The impact of mindfulness on suicidal behavior: a systematic review

de Aguiar, Kyara Rodrigues; Bilhalva, Júlia Bierhals; Cabelleira, Mariana Dias; Guimarães, Giovanna Oliveira; Madureira, Thiago; Agako, Arela; de Souza, Marília Silva; Souza, Luciano Dias de Mattos

doi:10.47626/2237-6089-2021-0316

Acessibilidade / Reportar erro

Brasil

Trends in Psychiatry and Psychotherapy

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Review Article • Trends Psychiatry Psychother. 44 • 2022 • https://doi.org/10.47626/2237-6089-2021-0316 copy

The impact of mindfulness on suicidal behavior: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Mindfulness-based interventions (MBI) have been growing progressively as treatment options in the field of mental health. Aim: To assess the impact of mindfulness-based interventions for reducing suicidal thoughts and behaviors.

Methods

A systematic review was performed in December 2020 using PubMed, PsycINFO, EMBASE, SciELO, Pepsic, and LILACS databases with no year restrictions. The search strategy included the terms (‘mindfulness’ OR ‘mindfulness-based’) AND (‘suicide’ OR ‘suicidal’ OR ‘suicide risk’ OR ‘suicide attempt’ OR ‘suicide ideation’ OR ‘suicide behavior’). The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO), CRD42020219514.

Results

A total of 14 studies met all inclusion criteria and were included in this review. Most of the studies presented Mindfulness-Based Cognitive Therapy as the MBI assessed (n=10). An emerging and rapidly growing literature on MBI presents promising results in reduction of suicide risk, particularly in patients with MDD. Four studies assessing other MBI treatment protocols (Mindfulness-Based Stress Reduction; Daily Mindfulness Meditation Practice; Mind Body Awareness and Mindfulness-Based Cognitive Behavior Therapy) all demonstrated that MBI reduces factors associated with suicide risk.

Conclusion

MBI might target specific processes and contribute to suicide risk reduction.

Suicide; suicide ideation; suicide behavior; mindfulness; systematic review

Study	Country	Design	Sample	Gender	Age	MBI	Control group	Suicide outcome measure	Main outcome related to suicide
Nabipour et al.,²⁶ 2018	Iran	Randomized clinical trial	30 cancer patients	There is no information about gender of the sample	There is no information about age	MBCT	Unclear	BSSI	Reduction in suicidal thoughts in MBCT group.
Britton et al.,²⁷ 2014	USA	Randomized clinical trial	100 children	45.5% were female	Mean age of 11.8 years	Daily mindfulness meditation practice lasting 6 weeks.	African history course with a matched experiential activity	Item-18 and 91 of Youth Self Report were combined to make a suicidal ideation/behavior critical item subscale	Greater reductions in development of suicidality in the MBI group.
Serpa et al.,²⁸ 2014	USA	Quasi-experimental	78 veterans	89% were male	Mean age was 60	MBSR 9 weekly sessions including seated and walking meditations, gentle yoga, body scans, and discussions of pain, stress, and mindfulness.	There was no control group	Item 9 of PHQ-9	The frequency of suicidal ideation decreased by almost half, from 24% to 12%.
Forkmann et al.,²⁹ 2014	The Netherlands	Randomized clinical trial	130 veterans	79% were female in intervention group and 73% were female in control group	Intervention group mean age was 44.6 and control group mean age was 43.2	MBCT Meditation exercises combined with cognitive behavioral techniques. Total of 20 hours.	Waiting list	Respective item from the self-rating form of the Dutch version of the Inventory of Depressive Symptoms	Post-hoc tests showed a significant reduction of suicidal ideation in the MBCT-group, but not in the waiting list control-group.
Forkmann et al.,³⁰ 2016	Germany	Randomized clinical trial	106 outpatients	65.7% were female in the TAU group, 63.9% were female in the CBASP group, and 58.2% were female in the MBCT group	Mean age was 50 years in the TAU group, 50.2 years in the CBASP group, and 48.4 years in the MBCT group	MBCT Individual pre-class interview and eight weekly 2.5-hour group sessions. Total number of hours: 20.	CBASP - consisted of two individual treatment sessions and eight weekly 2.5-h group sessions. TAU	Item 3 from the HAMD and item 9 of the BDI	MBCT and CBASP reduced suicidal symptoms if measured with the HAMD suicide item. Neither MBCT nor CBASP showed an incremental effect on the reduction of SI as assessed with the BDI suicide item compared to TAU.
Chesim et al.,³¹ 2016	USA	Quasi-experimental	10 outpatients	They were mostly female (80%)	They ranged in age from 18 to 64 years (mean 41.7)	MBCT developed to prevent suicidal behavior. The intervention lasted 9 weeks (SPI individually + 8 sessions of weekly group MBCT-based treatment). Total of 16 hours.	No control group.	Leiden Depression Sensitivity Index - Revised	Participants evidenced significant reductions in hopelessness/suicidality from pre to post-MBCT-S treatment.
Lu et al.,³² 2019	China	Randomized controlled trial	49 children	25.4% of participants were female	The average age of participants was 11.7	Based on MBCT with practices from MBSR. 8 weeks with 1 hour group sessions once a week and homework exercises. Total of 8 hours.	Waiting list	PANSI	The mindfulness-training group showed a significant decrease in suicide ideation.
Barnhofer et al.,³³ 2009	United Kingdom	Randomized controlled trial	28 patients	About two thirds were women	Most participants were middle-aged	MBCT with some minor alterations to address suicidality plus TAU. Eight weekly classes of 2h duration plus homework for about an hour per day for six days a week. Total of 16 hours.	TAU	BSSI	Neither analyses by intent-to-treat nor of the per-protocol sample yielded significant effects.
Barnhofer et al.,³⁴ 2015	United Kingdom	Randomized controlled trial	194 patients	74% were women	Mean age was 43.7 years	MBCT, except that they placed greater emphasis on patterns and thoughts associated with suicidality. Eight weekly classes of 2-hour sessions Total of 16 hours.	TAU CPE that comprised all elements of the MBCT program except for the experiential cultivation of mindfulness through meditation practice	BDI-II Suicidal Cognitions Scale	Participants in the MBCT group showed a general reduction in suicidal cognitions.
Raj et al.,³⁵2019	India	Quasi-experimental	30	50% respondents were female	Mean age was 14 years	MBCT. 12 sessions including assessments in the first and the last session. Sessions once a week, 45 minutes to an hour duration. Total amount of hours between 7h30 to 10 hours.	No control group	Modified version of the BSSI	Scores on the Modified Scale for Suicidal Ideation decreased in the post-test.
Kenny et al.,³⁶ 2007	Australia	Quasi-experimental	76 depressed patients and outpatients	20 were male and 59 were female.	They were aged between 17 and 61 years	MBCT 8 weekly classes of 2 hour sessions, up to an hour of which was spent in meditation practices. Homework involved around 1 h per day of meditation or yoga, and other related formal and informal practices for the 8 weeks. Total number of hours: 16.	No control group	BDI-II	They examined which BDI items significantly differed at pre-treatment for those who did and those who did not report suicidality.
Chesin et al.,³⁷ 2015	USA	Quasi-experimental	16	83% were female	They were aged between 18 and 64 years (mean=41.7)	MBCT to prevent suicidal behavior. Nine weekly classes of approximately 2-hour sessions. Session one was provided individually. Sessions two through nine were delivered in a group format. Beginning in session two, participants were asked to complete 20 min of formal mindfulness meditation practice three times per week between sessions. Total of 24 hours.	No control group	CSHF BSSI	Completers evidenced significant reductions in suicidal ideation, as measured using the BSSI, and in depression, as measured using the BDI-II, pre to post-MBCT-S treatment. In the intent-to-treat analyses, reductions in suicidal thoughts trended toward significance.
Le & Gobert,³⁸ 2015	USA	Quasi-experimental	8 youths	5 were male	Mean age 17 years	Adaptation/translation of a mindfulness curriculum for cultural relevancy with Native American traditions and spiritual practices. The mindfulness classes comprised four sessions per week, 55 min per session, over 10 weeks with weekly homework assignments. Total of 36 hours.	No control group	Item 9 of PHQ-9	At pre-test, 44 % reported several days to more than half the days of thinking that they thought that they were better off dead or had thoughts of hurting themselves in some way, while at post-test, 100% responded not at all to the item.
Miklovitz et al.,³⁹ 2009	USA	Quasi-experimental	16 outpatients	16 were female and 6 were male	Mean age 40.6 years	MBCT Mindfulness meditation strategies and traditional cognitive-behavioral techniques to address the mode in which negative thoughts and feelings and emerging manic symptoms are processed. Total of 16 hours.	No control group	BSSI	Reductions were observed in suicidal ideation.

