Efficacy of a Spanish Mobile Application to Reduce Self-Injurious Behavior

This week we will be discussing an article titled “CALMA, a Mobile Health Application, as an Accessory to Therapy for Reduction of Suicidal and Non-Suicidal Self-Injured Behaviors: A Pilot Cluster Randomized Controlled Trial.” This article, written by Rodante and colleagues, was  published in the Archives of Suicide Research Journal in October of 2020. In this article, the authors evaluated the utility of a mobile-health application (used as an adjunct to ongoing therapy), CALMA, in reducing the frequency of suicidal and non-suicidal behaviors and/or ideations.

Why did they do it?

According to the World Health Organization (WHO), approximately 800,000 people die by suicide every year, making suicide and suicidal behaviors a leading cause of death and injury worldwide. The authors note that for every completed suicide, between 10 and 20 suicide attempts occur, with the lifetime prevalence of suicide attempts landing around 2.7% of the population. Further, when suicidal ideation and behavior are combined, the prevalence rate increases to approximately 9.2% of the population. These are staggering numbers.

While effective intervention strategies for the management of suicidal ideation and/or non-suicidal self injury (NSSI) have been identified (e.g., Dialectical Behavior Therapy; DBT), new platforms are needed to provide evidence-based interventions at scale. New research has demonstrated that smartphones may provide a system through which novel interventions can be delivered; novel interventions such as CALMA, the mobile app evaluated in this study. 

How did they do it?

The authors used a parallel design randomized by clusters with a 4-week follow-up assessment to compare an intervention group (DBT + CALMA) and a treatment as usual group (DBT only). According to the authors, CALMA is a mobile application developed in Spanish that provides evidence-based tools to assist an individual experiencing suicidal or non-suicidal crisis. CALMA also interacts with the user in the absence of crises by promoting activities that reduce their vulnerability for future crises and providing psychoeducation about suicide and its prevention.

The primary data collected from participants included demographics; acceptability,  measured using the User Experience Questionnaire short version (UEQ-s); and suicidal behavior, assessed using the Spanish version of the Self-Injurious Thoughts and Behaviors Interview (SITBI).

What did they find?

Overall, 21 individuals met inclusion for the study, and 18 were included in analyses. The authors found that in the CALMA + DBT group, there was a high probability of decreased suicidal ideation, suicidal planning, suicidal gestures, thoughts about NSSI, and NSSI. In the DBT only group, the authors found probability of decreased suicidal ideation, suicidal plan, and suicide attempts.  While likelihood of decreased suicidal ideation was significant in the DBT only group, a high probability of a greater decrease in suicidal ideation and suicidal gestures was observed in the  CALMA+DBT group.

What does it all mean (our take)?

Continued development of supplemental behavioral health intervention strategies/technologies is critical. This is particularly important as we have entered into a time where in-person treatment accessibility is limited and reliance on technology is growing. 

The authors of this study took an important step in broadening out the audience of individuals who can be positively impacted by mental health applications - particularly a Spanish speaking community. We regularly examine the literature to stay up-to-date on new behavioral health mobile applications, and we enjoy reading about new technologies that facilitate better access to care for all populations. 

The digital health world is blossoming - we are excited to be part of it and we look forward to continuing to read new literature covering this exciting topic!