Digital cognitive–behavioural therapy to reduce suicidal ideation and behaviours: a systematic review and meta-analysis of individual participant data

  • Type :#article
  • Date read: 2023-04-04
  • Bibtex: @buscher2022
  • Bibliography: Büscher, R., Beisemann, M., Doebler, P., Micklitz, H. M., Kerkhof, A., Cuijpers, P., Batterham, P. J., Calear, A. L., Christensen, H., Jaegere, E. D., Domhardt, M., Erlangsen, A., Bergeijk, O. E. van, Hill, R., Lungu, A., Mühlmann, C., Pettit, J. W., Portzky, G., Steubl, L. S., … Sander, L. B. (2022). Digital cognitive–behavioural therapy to reduce suicidal ideation and behaviours: A systematic review and meta-analysis of individual participant data. BMJ Ment Health, 25(e1), e8–e17.

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My notes

Excellent argument for interventions for SI:

60% of individuals who transition from suicidal ideation to suicidal behaviour do so within twelve months of onset. A timely reduction of suicidal ideation is of utmost importance as conclusive indicators for who will proceed to suicidal behaviour are lacking.

  • They used 50% reduction as a cut-off for treatment response, but no reference to empirical work
  • Pre-reg:
  • In iCBT conditions, the rate of reliable deterioration was 2.8% (controls: 5.1%) and the rate of reliable improvement was 40.5% (controls: 27.3%) at postintervention.
  • At postintervention, a treatment response occurred in 41.5% of participants in the iCBT condition (controls: 28.2%). The number needed to treat was 7.5.
  • reduced suicidal ideation at postintervention among iCBT participants (g=−0.31; 95% CI −0.40 to −0.22; n=2048; k=9) when compared with those in control conditions.
  • Lack of follow-up data, one study contributed 80% of follow-up participants
  • They specifically call for interventions with more support


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. 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. 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. PDF: büscher_2022_digital_cognitive–behavioural_therapy_to_reduce_suicidal_ideation_and.pdf