Comparing the efficacy of psychotherapy interventions for suicidality

With the increase of children and adolescents experiencing suicidality and engaging in self-harm, the need for effective interventions is more pressing than ever. A systemic review in JAMA Network Open looked at the efficacy of psychosocial interventions.¹

Investigators searched PubMed, MEDLINE, PsycINFO, and Embase to find randomized clinical trials that compared psychotherapies for self-harm and suicidality in children and adolescents. The studies included patients aged 10 to 19 years. Interventions used in the study included cognitive behavioral therapy, family-based family, interpersonal therapy, mode deactivation therapy, supportive therapy, short-term psychoanalytic psychotherapy, brief intervention, and cognitive analytic therapy. Primary outcomes examined were dichotomized self-harm as well as retention in treatment. Secondary outcomes were scored on instruments used to measure suicidal ideation and depressive symptom and dichotomized all-cause treatment discontinuation.

A total of 44 randomized clinical trials were included in the literature review and spanned from January 1995 to December 2020. The median duration of treatment was 3 months (range, 0.25-12.00 months), and the median follow-up period was 12 months (range, 1-36 months). No psychotherapy investigated was linked to increases in study withdrawals or improvements in retention when compared to treatment as usual. The use of dialectical behavioral therapy was linked to reductions in self-harm (OR, 0.28; 95% CI, 0.12-0.64) and suicidal ideation (Cohen d SMD, −0.71; 95% CI, −1.19 to −0.23) at the end of the treatment period. On the other hand, mentalization-based therapies were linked to a decrease in suicidal ideation (Cohen d SMD, −1.22; 95% CI, −2.18 to −0.26) and self-harm (OR, 0.38; 95% CI, 0.15-0.97) at the end of follow-up periods.

The investigators concluded that the psychotherapies studied were effective. However, the evidence was low or very low quality for many of the psychotherapies, which makes it difficult to create a definitive ranking of available treatments. They urged for the creation of randomized clinical trials that will provide high-quality evidence.

Reference

1. Bahji A, Pierce M, Wong J, Roberge J, Ortega I, Patten S. Comparative efficacy and acceptability of psychotherapies for self-harm and suicidal behavior among children and adolescents. JAMA Netw Open. 2021;4(4):e216614. doi:10.1001/jamanetworkopen.2021.6614