A Systematic Analysis on the Effectiveness of Mobile Applications for Suicide Prevention

Öz

Objective: This descriptive systematic review was evaluated the effectiveness of mobile applications designed to aimed to prevent suicide. Material and Method: Within the scope of the study, open access Turkish and English articles published in online databases (Web of Science, PubMed, WİLEY, Taylor & Francis Online, Science Direct) between 2019 and August 2024 were reviewed. Randomized controlled trials on mobile applications whose role in preventing suicide was clearly stated in the articles were included in the study. Results: As a result of the screening, seven studies that met the inclusion criteria were included in this study. In four of the included studies, a routine intervention (awareness training, psychotherapy or medical treatment) was compared with an additional mobile application; in three studies, a routine intervention was compared with a mobile application. As a result of the evaluation, different results were obtained in terms of the effectiveness, acceptability and usability of mobile applications. It was concluded that mobile applications with psychotherapy content, especially applied together with face-to-face interventions, provided more positive results in reducing the risk of suicide. However, the level of effectiveness may vary depending on the content of the application, the characteristics of the sample, and whether it is a treatment support. All that, it has been determined that mobile applications are usable but that there is strictly limited data on their acceptability. Conclusion: Mobile applications aimed at preventing suicide are potential tools that can be used in preventing suicide. However, there is no definitive result regarding their alone effectiveness. It is important to increase randomized controlled studies with a large sample, long follow-up period, and high level of evidence.

Anahtar Kelimeler

• Suicide
• mobile applications
• mental health.

İntiharı Önlemeye Yönelik Geliştirilen Mobil Uygulamaların Etkinliği Üzerine Sistematik Bir Analiz

Öz

Amaç: Bu tanımlayıcı sistematik derleme, intiharı önlemeye yönelik tasarlanan mobil uygulamaların etkinliğini değerlendirmek amacıyla yapılmıştır. Gereç ve Yöntem: Çalışma kapsamında 2019 - Ağustos 2024 tarihleri arasında çevrimiçi veri tabanlarında (Web of Science, PubMed (MEDLINE), WİLEY, Taylor & Francis Online, Science Direct) sağlık alanındaki dergilerde yayınlanmış, açık erişimi olan, Türkçe ve İngilizce makaleler ele alınmıştır. Makalelerde intiharı önlemedeki rolü açıkça belirtilen mobil uygulamalarla ilgili randomize kontrollü deneysel araştırmalar çalışmaya dahil edilmiştir. Bulgular: Yapılan tarama sonucunda dahil etme kriterlerine uygun yedi araştırma bu çalışmaya dahil edilmiştir. Dahil edilen dört araştırmada rutin bir uygulama (farkındalık eğitimi, psikoterapi veya tıbbi tedavi) ile ek olarak bir mobil uygulama; üç araştırma da ise rutin bir uygulama ile mobil uygulama karşılaştırılmıştır. Değerlendirme sonucunda mobil uygulamaların etkinliği, kabul edilebilirliği ve kullanılabilirliği açısından farklı sonuçlar elde edilmiştir. Özellikle yüz yüze müdahaleler ile birlikte uygulanan psikoterapi içerikli mobil uygulamaların intihar riskini azaltmaya yönelik daha olumlu sonuç verdiği sonucuna ulaşılmıştır. Ancak etkinlik düzeyinin uygulamanın içeriğine, örneklemin özelliğine, bir tedavi desteği olup olmamasına göre değişebilmektedir. Aynı zamanda mobil uygulamaların kullanılabilir olduğu ancak kabul edilebilirliği ile ilgili kesin verilerin sınırlı olduğu belirlenmiştir. Sonuç: İntiharı önlemeye yönelik mobil uygulamalar potansiyel araç olarak kullanılabilir. Ancak tek başına etkinliği ile ilgili kesin bir sonuç yoktur. Geniş örneklemde, takip süresinin uzun sürdüğü, kanıt düzeyi yüksek olan randomize kontollü çalışmaların artırılması önemlidir.

