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18 & 19: Self-Guided Digital Interventions & Technology-based Tools

Risk Management and Treatment » Technology-based Modalities
18 & 19: Self-Guided Digital Interventions & Technology-based Tools

18

We suggest the use of self-guided digital interventions (app or web) that include, but are not limited to, cognitive behavioral-therapeutic content for short-term reduction in suicidal ideation.

Strength:

Weak for

Category:

ReviewedNew-replaced

19

There is insufficient evidence to recommend for or against the use of standalone or adjunctive technology-based tools (e.g., mobile and web apps, automated telephone-based) to reduce the risk of suicide attempts or suicide.

Strength:

Neither for nor against

Category:

ReviewedNew-replaced

Grades and Definitions

Strong for
or "We recommend offering this option …"
Weak for
or "We suggest offering this option …"
No recommendation
or "There is insufficient evidence …"
Weak against
or "We suggest not offering this option …"
Strong against
or "We recommend against offering this option …"

Categories and Definitions

Evidence Reviewed* Recommendation Category* Definition*
Reviewed New-added New recommendation following review of the evidence
New-replaced Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence
Not changed Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed based on review of the evidence
Not reviewed Not changed Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG
*Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72.

Recommendation Resources

Digital health care technology can be defined broadly as software programs, websites, apps, and other internet or computerized resources that facilitate the delivery of self-guided care, health and user learning. The Work Group found weak evidence to support the use of self-guided digital interventions that directly target suicidal ideation and support behaviors to reduce suicidal ideation. Studies evaluating the effect of technology-based interventions as adjuncts to routine suicide prevention treatment are rare.

Training and Clinical Resources

This section includes recommended training and/or clinical resources about self-guided digital interventions and technology-based tools.

VA Virtual Care Tools
Clinician's Guide: VA Virtual Care Tools
VA Veteran Training
Sleep EZ
Moving Forward
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Videos

This section includes recommended videos about self-guided digital interventions and technology-based tools.

VA Digital Tools for Veteran Health Care Delivery and Self-Care Management
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Webinars

This section includes recommended webinars about self-guided digital interventions and technology-based tools.

CPG Webinar iconDigital Delivery of Treatment Protocols as Upstream and Downstream Suicide Prevention Strategies: State of the Science Presenters: Drs. Lisa A. Brenner & Carolyn Greene
CPG Webinar iconSuicide Prevention 2.0 Clinical Telehealth Program Presented by Dr. Jessica Walker
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Mobile Apps

This section includes recommended mobile applications about self-guided digital interventions and technology-based tools.

VA Mobile App Store
My Healthy Vet Mobile App
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Podcasts

This section includes recommended podcasts about self-guided digital interventions and technology-based tools.

Rocky Mountain MIRECC Short Takes on Suicide Prevention
Short Takes podcast icon A Mobile Safety Planning App with Dr. Pearl McGee-Vincent
Short Takes podcast icon Insomnia, Treatment, and Finding a Path to Better Sleep with Drs. Carolyn Green and Andrew Moon
Short Takes podcast icon Talking to T2 about Mobile Apps for Mental Health
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Articles

This section includes recommended articles about self-guided digital interventions and technology-based tools.

