TY - JOUR
T1 - The Effects of Internet-Based Cognitive Behavioral Therapy for Suicidal Ideation or Behaviors on Depression, Anxiety, and Hopelessness in Individuals With Suicidal Ideation
T2 - Systematic Review and Meta-Analysis of Individual Participant Data
AU - Sander, Lasse B.
AU - Beisemann, Marie
AU - Doebler, Philipp
AU - Micklitz, Hannah Moon
AU - Kerkhof, Ad
AU - Cuijpers, Pim
AU - Batterham, Philip
AU - Calear, Alison
AU - Christensen, Helen
AU - De Jaegere, Eva
AU - Domhardt, Matthias
AU - Erlangsen, Annette
AU - Eylem-Van Bergeijk, Ozlem
AU - Hill, Ryan
AU - Mühlmann, Charlotte
AU - Österle, Marie
AU - Pettit, Jeremy
AU - Portzky, Gwendolyn
AU - Steubl, Lena
AU - van Spijker, Bregje
AU - Tighe, Joseph
AU - Werner-Seidler, Aliza
AU - Büscher, Rebekka
N1 - 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.
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
KW - CBT
KW - anxiety
KW - cognitive behavioral therapy
KW - depression
KW - depressive
KW - hopelessness
KW - internet-based cognitive behavioral therapy
KW - mental health
KW - meta-analysis
KW - psychotherapy
KW - review method
KW - suicidal
KW - suicidal ideation
KW - suicide
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85163796551&partnerID=8YFLogxK
U2 - 10.2196/46771
DO - 10.2196/46771
M3 - Article
SN - 1439-4456
VL - 25
JO - Journal of Medical Internet Research
JF - Journal of Medical Internet Research
M1 - e46771
ER -