Therefore, it is impossible to investigate the aforementioned questions using a conventional meta-analysis (MA). 13 However, most randomised controlled trials (RCTs) are underpowered to perform such moderator analyses, and seldom report such results. 3 In addition, there are many more factors associated with an increased risk of suicide (attempt) that may play a role in the effectiveness of psychotherapy on suicidality, such as age, ethnicity, education level, marital status, psychiatric diagnosis and history of prior attempt. 12 For instance, it has been suggested that female sex and a high number of treatment sessions per week may be associated with increased efficacy of psychotherapy in reducing suicidal thoughts and behaviour. Few studies have attempted to answer questions about whether the efficacy of psychotherapy is affected by moderators related to participant (eg, psychiatric disorder, sociodemographic, clinical factors) or intervention characteristics (eg, type of psychotherapy, number of sessions). Furthermore, not all types of psychotherapy may be effective for the entire spectrum of individuals with suicidality. 11 Given the ambiguity in these findings, there is a need for studies to establish the effectiveness of psychotherapy on decreasing suicidal thoughts and behaviour. 10 However, not all studies show favourable results on suicidality after psychotherapy. Studies have shown a reduction of suicidal thoughts and behaviour after cognitive–behavioural therapy (CBT), 6 7 dialectical behaviour therapy (DBT) 8 9 and cognitive therapy (CT). 3–5 For instance, a meta-analyses by Calati and Courtet 3 examined the effect of psychotherapy on suicide attempts compared with treatment as usual and found a pooled risk difference of −0.08 (95% CI=−0.04 to −0.11) after 1–18 months follow-up. Several studies have demonstrated promising results regarding the effectiveness of psychotherapy (ie, the use of psychological methods to change behaviour or overcome problems) in reducing suicide ideation and preventing further suicide attempts. 2 Therefore, there is an urgent need to determine the effectiveness of treatments across the range of individuals who experience suicidality. Healthcare professionals have found treatment of individuals with suicidal ideation and behaviour to be difficult. According to WHO, 1 800 000 people globally die by suicide every year. Suicide is one of the most pressing and significant mental health issues worldwide. Answering these questions will inform mental healthcare practitioners about optimal treatments for different groups of individuals with suicidal ideation and/or behaviour and consequently help to reduce suicide risk. IPD-MA may determine the effectiveness of psychotherapy in reducing suicidality and provide insights into the moderating factors influencing the efficacy of psychotherapy. Additionally, a conventional MA will be conducted to determine the differences between studies that provided IPD and those that did not. Subgroup and sensitivity analyses will be conducted to test the robustness of the findings. A 1-stage IPD-MA will be used to determine the effectiveness of psychotherapy on suicidal ideation, suicide attempts and/or suicide deaths, and to investigate potential patient-related and intervention-related moderators. In addition, as a comparison group we will focus on a control group (waiting-list, care as usual or placebo). For the IPD-MA, we will focus on adult outpatients with suicidal ideation or behaviour. Methods and analysis To build a comprehensive database, randomised controlled trials examining the effect of any psychotherapy targeting any psychiatric disorder on suicidal thoughts or behaviour will be identified by running a systematic search in PubMed, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Central Register of Controlled Trials from data inception to 12 August 2019. 7 Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia.6 Black Dog Institute, University of New South Wales, Sydneyali, New South Wales, Australia.5 Aristotle University of Thessaloniki, Thessaloniki, Greece.4 Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.3 Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZinGeest, Amsterdam, The Netherlands.2 113 Zelfmoordpreventie, Amsterdam, The Netherlands.1 GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands.
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