The effectiveness of psychoanalytic/psychodynamic psychotherapy for reducing suicide attempts and self-harm: Systematic review and meta-analysis

Background

Preventing suicide and self-harm is a global health priority. Although there is a growing evidence-base for the effectiveness of psychoanalytic and psychodynamic psychotherapies for a range of disorders, to date there has been no systematic review of its effectiveness in reducing suicidal and self-harming behaviours.

Aims

To systematically review randomised controlled trials (RCTs) of psychoanalytic and psychodynamic psychotherapies for suicidal attempts and self-harm.

Method

We searched PubMed, PsycINFO, Psycharticles, CINAHL, EMBASE, and the Cochrane Central Register of Controlled Trials for RCTs of psychoanalytic and psychodynamic psychotherapies for reducing suicide attempts and self-harm.

Results

Twelve trials (17 articles) were included in the meta-analyses. Psychoanalytic and psychodynamic therapies were effective in reducing the number of patients attempting suicide (pooled odds ratio = 0.469, 95% CI 0.274 to 0.804). We found some evidence for significantly reduced repetition of self-harm at 6-month follow-up, though not at 12 months.

Significant treatment effects were also found for improvements in psychosocial functioning and reduction in number of hospital admissions.

Conclusions

Psychoanalytic and psychodynamic psychotherapies are indicated to be effective in reducing suicidal behaviour and to have short-term effectiveness in reducing self-harm. They can also be beneficial in improving psychosocial well-being. However, the small number of trials and moderate quality of the evidence means further high quality trials are needed to confirm our findings and to identity which specific components of the psychotherapies are effective.