Suicide prevention and depression apps’ suicide risk assessment and management: a systematic assessment of adherence to clinical guidelines

Abstract Background There are an estimated 800,000 suicides per year globally, and approximately 16,000,000 suicide attempts. Mobile apps may help address the unmet needs of people at risk. We assessed adherence of suicide prevention advice in depression management and suicide prevention apps to six evidence-based clinical guideline recommendations: mood and suicidal thought tracking, safety plan development, recommendation of activities to deter suicidal thoughts, information and education, access to support networks, and access to emergency counseling. Methods A systematic assessment of depression and suicide prevention apps available in Google Play and Apple’s App Store was conducted. Apps were identified by searching 42matters in January 2019 for apps launched or updated since January 2017 using the terms “depression,” “depressed,” “depress,” “mood disorders,” “suicide,” and “self-harm.” General characteristics of apps, adherence with six suicide prevention strategies identified in evidence-based clinical guidelines using a 50-question checklist developed by the study team, and trustworthiness of the app based on HONcode principles were appraised and reported as a narrative review, using descriptive statistics. Results The initial search yielded 2690 potentially relevant apps. Sixty-nine apps met inclusion criteria and were systematically assessed. There were 20 depression management apps (29%), 3 (4%) depression management and suicide prevention apps, and 46 (67%) suicide prevention apps. Eight (12%) depression management apps were chatbots. Only 5/69 apps (7%) incorporated all six suicide prevention strategies. Six apps (6/69, 9%), including two apps available in both app stores and downloaded more than one million times each, provided an erroneous crisis helpline number. Most apps included emergency contact information (65/69 apps, 94%) and direct access to a crisis helpline through the app (46/69 apps, 67%). Conclusions Non-existent or inaccurate suicide crisis helpline phone numbers were provided by mental health apps downloaded more than 2 million times. Only five out of 69 depression and suicide prevention apps offered all six evidence-based suicide prevention strategies. This demonstrates a failure of Apple and Google app stores, and the health app industry in self-governance, and quality and safety assurance. Governance levels should be stratified by the risks and benefits to users of the app, such as when suicide prevention advice is provided.

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Coroners' records on suicide mortality in Montréal: limitations and implications in suicide prevention strategies

Chronic Diseases and Injuries in Canada ◽

10.24095/hpcdp.34.1.04 ◽

2014 ◽

Vol 34 (1) ◽

pp. 23-29 ◽

Cited By ~ 2

Author(s):

J Houle ◽

C Guillou-Ouellette

Keyword(s):

Suicide Prevention ◽

Suicide Attempts ◽

Decision Makers ◽

The Other ◽

Suicide Mortality ◽

Prevention Strategies ◽

The People ◽

Local Decision ◽

Local Decision Makers ◽

Very High

Introduction In Montréal, the characteristics of suicide cases may vary between different areas. The information collected by coroners during their investigations of suicides could be used to support local suicide-prevention planning actions. Methods This study analyzes all coroners' records on suicide in Montréal from 2007 to 2009 to 1. determine the usefulness of the data available; 2. develop a profile of cases; 3. examine local differences by comparing two areas, one with the highest suicide rate and the other with the lowest. Results The data collected revealed the lack of a systematic, standardized procedure for recording information about deaths by suicide. The rates of missing data varied, but were very high for antecedents of suicide attempts and recent events that could have precipitated the suicide. We observed differences in the characteristics of suicide cases according to area of residence. Conclusion By adopting a standardized procedure for collecting information on cases of suicide, coroners could provide local decision makers with a more accurate portrait of the people who die by suicide in their area. Local adjustments may improve suicide-prevention strategies.

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Mental health apps education on depression: Systematic assessment (Preprint)

10.2196/preprints.28942 ◽

2021 ◽

Author(s):

Laura Martinengo ◽

Anne-Claire Stona ◽

Lorainne Tudor Car ◽

Jimmy Lee ◽

Konstadina Griva ◽

...

