Abstract
BackgroundTreatment for suicidality can be delivered online, but evidence for its effectiveness is needed.ObjectiveThe goal of our study was to examine the effectiveness of an online self-help intervention for suicidal thinking compared to an attention-matched control program.MethodsA 2-arm randomized controlled trial was conducted with assessment at postintervention, 6, and, 12 months. Through media and community advertizing, 418 suicidal adults were recruited to an online portal and were delivered the intervention program (Living with Deadly Thoughts) or a control program (Living Well). The primary outcome was severity of suicidal thinking, assessed using the Columbia Suicide Severity Rating Scale.ResultsIntention-to-treat analyses showed significant reductions in the severity of suicidal thinking at postintervention, 6, and 12 months. However, no overall group differences were found.ConclusionsLiving with Deadly Thoughts was of no greater effectiveness than the control group. Further investigation into the conditions under which this program may be beneficial is now needed. Limitations of this trial include it being underpowered given the effect size ultimately observed, a high attrition rate, and the inability of determining suicide deaths or of verifying self-reported suicide attempts.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12613000410752; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=364016 (Archived by WebCite at http://www.webcitation.org/6vK5FvQXy); Universal Trial Number U1111-1141-6595
Highlights
Suicidal thinking is common and often precedes suicidal plans and attempts [1,2]
There was no overall group difference between the Living with Deadly Thoughts (LwDT) group and the control group on the primary outcome, severity of suicidal thinking at postintervention, t245.51=−1.20, P=.23; 6 months, t172.57=−0.88
These findings are discrepant from the original study of LwDT, where a significant difference was found for the intervention compared to a waitlist control group in suicidal thoughts and worry [13]
Summary
Suicidal thinking is common and often precedes suicidal plans and attempts [1,2]. Effective treatments exist for suicidal thinking [3,4], but many individuals do not seek help due to factors such as low suicide literacy (ie, having little knowledge about suicidality), lack of perceived need, preference to manage the problem alone, stigma, shame, beliefs about receiving professional help, fear of hospitalization, structural factors (eg, time and finances), and having previously experienced negative encounters with health care professionals [5,6,7,8,9]. A Dutch trial of a self-guided online intervention for suicidal thinking reported significant reductions in suicidal thoughts relative to the waitlist control condition that included access to a website with psychoeducational material about suicide [13,14]. Further investigation into the conditions under which this program may be beneficial is needed Limitations of this trial include it being underpowered given the effect size observed, a high attrition rate, and the inability of determining suicide deaths or of verifying self-reported suicide attempts. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613000410752; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=364016 (Archived by WebCite at http://www.webcitation.org/6vK5FvQXy); Universal Trial Number U1111-1141-6595
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