DIFFERENTIAL DYNAMICS OF DEPRESSIVE SYMPTOMATOLOGY AND SUICIDALITY IN COGNITIVE-BEHAVIORAL THERAPY: A RANDOMIZED CONTROLLED TRIAL

Depressive symptoms and suicidal ideation are closely related statistically; however, current evidence indicates that their trajectories during psychotherapy do not necessarily coincide in time: improvement in mood is not always accompanied by a proportional and sustained reduction in suicidality. Objective — to test the hypothesis that short-term cognitive-behavioral therapy (CBT) has different temporal effects on depressive symptoms and suicidality. Objectives: (1) to assess between-group differences on the BDI-II, HAM-D, and BSS immediately after therapy and at 3 months; (2) to formally test the group × time × outcome-type interaction; and (3) to examine whether an early reduction in depressive symptoms predicts subsequent changes in suicidality. Sample and methods. This parallel randomized controlled trial included 204 people with a depressive episode (ICD-10 F32/F33) and suicidal ideation: 105 in the CBT group and 99 in the active supportive-counseling group. Assessments were performed at baseline (T0), immediately after therapy (T1), and 3 months later (T2, follow-up). Results. At T1, CBT outperformed control on all three scales (d from -0.44 to -0.77, p<0.01). At T2, effects on BDI-II and HAM-D persisted (d=-0.45 and d=-0.90, respectively), whereas the BSS effect decreased (d=-0.22) and did not reach the conventional level of statistical significance (p=0.12).