Psychological interventions that are efficacious as treatments for depression could indirectly affect suicide-related outcomes. We examined suicidal thoughts and behaviours as eligibility criteria, outcomes, and adverse events across trials of psychotherapy for depression. We used a publicly available meta-analytic database developed through systematic searches (updated as of May 1, 2023) to identify randomised controlled trials in which a psychological intervention for depression was compared with an inactive or non-specific control condition in adults with depression and in which any suicide-related outcomes were reported. We also identified studies in which suicide risk was an exclusion criterion. We excluded inpatient studies and trials of unguided digital interventions or collaborative care that included a psychological component. Pairs of reviewers worked independently to select studies and extract data. In a random-effects meta-analysis with robust variance estimation, we assessed the effect of the psychological intervention on suicide outcomes in trials in which suicide was explicitly assessed as an outcome with clinical scales with established psychometric properties. Risk of bias was assessed with the Cochrane risk-of-bias tool (version 2). Of the 469 randomised trials we identified in which a psychological intervention was compared with an inactive control in people with depression, 251 excluded people judged at risk of suicide. Any assessment of suicide was included in only 45 trials, 12 of which assessed suicidal ideation or risk as an outcome. These 12 trials included 3930 participants, 2795 (71%) of whom were female and 1135 (29%) of whom were male; data for age and ethnicity were not consistently reported. Psychological interventions for depression were associated with a small reduction in suicidal ideation and risk in 11 trials (one trial reported only follow-up data) after the intervention (standardised mean difference –0·31 [95% CI –0·60 to –0·03]) but not at follow-up (–0·49 [–1·31 to 0·32]). Suicide-related adverse events were reported in 25 trials, and suicide-related serious adverse events (eg, suicide attempts, deaths by suicide) were reported in 13 trials. Heterogeneity was substantial across all analyses, and prediction intervals crossed zero. Trials of psychological interventions for depression rarely report assessments of suicide. Psychological interventions might reduce suicidal ideation in patients with depression, but more randomised controlled trials are required to clarify this effect. Monitoring and reporting of suicide-related adverse events should be improved in trials of psychological interventions for depression, and future trials should incorporate outcomes related to suicidal thoughts or behaviours. None. For the Spanish translation of the abstract see Supplementary Materials section.

中文翻译：

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抑郁症心理干预试验中自杀倾向的评估：荟萃分析

有效治疗抑郁症的心理干预措施可能会间接影响自杀相关的结果。我们在抑郁症心理治疗试验中检查了自杀想法和行为作为资格标准、结果和不良事件。我们使用通过系统搜索开发的公开荟萃分析数据库（截至 2023 年 5 月 1 日更新）来确定随机对照试验，其中将抑郁症的心理干预与不活跃或非特定的对照条件在成人抑郁症患者中进行比较，其中报告了任何与自杀相关的结果。我们还发现了将自杀风险作为排除标准的研究。我们排除了住院研究和无指导数字干预或包含心理成分的协作护理的试验。成对的评审员独立工作以选择研究并提取数据。在具有稳健方差估计的随机效应荟萃分析中，我们在试验中评估了心理干预对自杀结果的影响，在这些试验中，自杀被明确评估为具有既定心理测量特性的临床量表的结果。使用 Cochrane 偏倚风险工具（第 2 版）评估偏倚风险。在我们确定的 469 项随机试验中，对抑郁症患者进行了心理干预与非积极对照的比较，其中 251 项排除了被判断有自杀风险的人。仅 45 项试验纳入了对自杀的评估，其中 12 项将自杀意念或风险作为结果进行评估。这 12 项试验纳入了 3930 名参与者，其中 2795 名（71%）为女性，1135 名（29%）为男性；年龄和种族数据的报告不一致。11 项试验（其中一项试验仅报告随访数据）干预后，针对抑郁症的心理干预与自杀意念和风险小幅降低相关（标准化平均差 –0·31 [95% CI –0·60 至 –0 ·03]），但不在随访时（–0·49 [–1·31 至 0·32]）。25 项试验报告了与自杀相关的不良事件，13 项试验报告了与自杀相关的严重不良事件（例如自杀未遂、自杀死亡）。所有分析都存在很大的异质性，预测区间为零。抑郁症心理干预试验很少报告自杀评估。心理干预可能会减少抑郁症患者的自杀意念，但需要更多的随机对照试验来阐明这种效果。在抑郁症心理干预试验中应改进对自杀相关不良事件的监测和报告，未来的试验应纳入与自杀想法或行为相关的结果。没有任何。有关摘要的西班牙语翻译，请参阅补充材料部分。