Identifying (Effective) Elements in the Psychological Treatment of Suicidality: A Systematic Review and Meta-analysis

Objective: A variety of psychotherapeutic interventions have shown promise in reducing suicidal behaviours. However, it is unclear which techniques and components make interventions successful. Therefore, the current study aims to record and evaluate the individual components used in interventions for psychotherapy aimed at reducing suicidality.Methods: We systematically searched PubMed, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Central Register of Controlled Trials for randomised controlled trials up to April 1, 2024. Included studies directly targeted suicidality, and reported on suicide attempts. Data extraction and quality assessment was conducted independently by two researchers. Components were extracted using a specified codebook that was finalised in a two-step process that led to 21 possible components. This study was preregistered in OSF Registries.Results: We included 56 studies with a total of 60 interventions. Interventions employed 6.7 components on average. The most common components were cognitive techniques (68%), crisis management and safety planning (65%) and assessment strategies (62%). We were able to test 18 out of 21 components in a series of meta-analyses, and treatments containing 11 of these components were associated with a significant reduction in suicide attempts. The largest effects were found for treatments containing interpersonal effectiveness training (RR = 0.47), and emotion regulation training (RR = 0.58).Discussion: Our findings suggest that individual elements can be used to create a modular approach to treatment, thereby optimizing results.