Betthauser, L. M., Stearns-Yoder, K. A., McGarity, S., Smith, V., Place, S., & Brenner, L. A. (2020). Mobile App for Mental Health Monitoring and Clinical Outreach in Veterans: Mixed Methods Feasibility and Acceptability Study. Journal of medical Internet research, 22(8). e15506. https://doi.org/10.2196/15506
Büscher, R., Torok, M., Terhorst, Y., & Sander, L. (2020). Internet-Based Cognitive Behavioral Therapy to Reduce Suicidal Ideation: A Systematic Review and Meta-analysis. JAMA network open, 3(4), e203933. https://doi.org/10.1001/jamanetworkopen.2020.3933
Bush, N. E., Smolenski, D. J., Denneson, L. M., Williams, H. B., Thomas, E. K., & Dobscha, S. K. (2017). A Virtual Hope Box: Randomized Controlled Trial of a Smartphone App for Emotional Regulation and Coping With Distress. Psychiatric services (Washington, D.C.). 68(4), 330–336. https://doi.org/10.1176/appi.ps.201600283
Christensen, H., Farrer, L., Batterham, P. J., Mackinnon, A., Griffiths, K. M., & Donker, T. (2013). The effect of a web-based depression intervention on suicide ideation: secondary outcome from a randomised controlled trial in a helpline. BMJ open, 3(6). e002886. https://doi.org/10.1136/bmjopen-2013-002886
Comendador, L., Cebrià, A. I., Sanz, A., Pérez, V., & Palao, D. (2023). Telephone-Delivered Interventions for Suicide Prevention in Schizophrenia and Related Disorders: A Systematic Review. Healthcare (Basel, Switzerland). 11(3), 432. https://doi.org/10.3390/healthcare11030432
Depp, C. A., Parrish, E. M., Chalker, S. A., Ehret, B. C., Kamarsu, S., Perivoliotis, D., & Granholm, E. (2023). Pilot feasibility trial of a brief mobile-augmented suicide prevention intervention for serious mental illness. Psychiatric rehabilitation journal, 46(1). 74–82. https://doi.org/10.1037/prj0000547
Dimeff, L. A., Jobes, D. A., Koerner, K., Kako, N., Jerome, T., Kelley-Brimer, A., Boudreaux, E. D., Beadnell, B., Goering, P., Witterholt, S., Melin, G., Samike, V., & Schak, K. M. (2021). Using a Tablet-Based App to Deliver Evidence-Based Practices for Suicidal Patients in the Emergency Department: Pilot Randomized Controlled Trial. JMIR mental health, 8(3). e23022. https://doi.org/10.2196/23022
Guille, C., Zhao, Z., Krystal, J., Nichols, B., Brady, K., & Sen, S. (2015). Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns: A Randomized Clinical Trial. JAMA psychiatry, 72(12). 1192–1198. https://doi.org/10.1001/jamapsychiatry.2015.1880
Kasckow, J., Zickmund, S., Gurklis, J., Luther, J., Fox, L., Taylor, M., Richmond, I., & Haas, G. L. (2016). Using telehealth to augment an intensive case monitoring program in veterans with schizophrenia and suicidal ideation: A pilot trial. Psychiatry research, 239. 111–116. https://doi.org/10.1016/j.psychres.2016.02.049
King, T. L., Fleitas Alfonzo, L., Batterham, P., Mackinnon, A., Lockwood, C., Harvey, S., Kelly, B., Lingard, H., Cox, L., & LaMontagne, T. D. (2023). A blended face-to-face and smartphone intervention to improve suicide prevention literacy and help-seeking intentions among construction workers: a randomised controlled trial. Social psychiatry and psychiatric epidemiology, 58(6). 871–881. https://doi.org/10.1007/s00127-023-02429-9
King, C. A., Eisenberg, D., Zheng, K., Czyz, E., Kramer, A., Horwitz, A., & Chermack, S. (2015). Online suicide risk screening and intervention with college students: a pilot randomized controlled trial. Journal of consulting and clinical psychology, 83(3). 630–636. https://doi.org/10.1037/a0038805
Leavey, K., & Hawkins, R. (2017). Is cognitive behavioural therapy effective in reducing suicidal ideation and behaviour when delivered face-to-face or via e-health? A systematic review and meta-analysis. Cognitive behaviour therapy, 46(5). 353–374. https://doi.org/10.1080/16506073.2017.1332095
Sarubbi, S., Rogante, E., Erbuto, D., Cifrodelli, M., Sarli, G., Polidori, L., Lester, D., Berardelli, I., & Pompili, M. (2022). The Effectiveness of Mobile Apps for Monitoring and Management of Suicide Crisis: A Systematic Review of the Literature. Journal of clinical medicine, 11(19). 5616. https://doi.org/10.3390/jcm11195616
Simon, G. E., Shortreed, S. M., Rossom, R. C., Beck, A., Clarke, G. N., Whiteside, U., Richards, J. E., Penfold, R. B., Boggs, J. M., & Smith, J. (2022). Effect of Offering Care Management or Online Dialectical Behavior Therapy Skills Training vs Usual Care on Self-harm Among Adult Outpatients With Suicidal Ideation: A Randomized Clinical Trial. JAMA, 327(7). 630–638. https://doi.org/10.1001/jama.2022.0423
Torok, M., Han, J., Baker, S., Werner-Seidler, A., Wong, I., Larsen, M. E., & Christensen, H. (2020). Suicide prevention using self-guided digital interventions: a systematic review and meta-analysis of randomised controlled trials. The Lancet. Digital health, 2(1). e25–e36. https://doi.org/10.1016/S2589-7500(19)30199-2
Witt, K., Spittal, M. J., Carter, G., Pirkis, J., Hetrick, S., Currier, D., Robinson, J., & Milner, A. (2017). Effectiveness of online and mobile telephone applications ('apps') for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis. BMC psychiatry, 17(1). 297. https://doi.org/10.1186/s12888-017-1458-0
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