Effectiveness of mobile applications as intervention tools in suicidal ideation: a systematic review and meta-analysis

Cardoso, Nicolas de Oliveira; Salvador, Eduarda Zorgi; Tagliapietra, Ketlin da Rosa; Sanseverino, Marcela Alves; Vissoci, João Ricardo Nickenig; Machado, Wagner de Lara

doi:10.1590/1982-0275202340e210035

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REVIEW ARTICLE | Psychological Assessment • Estud. psicol. 40 • 2023 • https://doi.org/10.1590/1982-0275202340e210035 linkcopy

Effectiveness of mobile applications as intervention tools in suicidal ideation: a systematic review and meta-analysis

Eficácia dos aplicativos móveis como ferramentas de intervenção na ideação suicida: uma revisão sistemática e meta-análise

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective Evaluate the effectiveness of mobile applications developed for intervention in suicide risk in adults.

Method Searches for articles were carried out in four databases (PubMed, Web of Science, Scopus and PsychINFO). For the meta-analyses, we used fixed effect modelling to assess the primary outcome. The PROSPERO register is CRD42020163876.

Results After applying inclusion and exclusion criteria, six studies remained in the systematic review, of which four were eligible to the meta-analysis. There was no difference, or a little tendency in favor of control condition (usual treatment) comparing with applications.

Conclusion Applications can be as effective as standard treatments in reducing suicide ideation. The results should be interpreted with caution once all studies presented at least one bias in their study design.

Keywords
Mhealth; Mobile health; Smartphone; Telemedicine; Telepsychology

nº	Author / Country	Study Design	Treatment Length (n° of total sessions)	Sessions Frequency (minutes per use)	MAs	Control Condition	Outcome Measures² 2 For suicide risk.	Suicide Risk Reduction¹ 1 Based in outcome measures differences between pre/post intervention;
1	Denneson et al. (2019) / USA	RCT (Secondary Data)	12 weeks (NR)	Whenever needed (NR)	VHB	ETAU	BSS	Yes
2	O’Toole et al. (2019) / Denmark	RCT with 4-month follow-up	NR (9.4 ± 4.1)	Daily (NR)	LifeApp’tite	TAU	SSFIIR	Yes
3	Chen et al. (2018) / USA	RCT (Secondary Data)	12 weeks (86 median)	Whenever needed (109 median)	VHB	ETAU	BSS	Yes
4	Tighe et al. (2017) / Australia	RCT	6 weeks (NR)	NR	Ibobbly	Waitlist	DSI-SS	Yes
5	Bush et al. (2017) / USA	RCT	12 weeks (NR)	Whenever needed (NR)	VHB	ETAU	BSS	Yes
6	Franklin et al. (2016) / International	3 RCT with 1-month follow-up	4 weeks (NR)	Whenever needed (1-2)	TEC	Control TEC	SITBI	Yes

nº	Sample	Mean Age (SD)	Sex	Suicide Risk	Medication use (name)	Previous psychotherapy experience
1	117	47.5 (14.0)	80M; 37F	Suicidal ideation	Yes (NR)	Yes
2	129	28.7 (9.5)	45M; 84F	Suicidal ideation	NR	Yes
3	58	46.50 (13.7)	36M; 22F	Suicidal ideation	Yes (NR)	Yes
4	61	26.25 (8.13)	22M; 39F	Suicidal ideation	NR	Yes
5	118	47.5 (14.0)	81M; 37F	Suicidal ideation	Yes (NR)	Yes
6	114 [1]; 131 [2]; 163 [3]	23.02 (5.47) [1]; 22.91(4.99) [2]; 24.50 (6.61) [3]	22M; 92F [1]; 34M; 97F [2]; 65M; 98F [3]	Suicidal ideation (SITBs)	Yes (NR)	Yes

Study	Selection bias	Performance bias	Detection bias	Attrition bias	Reporting bias	Other bias
Study	Selection bias	Performance bias	Detection bias	Attrition bias	Reporting bias	Missing data bias	Treatment bias
Denneson et al. (2019) Chen et al. (2018) Bush et al. (2017)	-	+	-	-	?	+	-
O’Toole et al. (2019)	-	-	-	-	-	+	+
Tighe et al. (2017)	-	+	-	-	-	+	+
Franklin et al. (2016)	-	-	-	-	?	+	-

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Programa de Pós-Graduação em Psicologia, Pontifícia Universidade Católica de Campinas Editora Splendet, Pontifícia Universidade Católica de Campinas, Campus I, Rua Prof. Dr. Euryclides de Jesus Zerbini, 1516, Pq. Rural Fazenda Santa Cândida, Telefone: (55 19) 3343-7223. - Campinas - SP - Brazil
E-mail: psychologicalstudies@puc-campinas.edu.br

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[1] Note:

[TFN01] ¹
Based in outcome measures differences between pre/post intervention;

[TFN02] ²
For suicide risk.

[4] BSS: Beck Scale for Suicidal Ideation; DSI-SS: Depressive Symptom Inventory Suicidality Subscale; ETAU: Enhanced Treatment as Usual; NR: Not reported; RCT: Randomized Controlled Trial; SITBI: Self-Injurious Thoughts and Behaviors Interview; SSFIIR: Suicide Status Form II–R; TAU: Treatment as Usual; TEC:Therapeutic Evaluative Conditioning; VHB: Virtual Hope Box.