Interventions for suicide and self-injury: A meta-analysis of randomized controlled trials across nearly 50 years of research.
Abstract
Self-injurious thoughts and behaviors (SITBs) are major public health concerns impacting a wide range of individuals and communities. Despite major efforts to develop and refine treatments to reduce SITBs, the efficacy of SITB interventions remains unclear. To provide a comprehensive summary of SITB treatment efficacy, we conducted a meta-analysis of published randomized controlled trials (RCTs) that have attempted to reduce SITBs. A total of 591 published articles from 1,125 unique RCTs with 3,458 effect sizes from the past 50 years were included. The random-effects meta-analysis yielded surprising findings: The overall intervention effects were small across all SITB outcomes; despite a near-exponential increase in the number of RCTs across five decades, intervention efficacy has not improved; all SITB interventions produced similarly small effects, and no intervention appeared significantly and consistently stronger than others; the overall small intervention effects were largely maintained at follow-up assessments; efficacy was similar across age groups, though effects were slightly weaker for child/adolescent populations and few studies focused on older adults; and major sample and study characteristics (e.g., control group type, treatment target, sample size, intervention length) did not consistently moderate treatment efficacy. This meta-analysis suggests that fundamental changes are needed to facilitate progress in SITB intervention efficacy. In particular, powerful interventions target the necessary causes of pathology, but little is known about SITB causes (vs. SITB correlates and risk factors). The field would accordingly benefit from the prioritization of research that aims to identify and target common necessary causes of SITBs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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In a review of all published RCTs targeted at reducing suicidal thoughts and behaviors, DBT showed a small treatment effect for self-harm.
“In a review of all published RCTs targeted at reducing suicidal thoughts and behaviors, DBT showed a small treatment effect for self-harm, but had no effect on suicidal ideation (Fox et al., 2020).”
From Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis (2021) · cites this paper as Fox et al., 2020
In that review of all published RCTs, DBT had no effect on suicidal ideation.
“In a review of all published RCTs targeted at reducing suicidal thoughts and behaviors, DBT showed a small treatment effect for self-harm, but had no effect on suicidal ideation (Fox et al., 2020).”
From Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis (2021) · cites this paper as Fox et al., 2020
Therapeutic interventions for self-harm and suicidal ideation in general show limited efficacy.
“A growing body of research demonstrates that therapeutic interventions for self-harm and suicidal ideation in general show limited efficacy (Fox et al., 2020; Kothgassner et al., 2020), highlighting the importance of isolating specific therapies which show promise for further development.”
From Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis (2021) · cites this paper as Fox et al., 2020
Standard treatment of suicidality consisting of cognitive behavioral therapy, dialectical behavioral therapy, and/or medication has shown limited effects on suicidality.
“Until recently, standard treatment of suicidality consisted of cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and/or medication, but all showed limited effects on suicidality [11, 13, 14].”
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Youth Suicide Prevention and Intervention
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Metacognitions about suicidal thoughts
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Brief Cognitive Behavioral Therapy for Suicidal Military Personnel and Veterans
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A Cognitive-Behavioral Formulation of Narcissistic Self-Esteem Dysregulation
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Discrepant Results in Mental Health Research
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On the Randomness of Suicide: An Evolutionary, Clinical Call to Transcend Suicide Risk Assessment
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Nonsuicidal Self-Injury in Preadolescents
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BIS sensitivity, BAS sensitivity, and recent suicide attempts
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Evaluation of a Suicide Prevention Program Encompassing Both Student and Teacher Training Components
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The Short-Term Course of Nonsuicidal Self-Injury Among Individuals Seeking Psychiatric Treatment
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Addressing Suicide Risk in Patients Living With Dementia During the COVID-19 Pandemic and Beyond
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Suicide and Telehealth Treatments: A PRISMA Scoping Review
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Key Challenges and Potential Strategies for Engaging Youth with Lived Experience in Clinical Science
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Evidence-Based Strategies to Reduce Suicide Mortality Among Patients With Cancer
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A Digital Therapeutic Intervention for Inpatients With Elevated Suicide Risk
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Preparing for the Impact of COVID-19 on the Mental Health of Youth
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Gallyer, A. J., Burani, K., Mulligan, E. M., Santopetro, N. J., Dougherty, S. P., Jeon, M. E., Nelson, B. D., Joiner, T. E., & Hajcak, G. (2022) · Clinical Psychological Science · doi:10.1177/21677026221120426 · Cited by 8 · see citing works
- Authors
- Fox, K. R., Huang, X., Guzmán, E. M., Funsch, K. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C.
- Affiliations
- University of Denver (US)
- Florida State University (US)
- Columbia University (US)
- Venue
- Psychological Bulletin
- Published
- 2020-12
- Volume
- 146
- Issue
- 12
- Pages
- 1117-1145
- ISSN
- 0033-2909 (ISSN-L)
- 1939-1455
- OpenAlex
- W3094828322
- Cited by
- 351
- References
- 37
- Citations by year
- 2026: 65 · 2025: 75 · 2024: 77 · 2023: 52 · 2022: 45 · 2021: 33 · 2020: 3
- FWCI
- 2.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Bulletin (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- self-injurious thoughts and behaviors, suicide, treatment efficacy, intervention effects, follow-up maintenance, age differences in treatment response, risk factors
- MeSH terms
- Suicide Prevention, Antidepressive Agents, Crisis Intervention, Electroconvulsive Therapy, Hospitalization, Humans, Peer Group, Psychosurgery, Risk Factors, Social Support, Antipsychotic Agents, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Self-Injurious Behavior, Suicidal Ideation, Psychotherapy, Psychodynamic
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