TY  - JOUR
PY  - 2022//
TI  - Digital cognitive-behavioural therapy to reduce suicidal ideation and behaviours: a systematic review and meta-analysis of individual participant data
JO  - Evidence-based mental health
A1  - Büscher, Rebekka
A1  - Beisemann, Marie
A1  - Doebler, Philipp
A1  - Micklitz, Hannah M.
A1  - Kerkhof, Ad
A1  - Cuijpers, Pim
A1  - Batterham, Philip J.
A1  - Calear, Alison L.
A1  - Christensen, Helen
A1  - De Jaegere, Eva
A1  - Domhardt, Matthias
A1  - Erlangsen, Annette
A1  - Eylem van Bergeijk, Ozlem
A1  - Hill, Ryan
A1  - Lungu, Anita
A1  - Mühlmann, Charlotte
A1  - Pettit, Jeremy W.
A1  - Portzky, Gwendolyn
A1  - Steubl, Lena S.
A1  - van Spijker, Bregje A. J.
A1  - Tighe, Joseph
A1  - Werner-Seidler, Aliza
A1  - Wilks, Chelsey R.
A1  - Sander, Lasse B.
SP  - e8
EP  - e17
VL  - 25
IS  - e1
N2  - 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. <br><br>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. <br><br>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.<p />  <p>Language: en</p>
LA  - en
SN  - 1362-0347
UR  - http://dx.doi.org/10.1136/ebmental-2022-300540
ID  - ref1
ER  -