ImportanceSuicidal ideation and suicide attempts are debilitating mental health problems that are often treated with indirect psychotherapy (ie, psychotherapy that focuses on other mental health problems, such as depression or personality disorders). The effects of direct and indirect psychotherapy on suicidal ideation have not yet been examined in a meta-analysis, and several trials have been published since a previous meta-analysis examined the effect size of direct and indirect psychotherapy on suicide attempts.ObjectiveTo investigate the effect sizes of direct and indirect psychotherapy on suicidal ideation and the incidence of suicide attempts.Data SourcesPubMed, Embase, PsycInfo, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials were searched for articles published up until April 1, 2023.Study SelectionRandomized clinical trials of psychotherapy for any mental health problem, delivered in any setting, compared with any control group, and reporting suicidal ideation or suicide attempts were included. Studies measuring suicidal ideation with 1 item were excluded.Data Extraction and SynthesisPRISMA guidelines were followed. Summary data were extracted by 2 independent researchers and pooled using 3-level meta-analyses.Main Outcomes and MeasuresHedges g was pooled for suicidal ideation and relative risk (RR) was pooled for suicide attempts.ResultsOf 15 006 studies identified, 147 comprising 193 comparisons and 11 001 participants were included. Direct and indirect psychotherapy conditions were associated with reduced suicidal ideation (direct: g, −0.39; 95% CI, −0.53 to −0.24; I2, 83.2; indirect: g, −0.30; 95% CI, −0.42 to −0.18; I2, 52.2). Direct and indirect psychotherapy conditions were also associated with reduced suicide attempts (direct: RR, 0.72; 95% CI, 0.62 to 0.84; I2, 40.5; indirect: RR, 0.68; 95% CI, 0.48 to 0.95; I2, 0). Sensitivity analyses largely confirmed these results.Conclusions and RelevanceDirect and indirect interventions had similar effect sizes for reducing suicidal ideation and suicide attempts. Suicide prevention strategies could make greater use of indirect treatments to provide effective interventions for people who would not likely seek treatment for suicidal ideation or self-harm.

中文翻译：

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直接或间接心理治疗后的自杀意念和自杀未遂


重要性自杀意念和自杀未遂是使人衰弱的心理健康问题，通常通过间接心理治疗（即，专注于其他心理健康问题，如抑郁症或人格障碍的心理治疗）来治疗。尚未在荟萃分析中检查直接和间接心理治疗对自杀意念的影响，自从之前的荟萃分析检查了直接和间接心理治疗对自杀未遂的影响大小以来，已经发表了几项试验。目的探讨直接和间接心理治疗对自杀意念和自杀未遂发生率的影响大小。数据来源检索了 PubMed、Embase、PsycInfo、Web of Science、Scopus 和 Cochrane 对照试验中心注册库 （Cochrane Central Register of Controlled Trials） 截至 2023 年 4 月 1 日发表的文章。用 1 项测量自杀意念的研究被排除在外。遵循数据提取和 SynthesisPRISMA 指南。总结 资料由 2 名独立研究人员提取，并使用 3 级荟萃分析进行合并。主要结局和措施 Hedges g 合并自杀意念，相对风险 （RR） 合并自杀未遂。结果在确定的 15 006 项研究中，包括 147 项研究，包括 193 项比较和 11 001 名参与者。直接和间接心理治疗条件与自杀意念减少相关（直接：g，-0.39;95% CI，-0.53 至 -0.24;I2， 83.2;间接： g， −0.30;95% CI，-0.42 至 -0.18;I2， 52.2）。 直接和间接心理治疗条件也与自杀未遂减少相关（直接：RR，0.72;95% CI，0.62 至 0.84;I2,40.5;间接： RR， 0.68;95% CI，0.48 至 0.95;I2， 0）。敏感性分析在很大程度上证实了这些结果。结论和相关性直接和间接干预在减少自杀意念和自杀未遂方面具有相似的效果大小。自杀预防策略可以更多地利用间接治疗，为不太可能寻求自杀意念或自残治疗的人提供有效的干预措施。