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Young people experiencing low mood, thoughts related to self-harm, and suicidal ideation often struggle to communicate their emotions and receive timely support from family and friends. Technologically delivered support interventions may be useful in addressing this need.
This paper aimed to evaluate the acceptability and feasibility of “Village,” a communication app co-designed with young people and their family and friends from New Zealand.
A mixed methods pilot open trial design was adopted. Participants were primarily recruited via social media advertisements and clinicians in specialist mental health services over an 8-month period. The primary outcomes were acceptability of the app (via thematically analyzed qualitative feedback and retention rates) and feasibility of conducting a larger randomized controlled trial gauged via effectiveness of recruitment methods, completion of chosen outcome measures, and occurrence of unanticipated operational issues. Secondary outcomes were app usability, safety, and changes in symptoms of depression (via the Patient Health Questionnaire–9 modified for adolescents), suicidal ideation (on the Suicidal Ideation Questionnaire), and functioning (using the World Health Organization Disability Assessment Schedule 2.0 or Child and Youth version).
A total of 26 young people (“users”) were enrolled in the trial, of which 21 recruited friends and family members (“buddies”) and completed quantitative outcome measures at baseline, 4 weeks, and 3 months. Furthermore, 13 users and 12 buddies also provided qualitative feedback about the app, identifying the key themes of appeal of app features and layout, usefulness of its content, and technological challenges (primarily with onboarding and notifications). Users gave Village a mean rating of 3.8 (range 2.7-4.6) out of 5 on a 5-point scale for app quality and an overall star rating of 3.4 out of 5 for subjective quality. Within this limited sample, users reported a clinically significant reduction in depressive symptoms (
During this open trial, Village was found to be acceptable, usable, and safe. The feasibility of a larger randomized controlled trial was also confirmed after some modifications to the recruitment strategy and app.
Australian New Zealand Clinical Trials Network Registry ACTRN12620000241932p; https://tinyurl.com/ya6t4fx2
Internationally, rates of mental distress and depression among young people have steadily increased over the past few decades [
Over the past 20 years, rapidly evolving smart technology has led to the development of a range of digital health (eHealth) interventions, including those specifically designed to improve mental health [
Alongside these substantial technological developments, there has been a growing awareness that self-empowerment of well-being [
With these issues in mind, in 2020, our team undertook a co-design process to develop a working prototype for a digital, youth-nominated support system that might benefit young people experiencing low mood, self-harm, and suicidal ideation. Approximately 40 New Zealand youth (including many who had experienced these issues or were affiliated with a national telephone-based support organization [Youthline]), 20 family members, 3 mental health clinicians, and a team of 6 IT specialists from Datacom, one of New Zealand’s largest IT companies, were involved in the app’s co-design. After a 6-month, agile, iterative process that included
The nonviolent communication model helps people recognize their specific emotions and needs before they engage in self-empathy or any kind of conflict or problem-solving involving other people. Once self-awareness is gained, it teaches people to make requests of others that are specific and free of demand [
Systems theory is a philosophy that focuses on the interdependence of individuals in a group to help understand and optimize the achievements of the system [
Supportive therapy is designed to reduce psychological conflict and strengthen a person’s defenses through the use of various techniques such as reassurance, suggestion, counseling, and education [
Strength-based therapy seeks to focus a person’s attention on their own strengths, resourcefulness, and resilience to help them recognize positive aspects of their identity and to use these qualities to move forward [
The primary aim of this open trial was to evaluate the acceptability and usability of the prototype app. Second, we sought to undertake a preliminary evaluation of the app’s usability, safety, and efficacy in altering mood, suicidal ideation, and functioning, as well as the feasibility of undertaking a more definitive randomized controlled trial (RCT). The key hypotheses were that the Village app would be acceptable, usable, and safe for users and buddies; that its use would lead to an improvement in mood and functioning and a reduction in suicidal ideation; and that an RCT using chosen or modified outcome measures and parameters would be feasible.
