Psychotherapies for suicidal ideation are largely developed and tested in high-income countries (HICs) and therefore their effectiveness in low-and-middle-income countries (LMICs) is relatively unknown. The study aim was to assess effectiveness of psychotherapy for suicide ideation in LMICs. The MetaPsy database of randomized controlled trials (RCTs) on psychotherapies for suicidal thoughts and behavior was used for inclusion. A total of 91 RCTs were included in this meta-analysis, consisting of 18 studies from LMICs and 73 from HICs. Effect sizes (Hedge’s g) were calculated for suicidal ideation severity at post-treatment. Subgroup analyses, e.g. cultural adaptation, intervention provider, country income, were also conducted. Results suggest a large and statistically significant effect size in LMICs (g = 1.13, 95% CI: 0.64 - 1.61), albeit with high heterogeneity (I² = 92). A sensitivity analysis excluding outliers yielded a smaller effect size (g = 0.72, 95% CI: 0.42 - 1.02). Subgroup analysis did not indicate that cultural adaptation was correlated with the effect size. However, clinician-delivered interventions outperformed those delivered by laypersons (p<0.001). Comparison with studies from HICs showed that the effect size in HICs (g = 0.23, 95% CI: 0.17-0.29; I² = 30) was significantly lower than in LMICs (p<0.001). Trials of the effect of psychotherapy on suicidal ideation show larger effect sizes in LMICs than in HICs, although the quality of studies from LMICs was low and limits conclusions. Our findings underscore the effectiveness of psychotherapies in reducing suicidal ideation in LMICs while emphasizing the necessity for more quality RCTs in LMIC settings.