JMIR Publications

ABSTRACT

Background:

Suicide safety planning is an evidence-based approach used to help individuals identify strategies to keep themselves safe during mental health crises.

Objective:

This study systematically reviewed the literature focused on mobile health (mHealth) suicide safety planning apps to evaluated whether these apps included best practices for suicide safety planning based on Stanley and Brown’s safety planning framework, and if so, how these best practices were integrated into the design-based features of the apps.

Methods:

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically analyzed 14 peer-reviewed studies specific to mHealth apps for suicide safety planning. We conducted an analysis to evaluate adherence to best practices for suicide safety planning and examined similarities and differences between apps by conducting a comparative analysis of app features.

Results:

Most of the mHealth apps (86%) adhered to best practice safety planning and provided customizable features that expanded upon traditional paper safety planning processes. App designs were categorized into five over-arching themes: 1) Interactive App Safety Planning Components, 2) Individualized User Experiences, 3) Interface Design, 4) Guidance and Training, and 5) Privacy and Sharing. All apps included access to community and trusted supports and revisable safety plans. Fewer mHealth apps (43%) included interactive features, such as linking coping strategies to stressors. Most studies in our review (71%) examined usability, feasibility, and acceptability of the safety planning mHealth apps, rather than the effectiveness (29%) of suicide-related outcomes. Usability findings were generally positive, as users often found the apps easy-to-use and visually appealing. In terms of feasibility, users preferred using mHealth apps during times of crisis, but the continuous use of the apps outside of crisis situations received less support. Overall, few studies examined the effectiveness of mHealth apps for suicide-related outcomes. Positive shifts in attitudes and desire to live, improved coping strategies, enhanced emotional stability, and a reduction in suicidal thoughts and/or self-harm behaviors were examined in these studies.

Conclusions:

Our study highlights the need for researchers, clinicians, and app designers to continue to work together to align evidence-based research on mHealth suicide safety planning apps with best practices to deliver these technologies to end users. Our review brings to light mHealth safety planning strategies needing further development and testing, such as lethal means guidance, collaborative safety planning, and the opportunity to embed more interactive features that leverage the advanced capabilities of technology to improve safety planning outcomes, as well as foster sustained user engagement outside of crisis. Although preliminary evidence shows that safety planning apps may help to mitigate suicide risk, clinical trials with larger sample sizes and more robust research designs are needed to validate their efficacy prior to the widespread adoption and use of mHealth safety planning apps. Clinical Trial: None