Anahtar Kelimeler

• İntihar
• mobil uygulamalar
• ruh sağlığı

Kaynakça

1. World Health Organization. Suicide [Internet]. 2019. Available at: https://www.who.int/news-room/fact-sheets/detail/suicide. Access Date: 30.08.2024
2. Jha S, Jewer S, Agyapong VIO, Orji R. Can Your Smartphone save a life ? A Systematic review of mobile-based ınterventions for suicide prevention. Int J Human–Computer Interact [Internet]. 2024;0(0):1–19. Available at: https://doi.org/10.1080/10447318.2024.2323274
3. National Action Alliance for Suicide Prevention [Internet]. 2024. National Strategy and Action Plan. Available at: http://www.hhs.gov/ nssp. Access Date: 30.08.2024
4. Goldston DB, Asarnow JR. Quality ımprovement for acute trauma-ınformed suicide prevention care : Introduction to Special Issue. Evidence-Based Pract Child Adolesc Ment Heal [Internet]. 2021;6(3):303– 6. Available at: https://doi.org/10.1080/23794925.2021.1961645
5. Yu T, Hu D, Teng F, Mao J, Xu K, Han Y, et al. Effectiveness of internet-based cognitive behavioral therapy for suicide : A systematic review and meta-analysis of RCTs. Psychol Health Med [Internet]. 2022;27(10):2186– 203. Available at: https://doi.org/10.1080/13548506.2021.1930073
6. Leavey K, Hawkins R. Is cognitive behavioural therapy effective in reducing suicidal ideation and behaviour when delivered face-to-face or via e-health ? A systematic review and meta-analysis. Cogn Behav Ther [Internet]. 2017;6073:1–22. Available at: http://doi.org/10.1080/16 506073.2017.1332095
7. Kothgassner O, Goreis A, Robinson K, Huscsava M, Schmahl C, Plener P. Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation : a systematic review and meta-analysis. Psychol Med [Internet]. 2021;51:1057–67. Available at: https://doi.org/10.1017/ S0033291721001355
8. Pistorello J, Jobes DA, Gallop R, Compton SN, Locey NS, Au JS, et al. Archives of suicide research a randomized controlled trial of the collaborative assessment and management of suicidality ( CAMS ) versus treatment as usual ( TAU ) for suicidal college students. Arch Suicide Res [Internet]. 2021;25(4):765–89. Available at: https://doi.org/ 10.1080/13811118.2020.1749742