The single-arm, open trial of Village was conceptualized by 2 authors (HT and ES), and a mixed methods design was used. Participants were initially recruited by 2 authors (HK and HT) via specialist child and adolescent mental health services and primary health services in Auckland, New Zealand. Owing to low enrollment rates between November 2020 and February 2021 (most likely because of COVID-19–related service disruption), after the amendment of ethics approval, recruitment was expanded to social media advertisements (Facebook and Instagram linked to REDCap [Research Electronic Data Capture; Vanderbilt University], which recorded the number of individuals who signed up) between March 2021 and July 2021. Participants were selected by convenience and were supported to download the app via written and verbal instructions at the time of recruitment. They were encouraged to use the app as they wished to (with no set frequency) for 4 weeks. They were prompted (via automated REDCap messages and text if there was no response within 48 hours) to complete web-based quantitative outcome measures via REDCap at 3 time points: baseline, 4 weeks, and 3 months. After the use of Village for 4 weeks, more in-depth qualitative information regarding user experiences and feedback from buddies was collected by 1 author (HK, a female research assistant with prior experience of qualitative research and no prior relationship with participants before the study) on a single occasion, in person (one-on-one), at university premises via individual semistructured interviews lasting for 30-60 minutes. The interview schedule was developed by the research team and was road-tested with a couple of young people and adults. Interviewees were informed that questions were being asked to evaluate and improve the app before it became publicly available. The interviews were audio-recorded and transcribed by a certified transcriber who signed a confidentiality agreement. Data analysis and interpretation were undertaken by 2 authors (HT and HK). The paper was drafted by the first author (HT) and reviewed by all the authors (HT, HK, and ES) before submission.
Young people, aged between 16 and 25 years and of any gender, were invited to participate in the study. Eligible participants were experiencing low mood (self-reported, no quantified cutoff score), self-harm, or suicidal ideation; receiving psychotherapy or medication treatment; spoke adequate English to use the app; had access to a smartphone (iPhone or Android mobile); were able to provide electronic or written informed consent; and were able to nominate at least one buddy aged >16 years (as agreed with the ethics committee). Individuals who did not meet these criteria or who were currently receiving dialectical behavioral therapy (DBT), which includes active family and therapist support, were excluded. Each young person identified one of their friends to be invited to participate in follow-up interviews. These individuals provided separate written consent and demographic information before being interviewed.
Village is a communication app that helps young people experiencing low mood, self-harm, or suicidal ideation connect with a self-nominated support network of peers or family members. Young people (“users”) nominate and, via a text link, invite between 1 and 5 support people (“buddies”), to whom they can either send (the same or different) messages as often as they want and from whom they can receive daily check-ins and support. Users and buddies receive instructions on how to use the app through a series of onboarding messages. Users are guided to create messages letting buddies know how they are feeling and why, as well as what support they would ideally like them to provide. Buddies are coached via the app to respond sensitively to user messages. They were also provided with information about communication, common mental health issues (such as anxiety, depression, and self-harm), and what to do if they were worried about users’ safety. No additional or external support was provided to buddies during the trial. Software built into Village detects “risky messages” based on previously proven keywords for detecting high risk adolescents’ behavior on the web such as “suicide,” “kill myself,” “end my life,” “useless,” “want to die,” “dead,” and “worthless” [
Home screen.
Supported messages. Higher-resolution version of this figure is available in
Example of information module for buddies.
Schedule of outcome measurement.
Measures | Baseline | 4-week follow-up | 3-month follow-up |
PHQ-Aa | ✓b | ✓ | ✓ |
SIQc | ✓ | ✓ | ✓ |
WHODAS 2.0d | ✓ | ✓ | ✓ |
WHODAS-CYe | ✓ | ✓ | ✓ |
uMARSf |
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✓ |
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Semistructured interviews |
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✓ |
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aPHQ-A: Patient Health Questionnaire–9 modified for adolescents.
b✓: denotes completion of measures.
cSIQ: Suicidal Ideation Questionnaire.
dWHODAS 2.0: World Health Organization Disability Assessment Schedule 2.0.
eWHODAS-CY: World Health Organization Disability Assessment Schedule–Children and Youth.
fuMARS: user version of the Mobile Application Rating Scale.
