Conference Agenda

Suicidal ideations and behaviours are among the most complex and urgent challenges in mental healthcare, where effective prevention and treatment are essential. Hundreds of randomised controlled trials (RCTs) have examined the impact of interventions on suicidal ideation and attempts, with new studies emerging every year. However, synthesising this vast body of evidence and translating it into clinical practice is extremely challenging.

The Metapsy suicide prevention initiative addresses this issue by providing a comprehensive, open-source database of research evidence on interventions for suicidality. This database is updated annually with new research. As well as serving as a repository, Metapsy enables researchers to conduct meta-analyses online, thereby promoting transparency and reproducibility.

In this presentation, we will outline the structure of the database, which has been designed to align with the PRISMA guidelines. We will also argue for the modernisation of the PRISMA guidelines to allow for the integration of AI and to include papers resulting from living systematic reviews.

From a scientific perspective, Metapsy is a powerful tool that enables researchers to analyse the effects of treatments online and reduces their workload when conducting meta-analyses. It could also potentially reduce the number of publications on meta-analyses and prevent research groups worldwide from wasting time and resources on duplicate work.

From a clinical perspective, Metapsy informs the development of guidelines. Furthermore, we have developed a suicide prevention toolkit for clinicians that translates research evidence into practical advice, thereby bridging the gap between research and clinical practice.

Introduction: A variety of psychotherapeutic interventions have shown promise in reducing suicidal behaviours. However, it is unclear which techniques and components make interventions successful. Studying components individually rather than evaluating an intervention as a whole (e.g. cognitive-behavioural therapy) could help us find larger treatment effects and develop more effective interventions. Therefore, the current study systematically recorded and evaluated the individual components used in interventions for psychotherapy aimed at reducing suicidality.

Methods: We systematically searched PubMed, Embase, PsycINFO, Web of Science, Scopus

and The Cochrane Central Register of Controlled Trials for randomised controlled trials up to April 1, 2024. Included studies directly targeted suicidality, and reported on suicide attempts. Data extraction and quality assessment was conducted independently by two researchers. Components were extracted using a specified codebook that was finalised in a two-step process by clinical experts that led to 21 possible components. This study was preregistered in OSF Registries.

Results: We included 56 studies with a total of 60 interventions. The median number of components employed was 7. Employing fewer components was associated with larger reductions in suicide attempts. The most common components were cognitive techniques (68%), crisis management and safety planning (65%) and assessment strategies (62%). We were able to test 18 out of 21 components in a series of meta-analyses, and treatments containing 11 of these components were associated with a significant reduction in suicide attempts. The largest effects were found for treatments containing interpersonal effectiveness training (RR = 0.47, p = .016), and emotion regulation training (RR = 0.58, p = .003).

Conclusions: Our findings suggest that components used in psychotherapeutic interventions for suicidality vary significantly, with many but not all elements contributing to lower suicide attempt rates. Individual elements can be used to create a modular approach to treatment, thereby optimizing results.

Background: Suicide remains a major public health concern in low- and middle-income countries (LMICs), yet the effectiveness of psychotherapies for reducing suicidal ideation and suicide attempts in these settings is not well understood. This study aimed to evaluate the effectiveness of psychotherapy in reducing suicidal ideation and suicide attempts in LMICs.

Methods: We used the Metapsy living database of psychotherapy RCTs for suicidal thoughts and behaviors, including all eligible LMIC trials and relevant HIC trials. Suicidal ideation (Hedges’ g) and suicide attempts (risk ratios) were pooled at post-treatment using random-effects models, with three-level models applied when trials contributed multiple comparison arms. We examined prespecified moderators e.g. cultural adaptation, delivery agent, intervention target (direct vs. indirect), and country income, and assessed risk of bias using RoB 2.0. Robustness was evaluated through sensitivity analyses excluding outliers, influential studies, and high–risk-of-bias trials.

Preliminary Insights: Preliminary results suggest a large and statistically significant effect size in LMICs (g = 1.13, 95% CI: 0.64–1.61), albeit with high heterogeneity (I² = 92). A sensitivity analysis excluding outliers yielded a smaller effect size (g = 0.72, 95% CI: 0.42–1.02). Subgroup analyses did not indicate that cultural adaptation or intervention target (direct vs. indirect) moderated the effect size. However, clinician-delivered interventions outperformed those delivered by lay providers (p < 0.001). Comparisons with HIC studies showed that the pooled effect in HICs (g = 0.23, 95% CI: 0.17–0.29; I² = 30) was significantly lower than that in LMICs (p < 0.001).

Conclusion: Our findings underscore the effectiveness of psychotherapies in reducing suicidal ideation and suicide attempts in LMICs while emphasizing the necessity for more quality RCTs in LMIC settings. Strengthening the evidence base through more rigorous, context-sensitive trials is essential for informing suicide prevention strategies that are globally relevant and locally appropriate.

Introduction. Worldwide, men are at an increased risk of dying by suicide compared to women. Psychological interventions have been put forward as promising strategies in suicide prevention with increasing evidence for their effectiveness. Considering the increased suicide risk among men, and possible different pathways of help-seeking and help-receiving, it is important to examine whether existing interventions are effective for men. However, research examining whether gender moderates suicide-related treatment outcomes is currently lacking.

Aims. This meta-analysis aims to investigate whether gender moderates the effectiveness of cognitive behavioral therapy-based interventions, compared to control groups, on suicidal ideation and behavior among adults. Additionally, several moderators will be examined, such as intervention characteristics (intervention type, delivery format), study characteristics (setting, control group type), participant characteristics (age group, veteran status), and drop-out.

Methods. This preregistered meta-analysis (https://doi.org/10.17605/OSF.IO/C356J) uses the Metapsy database (https://www.metapsy.org/) containing randomized controlled trials evaluating psychological interventions for suicidal thoughts and behavior. Planned analyses include general meta-analysis, meta-regression with centred proportion of males as continuous moderator, meta-regressions examining interactions between gender and additional moderators, and subgroup analyses.

Hypotheses. Based on literature suggesting reduced treatment engagement and increased dropout among men, we hypothesize that higher proportions of male participants will be associated with smaller treatment effect sizes. Given that most existing psychotherapy research has used gender-blind approaches, and the previous study of Cuijpers et al (2014) which did not find gender to be a moderating factor in CBT effectiveness for depression, we expect that few studies will have been specifically designed or powered to detect gender differences, potentially limiting our ability to detect true moderation effects.

Results. Data analysis will begin in early 2026, and findings will be presented at the ESSSB21 conference.