Infectious Disease

High quality RCTs are required to assess the effectiveness of suicidality psychotherapy in adolescents

April 20, 2021

2 min read

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Disclosure:
Bahji reports that he has received grants from the American Psychiatric Association’s COVID-19 Impact on Psychiatry Research Initiative and the 2020 Friends of Matt Newell Foundation for substance use outside of the work submitted. The other authors do not report any relevant financial information.

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According to the study results, methodological problems and a high risk of bias prevented a consistent estimate of the comparative performance of certain psychotherapeutic modalities for self-harm and suicide in adolescents.

“There is currently insufficient data from randomized clinical trials (RCTs) to recommend targeted pharmacological treatments for self-harm or suicidal behavior in adolescents.” Anees Bahji, MD, from the Department of Psychiatry at the University of Calgary in Canada, and colleagues wrote on the JAMA Network Open. “However, some non-pharmacological interventions, including psychotherapy, appear to improve some aspects of suicidal behavior. Several meta-analyzes have synthesized data from RCTs examining psychotherapies for self-harm and suicide in youth populations. “

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Researchers performed the current systematic review and network meta-analysis to reevaluate the comparative effectiveness and safety of psychotherapies for treating self-harm and suicidal behavior in children and adolescents. They used a network meta-analysis to mitigate bias associated with certain studies that may not be identified through head-to-head RCTs. They searched PubMed, MEDLINE, PsycINFO and Embase between early and September 2020 and included RCTs in which psychotherapies for suicidality and / or self-harm in children and adolescents were compared with control conditions. Dichotomized self-harm and retention of treatment were the primary outcomes. Dichotomized treatment discontinuations of all causes and scores on instruments that assessed suicidal ideation and depressive symptoms served as secondary outcomes.

Bahji and colleagues included 44 RCTs with a total of 5,406 participants, 76% of whom were women. The included studies were published between January 1, 1995 and December 31, 2020. The median duration of treatment was 3 months and the median follow-up time was 12 months. The results showed no increase in drop-outs or an improvement in treatment retention for the psychotherapies studied compared to usual treatment. The researchers found a connection between dialectical behavioral therapies and self-harm reductions (OR = 0.28; 95% CI, 0.12-0.64) and suicidal ideation (Cohen d SMD = 0.71; 95% CI, 1.19 to 0, 23) at the end of the treatment. They also observed a connection between mentalization-based therapies and decreases in self-harm (OR = 0.38; 95% CI, 0.15-0.97) and suicidal ideation (Cohen d SMD = 1.22; 95% CI, 2.18 to 0, 26). up’s end. A high risk of bias overall, heterogeneity, publication bias, inconsistency and inaccuracy led to a deterioration in the quality of the evidence.

“Although the results of this review suggest that some psychotherapies are well tolerated and have some effectiveness for certain measures of self-harm or suicide, the estimates showed that the quality of evidence for most psychotherapies was low to very low,” wrote Bahji and colleagues . “A lack of consistent evidence rules out a definitive hierarchy of treatments and suggests the need for additional high quality RCTs.”

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