A review of smartphone tools for suicide prevention and recommendations for clinicians.
Suicide is a leading cause of death globally, particularly among young people. Despite the importance of seeking help during a crisis, barriers such as lack of perceived need, availability of services, and fear of stigma can be experienced. As in other branches of medicine and health care, the use of smartphone apps is of increasing interest as a means of providing continuous access to evidence-based support strategies. As suicide ideation and suicide risk change rapidly, access to these mobile resources may save lives.
Despite a lack of published research to demonstrate that apps can be effective at reducing suicidal ideation or behaviors, developers are pushing ahead with apps for suicide prevention-with unclear benefits and risks. With hundreds of thousands of downloads, consumers, too, are not waiting for a scientific tick of approval before using apps to support their mental health.
But are the available apps any good? With no published research to help answer this question, we aimed to identify the range of already publicly available apps that contain suicide prevention strategies.1 We examined the extent to which they are evidence-informed and in line with best practice guidelines. We also looked at whether these apps had the potential to cause harm. We used a systematic review methodology to identify iPhone and Android apps related to suicide and self-harm.
In our research, we examined the downloaded apps for a range of suicide prevention strategies, including public health techniques, screening tools, help accessing support, mental health treatments, and follow-up strategies following a suicide attempt. Suicide prevention strategies within the apps were coded based on their concordance with strategies described in the literature, as “good evidence,” “some evidence,” and “best practice.”
We initially downloaded 123 mental health apps for review, and we excluded those that did not contain any identifiable suicide prevention content. This included games with the aim to harm or kill the main character, including Russian Roulette, and one app that suggested that the user could self-harm or take drugs as a means of coping with their crisis.
Forty-nine of the apps we reviewed contained at least one suicide prevention strategy; the most common was support from friends and family (27 apps) for which there is some evidence of effectiveness. This was followed by the inclusion of a safety plan (14 apps), in line with best practice guidelines.
Apps generally contained one single suicide prevention strategy (mean: 1.1, range: 1-2), which fits with the concept of an app performing a single function. However, more strategies were identified within safety planning apps (mean: 3.9, range: 2-6), reflecting the different components within a safety plan and highlighting the potential for multifaceted suicide prevention support.
As expected, the reviewed apps did not cover the full range of suicide prevention strategies. This was particularly notable among the follow-up strategies, with no apps targeting adherence management or post-attempt peer-support. Only one app was related to outreach and contact, with a simple appointment reminder feature.
At the time of the review, no apps contained suicide prevention strategies with a high degree of evidence. It is therefore important to check the contents of any app before providing a recommendation in practice, particularly considering that potentially harmful content could be “hidden away” behind several screens.
Nevertheless, of the 49 apps reviewed, all of them contained elements at least in keeping with best practice guidelines. We found that safety planning apps provide an opportunity to deliver exposure to a number of different suicide prevention strategies.
Dr Larsen is a Research Fellow with the Black Dog Institute at the University of New South Wales, Sydney, Australia. Ms Nicholas is a PhD Candidate the Black Dog Institute and School of Psychiatry at the University of New South Wales, Sydney, Australia. Prof Christensen is the Chief Scientist and Executive Director of the Black Dog Institute, and Scientia Professor in Mental Health at the University of New South Wales, Sydney, Australia. The authors report no conflicts of interest concerning the subject matter of this article.
1. Larsen M, Nicholas J, Christensen H. A Systematic assessment of smartphone tools for suicide prevention. PLOS One. 2016;11(4):e0152285. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152285. Accessed January 4, 2017.