Comparative Effectiveness of Individual, Group, Family and Combined Therapy Formats on Suicidality: A Meta-Analysis

Through carefully choosing psychotherapeutic interventions based on treatment characteristics, we may increase the relatively small effect sizes for suicidal outcomes. This study aims to evaluate the efficacy of different psychotherapy formats in reducing suicidal ideation and attempts, including individual, group and family-based therapies, as well as combined modalities involving individual and group or individual and family interventions. We conducted a meta-analysis after systematically searching databases for randomised controlled trials up to April 1, 2024. Included studies targeted any mental health issue, were delivered in any setting, compared with any control group, and reported on suicidal ideation or attempts. Data extraction and quality assessment were performed independently by two researchers, and a mixed-effects model was used for data synthesis. One hundred and seventy-two studies were eligible, totalling 198 comparisons with a total of 22,440 participants. Individual therapy significantly reduced suicidal ideation (g = -0.33, p < 0.001, k = 72 comparisons), as did group therapy (g = -0.39, p < 0.001, k = 27 comparisons). For reducing suicide attempts, individual therapy (RR = 0.75, p < 0.001, k = 63 comparisons), and notably, combinations of individual with group (RR = 0.42, p = 0.010, k = 7 comparisons) and individual with family-based therapy (RR = 0.59, p = 0.041, k = 8 comparisons) were effective. Subgroup analysis showed that combined therapies were associated with larger effect sizes compared to single modalities in reducing suicide attempts (p < 0.001). This meta-analysis highlights that combined psychotherapy approaches, integrating individual sessions with group or family sessions, yields significantly higher effect sizes, reducing the risk of suicide attempts by 50%. These findings support the adoption of combined therapeutic strategies in clinical settings to effectively address suicidality. SUMMARY: Individual or group therapy is effective for reducing suicidal ideation. Family therapy seems less effective than other formats. Individual therapy, or combining individual therapy with group therapy or family therapy, is effective for preventing suicide attempts. A combination of individual therapy with group or family therapy seems more effective at preventing suicide attempts than other formats.