This study was approved by the New Zealand Health and Disability Ethics Committee (20/NTB/116). Users recruited via clinical service recruits and interviewed buddies provided written consent, and users recruited through the web provided electronic consent via REDCap. Written data were stored in secure filing cabinets, and electronic data were stored on a secure server, as per the University of Auckland regulations. A privacy impact assessment conducted at the request of the ethics committee rated the study as “low risk.” Although users had the option of being put through a telephone helpline if risky messages were detected by the app, none of their information was forwarded to any external agencies. All participants were encouraged to disclose any potential adverse events, including self-harm, suicide attempts, and hospitalization, to the research team at any stage of the study, and they were specifically asked about these events during the follow-up interviews. A log of these events and the number, dates, and outcomes of risky messages were maintained by the research team. Owing to the nature of the study, no external data safety monitoring committee was used. App users were informed that they were free to withdraw from the study at any stage. Regardless of the duration of the participants’ involvement, all enrolled users and buddies received a NZ $50 (US $30) gift voucher on exit from the study.
A total of 321 young people were made aware of the study, 23 via child and adolescent mental health services, 5 via general practice services, and 293 via social media advertisements. A total of 14 clinicians were involved in referring young people from the services mentioned above. Of those who knew about the study, 156 young people did not meet the eligibility criteria; 78 did not respond to contact from the research team about receiving more information regarding the trial; 58 declined to participate because they were not interested, their mental health was stable, or they did not have a suitable buddy; and 8 agreed to participate, but did not complete baseline measures and did not download the app. This resulted in 26 users, 21 of whom managed to enroll ≥1 buddies and complete the trial. The demographic characteristics of both groups are presented in
Participant characteristics.
Characteristic | Value | |||
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Registered and completed baseline outcome measures | 26 (100) | |
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Completed 4 and 12-week outcome measures | 21 (81) | |
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Completed follow-up interviews | 13 (50) | |
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Registered | 21 (100) | |
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Completed follow-up interviews | 12 (57) | |
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Young people or users | 17.7 (16-25) | ||
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Buddies | 23.6 (16-53) | ||
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Female | 17 (65) | |
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Male | 6 (23) | |
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Nonbinary | 3 (12) | |
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Female | 12 (57) | |
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Male | 5 (24) | |
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Nonbinary | 2 (10) | |
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Preferred not to answer | 1 (5) | |
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Māori | 4 (15) | |
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New Zealand European | 17 (65) | |
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Asian | 4 (15) | |
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MELAAb | 1 (4) | |
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Māori | 2 (10) | |
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New Zealand European | 12 (57) | |
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Asian | 2 (10) | |
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MELAA | 1 (5) | |
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Otherc | 4 (19) | |
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Low mood | 23 (88) | |
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Self-harm | 9 (35) | |
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Suicidal ideation | 13 (50) | |
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Other | 7 (27) | |
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Parents | 3 (14) | |
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Siblings | 1 (5) | |
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Partners | 2 (10) | |
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Friends | 14 (67) | |
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Child and adolescent mental health service | 8 (31) | |
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General practice | 4 (15) | |
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Social media | 14 (54) | |
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Invited by a young person | —e |
aOne buddy did not complete the demographic form.
bMELAA: Middle Eastern, Latin American, and African.
cOther: Fijian, Russian, and American.
dReason for participation: participants had the opportunity to select multiple reasons for participating in the trial. Other—hallucinations and dissociation identity disorder (n=1), anxiety and panic attacks (n=3), family issues (n=1), attention-deficit or hyperactivity disorder (n=1), and interest in marketing research (n=1).
eNot applicable.
Three key themes emerged from the analysis of user and buddy feedback: (1) appeal of app features and layout, (2) usefulness of content, and (3) technological challenges. Although most users and buddies found Village appealing to use and easy to navigate, a few experienced difficulties downloading or using the app for the first time. This was particularly an issue for buddies who needed to be invited by users and did not have access to support from one of the research team (HK). Both users and buddies found Village helpful in constructing useful messages. However, some who had prior experience with mental health services found guided responses “robotic” and said they would prefer greater freedom to compose more personally relevant messages. The themes, subthemes, and supporting examples are summarized in
Young people and Buddy feedback on acceptability of Village app.
