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Suicide prevention using self-guided digital interventions: a systematic review and meta-analysis of randomised controlled trials
Open accessAbstract
Background Digital interventions that deliver psychological self-help provide the opportunity to reach individuals at risk of suicide who do not access traditional health services. Our primary objective was to test whether direct (targeting suicidality) and indirect (targeting depression) digital interventions are effective in reducing suicidal ideation and behaviours, and our secondary analyses assessed whether direct interventions were more effective than indirect interventions. Methods In this systematic review and meta-analysis, we searched online databases MEDLINE, PubMed, PsycINFO, and Cochrane CENTRAL for randomised controlled trials published between database inception to May 21, 2019. Superiority randomised controlled trials of self-guided digital interventions (app or web based, which delivered theory-based therapeutic content) were included if they reported suicidal ideation, suicidal plans, or suicide attempts as an outcome. Non-inferiority randomised controlled trials were excluded to ensure comparability of the effect. Data were extracted from published reports, and intention-to-treat data were used if available. The primary outcome was the difference in mean scores of validated suicidal ideation measures (Hedges' g ) with the associated 95% CI for the analysis of digital intervention effectiveness on suicidal ideation. We also present funnel plots of the primary outcome measure (suicidal ideation) for direct and indirect interventions to assess for publication bias. We calculated I 2 (with I 2 CI) values to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcomes. This study is registered with PROSPERO, CRD42018102084. Findings The literature search yielded 739 articles (including manual searching) for suicidality and 8842 articles for depression. After screening, 14 papers reporting on 16 studies were included in the narrative review and meta-analysis. The 16 studies (ten on direct interventions and six on indirect interventions) provided baseline data for 4398 participants. The primary outcome of overall post-intervention effect for suicidal ideation was small but significant immediately following the active intervention phase (Hedges' g −0·18, 95% CI −0·27 to −0·10, p<0·0001; I 2 =0%, I 2 CI 0·0–47·9). The secondary objective, comparing direct and indirect interventions, showed that direct interventions (targeting suicidality) significantly reduced suicidal ideation at post-intervention ( g −0·23, 95% CI −0·35 to −0·11, p<0·0001; I 2 =17·6%, I 2 CI 0·0–58·6), but indirect interventions (targeting depression) failed to reach significance ( g −0·12, 95% CI −0·25 to 0·01, p=0·071; I 2 =0%, I 2 CI 0·0–30·7). Interpretation Self-guided digital interventions directly targeting suicidal ideation are effective immediately post-intervention. Indirect interventions were not significant for reducing suicidal ideation. Our findings suggest that digital interventions should be promoted and disseminated widely, especially where there is a lack of, or minimal access to, health services. Funding Australian National Health and Medical Research Council.
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“Meta-analyses with a specific focus on Internet-delivered prevention reported small significant effects on subclinical symptoms [45, 61–63], which were generally smaller or even insignificant for adolescents compared to adults [62].”
From Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial (2024) · cites this paper as [63]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“There is emerging evidence that adults readily access and benefit from suicide prevention interventions delivered via smartphone-based apps [25].”
From A mobile health intervention (LifeBuoy App) to help young people manage suicidal thoughts: protocol for a mixed-methods randomized controlled trial (2020) · cites this paper as [25]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“This need for development and testing of purpose designed treatments is because meta-analyses have shown that interventions directly targeting suicidal behaviors can reduce ideation in the short-term, whereas broader mental health interventions are unable to [14,20].”
From The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia. (2022) · cites this paper as [14]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Adults can readily access and benefit from technology-enabled solutions that directly target suicidal ideation and/or behaviors [14,15]; however, the evidence for this is largely derived from trials of web-based programs rather than smartphone interventions.”
From The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia. (2022) · cites this paper as [14]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Power analyses determined that a sample size of 189 participants per intervention group would be sufficient to detect an effect size of 0.30 [14] for our primary outcome at postintervention with at least 80% power and an α criterion of 0.05.”
From The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia. (2022) · cites this paper as [14]
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“Not only does this study strengthen the evidence base for the short-term efficacy of brief unsupervised and targeted digital therapeutics in young adults [14], but it also demonstrates that LifeBuoy application has a favorable risk–benefit profile.”
From The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia. (2022) · cites this paper as [14]
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“Our findings extend prior research showing that DBT can be effectively digitized to treat suicidal ideation [14] by showing promise for this approach in young adults.”
From The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia. (2022) · cites this paper as [14]
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“Our results are consistent with pooled meta-analytic findings that digital therapeutics appear to be effective in reducing suicidal ideation [14] yet deviate from the effects reported in standalone trials.”
