Effectiveness of Internet-Based Self-Help Interventions to Reduce Suicidal Ideation: Protocol for a Systematic Review and Meta-Analysis (Preprint)
BACKGROUND Suicidal ideation is a highly prevalent condition. Several barriers lead to a gap in healthcare provision, which might be addressed by providing internet-based self-help interventions (ISIs). Current evidence suggests that ISIs for mental disorders might only be effective in reducing suicidal ideation if they specifically target suicidal thoughts or behaviors. OBJECTIVE The aim of this systematic review and meta-analysis is to investigate the effectiveness of ISIs which directly target suicidal thoughts or behaviors. METHODS We will conduct a sensitive systematic literature search in PsycINFO, MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Centre for Research Excellence of Suicide Prevention database (CRESP). Only randomized controlled trials (RCTs) evaluating the effectiveness of ISIs for suicide prevention will be included. Interventions must be delivered primarily in an online setting; mobile-based interventions and interventions targeting gatekeepers will be excluded. Suicide ideation will be the primary outcome; secondary outcomes will be completed suicides, suicide attempts, depressiveness, anxiety and hopelessness. Study quality will be assessed using the Cochrane Risk of Bias tool. We will provide a narrative synthesis of included studies. If studies are sufficiently homogenous, we will conduct a meta-analysis of the effectiveness on suicide ideation and, if possible, we will evaluate publication bias using funnel plots. We will evaluate the cumulative evidence in accordance with the Grading of Recommendations Assessment, Development and Evaluation framework (GRADE). RESULTS This review is in progress, with findings expected by August 2019. CONCLUSIONS This systematic review and meta-analysis focuses on the effectiveness of ISIs for suicidal thoughts and behaviors. It will provide guidance to clinical practice and encourage further research by synthesizing the best available evidence. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews CRD42019130253.