Mobile Health Technology Interventions for Suicide Prevention: Systematic Review.

Ruth Melia,Karen Young,Mary O'Sullivan,Jim Duggan,John Bogue,Emma Hickey,Kady Francis

doi:10.2196/12516

Abstract

BackgroundDigital interventions are proposed as one way by which effective treatments for self-harm and suicidal ideation may be improved and their scalability enhanced. Mobile devices offer a potentially powerful medium to deliver evidence-based interventions with greater specificity to the individual when the intervention is needed. The recent proliferation of publicly available mobile apps designed for suicide prevention underlines the need for robust evidence to promote safe practice.ObjectiveThis review aimed to examine the effectiveness of currently available mobile health (mHealth) technology tools in reducing suicide-specific outcomes.MethodsThe following databases were searched: Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, and relevant sources of gray literature. All published and unpublished randomized controlled trials (RCTs), pseudo-RCTs, and pre-post observational studies that evaluated the effectiveness of mHealth technology in suicide prevention delivered via mobile computing and communication technology were included. Studies were included if they measured at least one suicide outcome variable (ie, suicidal ideation, suicidal intent, nonsuicidal self-injurious behavior, and suicidal behavior). A total of 2 review authors independently extracted data and assessed study suitability, in accordance with the Cochrane Collaboration Risk of Bias Tool, on July 31, 2018. Owing to the heterogeneity of outcomes found across studies, results were not amenable for pooled synthesis, and a meta-analysis was not performed. A narrative synthesis of the available research is presented here.ResultsA total of 7 studies met criteria for inclusion . Four published articles that reported on the effectiveness of the following mobile phone apps were included: iBobbly, Virtual Hope Box, BlueIce, and Therapeutic Evaluative Conditioning. Results demonstrated some positive impacts for individuals at elevated risk of suicide or self-harm, including reductions in depression, psychological distress, and self-harm and increases in coping self-efficacy. None of the apps evaluated demonstrated the ability to significantly decrease suicidal ideation compared with a control condition. In addition, 3 unpublished and recently completed trials also met criteria for inclusion in the review.ConclusionsFurther research is needed to evaluate the efficacy of stand-alone mHealth technology–based interventions in suicide prevention. The small number of studies reported in this review tentatively indicate that such tools may have a positive impact on suicide-specific outcomes. Future mHealth intervention evaluations would benefit from addressing the following 3 main methodological limitations : (1) heterogeneity of outcomes: a lack of standardized measurement of suicide outcomes across studies; (2) ecological validity: the tendency to exclude potential participants because of the elevated suicide risk may reduce generalizability within clinical settings; and (3) app regulation and definition: the lack of a standardized classification system for mHealth intervention type points to the need for better definition of the scope of such technologies to promote safe practice.Trial RegistrationPROSPERO CRD42017072899; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72899International Registered Report Identifier (IRRID)RR2-10.2196/resprot.8635

Highlights

BackgroundSuicide PreventionMore than 800,000 people die by suicide every year globally, accounting for 1.4% of all deaths worldwide [1]
Further research is needed to evaluate the efficacy of stand-alone mobile health (mHealth) technology–based interventions in suicide prevention
This review confirms and updates the findings of Witt et al [30] who identified only 2 studies describing the efficacy of mobile apps, with the majority of digital intervention studies evaluating the effectiveness of online programs, and adds to the review conducted by Larsen et al [36], which identified that 24 apps for the prevention of suicidal behavior were available for download

Summary

Introduction

More than 800,000 people die by suicide every year globally, accounting for 1.4% of all deaths worldwide [1]. Suicide occurs throughout the lifespan and was the second leading cause of death among people aged 15 to 29 years globally in 2012. Prior suicidal behavior increases the risk of subsequent death by suicide 10- to 60-fold [4-7]. Adolescents with depressive disorders and a history of suicidal behavior are a high-risk group for repeated suicide attempts and suicide [8]. Prospective studies have attempted to predict which individuals will attempt or die by suicide [9], and a diverse range of risk factors that correlate with suicidal behavior has been proposed to support the identification of those at elevated risk, such as sleep disturbances [10], emotion regulation deficits [11], family history of suicide [12], and chronic pain and illness [13]. The recent proliferation of publicly available mobile apps designed for suicide prevention underlines the need for robust evidence to promote safe practice

Methods

Results

Discussion

Conclusion