From The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia. (2022) · cites this paper as [14]
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“In considering why our findings may differ from previous studies, there is evidence that treatment approach may be an important moderator of efficacy [14,20].”
From The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia. (2022) · cites this paper as [14]
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“Certainly, while cognitive behavioral therapy (CBT) has been successfully translated into digital interventions for depression and anxiety [35], it appears to have little impact on ideation or other suicidal outcomes in comparison to alternative therapies such as DBT [14].”
From The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia. (2022) · cites this paper as [14]
In the citing paper
“Substantial human health resources will be saved if the CAIs are proven effective and suitable for widespread implementation [14].”
From Conversational Agent Interventions for Mental Health Problems: Systematic Review and Meta-analysis of Randomized Controlled Trials (2023) · cites this paper as [14]
In the citing paper
“In addition, smartphones have introduced self-guided digital interventions as novel suicide prevention methods that may prove as effective as face-to-face interventions (264).”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [264]
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“While there is a growing body of evidence supporting that DMHIs can have significant small-to-moderate effects on alleviating or preventing symptoms of mental health disorders (6–10)”
From Effect of Engagement With Digital Interventions on Mental Health Outcomes: A Systematic Review and Meta-Analysis (2021) · cites this paper as [10]
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“Furthermore, self-guided digital interventions directly targeting suicidal ideation have proven effective immediately post-intervention (Torok et al., 2020).”
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Interventions on fear of dementia among middle‐aged and older adults: A scoping review
Dai, H., Shen, H., Versluis, A., Sun, C., Dubbeldeman, E. M., Chavannes, N. H., & Aardoom, J. J. (2025) · Alzheimer s & Dementia Behavior & Socioeconomics of Aging · doi:10.1002/bsa3.70020 · Cited by 3
Emezue, C., Bishop‐Royse, J., Froilan, A. P., Wilkes, T., Karnik, N. S., & Julion, W. A. (2025) · JMIR Pediatrics and Parenting · doi:10.2196/70048 · Cited by 3
“Similarly, self-guided digital interventions have been shown to reduce suicidal ideation among youth [37].”
Halim, M. R. T. A., Ibrahim, N., Hassan, H., Idris, F., Musa, M., & Bustaman, N. A. A. (2025) · Multidisciplinary Science Journal · doi:10.31893/multiscience.2025611 · Cited by 3
Rudd, M. D., Wine, M. D., Pedler, R., Wright, M., Gleason, V. L., Pérez-Muñoz, A., Tuna, B., Tempchin, J., Flowers, T. A., & Bryan, C. J. (2025) · Contemporary Clinical Trials · doi:10.1016/j.cct.2025.108107 · Cited by 3
Abid, M., Iqbal, A., Mansell, W., Khaliq, A. A., Shehzad, W., & Shahzad, S. (2025) · BJPsych Open · doi:10.1192/bjo.2025.10902 · Cited by 5
“20,21 Several factors may explain these larger effect sizes in studies.”
Technology-based suicide prevention: An umbrella review
Siadat, S., Farajzadegan, Z., Motamedi, N., Nouri, R., & Eizadi‐Mood, N. (2024) · Journal of Research in Medical Sciences · doi:10.4103/jrms.jrms_791_23 · Cited by 4
“[32] Criteria* Authors Büscher R, 2020 [36] Chen M, 2022 [37] Torok M, 2019 [39] Witt K, 2017 [40] Yu T, 2021 [41] Schmeckenbecher J, 2022 [38] excluded.”
BackgroundMiché, M., Strippoli, M. F., Preisig, M., & Lieb, R. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05647-w · Cited by 3
“The reduction of long-term SA risk requires the identification of individuals who are at increased SA risk, and who may benefit from interventions that aim to reduce SA risk [e.g., 4–7].”
BackgroundThe Promise and Peril of Mental Health Apps
Kushlev, K., Moon, K., Harris, M., & Falgoust, G. (2025) · Policy Insights from the Behavioral and Brain Sciences · doi:10.1177/23727322251405255 · Cited by 3
“Another meta-analysis of 16 studies concluded that self-guided digital interventions — the majority of which have been web-based rather than mobile-based — lead to a small but signi fi cant reduction in suicidal ideation at post-test (Torok et al., 2020).”
