A systematic review and meta-analysis of cognitive behavioural treatments for suicidal and self-harm behaviours in adolescents.

Although cognitive-behavioural (CB) treatments are recognised as evidence-based interventions for depression and other disorders in adolescents, their efficacy in reducing suicidal and self-harm behaviours in this group remains equivocal. First, a systematic review of the literature was carried out (N = 25 studies) on CB treatments for adolescents who presented suicidal ideation, had made suicide attempts, or engaged in self-harm. Results suggest that the scientific quality of past studies is suboptimal. Second, a meta-analysis of the pooled data of 14 CB treatment studies was conducted using a pre-post control group design. Results indicate a significant treatment effect in reducing suicidal ideation (n = 13/14 studies; g = -.40, 95% CI [-.30, .49], z = 7.95, p = .001). A significant effect was observed also with respect to self-harm (n = 8/14 studies; g = -.27, 95% CI [-.17, .38], z = 4.96, p = .001). However, no significant effect was found for suicide attempts (n = 6/14 studies; g = -.01, 95% CI [-.13, .14], z = .07, p = .94). The poor effect observed in this case could be due to low baseline prevalence of suicide attempts in most studies owing to active exclusion of adolescents at high risk for suicide.Keywords: cognitive- behavioural, treatment, suicidal behaviours, self-harm, adolescentResumeLes traitements cognitivo-comportementaux (CB) sont parmi les interventions basees sur des connaissances scientifiques reconnues pour traiter la depression et d'autres troubles chez les adolescents. Toutefois, leur efficacite a reduire les comportements suicidaires et autodestructeurs parmi cette population demeure equivoque. Les auteurs ont d'abord effectue une revue systematique de la litterature (N ^ 25 etudes) sur les traitements CB pour adolescents presentant des idees suicidaires, ayant fait des tentatives de suicide ou ayant des comportements autodestructeurs. Les resultats suggerent que la qualite scientifique des etudes anterieures etait sousoptimale. Ensuite, a ete realisee une meta-analyse des donnees recueillies dans 14 etudes sur les traitements CB au moyen d'un groupe de controle pre et post. Les resultats indiquent un effet significatif des traitements pour la reduction des idees suicidaires (n ^ 13/14 etudes; g ^^0,40, 95 % CI [^0,30, 0,49], z ^ 7,95, p ^ 0,001). Un effet significatif a aussi ete constate en ce qui a trait aux comportements autodestructeurs (n ^ 8/14 etudes; g ^^0,27, 95 % CI [^0,17, 0,38], z ^ 4,96, p ^ 0,001). Toutefois, aucun effet significatif n'a ete constate sur le plan des tentatives de suicide (n ^ 6/14 etudes; g ^^0.01, 95 % CI [^0,13, 0,14], z ^ 0,07, p ^ 0,94). Cet effet modere pourrait etre attribuable a la faible prevalence de tentatives de suicide faisant partie des etudes, en raison de l'exclusion voulue d'adolescents a haut risque de suicide.Mots-cles : cognitivo-comportemental, traitement, comportement suicidaire, autodestructeur, adolescent.Suicide is the second leading cause of youth death in Canada (Canadian Association for Suicide Prevention, 2014). In 2011, 198 Canadian adolescents died by suicide (Statistics Canada, 2014). Moreover, evidence dating back to 2008 (Kutcher & Szumilas, 2008) attributed 25% of youth hospital admissions to suicide attempts. In addition, a recent community survey revealed that 8% of the adolescents surveyed had seriously considered suicide in the previous 12 months (Fuller-Thomson, Hamelin, & Granger, 2013). Furthermore, it has been estimated that 18% of adolescents engage in nonsuicidal self-harm behaviours in their teens (Muehlenkamp, Claes, Havertape, & Plener, 2012). Although these behaviours are not driven by suicidal intent, they are nonetheless a recognised risk factor for adolescent suicidal behaviours (Cooper et al., 2005).As defined by O'Connor and Nock (2014), suicidal behaviour is any self-reported thought of suicide and self-inflicted act with evidence of suicidal intent. Suicide ideation (SI) is the term used in practice to refer to any self-reported thought of engaging in suicide-related behaviour. …