Palabras clave
Digital intervention
Meta-analysis
Prevention
Mental health Suicidio
Intervenciones digitales
Metaanálisis
Prevención
Salud mental
Cómo citar
Resumen
Antecedentes: Las intervenciones digitales han mostrado potencial para reducir la ideación y la conducta suicida, pero la evidencia disponible es heterogénea. Este estudio sintetiza los hallazgos de ensayos clínicos aleatorizados que han evaluado su eficacia. Método: Se realizó una revisión sistemática y metaanálisis siguiendo las directrices PRISMA. Se incluyeron 17 estudios (N = 5.089). Los tamaños del efecto se estimaron mediante modelos de efectos aleatorios y se realizaron análisis por tipo de grupo control, moderadores (edad, contexto y modalidad), seguimiento, heterogeneidad y sesgo de publicación. Resultados: Las intervenciones digitales redujeron significativamente la ideación suicida (g = –0.61), manteniéndose los efectos en el seguimiento (g = –0.77). Se observaron efectos significativos frente a controles tradicionales y activos. En los intentos de suicidio se observó una reducción del riesgo de magnitud moderada, aunque sin significación estadística. Los efectos fueron mayores en muestras clínicas, intervenciones autoguiadas y participantes jóvenes. No se detectó sesgo de publicación robusto. Conclusiones: Las intervenciones digitales pueden constituir una estrategia complementaria prometedora para reducir la ideación suicida y potencialmente disminuir el riesgo suicida. No obstante, los resultados deben interpretarse con cautela debido a la heterogeneidad de los estudios y a la limitada evidencia disponible sobre los intentos de suicidio.
Citas
Al-Halabí, S., & Fonseca-Pedrero, E. (2024). Editorial for special issue on understanding and prevention of suicidal behavior: Humanizing care and integrating social determinants. Psicothema, 36(4), 309-318. https://doi.org/10.7334/psicothema2024.341
Baker, J. C., Starkey, A., Ammendola, E., Bauder, C. R., Daruwala, S. E., Hiser, J., Khazem, L. R., Rademacher, K., Hay, J., Bryan, A. O., & Bryan, C. J. (2024). Telehealth brief cognitive behavioral therapy for suicide prevention: A randomized clinical trial. JAMA Network Open, 7(11), Article e2445913. https://doi.org/10.1001/jamanetworkopen.2024.45913
Balk, E. M., Earley, A., Patel, K., Trikalinos, T. A., & Dahabreh, I. J. (2012). Empirical assessment of within-arm correlation imputation in trials of continuous outcomes. Agency for Healthcare Research and Quality (US).
Batterham, P. J., Calear, A. L., Farrer, L., McCallum, S. M., & Cheng, V. W.-S. (2018). FitMindKit: Randomised controlled trial of an automatically tailored online program for mood, anxiety, substance use and suicidality. Internet Interventions, 12, 91–99. https://doi.org/10.1016/j.invent.2017.08.002
Batterham, P. J., Calear, A. L., Farrer, L., Gulliver, A., & Kurz, E. (2021). Efficacy of a transdiagnostic self-help internet intervention for reducing depression, anxiety, and suicidal ideation in adults: Randomized controlled trial. Journal of Medical Internet Research, 23(1), Article e22698. https://doi.org/10.2196/22698
Berger, T. (2017). The therapeutic alliance in internet interventions: A narrative review and suggestions for future research. Psychotherapy Research, 27(5), 511–524. https://doi.org/10.1080/10503307.2015.1119908
Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H. (2022). Comprehensive meta-analysis version 4. Biostat.
Bryan, C. J., & Bozzay, M. (2026). Competing motives and forces: A complex systems view of suicidal ambivalence. In R. Baston & M. Weichold (Eds.), Exploring suicidal ambivalence: Philosophical and psychological perspectives. Taylor & Francis.
