JMIR Publications

ABSTRACT

Background:

Safety planning is an evidence-based suicide prevention approach used to help individuals identify strategies to keep themselves safe during mental health crises. Researchers and app developers have made significant strides in conducting empirical user studies on the design, development, and evaluation of mHealth applications (“apps”) for suicide safety planning. Yet, it is unclear whether insights from research are well-aligned with the apps currently available on the market.

Objective:

This study systematically reviews both the literature regarding suicide prevention technologies, as well as the mHealth apps available for download to assess gaps between research and practice.

Methods:

We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review of 18 studies related to suicide safety planning technologies, combined with an in-depth feature analysis of 21 mobile apps available on the iOS and Android app stores. From the literature we identified best practice guidelines for the design and development of suicide safety planning apps. Then, we benchmarked these recommendations against available apps to identify gaps and opportunities for aligning future safety planning mHealth apps with evidence-based guidelines from the literature.

Results:

Three hundred and forty-seven apps referring to suicide were downloaded for review, of which 21 included at least 3 components of safety planning. Most applications included features that helped to identify 1) support persons (100%; n=21), 2) coping strategies (95%; n=20), and 3) warning signs (86%; n=18), but fewer supported psychosocial education on lethal means safety (48%; n=10) and allowed for patients to download or share (43%; n=9) their safety plans. Our review of the literature identified five main design recommendation categories: 1) Personalization, 2) Key Safety Planning Components, 3) Simplicity of Design, 4) Guidance and Training, and 5) Privacy and Security. Most of the apps (86%) provided a customizable safety plan specific to the user as well as provided users access to location-based support services (71%), but fewer included other advanced components, such as the ability to upload personal photos (14%), view inspirational quotes (5%), or enable mood tracking (5%). Of the apps reviewed, we also report target user demographics, collaboration and privacy considerations, and other emergent themes based on our dataset.

Conclusions:

Overall, our study highlights the need for researchers, clinicians, and app developers to work together to align evidence-based research on mHealth apps for suicide safety planning with best practices being used to deliver these technologies to end users. Our review also brings to light mHealth safety planning strategies needing further development and testing, such as lethal means guidance, collaborative safety planning, and features to facilitate app usage and engagement in coping behaviors. Although preliminary evidence shows that safety planning apps may help to mitigate suicide risk, clinical trials are needed to further test their efficacy, specifically with diverse and high-risk populations.