Objectives Rates of youth suicide in Australian Indigenous communities are 4 times the national youth average and demand innovative interventions. Historical and persistent disadvantage is coupled with multiple barriers to help seeking. Mobile phone applications offer the opportunity to deliver therapeutic interventions directly to individuals in remote communities. The pilot study aimed to evaluate the effectiveness of a self-help mobile app (ibobbly) targeting suicidal ideation, depression, psychological distress and impulsivity among Indigenous youth in remote Australia.
Setting Remote and very remote communities in the Kimberley region of North Western Australia.
Participants Indigenous Australians aged 18–35 years.
Interventions 61 participants were recruited and randomised to receive either an app (ibobbly) which delivered acceptance-based therapy over 6 weeks or were waitlisted for 6 weeks and then received the app for the following 6 weeks.
Primary and secondary outcome measures The primary outcome was the Depressive Symptom Inventory—Suicidality Subscale (DSI-SS) to identify the frequency and intensity of suicidal ideation in the previous weeks. Secondary outcomes were the Patient Health Questionnaire 9 (PHQ-9), The Kessler Psychological Distress Scale (K10) and the Barratt Impulsivity Scale (BIS-11).
Results Although preintervention and postintervention changes on the (DSI-SS) were significant in the ibobbly arm (t=2.40; df=58.1; p=0.0195), these differences were not significant compared with the waitlist arm (t=1.05; df=57.8; p=0.2962). However, participants in the ibobbly group showed substantial and statistically significant reductions in PHQ-9 and K10 scores compared with waitlist. No differences were observed in impulsivity. Waitlist participants improved after 6 weeks of app use.
Conclusions Apps for suicide prevention reduce distress and depression but do not show significant reductions on suicide ideation or impulsivity. A feasible and acceptable means of lowering symptoms for mental health disorders in remote communities is via appropriately designed self-help apps.
Trial registration number ACTRN12613000104752.
- Aboriginal and Torres Strait Islander
- Suicide Prevention
- Indigenous Australian
- Acceptance and Commitment Therapy
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Collaborators JT made a substantial contribution to the study design, Indigenous community partnerships management, recruitment, data interpretation, statistical analyses and writing of this manuscript. FS and HC made a substantial contribution to the study design, data interpretation and writing. RR assisted with several elements of the study design. She was responsible for garnering ethics approval across several committees, as well as setting up online data managements systems. RR provided the project management for the creation of the app which included consolidating text, graphics and voice overs content. She also assisted in the editing of this manuscript. AM made a substantial contribution to the trial design, statistical analyses, production of figures, interpretation of the data, writing the manuscript and critically reviewing the manuscript. NDLM assisted with the analysis plan of the data and ensured the appropriate statistical methods were selected and validated statistical analyses. NDLM provided feedback on the draft manuscripts and approved of the final manuscript.
Funding The trial was funded by the Australian Government Department of Health and Ageing.
Competing interests None declared.
Ethics approval University of New South Wales Human Ethics Committee (Ref:HC13025), the Western Australian Aboriginal Health Ethics Committee (Ref:486) and the Kimberley Aboriginal Health Planning Forum (Ref:2013-006).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Additional data can be accessed via the Dryad data repository at http://datadryad.org/ with the doi:10.5061/dryad.860kn.
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