Direct, indirect interventions help lower suicidal ideation, self-harm attempts

Direct interventions that specifically target suicidal ideation or suicide attempts as well as indirect interventions that target other mental health problems both work well in terms of reducing the severity of suicidal ideation and the incidence of self-harm, according to the results of a meta-analysis.

Researchers searched multiple online databases for randomized clinical trials of psychotherapy for any mental health problem, delivered in any setting. Trials that reported on suicidal ideation or suicide attempts were included, while those that measured suicidal ideation on a categorical scale, such as a single item of a questionnaire for depression, were excluded.

The initial search yielded 15,006 studies, of which 147 met the eligibility criteria and were included in the meta-analysis. The total study population consisted of 11,001 participants. Data were pooled using 3-level meta-analyses.

Results showed that when compared with control, both direct and indirect psychotherapy interventions had favourable effects on suicidal ideation (direct: g, −0.39, 95 percent confidence interval [CI], −0.53 to −0.24; I2=83.2 percent; indirect: g, −0.30, 95 percent CI, −0.42 to −0.18; I2=52.2 percent).

Likewise, direct and indirect psychotherapy interventions were also associated with reduced suicide attempts (direct: relative risk [RR], 0.72, 95 percent CI, 0.62–0.84; I2=40.5 percent; indirect: RR, 0.68, 95 percent CI, 0.48–0.95; I2=0 percent).

Similar results were obtained in sensitivity analyses.

The findings underscore the potential of indirect psychotherapy interventions in suicide prevention strategies, especially for people who would not likely seek treatment for suicidal ideation or self-harm.