Gaynor Keith, O'Reilly Maeve Dwan, Redmond David, Nealon Ciara, Twomey Conal, Hennessy Eilis
School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland; DETECT, Early Intervention Service, Blackrock, Co. Dublin, Ireland.
School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland; Jigsaw the National Centre for Youth Mental Health, Westland Square, 16 Pearse St, Dublin, Ireland.
Compr Psychiatry. 2023 Apr;122:152374. doi: 10.1016/j.comppsych.2023.152374. Epub 2023 Jan 31.
Suicidality among young people is a significant societal issue. The current study conducted a meta-analysis of community and clinical interventions targeting suicide attempts, self-harm, and suicidal ideation in adolescents.
Interventions targeting suicide attempts, self-harm and suicidal ideation were identified by searching PsychINFO, Medline, CINAHL and Embase in line with the PRISMA statement. Study quality was determined using a risk of bias tool. Meta-analyses examined the efficacy of the interventions. Effect sizes were calculated for suicidal ideation data (continuous data) using Hedge's g for standardised mean differences. Suicide attempts and self-harm (dichotomous data) were calculated using odds ratios (ORs).
Seventeen RCTs were included in the meta-analysis. No significant differences were found between treatment and control groups on measures of suicide attempts or self-harm. A small effect-size was observed on measures of suicidal ideation (g = 0.47). A secondary meta-analysis investigated change over time in treatment as usual conditions, finding significant large effect-sizes for suicide attempts (OR = 18.67), self-harm (OR = 12.77), and suicidal ideation (g = 0.86).
The methodological decision to focus on specific outcomes over a broad definition of self-harm excluded some papers, which have been included in other reviews. It is unlikely to have significantly affected the overall results. The review was not preregistered.
These twin findings highlight the importance overcoming the methodological difficulty of discerning effective interventions during a period of baseline improvement. We suggest that future trials should move away from broadly addressing "suicidality/self-harm" and encourage a greater targeting of at-risk individuals.
青少年自杀行为是一个重大的社会问题。本研究针对青少年自杀未遂、自我伤害和自杀意念，对社区及临床干预措施进行了荟萃分析。
根据PRISMA声明，通过检索PsychINFO、Medline、CINAHL和Embase数据库，确定针对自杀未遂、自我伤害和自杀意念的干预措施。使用偏倚风险工具确定研究质量。荟萃分析检验了干预措施的有效性。对于自杀意念数据（连续数据），使用Hedge's g计算标准化平均差效应量。自杀未遂和自我伤害（二分数据）使用比值比（OR）计算。
荟萃分析纳入了17项随机对照试验。在自杀未遂或自我伤害测量方面，治疗组和对照组之间未发现显著差异。在自杀意念测量方面观察到较小的效应量（g = 0.47）。一项二次荟萃分析调查了常规治疗条件下随时间的变化，发现自杀未遂（OR = 18.67）、自我伤害（OR = 12.77）和自杀意念（g = 0.86）有显著的大效应量。
专注于特定结果而非广义自我伤害定义的方法学决策排除了一些已被其他综述纳入的论文。这不太可能对总体结果产生显著影响。该综述未预先注册。
这两项研究结果凸显了在基线改善期间克服辨别有效干预措施的方法学困难的重要性。我们建议未来的试验应不再广泛关注“自杀行为/自我伤害”，而是鼓励更有针对性地针对高危个体。
