Ibobbly mobile health intervention for suicide prevention in Australian Indigenous youth: a pilot randomised controlled trial

Abstract

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.

Keywords: Aboriginal and Torres Strait Islander; Acceptance and Commitment Therapy; Indigenous Australian; Suicide Prevention; eHealth; mHealth.

Figure 1

Determinants of social and emotional well-being.

Figure 2

Trial flow diagram.

Figure 3

Estimated marginal mean suicide ideation (DSI-SS) scores by time and intervention arm (error bars represent ±1 SE). DSI-SS, Depressive Symptom Inventory—Suicidality Subscale.

Figure 4

Estimated marginal mean depression (PHQ-9) scores by time and intervention arm (error bars represent ±1 SE). PHQ-9, Patient Health Questionnaire 9.

Figure 5

Estimated marginal mean psychological distress (K10) scores by time and intervention arm (error bars represent ±1 SE). K10, Kessler Psychological Distress Scale.

Figure 6

Estimated marginal mean impulsivity (BIS-11) scores by time and intervention arm (error bars represent ±1 SE). BIS-11, Barratt Impulsivity Scale.