Nuertey, B. D., Mumuni, K., Addai, J. A., Kunfah, S. M. P., Attibu, R. I. E., Acquah, D. K., Ekremet, K., Haidallah, A.-R., Mahama, I. B., Adjah, D. T., et al. (2022) · Pan African Medical Journal · doi:10.11604/pamj.2022.41.245.29660 · Cited by 3
“digital interventions and telephone calls have been found to be equally effective in times such as pandemics [16-18] where social distancing and isolation is the norm.”
BackgroundCyberbullying as a way of causing suicide in the digital age
Amelin, O. Y., Kyrychenko, T. M., Leonov, B. D., Shablystyi, V. V., & Chenshova, N. (2021) · JOURNAL OF THE NATIONAL ACADEMY OF LEGAL SCIENCES OF UKRAINE · doi:10.37635/jnalsu.28(3).2021.277-289 · Cited by 3
“M. Torok, D. Hahn, S. Baker, A. Werner-Seidler, J. Wong, M.E. Larsen [7] point to the efficiency of self-directed digital interventions for suicide prevention and emphasise the importance of including information on direct suicide prevention in digital interventions.”
Hirsig, A., Häfeli, X. A., & Schmidt, S. J. (2024) · Trials · doi:10.1186/s13063-024-08241-3 · Cited by 2
“Meta-analyses with a specific focus on Internet-delivered prevention reported small significant effects on subclinical symptoms [45, 61–63], which were generally smaller or even insignificant for adolescents compared to adults [62].”
BackgroundThe role of economic news in predicting suicides
Moscone, F., Tosetti, E., & Vittadini, G. (2024) · Economics & Human Biology · doi:10.1016/j.ehb.2024.101413 · Cited by 2
The Role of Digital Technology in Youth Suicide Prevention
Kenny, B., Robinson, J., & Núñez, D. (2025) · Depression and personality · doi:10.1007/978-3-031-96037-6_8 · Cited by 3
Doukani, A. (2022) · Springer eBooks · doi:10.1007/978-3-030-89594-5_109 · Cited by 2
Orr, M., van Kessel, K., & Parry, D. (2022) · Workshop on Computational Linguistics and Clinical Psychology (CLPsych) · doi:10.18653/v1/2022.clpsych-1.2 · Cited by 3
“…machine learning based interventions have the advantage that even if they have only a relatively small effect size on reducing suicidal behaviour they can be deployed at such scale and minimal marginal cost that they may have a significant impact at a population societal level (Torok et al., 2020).”
BackgroundCodesign of Digital Health Tools for Suicide Prevention: A Scoping Review
Wepa, D., Neal, M., Abo-Gazala, W., Cusworth, S., Hargan, J., Mistry, M., Vaughan, J., Giles, S., & Khan, M. (2023) · British journal of healthcare and medical research · doi:10.14738/bjhmr.105.15365 · Cited by 1
Genetic signatures of suicide attempt behavior: insights and applications
Drago, A. (2024) · Expert Review of Proteomics · doi:10.1080/14789450.2024.2314143 · Cited by 2
“[17] were reported to have some effect in containing the risk for suicide across different diagnoses (OR = 0.35 (0.12– 1.02)) [18], (OR = −0.29 (−0.40 - −0.19)) [19], (OR = −0.18 (−0.27 - −0.10)) [20], (OR = −0.53 (−0.89 - −0.71)) [21], (OR = 0.47 (0.30– 0.73)) [22].”
InfluentialA Digital Mental Health Approach for Supporting Suicide Prevention: A Qualitative Study
Castillo-Sánchez, G., Toribio-Guzmán, J. M., Celada-Bernal, S., Hernández, M. A., Díez, I. D. L. T., & Franco, M. (2024) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-024-01347-4 · Cited by 2
“Many of these digital health apps are based on protocols designed for depression, with little or no effect on suicide outcomes (Büscher et al., 2020; Torok et al., 2020).”
Teismann, T., Brakemeier, E., Brockmeyer, T., Christiansen, H., Fehm, L., Forkmann, T., Glombiewski, J. A., Heider, J., Hermann, A., Hoyer, J., et al. (2024) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2024.100843 · Cited by 2
“In a similar vein, Meerwijk et al. (2016) and Torok et al. (2020) found meta-analytic evidence that psychotherapeutic treatments that do not explicitly focus on suicidal ideation/behaviour have no antisuicidal effect, whereas suicide-specific treatments (e.g. Bryan and Rudd, 2018; Gysin-Maillart,…”
The ethical imperative of self-directed tools in crisis helplines to prevent suicide at scale
Meyerhoff, J., Coppersmith, D. D. L., & Fox, K. R. (2025) · Nature Mental Health · doi:10.1038/s44220-025-00384-9 · Cited by 2
Okuboyejo, S. R., Han, S., Jha, S., Eneja, C., & Orji, R. (2025) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2025.2476711 · Cited by 2
“Research suggests that suicide prevention apps can be effective in reducing suicidal ideation and connecting individuals in crisis to support on time (Martinengo et al., 2022; Melia et al., 2020; O’Grady et al., 2020; Torok et al., 2020).”
