Wouter van Ballegooijen,Josine Rawee,Christina Palantza,Clara Miguel,Mathias Harrer,Ioana Cristea,Remco de Winter,Renske Gilissen,Merijn Eikelenboom,Aartjan Beekman,Pim Cuijpers
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The effects of direct and indirect psychotherapy on suicidal ideation have not yet been examined in a meta-analysis, and several trials have been published since a previous meta-analysis examined the effect size of direct and indirect psychotherapy on suicide attempts.\r\n\r\nObjective\r\nTo investigate the effect sizes of direct and indirect psychotherapy on suicidal ideation and the incidence of suicide attempts.\r\n\r\nData Sources\r\nPubMed, Embase, PsycInfo, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials were searched for articles published up until April 1, 2023.\r\n\r\nStudy Selection\r\nRandomized clinical trials of psychotherapy for any mental health problem, delivered in any setting, compared with any control group, and reporting suicidal ideation or suicide attempts were included. Studies measuring suicidal ideation with 1 item were excluded.\r\n\r\nData Extraction and Synthesis\r\nPRISMA guidelines were followed. Summary data were extracted by 2 independent researchers and pooled using 3-level meta-analyses.\r\n\r\nMain Outcomes and Measures\r\nHedges g was pooled for suicidal ideation and relative risk (RR) was pooled for suicide attempts.\r\n\r\nResults\r\nOf 15 006 studies identified, 147 comprising 193 comparisons and 11 001 participants were included. Direct and indirect psychotherapy conditions were associated with reduced suicidal ideation (direct: g, -0.39; 95% CI, -0.53 to -0.24; I2, 83.2; indirect: g, -0.30; 95% CI, -0.42 to -0.18; I2, 52.2). Direct and indirect psychotherapy conditions were also associated with reduced suicide attempts (direct: RR, 0.72; 95% CI, 0.62 to 0.84; I2, 40.5; indirect: RR, 0.68; 95% CI, 0.48 to 0.95; I2, 0). Sensitivity analyses largely confirmed these results.\r\n\r\nConclusions and Relevance\r\nDirect and indirect interventions had similar effect sizes for reducing suicidal ideation and suicide attempts. 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引用次数: 0
摘要
重要性自杀意念和自杀未遂是使人衰弱的心理健康问题,通常采用间接心理疗法(即针对抑郁症或人格障碍等其他心理健康问题的心理疗法)进行治疗。直接和间接心理疗法对自杀意念的影响尚未在一项荟萃分析中进行过研究,而且自从之前的一项荟萃分析研究了直接和间接心理疗法对自杀未遂的影响后,又发表了几项试验。目的 研究直接和间接心理疗法对自杀意念和自杀未遂发生率的影响大小。数据来源检索了PubMed、Embase、PsycInfo、Web of Science、Scopus和Cochrane Central Register of Controlled Trials中截至2023年4月1日发表的文章。研究筛选纳入了针对任何心理健康问题、在任何环境下进行、与任何对照组进行比较、报告有自杀意念或自杀企图的心理治疗随机临床试验。数据提取与综合研究遵循PRISMA指南。由两名独立研究人员提取摘要数据,并采用3级元分析法进行汇总。主要结果和测量方法对自杀意念的Hedges g进行汇总,对自杀未遂的相对风险(RR)进行汇总。结果在确定的15 006项研究中,纳入了147项,包括193项比较和11 001名参与者。直接和间接心理治疗条件与自杀意念的减少有关(直接:g,-0.39;95% CI,-0.53 至 -0.24;I2,83.2;间接:g,-0.30;95% CI,-0.42 至 -0.18;I2,52.2)。直接和间接心理治疗条件也与自杀企图的减少有关(直接:RR,0.72;95% CI,-0.42 至-0.18;I2,52.2):RR,0.72;95% CI,0.62 至 0.84;I2,40.5;间接:RR,0.68;95% CI,0.48 至 0.95;I2,0)。结论与相关性直接和间接干预对减少自杀意念和自杀企图的效果大小相似。自杀预防策略可以更多地利用间接治疗,为那些不可能因自杀意念或自残而寻求治疗的人提供有效的干预。
Suicidal Ideation and Suicide Attempts After Direct or Indirect Psychotherapy: A Systematic Review and Meta-Analysis.
Importance
Suicidal ideation and suicide attempts are debilitating mental health problems that are often treated with indirect psychotherapy (ie, psychotherapy that focuses on other mental health problems, such as depression or personality disorders). The effects of direct and indirect psychotherapy on suicidal ideation have not yet been examined in a meta-analysis, and several trials have been published since a previous meta-analysis examined the effect size of direct and indirect psychotherapy on suicide attempts.
Objective
To investigate the effect sizes of direct and indirect psychotherapy on suicidal ideation and the incidence of suicide attempts.
Data Sources
PubMed, Embase, PsycInfo, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials were searched for articles published up until April 1, 2023.
Study Selection
Randomized clinical trials of psychotherapy for any mental health problem, delivered in any setting, compared with any control group, and reporting suicidal ideation or suicide attempts were included. Studies measuring suicidal ideation with 1 item were excluded.
Data Extraction and Synthesis
PRISMA guidelines were followed. Summary data were extracted by 2 independent researchers and pooled using 3-level meta-analyses.
Main Outcomes and Measures
Hedges g was pooled for suicidal ideation and relative risk (RR) was pooled for suicide attempts.
Results
Of 15 006 studies identified, 147 comprising 193 comparisons and 11 001 participants were included. Direct and indirect psychotherapy conditions were associated with reduced suicidal ideation (direct: g, -0.39; 95% CI, -0.53 to -0.24; I2, 83.2; indirect: g, -0.30; 95% CI, -0.42 to -0.18; I2, 52.2). Direct and indirect psychotherapy conditions were also associated with reduced suicide attempts (direct: RR, 0.72; 95% CI, 0.62 to 0.84; I2, 40.5; indirect: RR, 0.68; 95% CI, 0.48 to 0.95; I2, 0). Sensitivity analyses largely confirmed these results.
Conclusions and Relevance
Direct and indirect interventions had similar effect sizes for reducing suicidal ideation and suicide attempts. Suicide prevention strategies could make greater use of indirect treatments to provide effective interventions for people who would not likely seek treatment for suicidal ideation or self-harm.
期刊介绍:
JAMA Psychiatry is a global, peer-reviewed journal catering to clinicians, scholars, and research scientists in psychiatry, mental health, behavioral science, and related fields. The Archives of Neurology & Psychiatry originated in 1919, splitting into two journals in 1959: Archives of Neurology and Archives of General Psychiatry. In 2013, these evolved into JAMA Neurology and JAMA Psychiatry, respectively. JAMA Psychiatry is affiliated with the JAMA Network, a group of peer-reviewed medical and specialty publications.