Accepted for/Published in: JMIR Mental Health
Date Submitted: Dec 6, 2022
Date Accepted: Feb 23, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Does loneliness affect how young adults engage with and benefit from a digital therapeutic targeting suicidal ideation?
ABSTRACT
Background:
Loneliness is commonly reported by young people and has been shown to contribute to the rapid onset and escalation of depression and suicidal ideation during adolescence. Lonely people may also be particularly susceptible to disengaging from treatment early given the likelihood of their more complex clinical profiles leading to cognitive fatigue. While digital therapeutics have been shown to effectively reduce suicidal ideation in young adults, poor engagement is a well-documented issue for this therapeutic modality and has been shown to result in poorer treatment outcomes.
Objective:
To determine whether loneliness affects how young people experiencing suicidal ideation engage with and benefit from a therapeutic smartphone application (LifeBuoy).
Methods:
455 community-based Australian young adults (aged 18-25 years) experiencing recent suicidal ideation were randomised to use a therapeutic smartphone application (LifeBuoy) or an attention-matched control application (LifeBuoy-C) for 6-weeks. Participants completed measures of suicidal ideation, depression, anxiety, and loneliness at baseline (T0), postintervention (T1) and three-months post-intervention (T2). Piecewise linear mixed models were used to examine whether loneliness levels moderated the effect of LifeBuoy and LifeBuoy-C on suicidal ideation, and depression across time (T0 to T1; T1 to T2). This statistical method was then used to examine whether application engagement (number of modules completed) influenced the relationship between baseline loneliness and suicidal ideation and depression across time.
Results:
Loneliness was positively associated with higher levels of overall suicidal ideation (p = .028) and depression (p < .001), regardless of timepoint or allocated condition. However, loneliness did not affect suicidal ideation and depression scores across time in either condition. Similarly, engagement with the LifeBuoy app was not found to moderate the impact of loneliness on suicidal ideation and depression.
Conclusions:
Loneliness was not found to affect young adults’ engagement with a digital therapeutic (LifeBuoy) nor any clinical benefits derived from the intervention. LifeBuoy, in its current form, can effectively engage and treat individuals regardless of how lonely they may be. Clinical Trial: The trial protocol was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12619001671156). The LifeBuoy application was registered with the Therapeutic Goods Administration Clinical Trial Notification scheme (CT-2020-CTN-00256-1-v1).
Citation