Josifovski, N., Rochesson, S. E. D., Wong, Q. J. J., Han, J., Larsen, M. E., & Torok, M. H. (2025) · International Journal of Social Psychiatry · doi:10.1177/00207640251358109 · Cited by 2
“…we observed a small and significant pooled effect for digital interventions on suicidal ideation (i.e. Hedges’ g = –0.15) which was of a similar magnitude to those observed in prior reviews (effect size range = −0.18 and −0.29; Buscher et al., 2020, 2022; Sutori et al., 2024; Torok et al., 2020).”
InfluentialSelf-citationPrevention Strategies: Prevention and Promotion in Child Mental Health
Blaisdell, K. N., Horn, S. R. G.-V., & Fisher, P. A. (2023) · Autism and child psychopathology series · doi:10.1007/978-3-031-24926-6_26 · Cited by 2
Zuckerman, E., Fernandes, S. N., Sullivan, S. R., Ortin‐Peralta, A., Jeglic, E. L., Miranda, R., & Baroni, A. (2023) · Psychiatry Research Communications · doi:10.1016/j.psycom.2023.100134 · Cited by 2
“Meta-analytic evidence suggests that online interventions and mobile apps targeting suicide risk and safety planning can be effective at decreasing suicidal thoughts and behaviors (Büscher et al., 2020; Melia et al., 2020; Nuij et al., 2021; Torok et al., 2020).”
BackgroundDoukani, A. (2022) · Springer eBooks · doi:10.1007/978-3-030-48277-0_109-3 · Cited by 2
Targeted Digital Health Intervention in End‐of‐Life and Hospice Care: A Scoping Review
Jeon, M., Jeon, H., & Kim, S. (2025) · Journal of Advanced Nursing · doi:10.1111/jan.16734 · Cited by 3
Depression and Suicide in the “World’s Happiest Countries”
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0013 · Cited by 1
Hood, C., Hunt, S., Metse, A. P., Hodder, R. K., Colyvas, K., Sheather‐Reid, R. B., Duerden, D., & Bowman, J. (2025) · Journal of Medical Internet Research · doi:10.2196/64746 · Cited by 1
“For example, systematic reviews investigating internet-delivered cognitive behavior therapy have found it to be as effective as traditional face-to-face cognitive behavior therapy for anxiety and depressive disorders [15]; and to significantly reduce suicidal ideation compared with controls [16].”
Erasmus, P., Borrmann, M., Ali, A. T., Herta, S., Becker, J., Moriarty, G., & Meinlschmidt, G. (2025) · Archives of Public Health · doi:10.1186/s13690-025-01597-1 · Cited by 1
“This distinction notwithstanding, unguided OSIs are effective in the treatment of anxiety [25], depression [26], the prevention of suicides [27], and numerous other mental health disorders and conditions [28].”
Parent and Teen Engagement in Smart Choices 4 Teens to Address Teen Alcohol Use and Relationships
Wang‐Schweig, M., Miller, B. A., Byrnes, H. F., & Rogers, V. (2025) · Journal of Child and Family Studies · doi:10.1007/s10826-025-03074-3 · Cited by 1
Effectiveness of Mobile Applications for Suicide Prevention: A Systematic Review and Meta-Analysis
Sim, K., & Bae, S. (2025) · Behavioral Sciences · doi:10.3390/bs15101345 · Cited by 2
“Participant characteristics included age group, recognizing that previous research examined mixed samples of adolescents and adults (Torok et al., 2020) and interventions focusing exclusively on children and adolescents (Conley et al., 2022), allowing for the investigation of potential…”
InfluentialReisner, S. L., Cole, S. W., Keuroghlian, A. S., Katz‐Wise, S. L., Morrow, C., Kane, K., Feng, C., & Xu, R. (2025) · JMIR Research Protocols · doi:10.2196/78619 · Cited by 2
“Self-guided digital mental health interventions, including web-and smartphone-based apps, have demonstrated effectiveness in reducing depression and suicidality among young people [22,23].”
McKay, S., Ng, C., Nicholas, J., Browne, V., Chinnery, G. L., Choi, I., Nation-Ingle, B., Allison, K., Perlow, E., Lamblin, M., et al. (2025) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2025.101578 · Cited by 2
“Evidence suggests that digital programs can improve mental health literacy, reduce stigma, enhance self-regulation skills, and, in some cases, directly reduce suicidal ideation [15,16].”
