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: raffaella.calati@gmail.com.
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
http://www.journalofpsychiatricresearch.com/article/S0022-3956%2816%2930066-8/abstract
OBJECTIF:
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
Abstract
OBJECTIVE:
To determine the efficacy of psychotherapy interventions for reducing suicidal attempts (SA) and non-suicidal self-injury (NSSI).
METHODS:
Meta-analysis
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
Comprehensive Meta-analysis.
RESULTS:
In
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
applied.
CONCLUSION:
Psychotherapy
seems to be effective for SA treatment. However, trials with lower risk
of bias, more homogeneous outcome measures and longer follow-up are
needed.