The effects of psychotherapy for adult depression on suicidality and hopelessness: a systematic review and meta-analysis
Abstract
Background Although treatment guidelines suggest that suicidal patients with depression should be treated for depression with psychotherapy, it is not clear whether these psychological treatments actually reduce suicidal ideation or suicide risk.Methods We conducted a systematic review and meta-analysis of studies on psychotherapy for depression in which outcomes on suicidality were reported. We also focused on outcomes on hopelessness because this is strongly associated with suicidal behavior in depression.Results Thirteen studies (with 616 patients) were included, three of which examined the effects of psychotherapy for depression on suicidal ideation and suicide risk, and eleven on hopelessness. No studies were found with suicide attempts or completed suicides as the outcome variables. The effects on suicidal ideation and suicide risk were small (g=0.12; 95% CI: -0.20-0.44) and not statistically significant. A power calculation showed that these studies only had sufficient power to find an effect size of g=0.47. The effects on hopelessness were large (g=1.10; 95% CI: 0.72-1.48) and significant, although heterogeneity was very high. Furthermore, significant publication bias was found. After adjustment of publication bias the effect size was reduced to g=0.60.Discussion At this point, there is insufficient evidence for the assumption that suicidality in depressed patients can be reduced with psychotherapy for depression. Although psychotherapy of depression may have small positive effects on suicidality, available data suggest that psychotherapy for depression cannot be considered to be a sufficient treatment. The effects on hopelessness are probably higher.
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From One Size Does Not Fit All: A Comprehensive Clinical Approach to Reducing Suicidal Ideation, Attempts, and Deaths (2019) · cites this paper as [11]
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- Authors
- Cuijpers, P., de Beurs, D. P., van Spijker, B. A. J., Berking, M., Andersson, G., & Kerkhof, A. J. F. M.
- Affiliations
- Amsterdam Public Health (NL)
- Philipps University of Marburg (DE)
- Linköping University (SE)
- Corresponding author
- Cuijpers, Pim
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2013-01
- Volume
- 144
- Issue
- 3
- Pages
- 183-190
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2128072661
- Cited by
- 176
- References
- 49
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 10 · 2023: 18 · 2022: 8 · 2021: 12 · 2020: 22 · 2019: 12 · 2018: 23 · 2017: 13 · 2016: 21 · 2015: 6 · 2014: 12 · 2013: 4
- FWCI
- 1.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Multilingual Matters (Channel View Publications) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- psychotherapy, adult depression, suicidality, suicidal ideation, suicide risk, hopelessness, publication bias
- MeSH terms
- Suicide Prevention, Adult, Depression, Depressive Disorder, Emotions, Humans, Psychotherapy, Risk Factors, Suicide, Suicide, Attempted, Suicidal Ideation
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