A clinical audit of changes in suicide ideas with internet treatment for depression

OBJECTIVES To examine reductions in suicidal ideation among a sample of patients who were prescribed an internet cognitive behavior therapy (iCBT) course for depression. DESIGN Effectiveness study within a quality assurance framework. SETTING Primary care. PARTICIPANTS 299 patients who were prescribed an iCBT course for depression by primary care clinicians. INTERVENTION Six lesson, fully automated cognitive behaviour therapy course delivered over the internet. PRIMARY OUTCOME suicidal ideation as measured by question 9 on the Patient Health Questionnaire (PHQ-9). RESULTS Suicidal ideation was common (54%) among primary care patients prescribed iCBT treatment for depression but dropped to 30% post-treatment despite minimal clinician contact and the absence of an intervention focused on suicidal ideation. This reduction in suicidal ideation was evident regardless of sex and age. CONCLUSIONS The findings do not support the exclusion of patients with significant suicidal ideation.