ObjectivesTo synthesise the available evidence on interventions designed to improve individual resilience.DesignA systematic review and meta-analysisMethodsThe following electronic databases were searched: Ovid Medline, Ovid EMBASE, PsycINFO, Ovid Cochrane and WHO Clinical Trials Registry in order to identify any controlled trials or randomised controlled trials (RCTs) examining the efficacy of interventions aimed at improving psychological resilience. Pooled effects sizes were calculated using the random-effects model of meta-analysis.Outcome measuresValid and reliable measures of psychological resilience.ResultsOverall, 437 citations were retrieved and 111 peer-reviewed articles were examined in full. Seventeen studies met the inclusion criteria and were subject to a quality assessment, with 11 RCTs being included in the final meta-analysis. Programmes were stratified into one of three categories (1) cognitive behavioural therapy (CBT)-based interventions, (2) mindfulness-based interventions or (3) mixed Interventions, those combining CBT and Mindfulness training. A meta-analysis found a moderate positive effect of resilience interventions (0.44 (95% CI 0.23 to 0.64) with subgroup analysis suggesting CBT-based, mindfulness and mixed interventions were effective.ConclusionsResilience interventions based on a combination of CBT and mindfulness techniques appear to have a positive impact on individual resilience.

ObjectivesRates of youth suicide in Australian Indigenous communities are 4 times the national youth average and demand innovative interventions. Historical and persistent disadvantage is coupled with multiple barriers to help seeking. Mobile phone applications offer the opportunity to deliver therapeutic interventions directly to individuals in remote communities. The pilot study aimed to evaluate the effectiveness of a self-help mobile app (ibobbly) targeting suicidal ideation, depression, psychological distress and impulsivity among Indigenous youth in remote Australia.SettingRemote and very remote communities in the Kimberley region of North Western Australia.ParticipantsIndigenous Australians aged 18–35 years.Interventions61 participants were recruited and randomised to receive either an app (ibobbly) which delivered acceptance-based therapy over 6 weeks or were waitlisted for 6 weeks and then received the app for the following 6 weeks.Primary and secondary outcome measuresThe primary outcome was the Depressive Symptom Inventory—Suicidality Subscale (DSI-SS) to identify the frequency and intensity of suicidal ideation in the previous weeks. Secondary outcomes were the Patient Health Questionnaire 9 (PHQ-9), The Kessler Psychological Distress Scale (K10) and the Barratt Impulsivity Scale (BIS-11).ResultsAlthough preintervention and postintervention changes on the (DSI-SS) were significant in the ibobbly arm (t=2.40; df=58.1; p=0.0195), these differences were not significant compared with the waitlist arm (t=1.05; df=57.8; p=0.2962). However, participants in the ibobbly group showed substantial and statistically significant reductions in PHQ-9 and K10 scores compared with waitlist. No differences were observed in impulsivity. Waitlist participants improved after 6 weeks of app use.ConclusionsApps for suicide prevention reduce distress and depression but do not show significant reductions on suicide ideation or impulsivity. A feasible and acceptable means of lowering symptoms for mental health disorders in remote communities is via appropriately designed self-help apps.Trial registration numberACTRN12613000104752.

Background The proliferation of mental health apps purporting to target and improve psychological wellbeing is ever-growing and also concerning: Few apps have been rigorously evaluated, and, indeed, the safety of the vast majority of them has not been determined. Over 10,000 self-help apps exist but most are not used much after being downloaded. Gathering and analyzing usage data and the acceptability of apps are critical to inform consumers, researchers, and app developers. Objective This paper presents pilot usage and acceptability data from the iBobbly suicide prevention app, an app distributed through a randomized controlled trial. Methods Aboriginal and Torres Strait Islander participants from the Kimberley region of Western Australia completed a survey measuring their technology use in general (n=13), and data on their experiences with and views of the iBobbly app were also collected in semistructured interviews (n=13) and thematically analyzed. Finally, engagement with the app, such as the number of sessions completed and time spent on various acceptance-based therapeutic activities, was analyzed (n=18). Both groups were participants in the iBobbly app pilot randomized controlled trial (n=61) completed in 2015. Results Regression analysis indicated that app use improved psychological outcomes, although only minimally, and effects were not significant. However, results of the thematic analysis indicated that the iBobbly app was deemed effective, acceptable, and culturally appropriate by those interviewed. Conclusions There is a scarcity of randomized controlled trials and eHealth interventions in Indigenous communities, while extremely high rates of psychological distress and suicide persist. In this environment, studies that can add evidence from mixed-methods approaches are important. While the regression analysis in this study did not indicate a significant effect of app use on psychological wellbeing, this was predictable considering the small sample size (n=18) and typically brief app use. The results on engagement with the iBobbly app were however positive. This study showed that Indigenous youth are early and frequent users of technology in general, and they regarded the iBobbly app to be culturally safe and of therapeutic value. Qualitative analyses demonstrated that iBobbly app use was associated with self-reported improvements in psychological wellbeing, mental health literacy, and reductions in shame. Importantly, participants reported that they would recommend other similar apps if available to their peers.

