Article type
Abstract
Background: Previous suicide attempts are strong predictors of future suicide reattempts or suicide. Many psychological interventions aim to prevent suicide, but there is limited information regarding the comparative effectiveness of the multiple interventions available. We conducted a systematic review and network meta-analysis to evaluate relative treatment effects of psychological interventions for preventing suicide reattempts in people with previous suicide attempts.
Methods: We searched PubMed, Embase, Cochrane databases, and PsycINFO from database inception to January 01, 2024. Study selection and data extraction were conducted independently by two reviewers based on pre-specified criteria. Data about the efficacy of interventions, potential effect moderators, and study quality were extracted. Publication bias was assessed using a comparison-adjusted funnel plot and Egger test. Contributions of comparisons to each network estimate by overall risk of bias were investigated using CINeMA. The primary outcome was suicide reattempt rate. Random-effect network meta-analysis using a frequentist approach was implemented through the statistical package “netmeta” in R software.
Outcomes: A total of 3,014 participants from 26 RCTs was included in the network meta-analysis. Cognitive behavioral therapy (CBT) was the only intervention that was more effective for reducing suicide reattempts over a common comparator in both direct (OR: 0.45, 95%CI: 0.24-0.87) and indirect comparisons (OR: 0.47, 95%CI: 0.26-0.85). CBT also had the highest score (P-score: 0.8714) across the various interventions. Neither global nor local inconsistency was statically significant. There was no clear evidence of violations of the transitivity assumption when comparing characteristics of studies across interventions. Publication bias was not suspected.
Interpretation: Based on the current findings, CBT may be regarded as a reasonable first-line psychological intervention to prevent reattempts for people with previous suicide attempts. We observed moderate quality of evidence supporting an 87% probability of CBT being the best treatment available for preventing suicide reattempts.
Methods: We searched PubMed, Embase, Cochrane databases, and PsycINFO from database inception to January 01, 2024. Study selection and data extraction were conducted independently by two reviewers based on pre-specified criteria. Data about the efficacy of interventions, potential effect moderators, and study quality were extracted. Publication bias was assessed using a comparison-adjusted funnel plot and Egger test. Contributions of comparisons to each network estimate by overall risk of bias were investigated using CINeMA. The primary outcome was suicide reattempt rate. Random-effect network meta-analysis using a frequentist approach was implemented through the statistical package “netmeta” in R software.
Outcomes: A total of 3,014 participants from 26 RCTs was included in the network meta-analysis. Cognitive behavioral therapy (CBT) was the only intervention that was more effective for reducing suicide reattempts over a common comparator in both direct (OR: 0.45, 95%CI: 0.24-0.87) and indirect comparisons (OR: 0.47, 95%CI: 0.26-0.85). CBT also had the highest score (P-score: 0.8714) across the various interventions. Neither global nor local inconsistency was statically significant. There was no clear evidence of violations of the transitivity assumption when comparing characteristics of studies across interventions. Publication bias was not suspected.
Interpretation: Based on the current findings, CBT may be regarded as a reasonable first-line psychological intervention to prevent reattempts for people with previous suicide attempts. We observed moderate quality of evidence supporting an 87% probability of CBT being the best treatment available for preventing suicide reattempts.