The Use of Smart Phone Apps in Managing Self-Harm in Teens

Can Apps Prevent Self-Harm After Inpatient or Residential Treatment?

The trends in data on teen self-harm, suicidal ideation, and suicidal behavior are alarming. Over the past twenty years – and since 2012 specifically – rates of self-harm, suicidal ideation, and suicide attempts among adolescents increased dramatically.

Many parents know rates of mental health disorders for teens increased during the pandemic. The stress, isolation, and fear of illness led to increases in anxiety, depression, and various other mental heath disorders, many of which include, or can escalate to self-harm, suicidal ideation, or suicidal behavior.

We’ll start with the teen suicide facts, to give you an idea of the current situation before the pandemic. These statistics are from the Centers for Disease Control (CDC)

General Teen Suicide Facts

• Suicide exceeded homicide as the second leading cause of death for people age 10-24 in the year 2014
• Over 3,000 high-school age teens attempt suicide per day
• 80% of teens who attempt suicide show warning signs before the attempt
• About a third of those who die by suicide have made previous attempts
• Likelihood of a fatal suicide attempt increases 100 times after an initial attempt
• A majority of teens who attempt suicide also suffer from a mental health disorder such as depression.

During the pandemic, data shows that trends in hospital visits for mental health related reasons increased. This information is from a Surgeon General’s Advisory on teen mental health published in December, 2021:

• Emergency rooms visits for mental health issues for teens increased 31%
• Emergency rooms visits for suspected suicide attempts increased by 51% for teenage females and 4% for teenage males

Now let’s look at the figures for non-suicidal injury and self-harming behaviors. First, we’ll define those terms to ensure we’re all on the same page:

Non-Suicidal Self-Injury (NSSI)

NSSI is a deliberate direct destruction or alteration of body tissue without conscious suicidal intent.

Self-Harming Behavior:

Self-harm is an act of intentionally causing harm to own self, irrespective of the type, motive or suicidal intent.

Now let’s look at the statistics for NSSI and self-harm:

• In a study drawing on data collected from over 600,000 adolescents:
  • 22.1% reported engaging in NSSI at least once in their lives
  • 19.5% reported engaging NSSI in the past month
  • 14.2% reported engaging in self-harm in their lives
  • 13.7% reported aging in self-harm in the past month

That’s the first reason why we’re writing this article.

Those statistics – since they’re based on such a large sample size – allow us to make population-level generalizations. Those numbers tell us millions of teens each year engage in NSSI and self-harming behavior. Additional statistics tell us that the risk of suicide increases after an instance of NSSI or self-harm:

• Teens who report a NSSI/self-harm event were 46.0 times more likely to engage in suicidal behavior than adolescents with no history of self-harm
• Young adults report a NSSI/self-harm event were 19.2 times more likely to engage in suicidal behavior than adolescents with no history of self-harm
• Overall, adolescents and young adults who reported NSSI/self-harm event were at 26.7 times higher risk of suicide than adolescents and young adults without an initial NSSI/self-harm event

That’s the second reason we’re writing this article. While most teens who engage in NSSI or self-harm do not intend to die, any NSSI or self-harm event substantially increase the risk, for that teen, of subsequent suicidal ideation or suicidal behavior.

Now let’s address the question implied in the title of this article:

Can smart phone apps help teens manage NSSI/self-harming behavior after they’ve been in treatment for NSSI/self-harming behavior?

Study: Do Self-Harm Apps After Treatment Work for Teens?

Two studies have on this topic have our attention:

1. The Feasibility of Using Smartphone Apps to Manage Self-Harm and Suicidal Acts in Adolescents Admitted to an Inpatient Mental Health Ward

• • This study was published in November, 2020, and examined engagement on two smartphone apps in a group of 20 adolescents admitted to an inpatient psychiatric hospital for self-harming and/or suicidal behavior

2. Behavior Change Techniques in Mobile Apps Targeting Self-Harm in Young People: A Systematic Review

• • This study was published in March, 2021, and examined the therapeutic techniques five different self-harm prevention apps used to help teens at immediate risk of self-harm

We’re not going to pull any punches: the data on the effectiveness of these apps in preventing self-harm is not encouraging. It’s not all negative, as you’ll see, but the bottom line is that there is no solid evidence that these apps prevent self-harming behavior for teens who’ve received inpatient or residential treatment for NSSI/self-harming behavior.

Here are the results from the first study.

Apps for Preventing Self-Harm: Positive Results

• A majority of the teens in the study reported the apps were easy to use
• A majority of the teens said that using the apps in times of crisis was feasible
• Teens who used the apps showed a decrease in suicidal ideation

However, that’s where the positive data ends.

Apps for Preventing Self-Harm: Less-Than-Encouraging Results

• 40% said “the apps would not keep them safe when in crisis”
• 45% said the app BeyondNow did not help them manage their symptoms during a crisis
• 35% said the app BlueIce did not help them manage their symptoms during a crisis

Those results are a mixed bag. The apps are user friendly and seem practical to teens, but a significant percentage of the teens themselves report they’re not effective in preventing self-harming behavior. Also, a statistical analysis indicated no difference between in self-harming behavior between the teens who used the apps and the teens who didn’t: that’s not a ringing endorsement.

Now let’s look at the results of the second study. This one examined the therapeutic techniques the apps apply to help teens manage the symptoms of self-harm. Here’s what they found:

• Of the 93 apps they considered, only 5 had information on their therapeutic approach
• All five of these identified dialectical behavior therapy (DBT) as the therapeutic source of the techniques on their apps
• The DBT techniques they used were:
  • Distraction
  • Social Support
  • Behavior Substitution

The second study did not examine or evaluate the effectiveness of the apps. We can add that DBT is the gold standard treatment for supporting teens in extreme emotional or behavioral distress, and is effective in helping teens manage severe symptoms in times of crisis. That tells us those apps have the right idea, but require further research to determine their practical effectiveness.

Conclusion: Smartphone Apps Have Potential, But Aren’t There Yet

The idea of using smartphone apps to prevent NSSI/self-harm in teens is a good one. Previous research – including data from the first study, above – shows that apps like these can and do help teens manage symptoms of depression and anxiety.

That’s good news. But with regards to NSSI and self-harm, what these studies show is that traditional approaches to managing self-harm – such as in-person treatment and therapy, live online support chat, live support phone lines, and live, in-person community support – have a solid evidence base that proves their effectiveness, whereas the apps reviewed in theses studies do not have an evidence base that proves their effectiveness.

Given that information, we recommend that teens who’ve been in residential or inpatient treatment for NSSI/self-harm, when in crisis, should contact their therapist, treatment peers, or go to the emergency room. These apps may work, but the data do not support relying on them in times of crisis. Instead, or in addition to these apps, we recommend the resources below.

Self Harm, NSSI, and Suicide Hotlines

• Teens who need help can call or text the following numbers:
  • National Suicide Prevention Lifeline (24/7/365): 1-800-273-8255
  • The Trevor Project Phone (24/7/365): 1-866-488-7386
  • The Trevor Project Text (7 days/wk, 6am-am ET, 3am-10pm PT): Text START to 678678
  • Trevor Project Chat: CLICK HERE
  • The Crisis Text Line (24/7/365): Text CONNECT to 741741
  • Youth Yellow Pages TEEN LINE (6pm-10pm PT) 310-855-4673
  • The Youth Yellow Pages TEXT: Text TEEN to 839863

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.