TOPLINE:

Cognitive-behavioral therapy (CBT) that incorporates narrative assessment — a tool that uses storytelling to assess suicide risk while fostering therapeutic alliance — had a 32% lower risk for suicide attempts than CBT alone, a new meta-analysis showed.

METHODOLOGY:

• Investigators analyzed data for more than 3000 participants in 23 randomized clinical trials from the Metapsy Suicide Prevention database. The analysis included 14 studies of CBT with narrative assessment and nine studies without enhancement.
• The mean age of participants was significantly lower in studies without narrative assessment than in those with it (18 years vs 27 years, respectively; P = .02). Additionally, studies without narrative assessment showed a slightly higher overall risk for bias (2.89 vs 2.36; P = .01) and a lower mean event rate (0.05 vs 0.16; P = .01).
• Three separate meta-analyses were conducted to compare interventions with and without narrative assessment, followed by combined analysis for a direct comparison.

TAKEAWAY:

• Individuals receiving CBT with narrative assessment had a significantly reduced risk for suicide attempts compared with control individuals (relative risk [RR], 0.68; P < .001).
• CBT interventions without narrative assessment were not associated with significantly reduced risk for suicide attempts (RR, 1.17).
• CBT with or without narrative assessment was associated with a lower risk for suicide attempts (RR, 0.74; P = .02). However, subgroup analysis significantly favored the addition of narrative assessment (P = .007).

IN PRACTICE:

“The evidence is convincing that using patient-centered, collaboratively developed suicide risk assessment models contributes to reductions in suicide risk and distress,” Justin C. Baker, PhD, The Ohio State University, Wexner Medical Center, Columbus, Ohio, wrote in an accompanying editorial.

“This is good news for clinicians seeking to integrate simple interventions that can have a real impact on inspiring hope, reduce the risk of suicide attempts, and improve the lives of their patients,” added Baker, who was not part of the study.

SOURCE:

The study was led by Wilco C. Janssen, MSc, 113 Suicide Prevention, Amsterdam, Netherlands. The study and the accompanying editorial were published online on November 20 in JAMA Network Open.

LIMITATIONS:

The age differences between study populations may have influenced the findings because interventions in younger populations often yield smaller and more inconsistent effect sizes. Additionally, the studies without narrative assessment had a significantly lower event rate and a slightly higher risk for bias, and causal conclusions would require direct head-to-head trials.

DISCLOSURES:

The study investigators and the editorialist reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.