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

Katrina Witt, Matthew J Spittal, Gregory Carter, Jane Pirkis, Sarah Hetrick, Dianne Currier, Jo Robinson, Allison Milner, Katrina Witt, Matthew J Spittal, Gregory Carter, Jane Pirkis, Sarah Hetrick, Dianne Currier, Jo Robinson, Allison Milner

Abstract

Background: Online 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.

Methods: Seven 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.

Results: Fourteen 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.

Conclusions: Most 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.

Keywords: Application; Digital; Mobile telephone; Self-harm; Suicide; Suicide ideation.

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval and participant consent were not required for this review, since the study involved review and analysis of previously published data.

Consent for publication

Not applicable.

Competing interests

Two of the authors of this review (SH, JR) were authors of one of the included studies. The remaining authors have no other competing interest to declare.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of included and excluded studies
Fig. 2
Fig. 2
Random effects odds ratio (OR) and accompanying 95% confidence interval (CI) for digital interventions on the proportion of participants reaching defined clinical thresholds for suicidal ideation
Fig. 3
Fig. 3
Random effects mean difference (MD) and accompanying 95% confidence interval (CI) for digital interventions on frequency of self-reported suicidal ideation
Fig. 4
Fig. 4
Random effects standard mean difference (SMD) and accompanying 95% confidence interval (CI) for digital interventions of suicidal ideation scores
Fig. 5
Fig. 5
Random effects mean difference (MD) and accompanying 95% confidence interval (CI) for digital interventions on frequency of self-reported self-cutting and non-suicidal self-injury (NSSI)

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