Abstract
Digital interventions that deliver psychological self-help provide the opportunity to reach individuals at risk of suicide who do not access traditional health services. Our primary objective was to test whether direct (targeting suicidality) and indirect (targeting depression) digital interventions are effective in reducing suicidal ideation and behaviours, and our secondary analyses assessed whether direct interventions were more effective than indirect interventions. In this systematic review and meta-analysis, we searched online databases MEDLINE, PubMed, PsycINFO, and Cochrane CENTRAL for randomised controlled trials published between database inception to May 21, 2019. Superiority randomised controlled trials of self-guided digital interventions (app or web based, which delivered theory-based therapeutic content) were included if they reported suicidal ideation, suicidal plans, or suicide attempts as an outcome. Non-inferiority randomised controlled trials were excluded to ensure comparability of the effect. Data were extracted from published reports, and intention-to-treat data were used if available. The primary outcome was the difference in mean scores of validated suicidal ideation measures (Hedges'g) with the associated 95% CI for the analysis of digital intervention effectiveness on suicidal ideation. We also present funnel plots of the primary outcome measure (suicidal ideation) for direct and indirect interventions to assess for publication bias. We calculated I2 (with I2 CI) values to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcomes. This study is registered with PROSPERO, CRD42018102084. The literature search yielded 739 articles (including manual searching) for suicidality and 8842 articles for depression. After screening, 14 papers reporting on 16 studies were included in the narrative review and meta-analysis. The 16 studies (ten on direct interventions and six on indirect interventions) provided baseline data for 4398 participants. The primary outcome of overall post-intervention effect for suicidal ideation was small but significant immediately following the active intervention phase (Hedges'g -0·18, 95% CI -0·27 to -0·10, p<0·0001; I2=0%, I2 CI 0·0-47·9). The secondary objective, comparing direct and indirect interventions, showed that direct interventions (targeting suicidality) significantly reduced suicidal ideation at post-intervention (g -0·23, 95% CI -0·35 to -0·11, p<0·0001; I2=17·6%, I2 CI 0·0-58·6), but indirect interventions (targeting depression) failed to reach significance (g -0·12, 95% CI -0·25 to 0·01, p=0·071; I2=0%, I2 CI 0·0-30·7). Self-guided digital interventions directly targeting suicidal ideation are effective immediately post-intervention. Indirect interventions were not significant for reducing suicidal ideation. Our findings suggest that digital interventions should be promoted and disseminated widely, especially where there is a lack of, or minimal access to, health services. Australian National Health and Medical Research Council.
Highlights
An estimated 817 000 people die by suicide each year, accounting for 1·4% of deaths globally.[1]
Overall, digital interventions are effective for reducing suicidal ideation, and we found encouraging evidence for the superior effectiveness of digital interventions targeting suicidality over those targeting depression
Key search terms derived from the medical subject heading terms used in the test papers were established, which included four primary sets of terms pertaining to suicide, depression, randomised controlled trials, and digital interventions
Summary
An estimated 817 000 people die by suicide each year, accounting for 1·4% of deaths globally.[1] Psychological treatment is effective in reducing suicidality, but many individuals who die from, or attempt, suicide do not seek help from health services. A 2015 review[2] reported that, of 12 006 individuals with suicide ideation, plans, or attempts in the past year, the weighted average proportion of individuals seeking or engaging with mental health services was 29∙5%. Self-guided digital interventions, designed to be used without professional guidance and delivered through webbased programmes or mobile applications, have proved to be successful in preventing and reducing depression and anxiety.[5,6] In the past 5 years, digital interventions have www.thelancet.com/digital-health Vol 2 January 2020 The proportion of individuals seeking help ranged from 30% to 70%, with lower frequencies of help seeking associated with being younger (12–18 years), male, and from diverse cultural backgrounds.[2,3] Among individuals least likely to seek help, perceived stigma, difficulty expressing concerns, and a preference for self-reliance have been identified as barriers to accessing care and support.[4]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
