{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:23:45Z","timestamp":1793075025559,"version":"4.5.0"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:00:00Z","timestamp":1653955200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001036","name":"Australian Rotary Health","doi-asserted-by":"publisher","award":["RG192840"],"award-info":[{"award-number":["RG192840"]}],"id":[{"id":"10.13039\/501100001036","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1138710"],"award-info":[{"award-number":["1138710"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"name":"S & C Roth Family Foundation","award":["RG20210528"],"award-info":[{"award-number":["RG20210528"]}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"\n Background<\/jats:title>\n Suicidal ideation is a major risk for a suicide attempt in younger people, such that reducing severity of ideation is an important target for suicide prevention. Smartphone applications present a new opportunity for managing ideation in young adults; however, confirmatory evidence for efficacy from randomized trials is lacking. The objective of this study was to assess whether a therapeutic smartphone application (\u201cLifeBuoy\u201d) was superior to an attention-matched control application at reducing the severity of suicidal ideation.<\/jats:p>\n <\/jats:sec>\n \n Methods and findings<\/jats:title>\n \n In this 2-arm parallel, double-blind, randomized controlled trial, 455 young adults from Australia experiencing recent suicidal ideation and aged 18 to 25 years were randomly assigned in a 2:2 ratio to use a smartphone application for 6 weeks in May 2020, with the final follow-up in October 2020. The primary outcome was change in suicidal ideation symptom severity scores from baseline (T0) to postintervention (T1) and 3-month postintervention follow-up (T2), measured using the Suicidal Ideation Attributes Scale (SIDAS). Secondary outcomes were symptom changes in depression (Patient Health Questionnaire-9, PHQ-9), generalized anxiety (Generalized Anxiety Disorder-7, GAD-7), distress (Distress Questionnaire-5, DQ5), and well-being (Short Warwick\u2013Edinburgh Mental Well-Being Scale, SWEMWBS). This trial was conducted online, using a targeted social media recruitment strategy. The intervention groups were provided with a self-guided smartphone application based on dialectical behavior therapy (DBT; \u201cLifeBuoy\u201d) to improve emotion regulation and distress tolerance. The control group were provided a smartphone application that looked like LifeBuoy (\u201cLifeBuoy-C\u201d), but delivered general (nontherapeutic) information on a range of health and lifestyle topics. Among 228 participants randomized to LifeBuoy, 110 did not complete the final survey; among 227 participants randomized to the control condition, 91 did not complete the final survey. All randomized participants were included in the intent-to-treat analysis for the primary and secondary outcomes. There was a significant time \u00d7 condition effect for suicidal ideation scores in favor of LifeBuoy at T1 (\n p<\/jats:italic>\n < 0.001,\n d<\/jats:italic>\n = 0.45) and T2 (\n p<\/jats:italic>\n = 0.007,\n d<\/jats:italic>\n = 0.34). There were no superior intervention effects for LifeBuoy on any secondary mental health outcomes from baseline to T1 or T2 [\n p<\/jats:italic>\n -values: 0.069 to 0.896]. No serious adverse events (suicide attempts requiring medical care) were reported.\n <\/jats:p>\n The main limitations of the study are the lack of sample size calculations supporting the study to be powered to detect changes in secondary outcomes and a high attrition rate at T2, which may lead efficacy to be overestimated.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n LifeBuoy was associated with superior improvements in suicidal ideation severity, but not secondary mental health outcomes, compared to the control application, LifeBuoy-C. Digital therapeutics may need to be purposefully designed to target a specific health outcome to have efficacy.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n \n Australian New Zealand Clinical Trials Registry\n ACTRN12619001671156<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pmed.1003978","type":"journal-article","created":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T13:23:27Z","timestamp":1654003407000},"page":"e1003978","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":78,"title":["The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3741-8075","authenticated-orcid":true,"given":"Michelle","family":"Torok","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7624-9468","authenticated-orcid":true,"given":"Jin","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9022-0274","authenticated-orcid":true,"given":"Lauren","family":"McGillivray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9393-4301","authenticated-orcid":true,"given":"Quincy","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliza","family":"Werner-Seidler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1731-210X","authenticated-orcid":true,"given":"Bridianne","family":"O\u2019Dea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7028-725X","authenticated-orcid":true,"given":"Alison","family":"Calear","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0435-2065","authenticated-orcid":true,"given":"Helen","family":"Christensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,5,31]]},"reference":[{"key":"pmed.1003978.ref001","author":"World Health Organization","year":"2018","journal-title":"LIVE LIFE: Preventing Suicide"},{"key":"pmed.1003978.ref002"},{"issue":"10193","key":"pmed.1003978.ref003","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/S0140-6736(19)31102-X","article-title":"Rising suicide rates among adolescents in England and Wales","volume":"394","author":"H Bould","year":"2019","journal-title":"Lancet"},{"key":"pmed.1003978.ref004","doi-asserted-by":"crossref","first-page":"l4289","DOI":"10.1136\/bmj.l4289","article-title":"US suicide rates in young people are highest since 2000","volume":"365","author":"E. 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