important advances in treatment, diagnosis, aetiology, prognosis, continuing education, economic evaluation and qualitative research in mental health. Published by the British Psychological Society, the Royal College of Psychiatrists and the BMJ Publishing Group the journal surveys a wide range of international medical journals applying strict criteria for the quality and validity of research. Clinicians assess the relevance of the best studies and the key details of these essential studies are presented in a succinct, informative abstract with an expert commentary on its clinical application.Evidence-Based Mental Health is a multidisciplinary, quarterly publication.