Efficacy and Safety of Psychotherapeutic Interventions in Adults at Risk of Suicide: An Umbrella Review

Author(s): Erasmo Saucedo Uribe, Leonel Estanislao Villalobos Gutiérrez,Neri Alejandro Álvarez Villalobos,Sandra Sabrina Rojo Garza,Rodrigo Huereca Lucio, Alessandro Javier Vite Castillo,Alan Iván Macias Quintanilla,Irma Guadalupe Rocha Rangel,Eduardo Jahir López Sanchéz.

Background: Psychological therapies are increasingly important in providing interventions to people at risk of suicide, but good quality evidence on their effectiveness remains low. The aim of this study is to determine the efficacy and safety of psychotherapies on suicidality in psychiatric adult patients.

Method: We conducted a systematic search in MEDLINE, Embase, Web of science, Scopus, PsycInfo and CDSR database from the first available year to August 2023. The methodological quality was evaluated by the AMSTAR-2 tool. We summarized the effects of psychotherapies on suicide-related outcomes.

Results: 7 systematic reviews (SR) and meta-analyses (MA) were included, 3 in patients with depression and 4 in borderline personality disorder (BPD). The studies´ quality of evidence ranges from critically low to high. The effect of psychotherapies on suicide-related outcomes were summarized, highlighting mindfulness-based interventions (MBIs) and problem-solving therapy (PST) for depression, and Schema therapy (SchT), mentalization-based therapy (MBT), psychodynamic therapy (PDT), and dialectical behavioral therapy (DBT) for BPD. Only one study reported safety results. Limitations: The number of studies excluded not meeting the inclusion criteria; a more inclusive search strategy; the quality of the evidence of the included studies.

Conclusion: In major depressive disorder (MDD), PST and MBIs show statistically significant improvements in reducing suicidal ideation. In BPD, SchT can be effective in reducing unspecified suicidality, MBT on “self-harm” and “suicidal ideation and behavior”, DBT and PDT in selfinjurious behaviors. Only 1 study reported data of the psychotherapies´ safety. More precise, specific and higher quality evidence is required to establish reliable conclusions.