JMIR Publications

ABSTRACT

Background:

Digital interventions have been proposed as one mechanism by which the scalability of effective treatments for self-harm and suicidal ideation may be improved. Mobile devices offer a potentially powerful means of delivering evidence-based interventions with greater specificity to the individual and at the time at which 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. This systematic review examines current research on the use of mobile health (mHealth) technology-based interventions in suicide prevention.

Objective:

The objective of this review is to examine the effectiveness of currently available mHealth technology tools in reducing suicide-specific outcomes.

Methods:

The search included the Cochrane Central Register of Controlled Trials (CENTRAL: The Cochrane Library), MEDLINE, Embase, PsycINFO and relevant sources of grey literature. All published and unpublished randomised controlled trials (RCTs), pseudo RCTs and pre-post observational studies which evaluated the effectiveness of mHealth technology in suicide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 (i.e. suicidal ideation, suicidal intent, non-suicidal self-injurious behaviour, suicidal behaviour). Two review authors independently extracted data and assessed study suitability, in accordance with the Cochrane Collaboration Risk of Bias Tool, to 31st July 2018. Due 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.

Results:

Seven studies met criteria for inclusion in the review. Four published articles that reported on the effectiveness of the following smartphone apps were included: iBobbly, Virtual Hope Box, BlueIce and Therapeutic Evaluative Conditioning. Results demonstrated some positive impact 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 applications evaluated demonstrated the ability to significantly decrease suicidal ideation as compared to a control condition. Three unpublished recently completed trials also met criteria for inclusion in the review, two mobile app-based programs and one automated text messaging-based intervention.

Conclusions:

Further research is needed to evaluate the efficacy of stand-alone mHealth technology-based interventions in suicide prevention. The small number of studies reported on here tentatively indicates the positive impact of such tools on suicide-specific outcomes. Future mHealth intervention evaluations would benefit from addressing three main methodological limitations observed across studies: (a) heterogeneity of outcomes: a lack of standardized measurement of suicide outcomes across studies is hindering comparison and synthesis of available data; (b) ecological validity: the tendency to exclude potential participants due to elevated suicide risk may contribute to a sample bias and reduce generalizability within clinical settings; and (c) app regulation and definition: the lack of a standardised classification system for mHealth intervention-type points to the need for better definition of the scope of such technologies, in order to promote safe practice. Clinical Trial: PROSPERO International Prospective Register of Systematic Reviews CRD42017072899