Theme and subthemes | Examples | ||
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Ease of use |
“I actually it was really straight forward, which is nice, like a lot of, I’ve tried other mental health apps before and a lot of them they’re either they’re really complicated to figure out or they’re just not intuitive but it felt like Village was quite intuitive, like it was kind of obvious what would, what buttons would do what.” (User 26) “I really enjoyed the experience of using Village. I felt that it was a really nice missing piece of interactions with a young person who’s struggling to be able to interact in that way.” (Buddy 26, friend) |
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Orientation challenges |
“It was kind of confusing to get around, especially. Like if the, it’s not like a tutorial on how to use it. You kind of just turn right into it and like had no idea of what to do initially.” (User 23) |
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Support with messaging |
“I really enjoyed how the, like to explain how you’re feeling, they had the options for like what you could say. It made it easier because I know a lot of people, and especially me when I’m feeling really down, I find it really hard to know what to like to say to get help so I thought that was really good and helpful.” (User 11) “I looked at the tips and I read those and actually thought they were really, really good. They’re quite similar to, you know, what I learn at DBTa. I especially wanted to congratulate you on the validation portion. I think that that part was really good, really well written and absolutely perfect for the app.” (User 8) “You don’t have to think about what to write when you’re talking to a buddy, which is great because that’s a really annoying thing, having to think about what to say or trying to reach out and having no idea how to say it. I also liked the option to also edit that and put in your own things as well, your own thoughts. The hardest thing for me is knowing what to say when you need to ask for help or how to tell people how you’re feeling when you’re not feeling great. I think that made me feel a bit more confident on sharing how I’m feeling with someone and that’s definitely changed a lot about how I think about myself and accepting how I feel as well.” (User 17) “I can remember the tips that were saying, you know, you could respond like this or, you know, don’t forget to say this. And it was like, oh yeah that’s right, yep no I need to do that. So, they were quite useful to help compose a response.” (Buddy 1, parent) |
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Improved mental health knowledge |
“I found the Discover section the most useful with the information. I thought the way that it was in snippets and then let you read more and stuff like that, it made it kind of seem like everything was backed up well by research and all that, which I thought was, you know, adds like an extra level of confidence to it. Gave me some insight on how to kind of talk to people who might be going through, you know, depression or anxiety, and that sort of thing.” (Buddy 11, friend) “It was pretty good actually, as well as interesting because like it kind of helped me get a bearing of what’s best to support people with those like common mental health issues, even if it wasn’t what the person I was supporting was dealing with.” (Buddy 15, friend) “I thought it was like a really good option because I know like, you know, lots of people don’t have a wide range of knowledge on different mental health issues so I thought that was like good, yeah informing me on issues.” (Buddy 21, friend) |
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Rote nature of responses |
“It felt kind of, kind of clinical and removed though. Just with the way the responses were formulated.” (Buddy 7, friend) “I’m not sure how useful it was because he mentioned that it was like canned responses that he wasn’t able to like add much.” (Buddy 26, friend) |
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Positive impact on relationships |
“I think it made a big difference. I went from like not talking to my friend, like anything like mental health wise to like actually like being able to like open up to them a lot more. I felt really like cared for and supported. Before, like I started using Village, I definitely if someone was to bring something up in real life, like I would shut it down, like the conversation or joke about it and try and move on. But it definitely, I felt a lot more comfortable, I wanted to talk about it, like in face-to-face if something was wrong.” (User 3) “I feel like my dad kind of he can sort of validate much better now because like before he was very like, it was like he was reading off a script every time. But with the app he’s discovered there’s so many other different ways to validate and I feel like he’s putting that into like real life and actually thinking about it, which has been really good.” (User 1) |
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Technological issues |
“There was a little hitch up with the signup but once we got around that it was, yeah smooth sailing.” (Buddy 11, friend) “The only kind of thing that kind of sucked was how you only get notifications whilst the app was open and not when it was closed.” (User 16) “Another one I found issue with in the app is friend requests. It was really confusing.” (User 23) “Occasionally actually it would log me out. I’m not sure why but sometimes I get logged out and have to relog in but that’s just a small thing.” (User 17) |
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Suggestions for improvement |
“I think there was a few things that could have been improved like the avatar. There wasn’t too much of a variety to choose from.” [user 9] “Maybe having your phone receive notifications when the app’s closed as well.” (User 16) |
aDBT: dialectical behavioral therapy.
Overall, recruitment via social media advertising (n=14) was substantially more effective than recruitment via specialist mental health services (n=8) or primary health services (n=4). However, recruitment rates were reversed between these methods, with 80% (4/5) of those from primary care, 67% (8/12) of those from specialist services, and 5% (14/280) of those who heard about the study via social media actually being enrolled. This suggests that more effective collaboration with clinicians may be necessary for successful recruitment via clinical services. The relatively low uptake via all means among males might indicate that this group needs to be specifically targeted during the next phase of research. There were no reported issues with comprehension or completion of outcome measures using the REDCap software. Furthermore, no other unanticipated operational issues were observed.
