Most (93 percent) mobile apps for suicide prevention and depression management do not provide all six suicide prevention strategies commonly recommended in international clinical guidelines, according to a new study led by Nanyang Technological University (NTU), Singapore.
Currently, there are more than 10,000 mental health apps available on the Apple App store and Google Play. But even as digital mental health interventions seem to offer a promising alternative to in-person visits, very few apps available in the app stores have been evaluated in clinical trials or by regulatory bodies.
The study, published online in the journal BMC Medicine, highlights the need for responsible design and creation of guidelines for apps that could have a significant impact on people’s lives.
For preventing suicide, international guidelines from the UK, US and the World Health Organization (WHO) recommend six evidence-based strategies: the tracking of mood and suicidal thoughts, development of a safety plan, recommendation of activities to deter suicidal thoughts, information and educational articles on signs of suicidality, access to support networks, and emergency counselling.
The majority of the apps surveyed in the study provided emergency contact information and direct access to a crisis helpline but the researchers found that less than one in ten provided the full set of strategies for suicide prevention.
Most apps included at least three suicide prevention approaches, most commonly emergency contact information (94 percent of apps tested), direct access to a crisis helpline (67 percent) and suicide-related education (51 percent).
Incorrect emergency telephone numbers were found in several apps available worldwide. Among the apps providing incorrect information were two that had been downloaded more than one million times each.
“Some patients may feel more at ease discussing their mental condition online than in person,” said Associate Professor Josip Car from the Lee Kong Chian School of Medicine (LKCMedicine) at NTU Singapore, who is Director of NTU’s Centre for Population Health Sciences.
“They also consider the Internet accessible, affordable and convenient. With the high rates of smartphone use around the world, health apps can be a crucial addition in the way users manage their health and wellbeing on a global scale.”
“However, for this to become a reality, health app development and release should follow a transparent, evidence-based model,” said Car, who also leads NTU’s WHO Collaborating Centre for Digital Health and Health Education.
In this study, the NTU-led team looked at 69 apps sourced through a systematic search on Apple’s App Store and Google Play. A total of 20 were depression management apps and 46 were suicide prevention apps.
Of the 69 apps, three covered both conditions. The apps were identified based on keywords used to describe them and selected through a set of criteria including the stated target users, and provision of advice to prevent suicide attempts. The researchers then assessed the apps against the clinical strategies stated in the international guidelines, using a series of 50 criteria-based questions.
Wong Lai Chun, senior assistant director at Samaritans of Singapore, a non-profit organization focused on crisis intervention and suicide prevention, advised against over-reliance on mobile apps.
“As suicide is a complex and multifaceted issue, intervention should not be replaced by mobile applications but rather, act as a complement to the existing pool of resources,” Wong said.
“The findings in the study raised the worrying issue of inaccurate information and the lack of quality assurance for apps that are accessible to the general public. It is vital that mobile application developers ensure the information in their apps is kept up-to-date.”
Source: Nanyang Technological University