Paper	1	2	3	4	5	6	7	8	9	10	11	12
Kenny et al.,³⁶ 2007	Good	Good	Good	Good	Good	Good	Good	Poor	Good	Good	Poor	Good
Miklowitz et al.,³⁹ 2009	Good	Good	Good	Good	Fair	Good	Good	Poor	Poor	Poor	Poor	Good
Serpa et al.,²⁸ 2014	Good	Fair	Good	Fair	Good	Good	Good	Poor	Poor	Good	Poor	Good
Chesin et al.,³⁷ 2015	Good	Good	Good	Good	Good	Fair	Good	Poor	Good	Good	Poor	Good
Le & Gobert.,³⁸ 2015	Good	Poor	Good	Poor	Poor	Good	Good	Poor	Good	Poor	Poor	Good
Chesin et al.,²⁰ 2016	Good	Good	Good	Good	Good	Good	Fair	Poor	Good	Good	Poor	Good
Raj et al.,³⁵ 2019	Good	Good	Good	Good	Good	Good	Good	Poor	Fair	Good	Poor	Good

Paper	Random sequence generation	Allocation concealment	Blinding of outcome assessment	Blinding of participants and personnel	Incomplete outcome data	Selective reporting	Other bias
Barnhofer et al.,³³ 2009	Low	Unclear	Unclear	Low	Low	Low	N/A
Barnhofer et al.,³⁴ 2015	Unclear	Low	High	Unclear	Unclear	Low	N/A
Britton et al.,²⁷ 2014	Low	Low	Low	Low	Low	Low	Potential bias from committee of educators
Forkmann et al.,²⁹ 2014	Low	Low	High	High	Low	Low	N/A
Forkmann et al.,³⁰ 2016	Low	Low	Low	Unclear	Low	Low	Potential bias from exclusion of Borderline Personality Disorder patients
Lu et al.,³² 2019	Unclear	Unclear	High	Unclear	High	Low	Participants were students who didn’t have classes at the time of group
Nabipour et al.,²⁶ 2018	High	Unclear	High	Unclear	Unclear	Unclear	No demographic information on participants

Associação de Psiquiatria do Rio Grande do Sul Av. Ipiranga, 5311/202, 90610-001 Porto Alegre RS/ Brasil, Tel./Fax: (55 51) 3024 4846 - Porto Alegre - RS - Brazil
E-mail: trends@aprs.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Luciano Souza Rua Gonçalves Chaves, 373, sala 418c 96015-560 - Pelotas, RS - Brazil E-mail: luciano.dms@gmail.com