Keyword(s):

Mental Health ◽

Clinical Guidelines ◽

Help Seeking ◽

Support Network ◽

Evidence Based ◽

Educational Content ◽

Systematic Assessment ◽

Android Apps ◽

Symptoms Of Depression ◽

Health Apps

BACKGROUND Suboptimal understanding of depression and mental health disorders by the general population is an important contributor to the wide treatment gap in depression. Mental health literacy encompasses knowledge and beliefs about mental disorders and supports their recognition, management, and prevention. Besides knowledge improvement, psychoeducational interventions reduce symptoms of depression, enhance help-seeking behavior, and decrease stigma. Mental health apps often offer educational content, but the trustworthiness of included information is unclear OBJECTIVE To systematically evaluate adherence to depression clinical guidelines of the information offered by mental health apps available in major commercial app stores. METHODS A systematic assessment of the educational content about depression in apps available in Google Play and Apple’s App Store was conducted in July 2020. A systematic search for apps published or updated since January 2019 was performed using 42matters. Apps meeting inclusion criteria were downloaded and assessed using an iPhone 7 (iOS 14.0.1) and a Sony XPERIA XZs (Android 8.0.0) smartphones. The 156 questions assessment checklist comprised general characteristics of apps, appraisal of educational content and its adherence to evidence-based clinical guidelines, and technical aspects and quality assurance. Results were tabulated and reported as a narrative review, using descriptive statistics. RESULTS The app search retrieved 2,218 apps of which 58 were included in the analysis (29 Android apps and 29 iOS apps). Thirty-seven apps (64%) offered educational content within a more comprehensive depression or mental health management app. Twelve apps (21%) provided non-evidence-based information. Most apps (51/58, 88%) included up to 20/38 educational topics assessed. Common educational topics were listing symptoms of depression (52/58, 90%) and available treatments (48/58, 83%), particularly psychotherapy. Depression-associated stigma was mentioned by 38% of apps, while suicide risk was mentioned by 71% of apps, generally as one item in a list of symptoms. Forty-four (76%) apps highlighted the importance of help-seeking, and 50% of apps emphasized the importance of involving the user’s support network. Thirty apps (52%) referenced their content and ten apps (17%) included advertisements. CONCLUSIONS Information in mental health and depression apps is often brief and incomplete. One in five apps provided non-evidence-based information. Given the unmet needs and stigma associated with the disease, it is imperative that apps seize the opportunity to offer quality, evidence-based education and/or point the users to relevant resources. A multi-stakeholder consensus on a more stringent development and publication process for mental health apps is imperative.

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Suicide

Landmark Papers in Psychiatry ◽

10.1093/med/9780198836506.003.0022 ◽

2020 ◽

pp. 363-380

Author(s):

Danuta Wasserman ◽

Marcus Sokolowski ◽

Vladimir Carli

Keyword(s):

Suicide Prevention ◽

Cause Of Death ◽

Suicidal Behaviour ◽

Physician Education ◽

Future Research ◽

Evidence Based ◽

Prevention Strategies ◽

Iatrogenic Effects ◽

School Based ◽

Prevention Programmes

Suicide is a leading cause of death and is preventable. This chapter identifies landmark papers from three areas within the field of suicide prevention that are important for trainees, experienced clinicians, and policymakers alike. Firstly, it reviews papers on evidence-based suicide prevention strategies. Physician education, pharmacological and psychotherapy treatments, school-based suicide prevention programmes, and means of suicide restriction are found to be effective in preventing suicidal behaviours. Suicide prevention strategies that require further research on efficacy are identified, along with directions for future research. Secondly, several papers are analysed providing evidence that talking about suicide does not cause iatrogenic effects. Suicide research and prevention should not be hindered due to unsubstantiated concerns. Lastly, a paper discussing the genetics of suicidal behaviour provides an understanding of the diathesis of suicide. These landmark papers highlight the importance of suicide prevention and inform future research.

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Restricting Access to Methods of Suicide

Crisis ◽

10.1027/0227-5910.28.s1.4 ◽

2007 ◽

Vol 28 (S1) ◽

pp. 4-9 ◽

Cited By ~ 81

Author(s):

Keith Hawton

Keyword(s):

Suicide Prevention ◽

Suicidal Behavior ◽

Suicide Attempts ◽

Prevention Strategies ◽

Long Term Survivors ◽

Methods Of Suicide

Abstract. Restriction of access to means for suicidal behavior, especially dangerous methods, is a key element in most national suicide prevention strategies. In this paper the rationale for this is discussed, including the fact that suicidal impulses are often brief, that availability of a method may influence both the occurrence and outcome of a suicidal act, and that if a favored means becomes less available it does not always result in substitution by another method. Examples of evidence for the effectiveness of restricting availability of suicidal methods on subsequent suicidal behavior are presented, plus the supporting findings from studies of long-term survivors of serious suicide attempts in which only a minority have gone on to die in subsequent suicide attempts. Finally, factors likely to determine the effectiveness of modifying access to means for suicide are considered, together with the main elements that need to be addressed in evaluation.