Bryan, C. J., Simon, P., Wilkinson, S. T., Allen, M. H., Perez, J., Adler, C., Moon, K., Astorino, L., Carpenter, K. M., Misquitta, L., Brownlowe, K., Khazem, L. R., Hay, J., Starkey, A. G., Tartaglia, J., Winston, H., Simpson, S., Dager, A. D., & Feuerstein, S. (2025). A digital therapeutic intervention for inpatients with elevated suicide risk: A randomized clinical trial. JAMA Network Open, 8(8), Article e2525809. https://doi.org/10.1001/jamanetworkopen.2025.25809
Burback, L., Yap, S., Purdon, S. E., Abba-Aji, A., O’Shea, K., Brémault-Phillips, S., Greenshaw, A. J., & Winkler, O. (2024). Randomized controlled trial investigating web-based, therapist delivered eye movement desensitization and reprocessing for adults with suicidal ideation. Frontiers in Psychiatry, 15, Article 1361086. https://doi.org/10.3389/fpsyt.2024.1361086
Burr, S. K., Yu, M., Clark, D., Alonzo, D., & Gearing, R.E. (2025). Digital interventions for suicide prevention: Systematic review and meta-analysis of RCTs examining age, gender, and control group type. Crisis, 46(3),176–186. http://doi.org/10.1027/0227-5910/a000996
Büscher, R., Beisemann, M., Doebler, P., Micklitz, H. M., Kerkhof, A., Cuijpers, P., Batterham, P. J., Calear, A. L., Christensen, H., De Jaegere, E., Domhardt, M., Erlangsen, A., Eylem van Bergeijk, O., Hill, R., Lungu, A., Mühlmann, C., Pettit, J. W., Portzky, G., Steubl, L. S., … Sander, L. B. (2022). Digital cognitive-behavioral therapy to reduce suicidal ideation and behaviors: a systematic review and meta-analysis of individual participant data. Evidence-based Mental Health, 25(e1), e8–e17. https://doi.org/10.1136/ebmental-2022-300540
Büscher, R., Torok, M., Terhorst, Y., & Sander, L. (2020). Internet-based cognitive behavioral therapy to reduce suicidal ideation: A systematic review and meta-analysis. JAMA Network Open, 3(4), Article e203933. https://doi.org/10.1001/jamanetworkopen.2020.3933
Bush, N. E., Smolenski, D. J., Denneson, L. M., Williams, H. B., Thomas, E. K., & Dobscha, S. K. (2016). A Virtual Hope Box: Randomized controlled trial of a smartphone app for emotional regulation and coping with distress. Psychiatric Services, 68(4), 330–336. https://doi.org/10.1176/appi.ps.201600283
Cuijpers, P., Miguel, C., Ciharova, M., Harrer, M., Basic, D., Cristea, I. A., de Ponti, N., Driessen, E., Hamblen, J., Larsen, S. E., Matbouriahi, M., Papola, D., Pauley, D., Plessen, C. Y., Pfund, R. A., Setkowski, K., Schnurr, P. P., van Ballegooijen, W., Wang, Y., … Karyotaki, E. (2024). Absolute and relative outcomes of psychotherapies for eight mental disorders: A systematic review and meta-analysis. World Psychiatry, 23(2), 267–275. https://doi.org/10.1002/wps.21203
Cuijpers, P., Weitz, E., Cristea, I. A., & Twisk, J. (2017). Pre–post effect sizes should be avoided in meta-analyses. Epidemiology and Psychiatric Sciences, 26(4), 364–368. https://doi.org/10.1017/S2045796016000809
De Jaegere, E., van Landschoot, R., van Heeringen, K., van Spijker, B. A. J., Kerkhof, A. J. F. M., Mokkenstorm, J. K., & Portzky, G. (2019). The online treatment of suicidal ideation: A randomised controlled trial of an unguided web-based intervention. Behaviour Research and Therapy, 119, Article 103406. https://doi.org/10.1016/j.brat.2019.05.003
Egger, M., Davey Smith, G., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315(7109), 629–634. https://doi.org/10.1136/bmj.315.7109.629
Eylem, O., van Straten, A., de Wit, L., Rathod, S., Bhui, K., & Kerkhof, A. J. F. M. (2021). Reducing suicidal ideation among Turkish migrants in the Netherlands and in the UK: The feasibility of a randomised controlled trial of a guided online intervention. Pilot and Feasibility Studies, 7(1), Article 30. https://doi.org/10.1186/s40814-021-00772-9
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172
Forte, A., Sarli, G., Polidori, L., Lester, D., & Pompili, M. (2021). The role of new technologies to prevent suicide in adolescence: A systematic review of the literature. Medicina, 57(2), Article 109. https://doi.org/10.3390/medicina57020109
Fox, K. R., Huang, X., Guzmán, E. M., Funsch, K. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2020). Interventions for suicide and self-injury: A meta-analysis of randomized controlled trials across nearly 50 years of research. Psychological Bulletin, 146(12), 1117–1145. https://doi.org/10.1037/bul0000305
Han, J., Batterham, P. J., Calear, A. L., & Randall, R. (2017). Factors influencing professional help-seeking for suicidality: A systematic review. Crisis, 39(3), 175–196. https://doi.org/10.1027/0227-5910/a000485
