Effects of digital cognitive behavioral therapy for depression on suicidal thoughts and behavior: Protocol for a systematic review and meta-analysis of individual participant data

Lasse Bosse Sander; Marie Beisemann; Eirini Karyotaki; Wouter van Ballegooijen; Pim Cuijpers; Tobias Teismann; Philipp Doebler; Matthias Domhardt; Harald Baumeister; Rebekka Büscher

doi:10.1371/journal.pone.0285622

Effects of digital cognitive behavioral therapy for depression on suicidal thoughts and behavior: Protocol for a systematic review and meta-analysis of individual participant data

PLoS One. 2023 Jun 8;18(6):e0285622. doi: 10.1371/journal.pone.0285622. eCollection 2023.

Authors

Affiliations

¹ Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
² Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia.
³ Department of Statistics, TU Dortmund University, Dortmund, Germany.
⁴ Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
⁵ Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands.
⁶ Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany.
⁷ Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany.

Abstract

Introduction: Digital cognitive behavioral therapy (i-CBT) interventions for the treatment of depression have been extensively studied and shown to be effective in the reduction of depressive symptoms. However, little is known about their effects on suicidal thoughts and behaviors (STB). Information on the impact of digital interventions on STB are essential for patients' safety because most digital interventions are self-help interventions without direct support options in case of a suicidal crisis. Therefore, we aim to conduct a meta-analysis of individual participant data (IPDMA) to investigate the effects of i-CBT interventions for depression on STB and to explore potential effect moderators.

Methods: Data will be retrieved from an established and annually updated IPD database of randomized controlled trials investigating the effectiveness of i-CBT interventions for depression in adults and adolescents. We will conduct a one-stage and a two-stage IPDMA on the effects of these interventions on STB. All types of control conditions are eligible. STB can be measured using specific scales (e.g., Beck scale suicide, BSS) or single items from depression scales (e.g., item 9 of the PHQ-9) or standardized clinical interviews. Multilevel linear regression will be used for specific scales, and multilevel logistic regression will be used for treatment response or deterioration, operationalized as a change in score by at least one quartile from baseline. Exploratory moderator analyses will be conducted at participant, study, and intervention level. Two independent reviewers will assess the risk of bias using the Cochrane Risk of Bias Tool 2.

Conclusion: This IPDMA will harness the available data to assess the effects (response and deterioration) of i-CBT interventions for depression interventions on STB. Information about changes in STB is essential to estimate patients' safety when engaging in digital treatment formats.

Trial registration: We will pre-register this study with the open science framework after article acceptance to ensure consistency between online registration and the published trial protocol.

Copyright: © 2023 Sander et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Cognitive Behavioral Therapy* / methods
Depression / therapy
Humans
Meta-Analysis as Topic
Suicidal Ideation*
Systematic Reviews as Topic

Grants and funding

LBS received funding for the study described in this protocol from the German Research Foundation (project “Effects of internet interventions for depression on suicide ideation - a meta-analysis of individual participant data (IPDMA), grant No. SA 3767/2-1). URL: http://www.dfg.de The article processing charge was funded by the German Research Foundation (DFG) and the University of Freiburg in the funding program Open Access Publishing. The funders had no role in the study design, the decision to publish, or in the preparation of the manuscript. The views expressed are those of the author(s) and not necessarily those of the funder.