Cognitive behaviour therapy via the internet for depression: a useful strategy to reduce suicidal ideation

J Affect Disord. 2015 Jan 1:170:78-84. doi: 10.1016/j.jad.2014.08.038. Epub 2014 Sep 1.


Background: Depression is a major risk factor for suicide. Given the strong association between depression and suicide, treatment for depression should be a fundamental component of suicide prevention. Currently it is not. This study aims to demonstrate the usefulness of internet-delivered cognitive behavioural therapy (iCBT) for depression as a means of reducing suicide ideation.

Methods: The sample comprised 484 patients who were prescribed iCBT for depression by their primary care physician. The outcomes of interest were major depression, as indexed by the PHQ-8, and suicidal ideation as measured by question 9 of the PHQ-9. Marginal models were used to appropriately analyse available data without biasing parameter estimates.

Results: Following iCBT for depression, suicidal ideation and depression decreased in parallel over time. The prevalence of suicidal ideation reduced from 50% at baseline to 27% after treatment, whilst the prevalence of major depression reduced from 70% to 30%. Depression scores and suicidal ideation decreased after treatment regardless of demographic or clinical variables of interest.

Limitations: This is a naturalistic study; randomisation and scientific control were not possible.

Conclusions: The current study demonstrates the usefulness of iCBT for depression as a means of reducing suicidal ideation which can be implemented on a large scale without enacting major structural change at the societal level. These findings need to be replicated in randomised controlled trials.

Keywords: Internet cognitive behavioural therapy; Major depression; Suicide.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cognitive Behavioral Therapy*
  • Depressive Disorder, Major / psychology*
  • Depressive Disorder, Major / therapy*
  • Female
  • Humans
  • Internet*
  • Male
  • Middle Aged
  • Patient Compliance
  • Suicidal Ideation*
  • Therapy, Computer-Assisted*
  • Treatment Outcome
  • Young Adult