9. Arshad U, Ul-Ain F, Gauntlett J, Husain N, Chaudhry N, Taylor P. A systematic review of the evidence supporting mobile- and ınternet-based psychological ınterventions for self-harm. Suicide Life Threat Behav. 2020;50(February):151–79.
10. Melia R, Francis K, Hickey E, Bogue J, Duggan J, Sullivan MO, et al. Mobile health technology ınterventions for suicide prevention : Systematic Review. JMIR Mhealth Uhealth. 2020;8(1). doi: 10.2196/12516
11. King TL, Fleitas L, Philip A, Andrew B, Lockwood C, Harvey S, et al. A blended face to face and smartphone intervention to improve suicide prevention literacy and help seeking intentions among construction workers : A randomised controlled trial. Soc Psychiatry Psychiatr Epidemiol [Internet]. 2023;58(6):871–81. Available at: https:// doi.org/10.1007/s00127-023-02429-9
12. Rodante DE, Kaplan MI, Fedi RO, Gagliesi P, Pascali A, Quintero PSJ, et al. CALMA, a mobile health application , as an accessory to therapy for reduction of suicidal and non-suicidal self-ınjured behaviors : A Pilot Cluster Randomized Controlled Trial. Arch Suicide Res [Internet]. 2022;26(2):801–18. Available at: https://doi.org/10.1080/13811118.202 0.1834476
13. Sarubbi S, Rogante E, Erbuto D, Cifrodelli M, Sarli G, Polidori L, et al. The effectiveness of mobile apps for monitoring and management of suicide crisis : A Systematic Review of the Literature. J Clin Med. 2022 Sep 23;11(19):5616. doi: 10.3390/jcm11195616
14. Goldstein TR, Kennard BD, Porta G, Miller AO, Aguilar K, Bigley K, et al. Bridging gaps in care following hospitalization for suicidal adolescents: As safe as possible (ASAP) and BRITE App. J Am Acad Child Adolesc Psychiatry [Internet]. 2024;S0890-8567(24):361–7. Available at: https:// doi.org/10.1016/j.jaac.2024.06.008
15. Josifovski N, Torok M, Batterham P, Wong Q, Joanne R, Cockayne N, et al. Efficacy of BrighterSide, a self-guided app for suicidal ideation : Randomized controlled trial. JMIR Ment Health. 2024; 11: 55528 doi: 10.2196/55528
16. Torok M, Han J, Mcgillivray L, Wong Q, Aliza W, O Dea B, vd. The effect of a therapeutic smartphone application on suicidal ideation in young adults : Findings from a randomized controlled trial in Australia. PLoS Med. 2022;1–19. 19(5): e1003978.Available at: http://dx.doi. org/10.1371/journal.pmed.1003978
17. Karaçam, Z. Sistematik derleme metodolojisi: Sistematik derleme hazırlamak için bir rehber. DEUHYOED, 2013;6(1):26–33
18. Page MJ, Mckenzie JE, Bossuyt PM, Boutron I, Hoffmann C, Mulrow CD, et al. The PRISMA 2020 statement : an updated guideline for reporting systematic reviews Systematic reviews and Meta-Analyses. BMJ. 2021;372:n71 Available at:http://dx.doi.org/10.1136/bmj.n7
19. Yu F, Liu C, Sharmin S. Performance, usability, and user experience of rayyan for systematic reviews. Proc Assoc Inf Sci Technol. 2022;59(1):843–4.
20. Study Quality Assessment Tools [Internet]. 2013. National Institute of Health. Available at: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Access Date: 30.08.2024
21. Toole MSO, Arendt MB, Pedersen CM. ScienceDirect testing an app-assisted treatment for suicide prevention in a randomized controlled trial : Effects on suicide risk and depression. Behav Ther [Internet]. 2019;50(2):421–9. Available at: https://doi.org/10.1016/j. beth.2018.07.007
22. Soltani Z, Parizad N, Radfar M, Alinejad V, Arzanlo M. The effect of the Yara smartphone application on anxiety , sleep quality , and suicidal thoughts in patients with major depressive disorder in Iran : A randomized controlled trial. BMC Psychiatry [Internet]. 2024;1–12. Available at: https://doi.org/10.1186/s12888-024-05688-1
23. Stallard P, Whittle K, Moore E, Medina-lara A, Morrish N, Cliffe B, et al. Clinical effectiveness and safety of adding a self-harm prevention app ( BlueIce ) to specialist mental health care for adolescents who repeatedly self-harm : A single blind randomised controlled trial ( the BASH study ). Psychiatry Res [Internet]. 2024;339(December 2023):116017. Available at: https://doi.org/10.1016/j.psychres.2024.116017
24. Ali W, Riaz O, Mumtaz S, Khan AR, Saba T, Bahaj SA. Mobile application usability evaluation : A study based on demography. IEEE Access. 2022;10:41512–24.
25. Jiménez-muñoz L, Peñuelas-calvo I, Díaz-oliván I, Gutiérrez-rojas L, Baca-garcía E. Suicide prevention in your pocket : A Systematic review of ecological momentary ınterventions for the management of suicidal thoughts and behaviors. Harv Rev Psychiatry. 2022;30(2):85–99. doi: 10.1097/HRP.0000000000000331.
26. Malakouti SK, Rasouli N, Rezaeian M, Nojomi M, Ghanbari B. Effectiveness of self-help mobile telephone applications ( apps ) for suicide prevention : A systematic review. Med J Islam Repub Iran. 2020;34:85. doi: 10.34171/mjiri.34.85
27. Castillo-Sánchez G, Camargo-Henríquez I, Muñoz-Sánchez J, Franco-Martín M, de la Torre-Díez I. Suicide prevention mobile apps : Descriptive analysis of apps from the most popular virtual stores. JMIR Mhealth Uhealth. 2019;13(7(8)):e13885. doi: 10.2196/13885.
28. Witt K, Spittal MJ, Carter G, Pirkis J, Hetrick S, Currier D, et al. Effectiveness of online and mobile telephone applications (‘ apps ’) for the self- management of suicidal ideation and self- harm : A systematic review and meta-analysis. BMC Psychiatry. 2017;17(1)(297):2–18. doi: 10.1186/s12888-017-1458-0
29. Braciszewski JM. Digital technology for suicide prevention. Adv Psychiatry Behav Heal [Internet]. 2021;1(1):53–65. Available at: https:// doi.org/10.1016/j.ypsc.2021.05.008
30. Forte A, Sarli G, Polidori L, Lester D. The role of new technologies to prevent suicide in adolescence : A systematic review of the literature. Medicina (Kaunas). 2021;57 (2):1–13. https://doi.org/10.3390/ medicina57020109