The Impact of Previous Suicide Attempts on Psychotherapy Outcome: A Multiverse Approach to Treatment Success...

Evidence of the association between previous suicide attempts and psychotherapy outcome is inconclusive because of a lack of transdiagnostic investigations and diverging methodological approaches to treatment success. The present work aimed to address these research gaps.

We used routine patient data (N = 706; N = 118 with a lifetime history of suicide attempts) to investigate the relevance of suicide attempts for outcome using validated instruments (Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Screener (GAD-7)), testing the association in different ways: symptom reductions, achievement of subclinical symptom levels, reliable and clinically significant change (RCI, RCSI), subjective evaluations of the therapeutic relationship (Helping Alliance Questionnaire (HAQ)), and regression models of symptoms at discharge adjusted for baseline severity and personality functioning.

Although patients with a history of suicide attempts exhibited greater baseline symptom severity, they achieved comparable reductions in depression and anxiety symptoms (in terms of absolute values as well as using the RCI and RCSI). They achieved comparatively greater mean decreases in suicidal ideation but were less likely to be classified as responders on the suicidal ideation item and less likely to report subclinical levels of depression symptoms or the absence of suicidal ideation at discharge. Regression analyses that controlled for baseline symptoms and the level of personality functioning revealed no independent effect of suicide attempts. Treatment satisfaction and perceived success were comparable across groups.

Previous suicide attempts are an important marker of clinical severity. While comparable symptom reductions are achieved, reaching the subclinical symptom range might be harder for individuals struggling with suicidality. These findings emphasize the importance of contextualizing treatment success (methodologically and with respect to the individual case).