Symposium 126 - Interventions for Suicidality: How Good Are They, and How Can We Improve Them?
Suicide and Self-Injury
Keywords: Suicide | Self-Injury | Randomized Controlled Trial
Presentation Type: Symposium
Background: In recent decades, there have been major institutional and scientific efforts directed at reducing suicide and related self-injurious thoughts and behaviors (SITBs). However, it remains unclear which approaches are most effective. We sought to summarize the state of research on SITB treatment and prevention programs via a meta-analytic review of this literature.
Method: After screening nearly 4,000 studies, the present meta-analysis included 345 randomized control trials (RCTs) in which SITBs (including nonsuicidal self-injury, self-harm, suicide ideation, suicide attempts, and suicide deaths) were measured post-treatment. Study characteristics and results were coded in detail.
Results: Active treatments provided small to modest reductions in SITBs compared to control treatments (averaged weighted ORs ~ 0.85, p< .001; [i.e., 15% reductions]), with the weakest effects emerging for suicide deaths. No factors substantially moderated these effects. For example, no treatment type was significantly better than any other, and the efficacy of SITB treatments have not improved significantly across nearly 60 years of research.
Discussion: Overall, results suggest that current treatments for SITBs provide only modest reductions in these outcomes compared to control treatments, and that these effects have not improved in several decades. Contrary to expectations, active treatments (including cognitive behavioral therapy, dialectical behavioral therapy, and psychopharmacological treatments) perform similarly well, with no treatments emerging as particularly efficacious. Despite an exponential increase in research on this topic over time, treatments have not improved. Many treatment types have been applied to SITBs, but these treatments and their targets have changed little since the 1980s and there is little-to-no evidence that proposed treatment targets play a major causal role in SITBs. These findings suggest that major innovations are needed and that researchers should prioritize the identification of treatment targets that play central causal roles in SITBs.