Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Psychother Psychosom. 2023;92(3):152-161. doi: 10.1159/000529753. Epub 2023 Apr 4.
Many psychological interventions aim to prevent suicide, but there is limited information regarding their comparative effectiveness.
We conducted a systematic review and network meta-analysis to evaluate the relative effects of psychological interventions for preventing suicide re-attempts in psychiatric emergencies.
We searched PubMed, Embase, Cochrane, and PsycINFO from inception to December 1, 2022. Selection and data extraction were conducted independently by two reviewers based on prespecified criteria. We evaluated the efficacy of interventions, potential effect moderators, and study quality both within individual studies and across studies. Global and local inconsistencies and publication bias were explored. The primary outcome was suicide re-attempt rate. The network meta-analysis was conducted using the "netmeta" package in R. The protocol was registered with PROSPERO (CRD42021291407).
There were 3,155 participants from 26 randomized controlled trials included in the network meta-analysis. Cognitive behavioral therapy (CBT) was the only intervention that was more effective than a common comparator for reducing suicide re-attempts among psychological interventions in both direct and indirect comparisons (odds ratio: [95% confidence interval], 0.46 [0.25-0.85] vs. 0.47 [0.27-0.83]). CBT had the highest score (p score = 0.8727) across the various psychological interventions. Neither global nor local inconsistencies were significant. There was no clear evidence of violations of the transitivity assumption when comparing characteristics of studies across interventions. Publication bias was not suspected for the primary outcome.
CBT may be regarded as a reasonable first-line psychological intervention to prevent re-attempts among people with previous suicide attempts. We observed a moderate quality of evidence supporting an 87% probability of CBT being the best treatment available for preventing suicide re-attempts.
许多心理干预旨在预防自杀，但关于它们的相对有效性的信息有限。
我们进行了一项系统评价和网络荟萃分析，以评估精神科急症中预防自杀再尝试的心理干预措施的相对效果。
我们从建库至 2022 年 12 月 1 日，在 PubMed、Embase、Cochrane 和 PsycINFO 中进行了检索。两名审查员根据预设标准独立进行了选择和数据提取。我们评估了干预措施的疗效、潜在的效果调节因素以及个体研究和跨研究的研究质量。探讨了全局和局部不一致性以及发表偏倚。主要结局是自杀再尝试率。网络荟萃分析使用 R 中的“netmeta”包进行。该方案已在 PROSPERO（CRD42021291407）中注册。
网络荟萃分析纳入了 26 项随机对照试验，共 3155 名参与者。认知行为疗法（CBT）是唯一一种在直接和间接比较中均比常见对照更有效的干预措施，可降低心理干预措施中的自杀再尝试率（比值比：[95%置信区间]，0.46 [0.25-0.85] vs. 0.47 [0.27-0.83]）。CBT 在各种心理干预措施中得分最高（p 得分=0.8727）。全局和局部不一致均不显著。当比较干预措施之间的研究特征时，没有违反可传递性假设的明显证据。主要结局无发表偏倚的迹象。
CBT 可被视为预防有自杀史的患者再次自杀尝试的合理一线心理干预措施。我们观察到支持 CBT 是预防自杀再尝试的最佳治疗方法的证据质量为中等，概率为 87%。
