Question Digital interventions based on cognitive–behavioural therapy (iCBT) is associated with reductions in suicidal ideation. However, fine-grained analyses of effects and potential effect-moderating variables are missing. This study aimed to investigate the effectiveness of iCBT on suicidal ideation, effect moderators, effects on suicide attempts and predictors of adherence. Study selection and analysis We systematically searched CENTRAL, PsycINFO, Embase and PubMed for randomised controlled trials that investigated iCBT for suicidal ideation or behaviours. Participants reporting baseline suicidal ideation were eligible. We conducted a one-stage individual participant data (IPD) meta-analysis. Suicidal ideation was the primary outcome, analysed as three indices: severity of suicidal ideation, reliable changes and treatment response. Findings We included IPD from nine out of ten eligible trials (2037 participants). iCBT showed significant reductions of suicidal ideation compared with control conditions across all indices (severity: b=−0.247, 95% CI −0.322 to −0.173; reliable changes: b=0.633, 95% CI 0.408 to 0.859; treatment response: b=0.606, 95% CI 0.410 to 0.801). In iCBT, the rate of reliable improvement was 40.5% (controls: 27.3%); the deterioration rate was 2.8% (controls: 5.1%). No participant-level moderator effects were identified. The effects on treatment response were higher for trials with waitlist-controls compared with active controls. There were insufficient data on suicide attempts. Human support and female gender predicted treatment adherence. The main source of potential bias was missing outcome data. Conclusions The current evidence indicates that iCBT is effective in reducing suicidal ideation irrespective of age, gender and previous suicide attempts. Future studies should rigorously assess suicidal behaviour and drop-out reasons. No data are available. The analysis R codes are available online at OSF with publication (). Individual participant data cannot be provided due to confidenciality agreements.

中文翻译：

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减少自杀意念和行为的数字认知行为疗法：对个体参与者数据的系统回顾和荟萃分析

问题 基于认知行为疗法 (iCBT) 的数字干预与自杀意念的减少有关。然而，缺少对影响和潜在影响调节变量的细粒度分析。本研究旨在调查 iCBT 对自杀意念、效应调节剂、对自杀企图的影响和依从性预测因素的有效性。研究选择和分析 我们系统地搜索了 CENTRAL、PsycINFO、Embase 和 PubMed，寻找调查 iCBT 自杀意念或行为的随机对照试验。报告基线自杀意念的参与者符合条件。我们进行了单阶段个体参与者数据 (IPD) 荟萃分析。自杀意念是主要结果，分析为三个指标：自杀意念的严重程度、可靠的变化和治疗反应。结果 我们纳入了十分之九的符合条件的试验（2037 名参与者）的 IPD。iCBT 显示，与所有指标的对照条件相比，自杀意念显着减少（严重程度：b=-0.247，95% CI -0.322 至 -0.173；可靠变化：b=0.633，95% CI 0.408 至 0.859；治疗反应：b= 0.606，95% CI 0.410 至 0.801）。在 iCBT 中，可靠改善率为 40.5%（对照组：27.3%）；劣化率为2.8%（对照：5.1%）。没有发现参与者级别的调节效应。与主动控制相比，候补控制试验对治疗反应的影响更高。关于自杀未遂的数据不足。人类支持和女性性别预测治疗依从性。潜在偏倚的主要来源是缺少结果数据。结论 目前的证据表明，无论年龄、性别和以前的自杀企图如何，iCBT 都能有效减少自杀意念。未来的研究应该严格评估自杀行为和辍学原因。没有可用数据。分析 R 代码可在 OSF 在线获得，并附有出版物（). 由于保密协议，无法提供个人参与者数据。