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Evaluation of Suicide in Trials of Psychological Interventions for Depression: A Meta-Analysis
28 Pages Posted: 20 Oct 2023
More...Abstract
Background: As effective depression treatments, psychological interventions could indirectly reduce suicide-related outcomes. We examined suicidal thoughts and behaviors as eligibility criteria, outcomes, and adverse effects across trials of psychotherapy for depression.
Methods: We used a publicly available meta-analytic database (http://www.metapsy.org/depression-psychotherapy), developed through systematic searches, updated January 1st 2023. Included were randomized trials comparing psychological interventions for adult depression with control conditions and reporting on any suicide-related or hopelessness outcomes. Two reviewers independently selected studies and extracted data. Risk of bias was assessed with the Cochrane Risk of Bias 2.0. tool. Effect sizes were calculated as standardized mean differences (SMD) and pooled with a random effects model with robust variance estimation.
Outcomes: Of 461 reports, 249 excluded at-risk participants and 47 reported any evaluation of suicide. Of these, 22 trials, representing 4746 randomized participants, assessed suicidal ideation, risk or hopelessness. Pooled effect estimates showed psychological interventions had a small, significant benefit on suicidal ideation and risk at post-test (SMD= -0.31, 95% CI -0.6 to -0.03), but not follow-up (SMD= -0.49, 95% CI -1.31 to 0.32). Heterogeneity was substantial and prediction intervals crossed zero. Interventions also reduced hopelessness (post-test SMD= -0.64, 95% CI -0.89 to -0.40; follow-up: SMD= -0.47, 95% CI -0.78 to -0.18). Twenty trials reported suicide-related adverse effects, 11 of which reported suicide attempts or deaths.
Interpretation: Suicide is rarely assessed in trials of psychological interventions for depression.Future depression trials need to routinely monitor and report suicide-related adverse and prespecify outcomes related to suicidal thoughts or risk.
Funding: None.
Declaration of Interest: The authors report no competing interest.
Keywords: suicide, depression, hopelessness, psychological interventions, meta-analysis, randomized trials
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