Effectiveness of a digital app to manage suicidal thoughts and behaviours in young people
What's the issue?
Digital interventions are an accessible and flexible way to support management of mental health conditions, and suicidal thoughts and behaviours. Research shows that many young people prefer to engage with digital-based support for mental health conditions due to privacy, accessibility and low exposure to stigma.
In Australia, suicide is the leading cause of death for young people aged 15-24 years. Evidence shows that 60% of first attempts of suicide in young people occurred within 12 months of experiencing suicidal thoughts and behaviours.
Digital support interventions can play an important role in the prevention and management of suicidal thoughts and behaviours.
Engagement with digital interventions can influence their effectiveness. The effectiveness of a digital support intervention may be compromised if a person doesn’t use it in the recommended ways.
Digital engagement strategies to encourage the use of support apps may help to increase use and improve their effectiveness.
What was done?
Researchers tested the effectiveness of a digital app, LifeBuoy in preventing and managing suicidal thoughts and behaviours. Frequency of use was also tested to determine if this may impact effectiveness of the app.
LifeBuoy is a smart phone-based app for young adults with suicidal thoughts and behaviours, and is based on a cognitive behavioural therapy (CBT) approach. CBT helps people identify and challenge unhelpful thoughts, and to learn practical self-help strategies.
There were 692 research participants included in the study. Research participants were people aged 17–24 years (inclusive) residing in Australia who had experienced suicidal thoughts in the past 30 days. 481 were female, 99 were male, 97 identified as non-binary and 15 participants preferred not to answer. Eligible research participants spoke fluent English and owned a compatible smart phone.
Young people receiving professional support at the time of the study were still eligible to participate. However young people who had been diagnosed with a psychotic or bipolar disorder in the preceding 30 days were excluded.
Participants were randomly assigned to one of three study groups:
- Group 1: LifeBuoy app only
- Group 2: LifeBuoy app plus a digital engagement strategy designed to encourage participants to use the app
- Group 3: A control app (sham app that looked and operated like LifeBuoy and was matched for task and time expectancy to control for digital placebo effects).
Participants were recruited online, via Black Dog Institute's social media channels (Instagram, Facebook and X). The study sample included:
- People who had attempted suicide at least once in their lifetime (59.5% of participants)
- People who had engaged in non-suicidal self-harm in their lifetime (89.5% of participants)
- People who were involved in psychological support therapy or taking prescribed medicines for mental health (63.0% of participants).
The research questions for the study were:
- Whether the LifeBuoy app (intervention) would be more effective than a control (sham app) in reducing suicidal ideation intensity in adolescents and young adults; and
- Whether a digital ‘engagement’ strategy delivered alongside LifeBuoy would lead to greater levels of app engagement (greater app module completion and greater number of app logins) compared to using the LifeBuoy app alone.
Data was recorded at 30-, 60- and 120-day interval periods. Suicidal thoughts and behaviours were recorded by the Suicidal Ideation Attributes Scale (SIDAS). Anxiety symptoms were measured using the seven-item Generalised Anxiety Disorder-7 scale (GAD-7).
What was found?
The researchers found that:
- Young people who engaged with the LifeBuoy app reported significantly greater reductions in their suicidal thoughts for up to three months.
- The severity of suicidal thoughts was reduced in the group assigned the LifeBuoy app in comparison to the control group at 60 day and 120 intervals (sham app).
- During the study period, 6.1% of the total study sample presented to hospital for a suicide attempt or non-suicidal self-harm. The adverse events were most common in the group receiving the control intervention (61%) compared to groups using the LifeBuoy app (39%).
- There was no significant difference between depression scores for the first 30 days of the study between all groups. Depression scores were lower however in Group 1 and 2 between the 60- and 120-day intervals.
- There was no significant difference in the number of participants who attempted suicide between Group 1 and 2.
Why are the findings important?
The group receiving the LifeBuoy app recorded less adverse outcomes than the group receiving the sham app, demonstrating the potential for self-guided therapeutic apps to support early intervention, reducing the level of distress and preventing suicidal thoughts from escalating into harm.
Young people exposed to the LifeBuoy app reported significantly greater reductions in their suicidal ideation for up to three months.
The results from this study found no significant difference in the prevention of suicidal thoughts and behaviours between the group receiving the LifeBuoy app, and the group receiving the app plus additional resources to promote engagement with the app. The additional materials did not enhance the effects of the LifeBuoy app. The researchers suggest that incorporating artificial intelligence (AI) as part of an app may create a tailored experience for young people and encourage engagement.
The protective effects of the app were seen at the longer study intervals, suggesting that skills for the effective self-management of suicidal thoughts and behaviours in young people may take a minimum of six weeks to develop.