Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Feb 26, 2023
Date Accepted: Apr 23, 2023
The Effects of Internet-based Cognitive Behavior 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
ABSTRACT
Background:
Internet-based cognitive behavioral therapy (iCBT) targeting suicidal ideation has demonstrated effectiveness in reducing suicidal ideation. 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.
Methods:
We systematically searched CENTRAL, PsycINFO, Embase and PubMed for randomized controlled trials that investigated iCBT for suicidal ideation or behaviors. Participants reporting baseline suicidal ideation were eligible. We conducted a one-stage individual participant data (IPD) meta-analysis on the effects on depression, anxiety and hopelessness, analyzed as two indices: symptom severity and treatment response.
Results:
We included IPD from eight out of nine eligible trials comprising 1980 participants with suicidal ideation. iCBT was associated with significant reductions in depression severity (b=-0.169; 95%-CI -0.248 to -0.089, p<0.001) and higher treatment response (i.e., 50% reduction of depressive symptoms) (b=0.359; 95%-CI 0.116 to 0.603, p=0.008). 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. 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. Clinical Trial: https://osf.io/mvnjk
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