Behavioural activation and trial‐based cognitive therapy may be beneficial to reduce suicidal ideation in major depressive disorder: A post hoc study from a clinical trial

Abstract

What is known and objective The suicidality spectrum is a clinical challenge because of the difficulty of its management and its association with mortality. Few studies have investigated psychotherapies for reducing the components of suicidality. In this study, we compared the effect of behavioural activation (BA), trial‐based cognitive therapy (TBCT) – both added to antidepressant (AD) treatment – and treatment as usual (TAU) in mitigating suicidal ideation in patients with major depressive disorder (MDD). Methods A post hoc study was conducted with data from a randomized clinical trial. Secondary analyses compared the treatments using scores from the items that evaluated suicidal ideation with the HAM‐D (HAM‐D‐3) and BDI (BDI‐9). A composite measurement was constructed by summing the scores from the two items (HAM‐D‐3 plus BDI‐9). Results and discussion Seventy‐six patients were analysed (BA + AD = 24; TBCT + AD = 26 and TAU = 26). In HAM‐D‐3, the BA + AD group showed a statistically greater reduction than the TAU group. In BDI‐9, the three groups did not show significant differences. In the HAM‐D‐3 plus BDI‐9, TBCT + AD reduced ideations more than the TAU group. There were no differences among the psychotherapies in any of the measures. Sensitivity analyses showed improvement in suicidal ideation in both psychotherapies compared to TAU. What is new and conclusion This is one of the few studies that evaluated the effect of BA and TBCT in lowering suicidal ideation. Adding these therapies to ADs seems to decrease suicidal ideation. We suggest the possible beneficial effects of BA and TBCT in the management of suicidal ideation in patients with recurrent MDD. Our findings need further studies to confirm these results.

Internet-based behavioural activation therapy versus online psychoeducation for self-reported suicidal ideation in individuals with depression in Indonesia: a secondary analysis of an RCT

“…Current evidence of the effectiveness of psychological treatments for SI in the context of depression is inconsistent. Several studies have shown no effect of short-term psychotherapy or cognitive behavioural therapy (CBT) on SI,29 whereas other studies showed positive effects on SI when interpersonal therapy, a form of (online) CBT, or a combination of cognitive or problem-solving approaches with a BA intervention or a short-term behavioural intervention was provided 5 6 13 30. Together with our findings, these studies affirm the ongoing clinical challenge in targeting SI with currently available (online) interventions and emphasise the need for additional research examining efficacy of (novel) interventions targeting SI.…”

“…BA leads to increased pleasant activities or problem-solving strategies, resulting in improved mood 12. Studies have also suggested that BA can lead to reduced SI via increased activity 13…”