Introduction: Psychotherapy has been shown to be effective in reducing suicidality, but it is as of yet unclear whether the way therapy is offered has an effect. The current study aims to examine five distinct treatment formats and comparing their effectiveness in reducing suicidal ideation and attempts. The five formats studied are individual, group, and family-based interventions, as well as combinations between individual and group or individual and family-based interventions. No meta-analyses have been conducted to investigate the effect of combined psychotherapy formats on suicidality, nor have psychotherapy formats been compared in their efficacy.
Methods: We systematically searched databases, including PubMed, Embase, PsycINFO, Web of Science, Scopus, and The Cochrane Central Register of Controlled Trials, up to April 1, 2023. Randomized controlled trials focusing on psychotherapy for any mental health problem were included. The primary outcomes were suicidal ideation and suicide attempts. Two independent researchers conducted the study selection and data extraction. The Cochrane Risk of Bias tool 2.0 was employed for assessing data quality, and a random-effects model was used for data synthesis. A subgroup analysis was used to investigate differences in efficacy between the treatment formats.
Results: A total of 143 studies with 153 comparisons were included. Individual or group therapies independently demonstrated efficacy in reducing suicidal ideation (g=-0.36, p<.001 and g=-0.35, p=.001, respectively). In terms of reducing suicide attempts, individual therapy (RR=0.77, p<.001), individual and group therapy (RR=0.42, p=.010), and individual and family-based therapy (RR=0.5, p=.016) were all effective. Subgroup analysis revealed no significant difference in suicidal ideation outcomes across formats, but the combined therapy formats outperformed single formats in reducing suicide attempts, yielding a 50-60% decrease in suicide attempts in the intervention group.
Conclusion: This meta-analysis underscores the importance of considering combined individual therapy sessions with group or family sessions in clinical treatment. The findings suggest that this approach may be particularly effective in reducing suicide attempts, with over a 50% reduction in attempts compared to the control group.