title: Ibobbly mobile health intervention for suicide prevention in Australian Indigenous youth: a pilot randomised controlled trial.
abstract: 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.
  
  
  
  Remote and very remote communities in the Kimberley region of North Western Australia.
  
  
  
  Indigenous Australians aged 18-35 years.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  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.
  
  
  
  ACTRN12613000104752.
authors.affiliation: Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia.|Men's Outreach Service Inc., Broome, Western Australia, Australia.
authors.forename: Joseph
authors.identifier: 0000-0003-3553-6721
authors.initials: J
authors.lastname: Tighe
authors.affiliation: Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Shand
authors.affiliation: Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ridani
authors.affiliation: Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Mackinnon
authors.affiliation: Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: De La Mata
authors.affiliation: Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Christensen
mesh_terms: D000293:Adolescent; D000328:Adult; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007175:Impulsive Behavior; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D010865:Pilot Projects; D000073278:Self-Management; D013315:Stress, Psychological / Q000523:psychology / Q000628:therapy*; D059020:Suicidal Ideation; D017216:Telemedicine; D014904:Western Australia; D055815:Young Adult; D000092864:Suicide Prevention; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Aboriginal and Torres Strait Islander; Acceptance and Commitment Therapy; Indigenous Australian; Suicide Prevention; eHealth; mHealth