Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA; Geha Mental Health Center, Petah-Tikva, Israel.
Department of Psychiatry, Columbia University, New York, NY 10032, USA.
J Affect Disord. 2022 Mar 1;300:511-531. doi: 10.1016/j.jad.2021.12.094. Epub 2021 Dec 31.
During adolescence, suicide risk increases; effective treatments are needed to reduce risk.
Databases were searched (1995-2020) for randomized controlled trials (RCTs) concerning psychosocial treatments for suicide prevention in adolescents (10-18 yrs). Data were extracted from the timepoint closest to 6 months. Cohen's ds were estimated for reducing suicidal ideation (SI), self-harming behaviors (SHB) excluding strictly non-suicidal self-injury, and suicide attempts (SA) and analyzed using generalized least square regression. Meta-analytic innovations included within-person correlations to reflect trait suicidality; annualization to control for exposure; estimated lifetime risk based on ages; and modeling inclusion/exclusion criteria. Alternate approaches included relative risk and comparison of intervention and control treatments to baseline.
Of 30 RCTs, 6 assessing SHB (4 measuring SA), and 7 assessing SI demonstrated treatment effectiveness. Overall, interventions decreased SI (n = 25) with low effect size (d = 0.08, p = 0.01), non-significant after controlling for publication bias (d = 0.05, p = 0.1); interventions were non-significant for SHB (n = 25, d = 0.001, p = 0.97) or SA (n = 18, d = 0.03, p = 0.52). To prevent one SHB, the number needed to treat (NNT) was 45[26,156]; for SA, NNT=42[24,149]. Non-superiority may relate to effectiveness of control treatments. Thus, experimental and control treatments also were compared to baseline: both reduced SI (p < 0.0001), and effectiveness improved for SHB (NNT=12) and SA (NNT=11).
Study heterogeneity and inconsistent statistical reporting limited meta-analysis.
Psychosocial interventions for suicide risk in adolescents showed little effectiveness compared with control treatments; suicide outcomes improved in both groups compared to baseline. Different approaches may be needed, including precision medicine methodologies and standardized statistical reporting criteria.
在青少年时期，自杀风险增加；需要有效的治疗方法来降低风险。
检索数据库（1995-2020 年），寻找针对青少年自杀预防的心理社会治疗的随机对照试验（RCT）。数据从最接近 6 个月的时间点提取。使用广义最小二乘回归估计减少自杀意念（SI）、不包括严格非自杀性自伤的自伤行为（SHB）和自杀企图（SA）的 Cohen's ds。荟萃分析创新包括个体内相关性以反映特质性自杀倾向；年化以控制暴露；根据年龄估计终生风险；以及建模纳入/排除标准。替代方法包括相对风险和干预与对照治疗与基线的比较。
在 30 项 RCT 中，有 6 项评估 SHB（4 项评估 SA），7 项评估 SI，显示出治疗效果。总体而言，干预措施降低了 SI（n=25），效果较小（d=0.08，p=0.01），在控制发表偏倚后无显著性（d=0.05，p=0.1）；干预措施对 SHB（n=25，d=0.001，p=0.97）或 SA（n=18，d=0.03，p=0.52）无显著性。为了预防一次 SHB，需要治疗的人数（NNT）为 45[26，156]；对于 SA，NNT=42[24，149]。非优越性可能与对照治疗的有效性有关。因此，实验和对照治疗也与基线进行了比较：两种治疗都降低了 SI（p<0.0001），SHB（NNT=12）和 SA（NNT=11）的疗效也有所提高。
研究异质性和不一致的统计报告限制了荟萃分析。
与对照治疗相比，针对青少年自杀风险的心理社会干预效果甚微；与基线相比，两组的自杀结局都有所改善。可能需要采用不同的方法，包括精准医学方法和标准化统计报告标准。