BackgroundSince its emergence in the 1980s, acceptance and commitment therapy (ACT) has become a reputable evidence-based psychological therapy for certain disorders. Trials examining the efficacy of ACT are spread across a broad spectrum of presentations, such as chronic pain, anxiety, and depression. Nevertheless, ACT has very rarely been trialed as an intervention for suicidal ideation (SI) or deliberate self-harm (DSH).ObjectiveThe objective of this review is to assess the efficacy of ACT in reducing SI and DSH and to examine the suitability of reported SI, DSH, and other measures in determining the efficacy of ACT.MethodsWe systematically reviewed studies on ACT as intervention for SI and self-harm. Electronic databases, including MEDLINE, PubMed, EMBASE, PsycINFO, SCOPUS, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, were searched. The reference lists of included studies and relevant systematic reviews were examined to identify additional publications. Search terms were identified with reference to the terminology used in previous review papers on ACT and suicide prevention. The study design was not restricted to randomized controlled trials. Screening was completed by 2 reviewers, and all duplicates were removed. Publications were excluded if they were not published in English, were multicomponent therapy or were not based on ACT, or lacked a validated measure or structured reporting of SI/DSH outcomes.ResultsAfter removing the duplicates, 554 articles were screened for relevance. Following the screening, 5 studies that used ACT as an intervention for suicidal or self-harming individuals were identified. The studies used diverse methodologies and included 2 case studies, 2 pre–post studies, and 1 mHealth randomized controlled trial.ConclusionsThe review found that ACT is effective in reducing SI in the 2 pre–post studies but not in other studies. However, given the small number and lack of methodological rigor of the studies included in this review, insufficient evidence exists for the recommendation of ACT as an intervention for SI or DSH.

QuestionDigital interventions based on cognitive–behavioural therapy (iCBT) is associated with reductions in suicidal ideation. However, fine-grained analyses of effects and potential effect-moderating variables are missing. This study aimed to investigate the effectiveness of iCBT on suicidal ideation, effect moderators, effects on suicide attempts and predictors of adherence.Study selection and analysisWe systematically searched CENTRAL, PsycINFO, Embase and PubMed for randomised controlled trials that investigated iCBT for suicidal ideation or behaviours. Participants reporting baseline suicidal ideation were eligible. We conducted a one-stage individual participant data (IPD) meta-analysis. Suicidal ideation was the primary outcome, analysed as three indices: severity of suicidal ideation, reliable changes and treatment response.FindingsWe included IPD from nine out of ten eligible trials (2037 participants). iCBT showed significant reductions of suicidal ideation compared with control conditions across all indices (severity: b=−0.247, 95% CI −0.322 to −0.173; reliable changes: b=0.633, 95% CI 0.408 to 0.859; treatment response: b=0.606, 95% CI 0.410 to 0.801). In iCBT, the rate of reliable improvement was 40.5% (controls: 27.3%); the deterioration rate was 2.8% (controls: 5.1%). No participant-level moderator effects were identified. The effects on treatment response were higher for trials with waitlist-controls compared with active controls. There were insufficient data on suicide attempts. Human support and female gender predicted treatment adherence. The main source of potential bias was missing outcome data.ConclusionsThe current evidence indicates that iCBT is effective in reducing suicidal ideation irrespective of age, gender and previous suicide attempts. Future studies should rigorously assess suicidal behaviour and drop-out reasons.

Background: Acceptance and Commitment Therapy (ACT) has become a reputable evidence-based psychological therapy for certain disorders since its emergence in 1999.Trials examining the efficacy of ACT are spread across a broad spectrum of presentations such as chronic pain, anxiety and depression. ACT has very rarely been trialled as an intervention for suicide ideation (SI) or deliberate self-harm (DSH).Objective: The objective of this review was to assess the efficacy of ACT in reducing SI and DSH, to examine reported SI and DSH outcomes and to examine whether a particular cohort of participants would be more likely to engage with an ACT trial targeting SI/DSH. Methods:We conducted a systematic review of ACT trials for suicidal ideation and selfharm. An electronic search of databases, including MEDLINE, PubMed, EMBASE, PsycINFO, SCOPUS, as well as the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews was conducted. Reference lists of included studies and relevant systematic reviews were examined to identity additional publications. Search terms were identified with reference to terminology used in previous review papers on ACT and suicide prevention. Study design was not limited to randomized controlled trials.Screening was completed by two reviewers and all duplicates removed. Publications were excluded if they were not published in English, were multicomponent therapy or not based on ACT, or lacked a validated measure or structured reporting of SI/DSH outcomes.Results: After duplicates were removed 554 articles were screened for relevance. Following screening five studies were identified which used ACT as an intervention for suicidal or selfharming individuals. The methodologies used were diverse with two case studies, two prepost studies and one mHealth randomized controlled trial. Conclusions:The review found that ACT was effective for reducing suicide ideation in the two pre-post studies, but not in the other studies. However the very small number of studies included coupled with their lack of methodological rigour means that as yet, there is insufficient evidence to recommend ACT as a treatment for reducing suicide ideation or deliberate self-harm.

UNSTRUCTURED The proliferation of mental health apps purporting to target and improve psychological wellbeing is ever-growing yet also concerning: few apps have been rigorously evaluated and the safety of most of them has not been determined. Over 10000 self-help apps exist but the majority are not used much after being downloaded. Gathering and analysing usage data and the acceptability of apps is critical to inform consumers, researchers and app developers. This paper presents pilot usage and acceptability data from the ibobbly suicide prevention app, an app distributed through a randomised controlled trial. Aboriginal and Torres Strait Islander participants from the Kimberley region of Western Australia completed a survey measuring their technology use in general (n=13) and data on their experiences and views of the ibobbly app were also collected in semi-structured interviews (n=13) and thematically analysed. Finally, engagement with the app, such as the number of completed sessions and time spent on various acceptance-based therapeutic activities were analysed (n=18). Regression analysis indicate that app use improved psychological outcomes although only minimally and effects were not significant. However, results of the thematic analysis indicate that the ibobbly app was deemed effective, acceptable and culturally appropriate by those interviewed.