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Best Practice Elements of Multilevel Suicide Prevention Strategies

Crisis ◽

10.1027/0227-5910/a000109 ◽

2011 ◽

Vol 32 (6) ◽

pp. 319-333 ◽

Cited By ~ 129

Author(s):

Christina M. van der Feltz-Cornelis ◽

Marco Sarchiapone ◽

Vita Postuvan ◽

Daniëlle Volker ◽

Saska Roskar ◽

...

Keyword(s):

Best Practices ◽

Suicide Prevention ◽

Systematic Reviews ◽

Best Practice ◽

Suicide Attempts ◽

Synergistic Effects ◽

Data Extraction ◽

Evidence Based ◽

Practice Elements ◽

Multilevel Interventions

Background: Evidence-based best practices for incorporation into an optimal multilevel intervention for suicide prevention should be identifiable in the literature. Aims: To identify effective interventions for the prevention of suicidal behavior. Methods: Review of systematic reviews found in the Pubmed, Cochrane, and DARE databases. Steps include risk-of-bias assessment, data extraction, summarization of best practices, and identification of synergistic potentials of such practices in multilevel approaches. Results: Six relevant systematic reviews were found. Best practices identified as effective were as follows: training general practitioners (GPs) to recognize and treat depression and suicidality, improving accessibility of care for at-risk people, and restricting access to means of suicide. Although no outcomes were reported for multilevel interventions or for synergistic effects of multiple interventions applied together, indirect support was found for possible synergies in particular combinations of interventions within multilevel strategies. Conclusions: A number of evidence-based best practices for the prevention of suicide and suicide attempts were identified. Research is needed on the nature and extent of potential synergistic effects of various preventive activities within multilevel interventions.

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Evidence-based suicide prevention strategies during and after the COVID-19 pandemic

Oxford Textbook of Suicidology and Suicide Prevention ◽

10.1093/med/9780198834441.003.0096 ◽

2021 ◽

pp. 795-800

Author(s):

Danuta Wasserman ◽

Vladimir Carli

Keyword(s):

Public Health ◽

Health Care ◽

Protective Factors ◽

Suicide Prevention ◽

Ecological Model ◽

Risk And Protective Factors ◽

Evidence Based ◽

Prevention Strategies ◽

Suicide Rates ◽

The Impact

Evidence has shown that during times of crises, suicide rates can decrease but tend to increase as the crisis alleviates. The consequences of the global COVID-19 pandemic, whether direct or indirect, will be far reaching. In this chapter the impact of the pandemic on the risk and protective factors of suicide, grouped according to the socio-ecological model at individual, relationship, community, and society levels, is described. To prevent unnecessary suicides, the effects of Covid-19 pandemic, on health care and public health suicide prevention strategies, and recommendations for implementation are presented.

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Preventing Suicide in Detention and Correctional Facilities

10.1093/oxfordhb/9780199948154.013.25 ◽

2016 ◽

Author(s):

Robert D. Canning ◽

Joel A. Dvoskin

Keyword(s):

Suicide Prevention ◽

Best Practice ◽

Suicide Attempts ◽

Clinical Care ◽

The United States ◽

National Standards ◽

Individual Risk ◽

Correctional Facilities ◽

Prevention Strategies ◽

Essential Components

This essay describes and critiques suicide-prevention strategies in prison, including the extent to which screening and prevention programs are used in the United States. The epidemiology of suicide and suicide attempts in both jails and prisons is reviewed, with discussions of differences in suicide risk by demographic factors, individual risk and suicide protective factors, and contextual factors. A cross-section of legal cases leading to the establishment of a legal basis for suicide prevention in US correctional facilities is provided, followed by an overview of current national standards and best practice guidelines for preventing inmate suicides. The essential components of correctional suicide-prevention strategies are described and critiqued, including core values at the center of these strategies, aspects of most effective systems management, and evidenced-based clinical care. Finally, special considerations for different types of confinement settings are described.

