Effectiveness of online and mobile telephone applications (‘apps’) for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis

Abstract

BackgroundOnline and mobile telephone applications (‘apps’) have the potential to improve the scalability of effective interventions for suicidal ideation and self-harm. The aim of this review was therefore to investigate the effectiveness of digital interventions for the self-management of suicidal ideation or self-harm.MethodsSeven databases (Applied Science & Technology; CENTRAL; CRESP; Embase; Global Health; PsycARTICLES; PsycINFO; Medline) were searched to 31 March, 2017. Studies that examined the effectiveness of digital interventions for suicidal ideation and/or self-harm, or which reported outcome data for suicidal ideation and/or self-harm, within a randomised controlled trial (RCT), pseudo-RCT, or observational pre-test/post-test design were included in the review.ResultsFourteen non-overlapping studies were included, reporting data from a total of 3,356 participants. Overall, digital interventions were associated with reductions for suicidal ideation scores at post-intervention. There was no evidence of a treatment effect for self-harm or attempted suicide.ConclusionsMost studies were biased in relation to at least one aspect of study design, and particularly the domains of participant, clinical personnel, and outcome assessor blinding. Performance and detection bias therefore cannot be ruled out. Digital interventions for suicidal ideation and self-harm may be more effective than waitlist control. It is unclear whether these reductions would be clinically meaningful at present. Further evidence, particularly with regards to the potential mechanisms of action of these interventions, as well as safety, is required before these interventions could recommended.

The prediction of behavioral intention to use online mental health interventions

“…To address this issue, researchers have studied the advantages of online mental health interventions in the form of an online psychological educational program to promote well‐being and prevent and reduce mild mental health problems and suicide ideation (Andersson, Carlbring, & Hadjistavropoulos, ; Hoffmann, ; Li, Zhu, & Ning, ; Witt et al, ). However, few studies have explored relevant factors that influence behavioral intention (Davis, ) to use online interventions or identified factors that explain how this type of e‐mental health intervention may alleviate the mental distresses or which factors will affect the effectiveness of a particular program.…”

A Systematic Review of the Evidence Supporting Mobile‐ and Internet‐Based Psychological Interventions For Self‐Harm

“…This is important since intervention effects on STB prevention may be better when this is the primary focus (Christensen et al., ; Tarrier et al., ). The majority of identified studies ( k = 17) were not included in the last review on this topic (Witt et al., ). Results suggest that evidence for the efficacy of Internet‐ and mobile‐based interventions for STB remains limited.…”

“…These online literature searches were supplemented by (1) checking for any additional potentially eligible papers cited by included articles; (2) contacting all corresponding authors of included articles inquiring whether they have any other studies (published or not) that might be eligible for the review); and (3) checking reference lists of relevant reviews (Christensen et al., ; Lai et al., ; Perry et al., ; Witt et al., ).…”

A clinician's quick guide to evidence‐based approaches: Managing suicide risk in young people

“…Differentiation of non‐suicidal self‐harm and suicide risk should be made, as the two phenomena typically vary in function and management, though they may overlap (Orygen, ). Young people may be particularly likely to express suicidal intention via technology platforms and social media, and there is emerging evidence supporting the application of technology‐based interventions for young people with suicidal ideation (Hetrick et al, ; Witt et al, ).…”