A Mobile Health Intervention (LifeBuoy App) to Help Young People Manage Suicidal Thoughts: Protocol for a Mixed-Methods Randomized Controlled Trial

Abstract

Background: Self-help smartphone apps offer a new opportunity to address youth suicide prevention by improving access tosupport and by providing potentially high fidelity and cost-effective treatment. However, there have been very few smartphoneapps providing evidence-based support for suicide prevention in this population. To address this gap, we developed the LifeBuoyapp, a self-help smartphone app informed by dialectical behavior therapy (DBT), to help young people manage suicidal thoughtsin their daily life.Objective: This study describes the protocol for a randomized controlled trial to evaluate the efficacy of the LifeBuoy app forreducing suicidal thoughts and behaviors, depression, anxiety, and psychological distress, and improving general mental well-beingin young adults aged 18 to 25 years.Methods: This is a randomized controlled trial recruiting 378 young adults aged between 18 and 25 years and comparing theLifeBuoy app with a matched attention control (a placebo app with the same display but no DBT components). The primaryoutcome is suicidal thoughts measured by the Suicidal Ideation Attributes Scale (SIDAS). The secondary outcomes are suicidalbehavior, depression, anxiety, psychological distress, and general mental well-being. The changes in the levels of insomnia,rumination, suicide cognitions, distress tolerance, loneliness, and help seeking before and after using the app are evaluated in thisstudy. The study also addresses risk factors and responses to the intervention. A series of items assessing COVID-19 experiencesis included in the trial to capture the potential impact of the pandemic on this study. Assessments will occur on the followingthree occasions: baseline, postintervention, and follow-up at 3 months postintervention. A qualitative interview about userexperience with the LifeBuoy app will take place within 4 weeks of the final assessment. Using linear mixed models, the primaryanalysis will compare the changes in suicidal thoughts in the intervention condition relative to the control condition. To minimizerisks, participants will receive a call from the team clinical psychologist by clicking a help button in the app or responding to anautomated email sent by the system when they are assessed with elevated suicide risks at the baseline, postintervention, and3-month follow-up surveys.Results: The trial recruitment started in May 2020. Data collection is currently ongoing.Conclusions: This is the first trial examining the efficacy of a DBT-informed smartphone app delivered to community-livingyoung adults reporting suicidal thoughts. This trial will extend knowledge about the efficacy and acceptability of app-basedsupport for suicidal thoughts in young people