The link between depression and suicidal thoughts and behavior has been extensively studied. Suicide ideation is often a symptom of depression and a key element in depression evaluation. However, recent theories suggest that suicidal behavior is a distinct process, not just a symptom of depression.
Despite the development of therapies like CAMS that directly target suicidality, most depressed patients reporting suicidal thoughts receive interventions focused on depression. Studies often exclude suicidal individuals, leaving a gap in understanding the impact of depression interventions on suicidality.
A recent meta-analysis titled “Assessment of Suicide Risk in Psychological Interventions for Depression” aimed to evaluate the effects of psychological interventions for depression on suicidal thoughts and behavior. The study analyzed a wide range of suicide-related factors using established instruments.
Do current available randomised controlled trials on psychological interventions for depression assess suicide risk?
Methods
The study used the Metapsy database to identify randomized controlled trials of psychological treatments for depression focusing on suicide-related outcomes. A total of 469 RCTs were analyzed, with a majority excluding participants at risk of suicide. The meta-analysis found a small effect of psychological interventions for depression on suicidal ideation.
Results
- 54% of studies excluded participants due to suicide risk.
- 12 trials were selected for the meta-analysis on the effectiveness of psychological interventions for depression on suicidal ideation.
- Different therapies like CBT, mindfulness, and behavioral activation were examined.
- Overall, there was a small effect on suicidal ideation, with no significant longitudinal effects found.
More than half (54%) of RCTs on psychological interventions for people with depression exclude people who are at risk of suicide.
Conclusions
- Trials studying psychological interventions for depression often do not report suicidal thoughts and behaviors.
- The exclusion of suicidal patients in many studies limits the understanding of intervention effectiveness.
- The meta-analysis showed a small effect on suicide ideation, but more research is needed to draw conclusive results.
“Suicidal thoughts and behaviours are rarely reported in trials studying the effect of psychological interventions on depression.”
Strengths and limitations
The study provides insight into reporting suicide risk factors in clinical trials but is limited by the small number of studies and their heterogeneity. Data on intervention effectiveness on suicide ideation remains inconclusive due to this limitation.
Studies relying on single items for suicide ideation may present biased insights, and fluctuations in suicidality over short periods are common. A more nuanced understanding may require alternative research methods.
Further research should focus on better assessing suicide risk within depression interventions and comparing different treatment approaches to address suicidality effectively.
Single item statements from depression questionnaires do not provide an accurate representation of suicide risk.
Implications for practice
The study highlights the need to include suicidal individuals in research on psychological interventions for depression to improve understanding of intervention effectiveness on suicidality. Clinicians should monitor suicidal ideation during treatment and discuss residual risk with patients.
Psychoeducation and safety planning can help prevent relapses in suicidal behavior. Future studies should focus on assessing suicidality more accurately and comparing different treatment strategies for better outcomes.
The effectiveness of psychological interventions on suicide risk requires further research attention to address the needs of suicidal individuals.
Statement of interests
Derek de Beurs is a member of the Dutch guideline for suicidal behavior and knows three of the authors involved in the study.
Links
Primary paper
Miguel, C., Cecconi, J., Harrer, M., Van Ballegooijen, W., Bhattacharya, S., Karyotaki, E., Cuijpers, P., Gentili, C., & Cristea, I. A. (2024). Assessment of suicidality in trials of psychological interventions for depression: A meta-analysis. The Lancet Psychiatry, 11(4), 252–261. https://doi.org/10.1016/S2215-0366(24)00027-0
Other references
Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: A meta-review. World Psychiatry, 13(2), 153–160. https://doi.org/10.1002/wps.20128
