Introduction: Many psychological interventions aim to prevent suicide, but there is limited information regarding their comparative effectiveness. Objectives: We conducted a systematic review and network meta-analysis to evaluate the relative effects of psychological interventions for preventing suicide re-attempts in psychiatric emergencies. Methods: We searched PubMed, Embase, Cochrane, and PsycINFO from inception to December 1, 2022. Selection and data extraction were conducted independently by two reviewers based on prespecified criteria. We evaluated the efficacy of interventions, potential effect moderators, and study quality both within individual studies and across studies. Global and local inconsistencies and publication bias were explored. The primary outcome was suicide re-attempt rate. The network meta-analysis was conducted using the “netmeta” package in R. The protocol was registered with PROSPERO (CRD42021291407). Results: There were 3,155 participants from 26 randomized controlled trials included in the network meta-analysis. Cognitive behavioral therapy (CBT) was the only intervention that was more effective than a common comparator for reducing suicide re-attempts among psychological interventions in both direct and indirect comparisons (odds ratio: [95% confidence interval], 0.46 [0.25–0.85] vs. 0.47 [0.27–0.83]). CBT had the highest score (p score = 0.8727) across the various psychological interventions. Neither global nor local inconsistencies were significant. There was no clear evidence of violations of the transitivity assumption when comparing characteristics of studies across interventions. Publication bias was not suspected for the primary outcome. Conclusions: CBT may be regarded as a reasonable first-line psychological intervention to prevent re-attempts among people with previous suicide attempts. We observed a moderate quality of evidence supporting an 87% probability of CBT being the best treatment available for preventing suicide re-attempts.
Psychother Psychosom

中文翻译：

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心理治疗对预防精神科紧急情况下再次自杀企图的有效性：随机对照试验的系统回顾和网络荟萃分析

简介：许多心理干预措施旨在预防自杀，但有关其相对有效性的信息有限。目的：我们进行了系统回顾和网络荟萃分析，以评估心理干预对于预防精神紧急情况下再次自杀企图的相对效果。方法：我们检索了从开始到2022年12月1日的PubMed、Embase、Cochrane和PsycINFO。选择和数据提取由两名评审员根据预先设定的标准独立进行。我们评估了单项研究和跨研究的干预措施的有效性、潜在效应调节因素和研究质量。探讨了全球和地方的不一致以及出版偏见。主要结果是自杀再尝试率。网络元分析是使用 R 中的“netmeta”包进行的。该协议已在 PROSPERO 中注册（CRD42021291407）。结果：网络荟萃分析包含来自 26 项随机对照试验的 3,155 名参与者。在直接和间接比较中，认知行为疗法 (CBT) 是唯一比常见比较方法更有效地减少心理干预中自杀再尝试的干预措施（比值比：[95% 置信区间]，0.46 [0.25–0.85]对比 0.47 [0.27–0.83]）。在各种心理干预措施中，CBT 得分最高（p得分 = 0.8727）。全球和局部的不一致都不显着。在比较不同干预措施的研究特征时，没有明确的证据表明违反了传递性假设。主要结局未怀疑发表偏倚。结论：CBT 可被视为一种合理的一线心理干预措施，可防止有过自杀企图的人再次尝试。我们观察到中等质量的证据支持 CBT 有 87% 的可能性是防止再次自杀的最佳治疗方法。
心理医生