Hawton, K., & Pirkis, J. (2024). Preventing suicide: a call to action. The Lancet. Public Health, 9(10), e825–e830. https://doi.org/10.1016/S2468-2667(24)00159-2
Hesser, H., Weise, C., Westin, V. Z., & Andersson, G. (2011). A systematic review and meta-analysis of randomized controlled trials of cognitive-behavioral therapy for tinnitus distress. Clinical Psychology Review, 31(4), 545–553. https://doi.org/10.1016/j.cpr.2010.12.006
Hetrick, S. E., Yuen, H. P., Bailey, E., Cox, G. R., Templer, K., Rice, S. M., Bendall, S., & Robinson, J. (2017). Internet-based cognitive behavioural therapy for young people with suicide-related behaviour (Reframe-IT): A randomised controlled trial. Evidence-Based Mental Health, 20(3), 76–82. https://doi.org/10.1136/eb-2017-102719
Higgins, J. P., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. British Medical Journal, 327(7414), 557-560. https://doi.org/10.1136/bmj.327.7414.557
Hill, R. M., & Pettit, J. W. (2019). Pilot randomized controlled trial of LEAP: A selective preventive intervention to reduce adolescents’ perceived burdensomeness. Journal of Clinical Child & Adolescent Psychology, 48(S1), S45–S56. https://doi.org/10.1080/15374416.2016.1188705
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1
Jobes, D. A., Mandel, A. A., Kleiman, E. M., Bryan, C. J., Johnson, S. L., & Joiner, T. E. (2024). Facets of suicidal ideation. Archives of Suicide Research, 28(4), 1263–1278. https://doi.org/10.1080/13811118.2023.2299259
Josifovski, N., Dit Rochesson, S. E., Wong, Q. J., Han, J., Larsen, M. E., & Torok, M. (2025). What works where and why? A systematic review and meta-analysis of digital interventions addressing suicide-related outcomes in community, education and clinical settings. International Journal of Social Psychiatry, 71(8), 1453–1469. https://doi.org/10.1177/00207640251358109
Kasckow, J., Gao, S., Hanusa, B., Rotondi, A., Chinman, M., Zickmund, S., Gurklis, J., Fox, L., Cornelius, J., Richmond, I., & Haas, G. L. (2015). Telehealth monitoring of patients with schizophrenia and suicidal ideation. Suicide and Life-Threatening Behavior, 45(5), 600–611. https://doi.org/10.1111/sltb.12154
Li, Y., Guo, Y., Hong, Y. A., Zhu, M., Zeng, C., Qiao, J., Xu, Z., Zhang, H., Zeng, Y., Cai, W., Li, L., & Liu, C. (2019). Mechanisms and effects of a WeChat-based intervention on suicide among people living with HIV and depression: Path model analysis of a randomized controlled trial. Journal of Medical Internet Research, 21(11), Article e14729. https://doi.org/10.2196/14729
Lohani, M., Bryan, C. J., Elsey, J. S., Dutton, S., Findley, S. P., Langenecker, S. A., West, K., & Baker, J. C. (2024). Collaboration matters: A randomized controlled trial of patient-clinician collaboration in suicide risk assessment and intervention. Journal of Affective Disorders, 360, 387–393. https://doi.org/10.1016/j.jad.2024.06.004
Mann, J. J., Michel, C. A., & Auerbach, R. P. (2021). Improving suicide prevention through evidence-based strategies: A systematic review. American Journal of Psychiatry, 178(7), 611–624. https://doi.org/10.1176/appi.ajp.2020.20060864
Oh, J., Ho, J., Lee, S., & Park, J. H. (2024). Effects of digital psychotherapy on suicide: A systematic review and meta-analysis. Healthcare, 12(14), Article 1435. https://doi.org/10.3390/healthcare12141435
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, Article n71. https://doi.org/10.1136/bmj.n71
Patterson, E., Boyle, M. H., Kivlenieks, M., & Van Ameringen, M. (2016). The use of waitlists as control conditions in anxiety disorders research. Journal of Psychiatric Research, 83, 112–120. https://doi.org/10.1016/j.jpsychires.2016.08.015
Potts, C., Kealy, C., McNulty, J. M., Madrid-Cagigal, A., Wilson, T., Mulvenna, M. D., O’Neill, S., Donohoe, G., & Barry, M. M. (2025). Digital mental health interventions for young people aged 16–25 years: Scoping review. Journal of Medical Internet Research, 27, Article e72892. https://doi.org/10.2196/72892
Rain, S., Williams, M., Mitchell, R., Zaheer, R., Bryan, C. J., Schaffer, A., Men, V. Y., Westreich, N., Ellis, J., Goldstein, B. I., Cheung, A. H., Selchen, S., & Sinyor, M. (2024). Youth self-harm and the role of reasons for living and hope: A secondary analysis from a randomized controlled trial. Psychiatry Research Communications, 4(2), Article 100174. https://doi.org/10.1016/j.psycom.2024.100174
