The online treatment of suicidal ideation: A randomised controlled trial of an unguided web-based intervention

  • Type :#article
  • Date read: 2023-04-03
  • Bibtex: @dejaegere2019
  • Bibliography: De Jaegere, E., van Landschoot, R., van Heeringen, K., van Spijker, B. A. J., Kerkhof, A. J. F. M., Mokkenstorm, J. K., & Portzky, G. (2019). The online treatment of suicidal ideation: A randomised controlled trial of an unguided web-based intervention. Behaviour Research and Therapy, 119, 103406.

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My notes

  • Unguided treatment vs waitlist
    • We could say that a limitation of this study and others is that waitlist is a weak control. Rather have supportive psychotherapy or something on the platform.
  • Primary outcome: BSS
  • Their registration was done after data collection.

Compared to the original self-help intervention, Think Life constitutes of more CBT elements and less MBCT exercises. The six modules each focus on different aspects, including 1) the relationship between suicidal thinking and worrying/rumination, 2) dealing with suicidal crises, 3) detecting automatic thoughts, 4) recognizing common thinking patterns, 5) challenging negative thoughts, and 6) dealing with future setbacks

  • I really like modules 1-2 and 6 here. I think we could probably adapt 3-5 to have less of a cognitive emphasis

An effect size of 0.35 was estimated. To detect such an effect size with α = 0.05 and β = 0.80, a total sample of 200 subjects was calculated. However, since a possible dropout of 20–30% was expected, the total required sample size was estimated at 260 participants.

Then why have such a huge group?? There’s not mention in the manuscript or on clinicaltrials. High dropout, worse effect than expected? It seems they had intake between December 2015 and February 2016 so perhaps a very high volume. A very favourable interpretation is that they saw huge interest and wanted to provide treatment for as many persons as possible, but you could also suspect p-hacking.


Suicide is a major public health issue, and treatment of suicidal thoughts may contribute to its prevention. Provision of online treatment of suicidal ideation may reduce barriers that suicidal individuals experience in face-to-face treatment. We therefore aimed at evaluating the effectiveness of a web-based intervention targeting a reduction of suicidal ideation. We carried out a two-arm, parallel-design, randomised controlled trial in the general population in Flanders (Belgium) (registered as NCT03209544). Participants who were 18 years or older and experienced suicidal ideation were included. The intervention group (n = 365) received access to the unguided web-based intervention, and the control group (n = 359) was placed on a waitlist. Assessments were carried out at baseline and at 6 and 12 weeks. Participants reported high levels of suicidal ideation, depression, hopelessness, worrying, and anxiety at baseline. Compared to the control group, participants in the intervention group experienced a significant decline in suicidal ideation, depression, hopelessness, worrying, and anxiety both at post-test and at follow-up. An important limitation of the study was a high dropout rate, in particular in the intervention group. Our findings suggest that the online self-help intervention was more effective in reducing suicidal ideation and suicide-related symptoms than a waitlist control in a severely affected population. It can help in filling the gap between crisis help and face-to-face treatment. PDF: de_jaegere_2019_the_online_treatment_of_suicidal_ideation_-_a_randomised_controlled_trial_of_an.pdf