The feasibility of using smartphone apps to manage self-harm and suicidal acts in adolescents admitted to an inpatient mental health ward

Abstract

Objective The aim of this study is to assess the feasibility (uptake, retention and adherence) and acceptability of a combination of smartphone apps to deliver a digitized safety plan, BeyondNow, and personalized management strategies, BlueIce, with adolescents discharged from a mental health inpatient ward following self-harm, suicidal ideation and/or behavior. Methods Participants in this pre-post pilot study included 20 adolescents between 13–18 years, presenting with self-harming or suicidal behaviors in an inpatient psychiatric ward at a tertiary pediatric hospital. Participants were familiarized with the apps and completed baseline measures prior to discharge. They used the apps for six weeks before completing the follow-up survey, which measured feasibility and acceptability of the apps, as well as suicide resilience. Results Seventeen participants completed the pilot. Most of the sample accessed both apps at least once, three accessed the BeyondNow safety plan five times or more, and six used the BlueIce toolbox five times or more. A total of 73.5% of the sample that experienced a crisis used at least one of the apps at least once. Forty seven percent felt that the apps would not keep them safe when in crisis, although almost all of the sample rated both apps as easy to use (94% for BeyondNow, and 82% for BlueIce). Medium to large effect sizes were also found with regard to improvements in suicide resilience. Conclusion Both apps were found to be feasible and acceptable in this population, and easy to use, although no conclusions can be drawn regarding the clinical efficacy of the apps.

Suicide Prevention in Your Pocket: A Systematic Review of Ecological Momentary Interventions for the Management of Suicidal Thoughts and Behaviors

“…Additionally, some interventions that were not based on safety planning included at least one element of this approach, such as the possibility of contacting family members or professionals in case of need 18,19,24,25,29,30,33,34 …”

“…Four of the safety plan–based interventions had studies evaluating their effectiveness. BeyondNow had two studies, 17,18 while BackUp, 15 Brite, 21 and LifeApp’tite 26 had one study each. In two of these interventions —BeyondNow and LifeApp’tite—suicidal ideation showed a significant decrease, 17,26 or other symptoms, such as emotional instability, improved 18 .…”

“…BeyondNow had two studies, 17,18 while BackUp, 15 Brite, 21 and LifeApp’tite 26 had one study each. In two of these interventions —BeyondNow and LifeApp’tite—suicidal ideation showed a significant decrease, 17,26 or other symptoms, such as emotional instability, improved 18 . In the other two interventions, the decrease in suicidal ideation was not significant 15,21 …”

“…[18][19][20][21]31,32,34,40 Two of the three studies in which effectiveness was tested in this population showed a (statistically) significant reduction of STB or other symptoms after the intervention. 18,19 Another four studies -three interventionsfocused on young adults. 24,25,28,36 In the studies in which effectiveness was tested, either STB were reduced 28 or other symptoms improved.…”

“…24,25,28,36 In the studies in which effectiveness was tested, either STB were reduced 28 or other symptoms improved. 24 Regarding the methods used to assess and quantify suicidal ideation and other related constructs, most studies employed standardized questionnaires administered by trained raters, such as the Columbia Suicide Severity Rating Scale, 17,21,30,35 Beck Scale for Suicide Ideation, 15,30 Suicide Resilience Inventory, 18 Suicidal Ideation Questionnaire-Junior, 21 Suicide Status Form, 26 Depressive Symptom Inventory-Suicidality Subscale, 24,25 or Self-Injurious Thoughts and Behaviors Interview. 23,28 Other studies relied on questionnaires created ad hoc for the project.…”