{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:45:41Z","timestamp":1791899141230,"version":"4.3.4"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PCN Reports"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Suicidal ideation, depressive symptoms, anxiety, and sleep disturbance remain difficult to manage in psychiatric populations, and intermittent theta\u2010burst stimulation (iTBS) has emerged as an accelerated, non\u2010invasive neuromodulation strategy for these outcomes. This meta\u2010analysis compares iTBS versus sham\u2013iTBS across suicidal ideation, depression severity, anxiety severity, and sleep quality to guide clinical decision\u2010making. We systematically searched relevant electronic databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses (PRISMA) guidelines. Continuous outcomes were pooled as standardized mean differences (SMDs) with 95% confidence intervals using random\u2010effects inverse\u2010variance models in RevMan 5.4. Heterogeneity was assessed using\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    and\n                    <jats:italic>\u03c7<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    statistics, and leave\u2010one\u2010out sensitivity analyses were performed. A\n                    <jats:italic>p<\/jats:italic>\n                    value\u2009&lt;\u20090.05 was considered statistically significant. Six studies were included. iTBS significantly reduced suicidal ideation versus sham\u2013iTBS (SMD\u2009=\u2009\u22120.51; 95% CI: \u22120.93 to \u22120.09;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    = 70%;\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009181 vs. 157), and the effect remained significant with lower heterogeneity after exclusion of Qin et al. (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    = 29%). Depression severity improved with iTBS (SMD\u2009=\u2009\u22121.06; 95% CI: \u22121.64 to \u22120.48;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.0003;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    = 80%;\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009162 vs. 142), with heterogeneity decreasing to 24% after exclusion of Huang et al. Anxiety severity also improved (SMD\u2009=\u2009\u22120.68; 95% CI: \u22121.27 to \u22120.09;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    = 79%;\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009139 vs. 120), and heterogeneity decreased to 38% after exclusion of Huang et al. Sleep quality did not differ significantly between groups (SMD\u2009=\u2009\u22120.32; 95% CI: \u22120.98 to 0.34;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.35;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    = 67%;\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200975 vs. 49), based on two trials. iTBS was associated with a reduction in suicidal ideation compared with sham stimulation, but the small evidence base and between\u2010study heterogeneity limit certainty. Secondary analyses suggested improvements in depression and anxiety severity, whereas sleep quality did not differ between groups. Larger, standardized randomized controlled trials with longer follow\u2010up are needed to determine the magnitude and durability of any antisuicidal effect.\n                  <\/jats:p>","DOI":"10.1002\/pcn5.70427","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:48:32Z","timestamp":1791895712000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intermittent theta\u2010burst stimulation versus sham stimulation for suicidal ideation and psychiatric symptoms in depressive disorders: A systematic review and meta\u2010analysis of randomized controlled trials"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7191-2749","authenticated-orcid":false,"given":"Muhammad","family":"Bilal","sequence":"first","affiliation":[{"name":"Department of Psychiatry Wah Medical College Wah Cantt Punjab Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4454-5559","authenticated-orcid":false,"given":"Muskan","family":"Kumari","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Liaquat University of Medical and Health Sciences (LUMHS) Jamshoro Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6168-712X","authenticated-orcid":false,"given":"Syeda Zainab","family":"Farooq","sequence":"additional","affiliation":[{"name":"College of Medicine Al Bukairiyah Sulaiman Al Rajhi University Qassim KSA Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8672-4558","authenticated-orcid":false,"given":"Fatima","family":"Sajjad","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Foundation University Medical College Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6581-5804","authenticated-orcid":false,"given":"Meerab Sana","family":"Ullah","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Sargodha Medical College Sargodha Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7914-4595","authenticated-orcid":false,"given":"Muhammad","family":"Akif","sequence":"additional","affiliation":[{"name":"Department of Psychiatry King Edward Medical University Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9950-6329","authenticated-orcid":false,"given":"Sana","family":"Iftikhar","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Shaikh Khalifa Bin Zayed Al Nahyan Medical and Dental College Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Nabeel","family":"Saddique","sequence":"additional","affiliation":[{"name":"Department of Psychiatry King Edward Medical University Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4680-3945","authenticated-orcid":false,"given":"Mohammad Jalal","family":"Nazari","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Kateb University Kabul Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2024.266"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00234-2"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph15071425"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(21)00292-3"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2020.00551"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0000000000001638"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2767"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2019.11.002"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/cercor\/bhaa244"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30295-2"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2019.19070720"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2016.00480"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-026-08283-8"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-025-03183-x"},{"key":"e_1_2_13_16_1","unstructured":"PRISMA statement [Internet] [cited 2026 Aug 2]. 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