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

R. Büscher; M. Beisemann; P. Doebler; H.M. Micklitz; A. Kerkhof; P. Cuijpers; P.J. Batterham; A.L. Calear; H. Christensen; E. De Jaegere; M. Domhardt; A. Erlangsen; O. Eylem Van Bergeijk; R. Hill; A. Lungu; C. Mühlmann; J.W. Pettit; G. Portzky; L.S. Steubl; B.A.J. Van Spijker; J. Tighe; A. Werner-Seidler; C.R. Wilks; L.B. Sander

doi:10.1136/ebmental-2022-300540

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

R. Büscher, M. Beisemann, P. Doebler, H.M. Micklitz, A. Kerkhof, P. Cuijpers, P.J. Batterham, A.L. Calear, H. Christensen, E. De Jaegere, M. Domhardt, A. Erlangsen, O. Eylem Van Bergeijk, R. Hill, A. Lungu, C. Mühlmann, J.W. Pettit, G. Portzky, L.S. Steubl, B.A.J. Van SpijkerJ. Tighe, A. Werner-Seidler, C.R. Wilks, L.B. Sander

Research output: Contribution to Journal › Review article › Academic › peer-review

Abstract

© 2022 Author(s). Published by BMJ.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.

Original language	English
Pages (from-to)	E8-E17
Journal	Evidence-Based Mental Health
Volume	25
Issue number	1
DOIs	https://doi.org/10.1136/ebmental-2022-300540
Publication status	Published - 19 Dec 2022

Funding

RB and LSS received a peer mentoring grant by the German Association of Behavioral Medicine and Behavioral Modification. In addition, we acknowledge support by the Open Access Publication Fund of the University of Freiburg. AL is employed by Lyra Health, a digital mental health company; she receives salary and stock options from Lyra Health. CRW received consulting fees from Mindstrong Health, Click Therapeutics and Behavioral Tech Research. LBS received grants from the German Research Foundation during the conduct of the study and personal fees from psychotherapy training institutes, clinic providers and the German pension fund outside the submitted work. All other authours declare no competing interests.

Funders	Funder number
Deutsche Forschungsgemeinschaft
Albert-Ludwigs-Universität Freiburg

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Büscher, R., Beisemann, M., Doebler, P., Micklitz, H. M., Kerkhof, A., Cuijpers, P., Batterham, P. J., Calear, A. L., Christensen, H., De Jaegere, E., Domhardt, M., Erlangsen, A., Eylem Van Bergeijk, O., Hill, R., Lungu, A., Mühlmann, C., Pettit, J. W., Portzky, G., Steubl, L. S., ... Sander, L. B. (2022). Digital cognitive-behavioural therapy to reduce suicidal ideation and behaviours: A systematic review and meta-analysis of individual participant data. Evidence-Based Mental Health, 25(1), E8-E17. https://doi.org/10.1136/ebmental-2022-300540

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abstract = "{\textcopyright} 2022 Author(s). Published by BMJ.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.",

author = "R. B{\"u}scher and M. Beisemann and P. Doebler and H.M. Micklitz and A. Kerkhof and P. Cuijpers and P.J. Batterham and A.L. Calear and H. Christensen and {De Jaegere}, E. and M. Domhardt and A. Erlangsen and {Eylem Van Bergeijk}, O. and R. Hill and A. Lungu and C. M{\"u}hlmann and J.W. Pettit and G. Portzky and L.S. Steubl and {Van Spijker}, B.A.J. and J. Tighe and A. Werner-Seidler and C.R. Wilks and L.B. Sander",

year = "2022",

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doi = "10.1136/ebmental-2022-300540",

language = "English",

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Büscher, R, Beisemann, M, Doebler, P, Micklitz, HM, Kerkhof, A, Cuijpers, P, Batterham, PJ, Calear, AL, Christensen, H, De Jaegere, E, Domhardt, M, Erlangsen, A, Eylem Van Bergeijk, O, Hill, R, Lungu, A, Mühlmann, C, Pettit, JW, Portzky, G, Steubl, LS, Van Spijker, BAJ, Tighe, J, Werner-Seidler, A, Wilks, CR & Sander, LB 2022, 'Digital cognitive-behavioural therapy to reduce suicidal ideation and behaviours: A systematic review and meta-analysis of individual participant data', Evidence-Based Mental Health, vol. 25, no. 1, pp. E8-E17. https://doi.org/10.1136/ebmental-2022-300540

TY - JOUR

T1 - Digital cognitive-behavioural therapy to reduce suicidal ideation and behaviours

T2 - A systematic review and meta-analysis of individual participant data

AU - Büscher, R.

AU - Beisemann, M.

AU - Doebler, P.

AU - Micklitz, H.M.

AU - Kerkhof, A.

AU - Cuijpers, P.

AU - Batterham, P.J.

AU - Calear, A.L.

AU - Christensen, H.

AU - De Jaegere, E.

AU - Domhardt, M.

AU - Erlangsen, A.

AU - Eylem Van Bergeijk, O.

AU - Hill, R.

AU - Lungu, A.

AU - Mühlmann, C.

AU - Pettit, J.W.

AU - Portzky, G.

AU - Steubl, L.S.

AU - Van Spijker, B.A.J.

AU - Tighe, J.

AU - Werner-Seidler, A.

AU - Wilks, C.R.

AU - Sander, L.B.

PY - 2022/12/19

Y1 - 2022/12/19

N2 - © 2022 Author(s). Published by BMJ.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.

AB - © 2022 Author(s). Published by BMJ.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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U2 - 10.1136/ebmental-2022-300540

DO - 10.1136/ebmental-2022-300540

M3 - Review article

SN - 1362-0347

VL - 25

SP - E8-E17

JO - Evidence-Based Mental Health

JF - Evidence-Based Mental Health

IS - 1

ER -

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

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