Abstract
Background: Suicide is a global public health problem. Digital interventions are considered a low-threshold treatment option for people with suicidal ideation or behaviors. Internet-based cognitive behavioral therapy (iCBT) targeting suicidal ideation has demonstrated effectiveness in reducing suicidal ideation. However, suicidal ideation often is related to additional mental health problems, which should be addressed for optimal care. Yet, the effects of iCBT on related symptoms, such as depression, anxiety, and hopelessness, remain unclear. Objective: We aimed to analyze whether digital interventions targeting suicidal ideation had an effect on related mental health symptoms (depression, anxiety, and hopelessness). Methods: We systematically searched CENTRAL, PsycInfo, Embase, and PubMed for randomized controlled trials that investigated guided or unguided iCBT for suicidal ideation or behaviors. Participants reporting baseline suicidal ideation were eligible. Individual participant data (IPD) were collected from eligible trials. We conducted a 1-stage IPD meta-analysis on the effects on depression, anxiety, and hopelessness—analyzed as 2 indices: symptom severity and treatment response. Results: We included IPD from 8 out of 9 eligible trials comprising 1980 participants with suicidal ideation. iCBT was associated with significant reductions in depression severity (b=−0.17; 95% CI −0.25 to −0.09; P<.001) and higher treatment response (ie, 50% reduction of depressive symptoms; b=0.36; 95% CI 0.12-0.60; P=.008) after treatment. We did not find significant effects on anxiety and hopelessness. Conclusions: iCBT for people with suicidal ideation revealed significant effects on depression outcomes but only minor or no effects on anxiety and hopelessness. Therefore, individuals with comorbid symptoms of anxiety or hopelessness may require additional treatment components to optimize care. Studies that monitor symptoms with higher temporal resolution and consider a broader spectrum of factors influencing suicidal ideation are needed to understand the complex interaction of suicidality and related mental health symptoms.
| Original language | English |
|---|---|
| Article number | e46771 |
| Pages (from-to) | 1-15 |
| Number of pages | 15 |
| Journal | Journal of Medical Internet Research |
| Volume | 25 |
| Early online date | 26 Jun 2023 |
| DOIs | |
| Publication status | Published - 2023 |
Bibliographical note
Publisher Copyright:©Lasse B Sander, Marie Beisemann, Philipp Doebler, Hannah Moon Micklitz, Ad Kerkhof, Pim Cuijpers, Philip Batterham, Alison Calear, Helen Christensen, Eva De Jaegere, Matthias Domhardt, Annette Erlangsen, Ozlem Eylem-van Bergeijk, Ryan Hill, Charlotte Mühlmann, Marie Österle, Jeremy Pettit, Gwendolyn Portzky, Lena Steubl, Bregje van Spijker, Joseph Tighe, Aliza Werner-Seidler, Rebekka Büscher. Originally published in the Journal of Medical Internet Research.
Funding
The authors thank Hanna Helfrich for helping with search updates and data extraction and Hanna Lehr for her support in the manuscript preparation. We acknowledge support by the Open Access Publication Fund of the University of Freiburg. RB is funded by a grant from the German Research Foundation (grant SA 3767/2-1). RB and LS received a peer mentoring grant from the German Association of Behavioral Medicine and Behavioral Modification. The funding organizations had no role in the design, conduct, or publication of the study.
| Funders | Funder number |
|---|---|
| German Association of Behavioral Medicine and Behavioral Modification | |
| Deutsche Forschungsgemeinschaft | SA 3767/2-1 |
| Albert-Ludwigs-Universität Freiburg |
Keywords
- anxiety
- CBT
- cognitive behavioral therapy
- depression
- depressive
- hopelessness
- internet-based cognitive behavioral therapy
- mental health
- meta-analysis
- psychotherapy
- review method
- suicidal
- suicidal ideation
- suicide
- systematic review