Rudd, M. D. (2006). Fluid vulnerability theory: A cognitive approach to understanding the process of acute and chronic suicide risk. In T. E. Ellis (Ed.), Cognition and suicide: Theory, research, and therapy (pp. 355–368). American Psychological Association. https://doi.org/10.1037/11377-016
Shoib, S., Shaheen, N., Anwar, A., Saad, A. M., Akr, L. M., Saud, A. I., Kundu, M., Nahidi, M., Chandradasa, M., Swed, S. & Saeed, F. (2024). The effectiveness of telehealth interventions in suicide prevention: A systematic review and meta-analysis. International Journal of Social Psychiatry, 70(3), 415–423. https://doi.org/10.1177/00207640231206059
Sterne, J. A. C., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., Cates, C. J., Cheng, H. Y., Corbett, M. S., Eldridge, S. M., Emberson, J. R., Hernán, M. A., Hopewell, S., Hróbjartsson, A., Junqueira, D. R., Jüni, P., Kirkham, J. J., Lasserson, T., Li, T., … Higgins, J. P. T. (2019). RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ, 366, Article l4898. https://doi.org/10.1136/bmj.l4898
Sutori, S., Hadlaczky, G., Eliasson, E., Wasserman, D., & Carli, V. (2024). Systematic review and meta-analysis: Effectiveness of stand-alone digital suicide preventive interventions for the self-management of suicidality. Journal of Technology in Behavioral Science, 9(3), 440–451. https://doi.org/10.1007/s41347-023-00374-7
Tabares, J. V., Muela, A., Ammendola, E., & García-Ormaza, J. (2025). Simulation networks elucidate the preliminary structure of suicide risk factors among adolescents. Journal of Child and Adolescent Psychiatric Nursing, 38(4), Article e70037. https://doi.org/10.1111/jcap.70037
Tighe, J., Shand, F., Ridani, R., Mackinnon, A., De La Mata, N., & Christensen, H. (2017). Ibobbly mobile health intervention for suicide prevention in Australian Indigenous youth: a pilot randomised controlled trial. BMJ open, 7(1), Article e013518. https://doi.org/10.1136/bmjopen-2016-013518
Torok, M., Han, J., Baker, S., Werner-Seidler, A., Wong, I., Larsen, M. E., & Christensen, H. (2020). Suicide prevention using self-guided digital interventions: A systematic review and meta-analysis of randomized controlled trials. The Lancet. Digital Health, 2(1), Article e25–e36. https://doi.org/10.1016/S2589-7500(19)30199-2
Torok, M., Han, J., McGillivray, L., Wong, Q., Werner-Seidler, A., O’Dea, B., Calear, A., & Christensen, H. (2022). The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia. PLOS Medicine, 19(5), e1003978. https://doi.org/10.1371/journal.pmed.1003978
van Ballegooijen, W., Rawee, J., Palantza, C., Miguel, C., Harrer, M., Cristea, I., de Winter, R., Gilissen, R., Eikelenboom, M., Beekman, A., & Cuijpers, P. (2025). Suicidal ideation and suicide attempts after direct or indirect psychotherapy: a systematic review and meta-analysis. JAMA Psychiatry, 82(1), 31–37. https://doi.org/10.1001/jamapsychiatry.2024.2854
van Spijker, B. A. J., van Straten, A., & Kerkhof, A. J. F. M. (2014). Effectiveness of online self-help for suicidal thoughts: Results of a randomised controlled trial. PLOS ONE, 9(2), Article e90118. https://doi.org/10.1371/journal.pone.0090118
Viechtbauer, W. (2010). Conducting meta-analyses in R with the metafor package. Journal of Statistical Software, 36(3), 1–48. https://doi.org/10.18637/jss.v036.i03
Wanniarachchi, V. U., Greenhalgh, C., & Warren, J. (2025). Adolescents’ and youths’ perceived barriers and facilitators to engaging with digital mental health interventions for depression and anxiety: A scoping review. Internet Interventions, 42, Article 100884. https://doi.org/10.1016/j.invent.2025.100884
Wilks, C. R., Lungu, A., Ang, S. Y., Matsumiya, B., Yin, Q., & Linehan, M. M. (2018). A randomized controlled trial of an internet-delivered dialectical behavior therapy skills training for suicidal and heavy episodic drinkers. Journal of Affective Disorders, 232, 219–228. https://doi.org/10.1016/j.jad.2018.02.053
Witt, K., Spittal, M. J., Carter, G., Pirkis, J., Hetrick, S., Currier, D., Robinson, J., & Milner, A. (2017). Effectiveness of online and mobile telephone applications (‘apps’) for the self-management of suicidal ideation and self-harm: A systematic review and meta-analysis. BMC Psychiatry, 17, 297. https://doi.org/10.1186/s12888-017-1458-0
World Health Organization. (2021). Suicide worldwide in 2019: global health estimates. World Health Organization
Yosep, I., Hikmat, R., Mardhiyah, A., & Hernawaty, T. (2024). A scoping review of digital-based intervention for reducing risk of suicide among adults. Journal of Multidisciplinary Healthcare, 17, 3545–3556. https://doi.org/10.2147/JMDH.S47226