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Title: Suicide prevention and depression apps' suicide risk assessment and management : a systematic assessment of adherence to clinical guidelines
Authors: Martinengo, Laura
Van Galen, Louise
Lum, Elaine
Kowalski, Martin
Subramaniam, Mythily
Car, Josip
Keywords: Science::Medicine
Issue Date: 2019
Source: Martinengo, L., Van Galen, L., Lum, E., Kowalski, M., Subramaniam, M. & Car, J. (2019). Suicide prevention and depression apps' suicide risk assessment and management : a systematic assessment of adherence to clinical guidelines. BMC Medicine, 17(1).
Journal: BMC Medicine
Abstract: Background: There are an estimated 800,000 suicides per year globally, and approximately 16,000,000 suicide attempts. Mobile apps may help address the unmet needs of people at risk. We assessed adherence of suicide prevention advice in depression management and suicide prevention apps to six evidence-based clinical guideline recommendations: mood and suicidal thought tracking, safety plan development, recommendation of activities to deter suicidal thoughts, information and education, access to support networks, and access to emergency counseling. Methods: A systematic assessment of depression and suicide prevention apps available in Google Play and Apple’s App Store was conducted. Apps were identified by searching 42 matters in January 2019 for apps launched or updated since January 2017 using the terms“depression,”“depressed,”“depress,”“mood disorders,”“suicide,”and“self-harm.”General characteristics of apps, adherence with six suicide prevention strategies identified in evidence-based clinical guidelines using a 50-question checklist developed by the study team, and trustworthiness of the app based on HON code principles were appraised and reported as a narrative review, using descriptive statistics. Results: The initial search yielded 2690 potentially relevant apps. Sixty-nine apps met inclusion criteria and were systematically assessed. There were 20 depression management apps (29%), 3 (4%) depression management and suicide prevention apps, and 46 (67%) suicide prevention apps. Eight (12%) depression management apps were chatbots. Only 5/69 apps (7%) incorporated all six suicide prevention strategies. Six apps (6/69, 9%), including two apps available in both app stores and downloaded more than one million times each, provided an erroneous crisis helpline number. Most apps included emergency contact information (65/69 apps, 94%) and direct access to a crisis helpline through the app (46/69 apps, 67%). Conclusions: Non-existent or inaccurate suicide crisis helpline phone numbers were provided by mental health apps downloaded more than 2 million times. Only five out of 69 depression and suicide prevention apps offered all six evidence-based suicide prevention strategies. This demonstrates a failure of Apple and Google app stores, and the health app industry in self-governance, and quality and safety assurance. Governance levels should be stratified by the risks and benefits to users of the app, such as when suicide prevention advice is provided.
ISSN: 1741-7015
DOI: 10.1186/s12916-019-1461-z
Rights: © 2019 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Fulltext Permission: open
Fulltext Availability: With Fulltext
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