A study led by Nanyang Technological University, Singapore (NTU Singapore) found that most (93%) mobile apps for suicide prevention and depression management do not provide all the six suicide prevention strategies that are commonly recommended in international clinical guidelines.

International guidelines from the UK, US and the World Health Organization (WHO) recommend six evidence-based strategies for preventing suicide: 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.

Through a systematic assessment of health apps on Apple’s App Store and Google Play, the team led by Associate Professor Josip Car from the NTU Lee Kong Chian School of Medicine found that less than one in ten provided the full set of strategies for suicide prevention set out in international guidelines from the UK, US and the WHO.

Most apps included at least three suicide prevention approaches, most commonly emergency contact information (94% of apps tested), direct access to a crisis helpline (67%) and suicide-related education (51%).

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.

HOW THE STUDY WAS DONE

There are about 318,000 healthcare apps globally today on the Apple App store and Google Play, of which more than 10,000 are mental health apps. But even as digital mental health interventions seem to offer a promising alternative to in-person visits, researchers still found that very few apps available in the app stores have been evaluated in clinical trials or by regulatory bodies.

In this study, the NTU-led team looked at 69 apps sourced through a systematic search on Apple’s App Store and Google Play. 20 were depression management apps and 46 suicide prevention apps. Of the 69, 3 apps 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.

The study was supported by NTU and included collaborators from Imperial College London, the Institute of Mental Health, Singapore, University of Split, Queensland University of Technology and Amsterdam University Medical Centre.

THE LARGER TREND

In June 2019, a new meta data study published in npj Digital Medicine found an overall lack of standardized measures for the quality and effectiveness of mental and behavioral health apps, MobiHealthNews reported. In the study analysis, researchers found that there was no one single framework used to evaluate the most frequently downloaded apps.

ON THE RECORD

“Some patients may feel more at ease discussing their mental condition online than in person. 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,” said Assoc Prof Car, Director of NTU’s Centre for Population Health Sciences.

“However, for this to become a reality, health app development and release should follow a transparent, evidence-based model,” added Assoc Prof Car, who also leads NTU’s WHO Collaborating Centre for Digital Health and Health Education.