Lai Mee Huong, Maniam Thambu, Chan Lai Fong, Ravindran Arun V
Faculty of Medicine & Health Sciences, Department of Psychological Medicine, Universiti Malaysia Sarawak, Kuching, Malaysia.
J Med Internet Res. 2014 Jan 28;16(1):e30. doi: 10.2196/jmir.2973.
Suicide is a serious and increasing problem worldwide. The emergence of the digital world has had a tremendous impact on people's lives, both negative and positive, including an impact on suicidal behaviors.
Our aim was to perform a review of the published literature on Web-based suicide prevention strategies, focusing on their efficacy, benefits, and challenges.
The EBSCOhost (Medline, PsycINFO, CINAHL), OvidSP, the Cochrane Library, and ScienceDirect databases were searched for literature regarding Web-based suicide prevention strategies from 1997 to 2013 according to the modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The selected articles were subjected to quality rating and data extraction.
Good quality literature was surprisingly sparse, with only 15 fulfilling criteria for inclusion in the review, and most were rated as being medium to low quality. Internet-based cognitive behavior therapy (iCBT) reduced suicidal ideation in the general population in two randomized controlled trial (effect sizes, d=0.04-0.45) and in a clinical audit of depressed primary care patients. Descriptive studies reported improved accessibility and reduced barriers to treatment with Internet among students. Besides automated iCBT, preventive strategies were mainly interactive (email communication, online individual or supervised group support) or information-based (website postings). The benefits and potential challenges of accessibility, anonymity, and text-based communication as key components for Web-based suicide prevention strategies were emphasized.
There is preliminary evidence that suggests the probable benefit of Web-based strategies in suicide prevention. Future larger systematic research is needed to confirm the effectiveness and risk benefit ratio of such strategies.
自杀是一个在全球范围内严重且日益突出的问题。数字世界的出现对人们的生活产生了巨大影响，既有负面的也有正面的，其中包括对自杀行为的影响。
我们的目的是对已发表的关于基于网络的自杀预防策略的文献进行综述，重点关注其有效性、益处和挑战。
根据修改后的PRISMA（系统评价和Meta分析的首选报告项目）声明，在EBSCOhost（医学期刊数据库、心理学文摘数据库、护理学与健康领域数据库）、OvidSP、考克兰图书馆和科学Direct数据库中检索1997年至2013年期间关于基于网络的自杀预防策略的文献。对所选文章进行质量评级和数据提取。
高质量的文献出奇地稀少，只有15篇符合纳入综述的标准，且大多数被评为中低质量。在两项随机对照试验（效应量，d = 0.04 - 0.45）以及对初级保健抑郁症患者的临床审计中，基于互联网的认知行为疗法（iCBT）减少了普通人群中的自杀意念。描述性研究报告称，学生使用互联网后，治疗的可及性提高，障碍减少。除了自动化的iCBT，预防策略主要是交互式的（电子邮件通信、在线个人或有监督的团体支持）或基于信息的（网站张贴）。强调了可及性、匿名性和基于文本的通信作为基于网络的自杀预防策略的关键组成部分的益处和潜在挑战。
有初步证据表明基于网络的策略在预防自杀方面可能有益。未来需要进行更大规模的系统研究，以确认此类策略的有效性和风险效益比。
