D'Anci KE, Uhl S, Giradi G, et al.Ann Intern Med.
doi: 10.7326/M19-0869
Abstract
Background:
Suicide is a growing public health problem, with the national rate in the United States increasing by 30% from 2000 to 2016.
Purpose:
To assess the benefits and harms of nonpharmacologic and pharmacologic interventions to prevent suicide and reduce suicide behaviors in at-risk adults.
Conclusion:
Both CBT and DBT showed modest benefit in reducing suicidal ideation compared with TAU or wait-list control, and CBT also reduced suicide attempts compared with TAU. Ketamine and lithium reduced the rate of suicide compared with placebo, but there was limited information on harms. Limited data are available to support the efficacy of other nonpharmacologic or pharmacologic interventions.
Discussion
In this SR, we reviewed and synthesized evidence from 8 SRs and 15 RCTs of nonpharmacologic and pharmacologic interventions intended to prevent suicide in at-risk persons. These interventions are a subset of topics included in the updated VA/DoD 2019 CPG for assessment and management of patients at risk for suicide. The full final guideline is available from the VA Web site (www.healthquality.va.gov).
Nonpharmacologic interventions encompassed a range of approaches delivered either face-to-face or via the Internet or other technology. We found moderate-strength evidence supporting the use of face-to-face or Internet-delivered CBT in reducing suicide attempts, suicidal ideation, and hopelessness compared with TAU. We found low-strength evidence suggesting that CBT was not effective in reducing suicides. However, rates of suicide were generally low in the included studies, which limits our ability to draw firm conclusions about this outcome. Data from small studies provide low-strength evidence supporting the use of DBT over client-oriented therapy or control for reducing suicidal ideation. For other outcomes and other comparisons, we found no benefit of DBT. There was low-strength evidence supporting use of WHO-BIC to reduce suicide, CRP to reduce suicide attempts, and Window to Hope to reduce suicidal ideation and hopelessness.
