The association between depression and suicidal thoughts and behavior has been well established in research (Chesney et al., 2014; De Beurs et al., 2019). Suicide ideation is a symptom of depression according to DSM criteria and is often measured in depression scales used in trials (Kroenke et al., 2001). While effective treatments for depression are assumed to impact suicidality, contemporary theories suggest that suicidal behavior is a distinct process (O’Connor & Kirtley, 2018).
Therapies like Collaborative Assessment and Management of Suicidality (CAMS) now directly target suicidality, but many depressed patients are still treated with interventions focused solely on depression, like cognitive behavioral therapy. Suicidality is often excluded from psychological intervention trials, raising the question of the impact of these interventions on suicidal ideation and behavior.
A recent meta-analysis titled “Assessment of Suicide Risk in Psychological Interventions for Depression” by Miguel and colleagues (2024) aimed to address this gap by examining the effects on suicidality in trials of psychological interventions for depression. The study used the Metapsy database, including RCTs of psychological treatments for depression.
Results showed that while psychological interventions had a small effect on suicidal ideation, studies were limited by exclusion of at-risk patients and reliance on single items to measure suicide outcomes. Long-term effects were lacking, and some studies even reported increased suicidality. The data highlighted the need for better reporting and assessment of suicide risk in depression treatment trials.
Clinicians should be vigilant in monitoring suicidal ideation and risk during treatment, especially as residual risk may persist even after successful depression treatment. Emphasizing specific risk factors for suicidality, like feelings of entrapment, can aid in assessment. Psychoeducation and safety planning can help prevent relapse in high-risk individuals.
Researchers should prioritize reporting on suicide outcomes in studies, using specialized scales like SIDAS to better assess suicidality. The complexity of suicidal behavior necessitates continued investigation using innovative research designs and perspectives to understand what interventions work best for whom.
In conclusion, addressing suicide risk in depression treatment requires ongoing attention and collaboration between clinicians, researchers, and ethical committees to improve outcomes for individuals at risk.
