Effectiveness of Psychotherapy on Suicidal Risk: A Systematic Review of Observational Studies

Abstract

Background: Suicidal behavior is a major public health concern worldwide, and the interest in the development of novel and more efficient treatment strategies and therapies to reduce suicidal risk is increasing. Some recent studies have summarized the results of randomized clinical trials (RCTs) assessing the efficacy of psychotherapeutic tools designed to treat patients at suicidal risk. However, observational studies, which reflect real-world effectiveness and may use original approaches, have not been reviewed. Method: The aim of this study is to systematically review the available scientific evidence issued from observational studies on the clinical effectiveness of psychotherapeutic tools designed to treat patients at suicide risk. We have thus performed a systematic search of PubMed and Web of Science databases. Results: Out of 1578 papers, 40 original observational studies fulfilled our selection criteria. The most used psychotherapeutic treatments were dialectical behavioral therapy (DBT, 27.5%) and cognitive behavioral therapy (CBT, 15.0%) in patients with a diagnosis of borderline personality disorder (32.5%) and depression (15.0%). Despite the between-study heterogeneity, interventions lead to a reduction in suicidal outcomes, i.e., suicidal ideation (55.0%) and suicide attempts (37.5%). The content and reporting quality varied considerably between the studies. Conclusion: DBT and CBT are the most widely used psychotherapeutic interventions and show promising results in existing observational studies. Some of the included studies provide innovative approaches. Group therapies and internet-based therapies, which are cost-effective methods, are promising treatments and would need further study.

Predictors of change in suicidal ideation across treatment phases of major depressive disorder: analysis of the STAR*D data

“…Therefore, in patients with TRD and comorbid SI, alternative treatments with anti-suicidal properties should be considered early in the sequence of treatments. Structured psychotherapies, such as cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are recommended to prevent suicide in general [ 11 , 27 ], with modest effect sizes for reduction of SI with CBT [ 28 ]. There is also evidence for DBT as a treatment for TRD itself [ 29 ], but not as a treatment specifically for SI in TRD.…”

Mindfulness and Behavior Change

“… 398 , 399 DBT has the most evidence for decreasing suicidal and self-injurious behavior. 400 , 401 In their systematic review, Chesin and colleagues 402 found six studies of MBIs and suicidal behavior. 403 Four studies reported inferential statistics on the effect of MBIs on SI, with three reporting significant reductions.…”

Suicide Risk in Bipolar Disorder: A Brief Review

“…Unfortunately, only a small number of studies have investigated up to now the efficacy of specific (e.g., dialectical behavior therapy, cognitive-behavioural therapy, interpersonal and social rhythm therapy) or unspecific (e.g., psychoeducation) psychosocial interventions against suicide among BD patients. Nonetheless, results of the few existing studies are promising [2,8,54,55,56,57,58].…”