Abstract

Objective

It is necessary for suicide prevention interventions to demonstrate safety. One important aspect of safety is evidence that deterioration rates are low. No studies have examined deterioration of suicidal ideation in the context of an internet-based cognitive behavioral therapy (CBT) intervention to reduce suicidal ideation. A secondary analysis of the outcomes of an online trial was conducted to determine rates of deterioration in a CBT intervention called Living with Deadly Thoughts, relative to an attention control condition, and to identify factors associated with deterioration.

Method

The randomized controlled trial included 418 adults with suicidal ideation at baseline (77% females, mean age 40.6 years). Deterioration was defined in two ways: a reliable increase in Suicidal Ideation Attributes Scale (SIDAS score) of ≥6.0 units; or triggering the safety protocol during the trial as determined by high levels of suicidality. Analyses were repeated with multiply imputed data. Predictors of deterioration were identified using logistic regression analysis.

Results

30 (14%) participants in the control group and 15 (7%) in the intervention group met criteria for reliable deterioration (Fisher’s exact p = 0.027). In a fully adjusted logistic regression model, greater initial severity of suicidal thinking was associated with lower odds of deterioration, while intervention condition, demographics, psychological factors and mental health factors had no significant association with deterioration.

Conclusions

Participation in an online suicide prevention intervention was associated with lower prevalence of reliable deterioration than participation in an attention-control intervention, providing further evidence that internet-based CBT interventions do not cause harm.

• Highlights

• First study to assess deterioration in an internet suicide prevention intervention

• Rates of reliable deterioration were higher in control (14%) than intervention (7%)

• No psychological or demographic factors were robustly associated with deterioration

• Findings provide further evidence that internet based CBT programs are not harmful

中文翻译：

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互联网提供的减少自杀念头的认知行为疗法试验中恶化的速率和预测因子

摘要

客观的

自杀预防干预措施有必要证明其安全性。安全性的一个重要方面是劣化率低的证据。没有研究在基于互联网的认知行为疗法 (CBT) 干预的背景下检查自杀意念的恶化，以减少自杀意念。对在线试验的结果进行了二次分析，以确定 CBT 干预中的恶化率，称为与致命思想一起生活，相对于注意力控制条件，并确定与恶化相关的因素。

方法

随机对照试验包括 418 名基线时有自杀意念的成年人（77% 为女性，平均年龄 40.6 岁）。恶化以两种方式定义：自杀意念属性量表（SIDAS 评分）可靠增加≥6.0 个单位；或在试验期间根据高度自杀率触发安全协议。使用多重估算数据重复分析。使用逻辑回归分析确定恶化的预测因子。

结果

对照组的 30 名 (14%) 参与者和干预组的 15 名 (7%) 参与者符合可靠恶化的标准 (Fisher 精确p  = 0.027)。在完全调整的逻辑回归模型中，自杀念头的初始严重程度越高，恶化的几率越低，而干预条件、人口统计学、心理因素和心理健康因素与恶化的可能性无关。

结论

与参与注意力控制干预相比，参与在线自杀预防干预与可靠恶化的发生率较低相关，这进一步证明基于互联网的 CBT 干预不会造成伤害。

• 强调

• 第一项评估网络自杀预防干预恶化的研究

• 控制组（14%）的可靠恶化率高于干预组（7%）

• 没有心理或人口因素与恶化密切相关

• 调查结果进一步证明基于互联网的 CBT 计划无害