Effectiveness of internet-based cognitive behavioral therapy in reducing suicidality among high-risk patients with depression: A multicenter randomized controlled trial in Korea

Objectives: To compare the effectiveness of Internet-based cognitive behavioral therapy (iCBT) + treatment as usual (TAU) to TAU in patients with major depressive disorder (MDD) and suicidal risk.

Design: This study was a multicenter, 1:1 single-blind randomized controlled trial (RCT) in which only the assessors were blinded.

Setting: 5 tertiary hospitals in Korea.

Participants: 190 patients with depression aged 18-44 years who had suicidal ideation at baseline or had attempted suicide within the past month.

Intervention: iCBT, consisted of five sessions over 4 weeks, and TAU including psychotherapy and pharmacotherapy. Data were collected through assessments and self-reports at baseline and at 6, 16, and 28 weeks after randomization.

Results: 200 patients were randomized, while 10 patients withdrew their consent to the study. (iCBT + TAU = 97, TAU = 93). 39 patients in iCBT + TAU group and 30 patients in TAU group completed final follow-up. Suicidal attempt was observed in 3 patients in iCBT + TAU group and 2 patients in TAU group.

Conclusion: No significant difference presented in the number of suicide attempts between groups during the follow-up period. However, iCBT + TAU showed faster improvements in suicidal ideation intensity, depressive symptoms, and social stress than TAU in the short term, but were not sustained at the long-term follow-up.