Cognitive therapy and interpersonal psychotherapy reduce suicidal ideation independent from their effect on depression

Abstract

Background Clinical guidelines suggest that psychological interventions specifically aimed at reducing suicidality may be beneficial. We examined the impact of two depression treatments, cognitive therapy (CT) and interpersonal psychotherapy (IPT) on suicidal ideation (SI) and explored the temporal associations between depression and SI over the course of therapy. Methods Ninety‐one adult (18–65) depressed outpatients from a large randomized controlled trial who were treated with CT (n = 37) and IPT (n = 54) and scored at least ≥1 on the Beck Depression Inventory II (BDI‐II) suicide item were included. Linear (two‐level) mixed effects models were used to evaluate the impact of depression treatments on SI. Mixed‐effects time‐lagged models were applied to examine temporal relations between the change in depressive symptoms and the change in SI. Results SI decreased significantly during treatment and there were no differential effects between the two intervention groups (B = −0.007, p = .35). Depressive symptoms at the previous session did not predict higher levels of SI at the current session (B = 0.016, p = .16). However, SI measured at the previous session significantly predicted depressive symptoms at the current session (B = 2.06, p < .001). Conclusions Both depression treatments seemed to have a direct association with SI. The temporal association between SI and depression was unidirectional with SI predicting future depressive symptoms during treatment. Our findings suggest that it may be most beneficial to treat SI first.

Cognitive Behavioral Therapy Approaches for Chronic Suicidality

“…In a report published in 2021, Bentum et al 6 examined the impact of 2 depression treatments, cognitive therapy (CT) and IPT on SI and the temporal relationship between depression and SI over time. This was done as part of a large single-center randomized controlled trial examining the effects of CT and IPT for major depressive disorder compared with a waitlist control (WLC).…”

Predictors of suicidal ideation severity among treatment-seeking young people with major depressive disorder: The role of state and trait anxiety

“…SI is a dynamic phenomenon and can fluctuate significantly over time with respect to both severity and content (Bryan et al, 2019; Czyz et al, 2018; Kleiman et al, 2017). How fluctuations in SI are related to fluctuations in depression symptomatology, or psychopathology more broadly, is not clear-cut (Cuijpers et al, 2013; Khazanov et al, 2021; van Bentum et al, 2021). Treatment-related amelioration of depressive symptoms might not be closely associated with changes in SI (Batterham et al, 2019).…”

Characterization of suicidal depression: A 1 year prospective study

“…Although suicidal ideation (SI), especially active SI (i.e. thought of suicide with plan), can be considered the first step of a continuum (from SI to SA and to death by suicide) [ 3 ], clinical practice focuses more on previous SA to prevent recurrence rather than on SI [ 4 ]. Two meta-analyses found that SI is the third most potent risk factor for future death by suicide (following lifetime history of SA and prior psychiatric hospitalization) [ 5 ], and that previous SA is not more strongly associated with death by suicide than SI [ 6 ].…”

“…Yet, SI is still considered a symptom or a consequence of a concomitant psychiatric disorder, mainly major depressive disorder [ 7 ]. Therefore, many clinicians think that by treating the psychiatric disorder, SI also will disappear [ 3 ]. Consequently, nonspecific anti-suicidal treatments [ 8 ], particularly antidepressants [ 7 ], are often used in patients with depression and SI.…”

“…Specific pharmacological treatments (e.g., ketamine and buprenorphine) [ 13 , 14 ] and psychotherapies (e.g., acceptance and commitment therapy) [ 15 ] are showing promising results on suicidal risk. Similarly, suicide-focused cognitive behavioral therapy efficiently reduces SA and/or SI [ 16 ], but not depression-focused psychotherapies [ 3 , 17 , 18 ]. This suggests that moderate to severe depression with active SI (i.e., suicidal depression) could be a specific subtype of depression with its own pathophysiology, clinical features, and management [ 19 , 20 ].…”