Ludin, N. M., Torok, M. H., McGillivray, L., Wong, Q. J. J., Fortune, S. A., Meinhardt, I., Thabrew, H., Cargo, T., & Hetrick, S. E. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-114884 · Cited by 1
“31 Since then, trials have shown positive results for young people hospitalised for suicidal ideation in the USA, 32 33 and for community-based young people in Australia with suicidal ideation.”
Self-citationCarrotte, E. R., Bellairs-Walsh, I., Hetrick, S. E., Robinson, J., & Bailey, E. (2026) · Health Expectations · doi:10.1111/hex.70572 · Cited by 1
“Other tools are fully autonomous and may be utilised in a self‐guided manner, without recommendation or guidance from a health professional [10, 12].”
Buddrus, U., Kutza, J.-O., Thye, J., Esdar, M., Hübner, U. H., & Liebe, J.-D. (2026) · Frontiers in Digital Health · doi:10.3389/fdgth.2026.1755598 · Cited by 4
Chernetska, V., & Millgram, Y. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122006 · Cited by 1
Seeking Late Night Life Lines: Experiences of Conversational AI Use in Mental Health Crisis
Ajmani, L., Ghosh, A., Kaveladze, B. T., Kim, E., Namuduri, K., Nguyen, T., Okoli, E., Schleider, J. L., Ford, D., & Suh, J. (2026) · ACM Conference on Fairness, Accountability, and Transparency (FAccT) · doi:10.1145/3805689.3812256 · Cited by 6
“This rich body of literature on technology-mediated mental healthcare indicates the need for a unique set of system requirements: something that is scalable, evidence-based, but effective even as a brief intervention.”
Mendoza-Martínez, I. A., Rivera, B. R. G., & García-Alcaráz, J. L. (2023) · IntechOpen eBooks · doi:10.5772/intechopen.1003219 · Cited by 1
Desirable and Adverse Effects of Communicative Suicide Prevention Interventions Among Men
Wagner, A., & Reifegerste, D. (2024) · Crisis · doi:10.1027/0227-5910/a000965 · Cited by 1
(2020) · International Journal of Biology and Genetics · doi:10.31829/2692-4242/biogen2020-3(1)-108 · Cited by 1
Doukani, A. (2021) · Springer eBooks · doi:10.1007/978-3-030-48277-0_109-1 · Cited by 1
Roca, M., & Gili, M. (2023) · Medicina Clínica (English Edition) · doi:10.1016/j.medcle.2023.03.024 · Cited by 1
Gaete, J., Núñez, D. E., Meza, D., Andaur, J., & Robinson, J. (2024) · Research Square · doi:10.21203/rs.3.rs-4824452/v1 · Cited by 1
遠隔心理支援（Telepsychology）におけるこれまでの検討課題—Structural Topic Modelによるアブストラクト解析—
Muranaka, S., & 竹林, 由. (2021) · Medical Entomology and Zoology · doi:10.24468/jjbct.20-026
Accueil d’un patient suspect d’une pathologie psychiatrique en structure des urgences
Conte, P. L., Texier, C., Sicot, R., Martinez, M., & Lefort, H. (2021) · Soins Psychiatrie · doi:10.1016/j.spsy.2021.06.007
Metadata
- Authors
- Torok, M., Han, J., Baker, S., Werner-Seidler, A., Wong, I., Larsen, M. E., & Christensen, H.
- Affiliations
- Black Dog Institute (AU)
- Corresponding author
- Torok, Michelle
- Venue
- The Lancet Digital Health
- Publisher
- Elsevier BV
- Published
- 2020-01
- Volume
- 2
- Issue
- 1
- Pages
- e25-e36
- ISSN
- 2589-7500 (ISSN-L)
- OpenAlex
- W2991439719
- Cited by
- 273
- References
- 47
- Citations by year
- 2026: 26 · 2025: 64 · 2024: 43 · 2023: 44 · 2022: 41 · 2021: 34 · 2020: 19
- FWCI
- 3.32
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Digital Health (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Health and Medical Research Council
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Social Psychology › Mental Health via Writing
- Keywords
- suicide prevention, suicidal ideation, depression, mental health apps, online intervention, suicide attempts, suicide planning, psychological self-help, digital mental health
- MeSH terms
- Digital Technology, Suicide Prevention, Humans, Self Care, Randomized Controlled Trials as Topic
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