Suicidal thoughts are a serious part of depression for many people, and clinicians want to know which treatments can help. Zhang and colleagues conducted a systematic review and meta-analysis of randomised controlled trials to look at one of them, mindfulness-based cognitive therapy (MBCT).
MBCT is already known to help prevent relapse of major depression. Less clear was whether it helps with suicidal ideation during a current depressive episode. The authors searched five databases for trials published in English or Chinese that compared MBCT with treatment as usual in people with current depression.
They included 7 randomised controlled trials with a total of 479 participants. Compared with treatment as usual, both suicidal ideation and general depression scores improved significantly following MBCT. The standardised mean difference was -0.33 for suicidal ideation and -0.96 for depression.
The authors read this as showing that MBCT is an effective intervention for reducing depressive symptoms and suicidal ideation in depressed patients. That is a modest number of trials, so it is best read as encouraging evidence rather than a final answer.
If you are having thoughts of suicide, please tell someone today: your GP, a psychologist, a trusted person in your life, or a crisis line such as Lifeline. Depression can be treated. Help is available.
What the study did
Mindfulness-based cognitive therapy (MBCT) is a structured psychological programme that combines elements of cognitive therapy with mindfulness practice. Earlier research has found that it can effectively prevent relapse of major depression. Zhang and colleagues pointed out that there was still insufficient evidence on whether it works against suicidal ideation (thoughts of suicide) while a person is in a depressive episode.
To address that gap, they carried out a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing MBCT with treatment as usual (TAU) in patients with current depression. They searched PubMed, Embase, Cochrane, CNKI and Wan Fang for RCTs published in English or Chinese. The data were pooled using a random-effects model, an approach that allows for real differences between studies. The review was registered in advance with PROSPERO and followed PRISMA guidelines, which are standards for reporting this kind of review.
What it found
Seven RCTs with a total of 479 participants were included. Suicidal ideation and general depression scores both improved significantly after MBCT compared with TAU. The standardised mean difference (SMD) for suicidal ideation was -0.33 (95% CI -0.56 to -0.10), and for depression it was -0.96 (95% CI -1.54 to -0.38). A negative value here means lower scores in the MBCT group, which is the direction that indicates improvement.
The effect on depression was larger than the effect on suicidal ideation, and the confidence interval for the depression result is wider. Both intervals sit entirely below zero, which is why the authors describe the improvements as significant.
How to read the result
The authors' interpretation is that MBCT is an effective intervention for reducing depressive symptoms and suicidal ideation in depressed patients. A few features of the evidence are worth keeping in mind. The review rests on 7 trials, which is a modest body of evidence. The comparison was with treatment as usual, so the findings tell us how MBCT performed against usual care rather than against another specific therapy. The abstract also does not report how long the benefits lasted or how safe the programme was for people with severe suicidal thoughts, and so those questions remain open.
None of this takes away from the finding. It is a useful one. A treatment that is already known to reduce relapse also appears to reduce suicidal thoughts during a current episode, which is useful information for clinicians and for people deciding what kind of help to seek. It also gives researchers a clear reason to run larger trials that follow participants for longer, measure safety directly, and compare MBCT with other active treatments rather than usual care alone, so that the strengths and limits of the approach can be understood more fully.
Why it matters
Depression and suicidal thoughts often occur together, and they can feel overwhelming. Evidence that a structured, skills-based programme can ease both is a good reason for people to ask about their options. MBCT is one of several approaches, and the right choice depends on the individual and on the guidance of a trained clinician.
If you are having thoughts of suicide, please reach out today to your GP, a psychologist, someone you trust, or a crisis service such as Lifeline. If you are in immediate danger, call emergency services. Depression is treatable, and you do not have to carry it alone.