Abstract
People with suicidal ideation and non-suicidal self-injury (NSSI) behavior face numerous barriers to help-seeking, which worsened during the COVID-19 pandemic. Mobile health applications (MHA) are discussed as one solution to improve healthcare. However, the commercial app markets are growing unregulated and rapidly, leading to an inscrutable market. This study evaluates the quality, features, functions, and prevention strategies of MHA for people with suicidal ideation and NSSI. An automatic search engine identified MHA for suicidal behavior and NSSI in the European commercial app stores. MHA quality and general characteristics were assessed using the Mobile Application Rating Scale (MARS). MHA of high quality (top 25%) were examined in detail and checked for consistency with established suicide prevention strategies. Of 10,274 identified apps, 179 MHA met the predefined inclusion criteria. Average MHA quality was moderate (M = 3.56, SD = 0.40). Most MHA provided emergency contact, but lacked security features. High-quality MHA were broadly consistent with the best-practice guidelines. The search revealed apps containing potentially harmful and triggering content, and no randomized controlled trial of any included MHA was found. Despite a large heterogeneity in the quality of MHA, high-quality MHA for suicidal behavior and NSSI are available in European commercial app stores. However, a lack of a scientific evidence base poses potential threats to users.
Highlights
Suicidal behavior is a major global health challenge with more than 800,000 persons dying by suicide every year, an even higher amount of suicide attempts, and a major burden caused by suicide bereavement [1, 2]
Given the rapid developments in the app market, this study presents an up-to-date overview of the quality, functions, and features of Mobile health applications (MHA) for prevention of suicidal behavior and non-suicidal self-injury (NSSI)
The aim of this study is to provide an overview of general characteristics, a standardized quality rating, and content analysis of MHA for the prevention of suicidal behavior and NSSI in European commercial app stores
Summary
Suicidal behavior is a major global health challenge with more than 800,000 persons dying by suicide every year, an even higher amount of suicide attempts, and a major burden caused by suicide bereavement [1, 2]. Based on established intention-to-action models in suicide research, these restrictions may lead to further increases in suicide rates [13,14,15,16], while simultaneously impeding access to mental health services, making face-to-face meetings between therapists and patients very difficult or even impossible [13, 17]. This is of particular concern as persons with suicidal ideation already show low help-seeking behavior [18, 19] and calls for innovative remote support measures
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