Identifying (effective) elements in the psychological treatment of suicidality: A systematic review and meta-analysis

Introduction: Various psychotherapeutic interventions have shown promise in reducing suicidality. However, it is unclear which components make interventions successful. Studying components individually rather than evaluating interventions as one (e.g. cognitive-behavioural therapy) could help us develop more effective interventions. The current study systematically recorded and evaluated individual components used in interventions aimed at reducing suicidality. Methods: We systematically searched six databases for randomised controlled trials up to April 1, 2024. Included studies directly targeted suicidality, and reported on suicide attempts. Data extraction and assessment was conducted by two researchers. Components were extracted using a specified codebook that led to 21 possible components. This study was preregistered in OSF Registries. Results: We included 56 studies with a total of 60 interventions. The median number of components employed was 7. 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 metaanalyses, 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, p = .016), and emotion regulation training (RR = 0.58, p = .003). Conclusions: Our findings suggest that components used in psychotherapeutic interventions for suicidality vary significantly, with many but not all elements contributing to lower suicide attempt rates. Individual elements can be used to create a modular approach to treatment, thereby optimizing results.