PT - JOURNAL ARTICLE AU - Rebekka Büscher AU - Marie Beisemann AU - Philipp Doebler AU - Hannah M Micklitz AU - Ad Kerkhof AU - Pim Cuijpers AU - Philip J Batterham AU - Alison L Calear AU - Helen Christensen AU - Eva De Jaegere AU - Matthias Domhardt AU - Annette Erlangsen AU - Ozlem Eylem van Bergeijk AU - Ryan Hill AU - Anita Lungu AU - Charlotte Mühlmann AU - Jeremy W Pettit AU - Gwendolyn Portzky AU - Lena S Steubl AU - Bregje A J van Spijker AU - Joseph Tighe AU - Aliza Werner-Seidler AU - Chelsey R Wilks AU - Lasse B Sander TI - Digital cognitive–behavioural therapy to reduce suicidal ideation and behaviours: a systematic review and meta-analysis of individual participant data AID - 10.1136/ebmental-2022-300540 DP - 2022 Dec 01 TA - Evidence Based Mental Health PG - e8--e17 VI - 25 IP - e1 4099 - http://mentalhealth.bmj.com//content/25/e1/e8.short 4100 - http://mentalhealth.bmj.com//content/25/e1/e8.full SO - Evid Based Ment Health2022 Dec 01; 25 AB - Question Digital interventions based on cognitive–behavioural therapy (iCBT) is associated with reductions in suicidal ideation. However, fine-grained analyses of effects and potential effect-moderating variables are missing. This study aimed to investigate the effectiveness of iCBT on suicidal ideation, effect moderators, effects on suicide attempts and predictors of adherence.Study selection and analysis We systematically searched CENTRAL, PsycINFO, Embase and PubMed for randomised controlled trials that investigated iCBT for suicidal ideation or behaviours. Participants reporting baseline suicidal ideation were eligible. We conducted a one-stage individual participant data (IPD) meta-analysis. Suicidal ideation was the primary outcome, analysed as three indices: severity of suicidal ideation, reliable changes and treatment response.Findings We included IPD from nine out of ten eligible trials (2037 participants). iCBT showed significant reductions of suicidal ideation compared with control conditions across all indices (severity: b=−0.247, 95% CI −0.322 to −0.173; reliable changes: b=0.633, 95% CI 0.408 to 0.859; treatment response: b=0.606, 95% CI 0.410 to 0.801). In iCBT, the rate of reliable improvement was 40.5% (controls: 27.3%); the deterioration rate was 2.8% (controls: 5.1%). No participant-level moderator effects were identified. The effects on treatment response were higher for trials with waitlist-controls compared with active controls. There were insufficient data on suicide attempts. Human support and female gender predicted treatment adherence. The main source of potential bias was missing outcome data.Conclusions The current evidence indicates that iCBT is effective in reducing suicidal ideation irrespective of age, gender and previous suicide attempts. Future studies should rigorously assess suicidal behaviour and drop-out reasons.No data are available. The analysis R codes are available online at OSF with publication (https://osf.io/45tcd). Individual participant data cannot be provided due to confidenciality agreements.