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The development and evaluation of an evidence-based suicide prevention strategy in Flanders (Belgium)

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1215 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Dumon ◽

G Portzky

Keyword(s):

Suicide Prevention ◽

Health Professionals ◽

Suicide Attempts ◽

Risk Groups ◽

Prevention Strategy ◽

Evidence Based ◽

Online Help ◽

Suicide Rates ◽

The Government ◽

Year 2000

Abstract Background Suicide rates in Belgium have been consistently high, with a current prevalence of 15.1 suicides per 100.000 inhabitants, which is 1.5 times higher than the European average. In Flanders (northern part of Belgium) more than 10.000 suicide attempts are being registered every year and studies show that 13 % of the population reports a lifetime history of suicidal thoughts. Since 2006 an extensive Suicide Prevention Strategy has been implemented in Flanders, aiming to decrease the Flemish suicide rate by 20% by 2020 (baseline year 2000). Methods The Suicide Prevention Strategy has been developed by a team of experts, involving multiple stakeholders and the lay public. The 'Flemish Centre of Expertise in Suicide Prevention' (VLESP) was launched by the government to coordinate and monitor the prevention campaigns, tools and interventions included in the strategy, and to study their effectiveness. Results The Suicide Prevention Strategy includes five key strategies namely: 1) mental health promotion, 2) providing helplines and online help, 3) educating health professionals and community facilitators, 4) developing programs targeting high risk groups, 5) developing and implementing targeted suicide prevention guidelines for health professionals and other key gatekeepers. A range of innovative suicide prevention tools and interventions, such as an e-learning course for health professionals, smartphone applications and group therapies for suicidal individuals, have been developed and positively evaluated. In 2017 (in comparison with the year 2000) suicide rates in men decreased with 27% and suicide rates in women with 26%. For suicide attempts, a decrease of 19% was noted. Conclusions Suicide prevention is a public health priority in Flanders. A combination of evidence-based tools and interventions have been developed and assessed in the past years, resulting in a decrease in suicide rates.

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Problematic Advice From Suicide Prevention Experts

Ethical Human Psychology and Psychiatry ◽

10.1891/1559-4343.20.2.79 ◽

2018 ◽

Vol 20 (2) ◽

pp. 79-85 ◽

Cited By ~ 2

Author(s):

Heidi Hjelmeland ◽

Katrina Jaworski ◽

Birthe L. Knizek ◽

Ian Marsh

Keyword(s):

Systematic Review ◽

Side Effects ◽

Suicide Prevention ◽

Suicide Rate ◽

Pharmacological Treatment ◽

Evidence Based ◽

Prevention Strategies ◽

Treatment Of Depression ◽

The Many ◽

Suicide Prevention Programs

Based on a 10-year systematic review of suicide prevention strategies, “29 suicide prevention experts from 17 European countries” recommend 4 allegedly evidence-based strategies to be included in national suicide prevention programs. One of the recommended strategies is pharmacological treatment of depression. This recommendation is problematic for several reasons. First, it is based on a biased selection and interpretation of available evidence. Second, the authors have failed to take into consideration the widespread corruption in the research on antidepressants. Third, the many and serious side effects of antidepressants are not considered. Thus, the recommendation may have deleterious consequences for countless numbers of people, and, in fact, contribute to an increase in the suicide rate rather than a decrease.

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A Comparison of Attitudes Toward Suicide Among Individuals With and Without Suicidal Thoughts and Suicide Attempts in South Korea

Crisis ◽

10.1027/0227-5910/a000528 ◽

2019 ◽

Vol 40 (1) ◽

pp. 27-35 ◽

Cited By ~ 2

Author(s):

Sang-Uk Lee ◽

Mina Jeon ◽

Jong-Ik Park

Keyword(s):

Suicide Attempt ◽

South Korea ◽

Suicide Prevention ◽

Suicide Attempts ◽

Suicidal Thought ◽

Suicidal Thoughts ◽

Cross Sectional ◽

Suicidal Person ◽

History Of ◽

Attitudes Toward Suicide

Abstract. Background: A suicidal person can go through different stages that include suicidal thoughts and suicide attempts. For a few individuals, these can end up with suicide. However, there have been no studies investigating any differences in attitudes toward suicides among individuals with no suicidal thoughts, those with suicidal thoughts, and those with suicide attempts. Aims: This study was carried out to compare attitudes toward suicide among three different groups: individuals with a history of no suicidal thoughts, those with a history of suicidal thoughts, and those with a history of suicide attempts. Method: To examine Koreans' attitudes toward suicide, we analyzed the data from the 2013 National Suicide Survey involving 1,500 participants aged between 19 and 75 years. Results: Different attitudes toward suicide were found among the three groups. Persons reporting that they had made a suicide attempt in their life showed the most permissive attitudes toward suicide. Limitations: Since this research is based on cross-sectional data, it is difficult to eliminate the possibility of changes in attitude toward suicide completely after having a suicidal thought and suicide attempt. Conclusion: These results can be a useful source for constructing effective messages for suicide prevention campaigns and can ultimately contribute to an improvement in the public's perceptions of suicide in the future.

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