Titre original : Is psychotherapy effective for reducing suicide attempt and non-suicidal self-injury rates? Meta-analysis and meta-regression of literature data.
Calati R 1, Courtet P 2.
1 INSERM U1061, University of Montpellier UM1, Montpellier, France; FondaMental Foundation, France. Electronic address: firstname.lastname@example.org.
2 INSERM U1061, University of Montpellier UM1, Montpellier, France; FondaMental Foundation, France; Department of Emergency Psychiatry & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.
J Psychiatr Res. 2016 Apr 16;79:8-20
Pour déterminer l'efficacité des interventions de psychothérapie pour réduire les tentatives de suicide (SA) et automutilation non suicidaire (NSSI) à partir d'une meta-analyse de la Littérature
To determine the efficacy of psychotherapy interventions for reducing suicidal attempts (SA) and non-suicidal self-injury (NSSI).
of randomized controlled trials (RCTs) comparing psychotherapy
interventions and treatment as usual (TAU; including also enhanced usual
care, psychotropic treatment alone, cognitive remediation, short-term
problem-oriented approach, supportive relationship treatment, community
treatment by non-behavioral psychotherapy experts, emergency care
enhanced by provider education, no treatment) for SA/NSSI. RCTs were
extracted from MEDLINE, EMBASE, PsycINFO and Cochrane Library and
analyzed using the Cochrane Collaboration Review Manager Software and
the 32 included RCTs, 4114 patients were randomly assigned to receive
psychotherapy (n = 2106) or TAU (n = 2008). Patients who received
psychotherapy were less likely to attempt suicide
during the follow-up. The pooled risk difference for SA was -0.08 (95%
confidence intervals = -0.04 to -0.11). The absolute risk reduction was
6.59% (psychotherapy: 9.12%; TAU: 15.71%), yielding an estimated number
needed to treat of 15. Sensitivity analyses showed that psychotherapy
was effective for SA mainly in adults, outpatients, patients with
borderline personality disorder, previously and non-previously suicidal patients (heterogeneous variable that included past history of SA, NSSI, deliberate self-harm, imminent suicidal risk or suicidal
ideation), long- and short-term therapies, TAU only as a control
condition, and mentalization-based treatment (MBT). No evidence of
efficacy was found for NSSI, with the exception of MBT. Between-study
heterogeneity and publication bias were detected. In the presence of
publication bias, the Duval and Tweedie's "trim and fill" method was
seems to be effective for SA treatment. However, trials with lower risk
of bias, more homogeneous outcome measures and longer follow-up are