Arch Suicide Res. 2022 Apr-Jun;26(2):937-947. doi: 10.1080/13811118.2020.1848671. Epub 2020 Nov 20.
It is necessary for suicide prevention interventions to demonstrate safety. One important aspect of safety is evidence that deterioration rates are low. No studies have examined deterioration of suicidal ideation in the context of an internet-based cognitive behavioral therapy (CBT) intervention to reduce suicidal ideation. A secondary analysis of the outcomes of an online trial was conducted to determine rates of deterioration in a CBT intervention called Living with Deadly Thoughts, relative to an attention control condition, and to identify factors associated with deterioration.
The randomized controlled trial included 418 adults with suicidal ideation at baseline (77% females, mean age 40.6 years). Deterioration was defined in two ways: a reliable increase in Suicidal Ideation Attributes Scale (SIDAS score) of ≥6.0 units; or triggering the safety protocol during the trial as determined by high levels of suicidality. Analyses were repeated with multiply imputed data. Predictors of deterioration were identified using logistic regression analysis.
30 (14%) participants in the control group and 15 (7%) in the intervention group met criteria for reliable deterioration (Fisher's exact = 0.027). In a fully adjusted logistic regression model, greater initial severity of suicidal thinking was associated with lower odds of deterioration, while intervention condition, demographics, psychological factors and mental health factors had no significant association with deterioration.
Participation in an online suicide prevention intervention was associated with lower prevalence of reliable deterioration than participation in an attention-control intervention, providing further evidence that internet-based CBT interventions do not cause harm.HighlightsFirst study to assess deterioration in an internet suicide prevention interventionRates of reliable deterioration were higher in control (14%) than intervention (7%)No psychological or demographic factors were robustly associated with deteriorationFindings provide further evidence that internet based CBT programs are not harmful.
自杀预防干预措施必须证明其安全性。安全性的一个重要方面是证据表明恶化率较低。没有研究在基于互联网的认知行为疗法（CBT）干预减少自杀意念的背景下，检查自杀意念的恶化情况。对一项在线试验结果的二次分析旨在确定一种名为“与致命思想共存”的 CBT 干预相对于注意对照条件下的恶化率，并确定与恶化相关的因素。
该随机对照试验纳入了 418 名基线时有自杀意念的成年人（77%为女性，平均年龄为 40.6 岁）。恶化以两种方式定义：自杀意念属性量表（SIDAS 评分）增加≥6.0 单位的可靠增加；或在试验过程中触发安全协议，因为自杀风险高。分析结果重复使用多重插补数据。使用逻辑回归分析确定恶化的预测因素。
对照组中有 30 名（14%）参与者和干预组中有 15 名（7%）参与者符合可靠恶化的标准（Fisher 确切检验 = 0.027）。在完全调整的逻辑回归模型中，自杀思维初始严重程度越高，恶化的可能性越低，而干预条件、人口统计学因素、心理因素和心理健康因素与恶化无显著关联。
与参加注意力控制干预相比，参加在线自杀预防干预与更低的可靠恶化发生率相关，这进一步证明了基于互联网的 CBT 干预不会造成伤害。这是评估在线自杀预防干预中恶化情况的第一项研究。对照组（14%）的可靠恶化率高于干预组（7%）。没有心理或人口统计学因素与恶化有明显关联。研究结果提供了进一步的证据，表明基于互联网的 CBT 计划没有危害。
