Abstract
BackgroundRecent years have seen a significant increase in the availability of smartphone apps for mental health problems. Despite their proliferation, few apps have been specifically developed for young people, and almost none have been subject to any form of evaluation.ObjectiveThis study aimed to undertake a preliminary evaluation of a smartphone app (BlueIce), coproduced with young people and designed to help young people manage distress and urges to self-harm. We aimed to assess the acceptability, safety, and use of BlueIce and to explore the effects on the primary outcome of self-harm and the secondary outcomes of psychological functioning.MethodsWe undertook an open trial where we recruited young people aged 12 to 17 years attending specialist child and adolescent mental health services (CAMHS) who were currently self-harming or had a history of self-harm. Eligible participants were assessed at baseline and then given BlueIce. They were assessed 2 weeks later (post familiarization) and again at 12 weeks (post use). A behavior-screening questionnaire (Strengths and Difficulties Questionnaire) was completed along with standardized measures of depression (Mood and Feelings Questionnaire or MFQ) and anxiety (Revised Child Anxiety and Depression Scale or RCADS), taking into account self-reports of self-harm, app helpfulness, and safety.ResultsAll core CAMHS professional groups referred at least 1 young person. Out of 40 young people recruited, 37 (93%) elected to use BlueIce after familiarization, with 29 out of 33 (88%) wanting to keep it at the end of the study. No young person called the emergency numbers during the 12-week trial, and no one was withdrawn by his or her clinician due to increased risk of suicide. Almost three-quarters (73%) of those who had recently self-harmed reported reductions in self-harm after using BlueIce for 12 weeks. There was a statistically significant mean difference of 4.91 (t31=2.11; P=.04; 95% CI 0.17-9.64) on postuse symptoms of depression (MFQ) and 13.53 on symptoms of anxiety (RCADS) (t30=3.76; P=.001; 95% CI 6.17-20.90), which was evident across all anxiety subscales. Ratings of app acceptability and usefulness were high.ConclusionsOur study has a number of methodological limitations, particularly the absence of a comparison group and a prospective way of assessing self-harm. Nonetheless, our findings are encouraging and suggest that BlueIce, used alongside a traditional CAMHS face-to-face intervention, can help young people manage their emotional distress and urges to self-harm.
Highlights
Figures from hospital episode statistics show that in 2014-2015, 16,000 young people attended accident and emergency department (A&E) in England following self-poisoning [8], whereas a survey of National Health Service (NHS) trusts found that 19,000 adolescents were hospitalized in England and Wales following self-harm in 2016 [9].This statistic underestimates the scale of the problem because the majority of self-harm remains hidden with comparatively few episodes being treated in a hospital [10]
Evidence that is available suggests that therapeutic assessment, mentalization, dialectical behavioral therapy (DBT), and cognitive-behavioral therapy (CBT) may be promising and warrant further evaluation [11]
Few apps have been developed for young people with mental health problems, almost none have been subject to any form of evaluation, and none have been developed for children who self-harm [16]
Summary
Methods Self-HarmSelf-harm has been defined as the intentional self-poisoning or self-injury, irrespective of the type of motive or the extent of suicidal intent [1]. Recent years have seen a significant increase in the availability of smartphone apps for mental health problems. Despite their proliferation, few apps have been developed for young people, and almost none have been subject to any form of evaluation. Objective: This study aimed to undertake a preliminary evaluation of a smartphone app (BlueIce), coproduced with young people and designed to help young people manage distress and urges to self-harm. Methods: We undertook an open trial where we recruited young people aged 12 to 17 years attending specialist child and adolescent mental health services (CAMHS) who were currently self-harming or had a history of self-harm. Our findings are encouraging and suggest that BlueIce, used alongside a traditional CAMHS face-to-face intervention, can help young people manage their emotional distress and urges to self-harm
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