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Sander LB, Beisemann M, Doebler P, Micklitz HM, Kerkhof A, Cuijpers P, Batterham P, Calear A, Christensen H, De Jaegere E, Domhardt M, Erlangsen A, Eylem-van Bergeijk O, Hill R, Mühlmann C, Österle M, Pettit J, Portzky G, Steubl L, van Spijker B, Tighe J, Werner-Seidler A, Büscher R. The Effects of Internet-Based Cognitive Behavioral Therapy for Suicidal Ideation or Behaviors on Depression, Anxiety, and Hopelessness in Individuals With Suicidal Ideation: Systematic Review and Meta-Analysis of Individual Participant Data. J Med Internet Res 2023; 25:e46771. [PMID: 37358893 DOI: 10.2196/46771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 06/27/2023] Open
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.
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Affiliation(s)
- Lasse B Sander
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marie Beisemann
- Department of Statistics, Technical University of Dortmund, Dortmund, Germany
| | - Philipp Doebler
- Department of Statistics, Technical University of Dortmund, Dortmund, Germany
| | - Hannah Moon Micklitz
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ad Kerkhof
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Philip Batterham
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Alison Calear
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Eva De Jaegere
- Department of Head and Skin, Flemish Centre of Expertise in Suicide Prevention, Ghent University, Ghent, Belgium
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | | | - Ryan Hill
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Charlotte Mühlmann
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Marie Österle
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jeremy Pettit
- Department of Psychology, Center for Children and Families, Florida International University, Miami, FL, United States
| | - Gwendolyn Portzky
- Department of Head and Skin, Flemish Centre of Expertise in Suicide Prevention, Ghent University, Ghent, Belgium
| | - Lena Steubl
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Bregje van Spijker
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Joseph Tighe
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebekka Büscher
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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