Usability of the Village app was evaluated using all 3 subscales of the uMARS questionnaire. Users gave Village a mean rating of 3.8 (range 2.7-4.6) out of 5 on a 5-point scale for app quality and an overall star rating of 3.4 out of 5 for subjective quality. Although knowledge, attitudes, and behavior change were rated lower (2.7-2.9 out of 5), the majority said it would increase the likelihood of future help-seeking (3.9 out of 5). Further details are provided in
Young people’s quality and impact rating of Village app using the Mobile Application Rating Scalea.
Rated item | Score, mean (SD) | ||
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Engagement (fun, interesting, customizable, interactive, and has prompts) | 3.6 (0.6) | |
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Functionality (app functioning, easy to learn, navigation, flow logic, and gestural design of the app) | 4.0 (0.6) | |
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Esthetics (graphic design, overall visual appeal, color scheme and stylistic consistency) | 3.7 (0.7) | |
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Information (contains high-quality information from a credible source) | 3.8 (0.8) | |
Total app quality mean score | 3.8 (0.8) | ||
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Would you recommend this app to people who might benefit from it? (1=not at all, 5=definitely) | 3.0 (1.1) | |
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How many times do you think you would use this app in the next 12 month if it was relevant to you? (1=none, 2=1−2, 3=3−10, 4=10−50, and 5≥50) | 3.6 (0.9) | |
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Would you pay for this app? (1=definitely not, 5=definitely yes) | 1.6 (0.7) | |
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What is your overall (star) rating of the app? (1=one of the worst apps I have used, 3=average, and 5=one of the best apps I have used) | 3.4 (0.9) | |
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Awareness (this app has increased my awareness of the importance of addressing the health behavior) | 3.5 (1.4) | |
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Knowledge (this app has increased my knowledge or understanding of the health behavior) | 2.9 (1.1) | |
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Attitude (the app has changed my attitudes toward improving this health behavior) | 2.7 (1.1) | |
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Intention to change (the app has increased my intentions or motivation to address this health behavior) | 3.4 (1.2) | |
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Help-seeking (this app would encourage me to seek further help to address the health behavior) | 3.9 (1.1) | |
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Behavior change (use of this app will increase or decrease the health behavior) | 2.9 (1.0) |
aAll rating scales ranged from 1 to 5 in the user version of the Mobile Application Rating Scale questionnaire.
“I used it when I was feeling bad and when I was feeling like I wanted to help my friends and stuff. So, I would go on the app to check if they needed any help or anything.” (User 16)
“Most of the time I let people know when I wasn’t feeling good but like when I was overwhelmed more and when I wasn’t seeing my friends as much, when I wasn’t being able to check in on them in person. One of my friends I was messaging him probably like more, maybe like five times a week, especially like during the holidays and stuff when I wasn’t seeing him. And then other one µm like less often, maybe two times a week. And the other one maybe once a week.” (User 21)
“If I’m being honest, at first, I didn’t really use it, but then, um, towards like the middle of like the trial, me and my friend would use it more because like lockdown and stuff happened and then there was another way to contact each other and let us know how we feel.” (User 11)
The risk detection software was activated on 3 occasions during the study. Two followed users entering the words “burden” or “suicidal ideation” and one followed a buddy entering of the words “useless” and “not good enough” within the same message. On all 3 occasions, participants elected to be contacted by a member of the research team rather than being put through to a national telephone helpline, and they reported that they were fine. None of the participants interviewed toward the end of the study reported any episodes of self-harm or hospitalization during the period of enrollment.
Preliminary evaluation of the efficacy of Village was undertaken by measuring changes in symptoms of depression, level of suicidal ideation, and level of functioning following app use; the results are presented in
Changes in severity of depression, suicidal ideation, and functioning.
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Depression (PHQ-Aa) | Suicidal ideation (SIQb) | Functioning (WHODAS 2.0c or WHODAS-CYd) | ||||||||
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Baseline | 4-week follow-up | 3-month follow-up | Baseline | 4-week follow-up | 3-month follow-up | Baseline | 4-week follow-up | 3-month follow-up | ||
Participant, n | 26 | 18 | 21 | 26 | 20 | 21 | 25 | 19 | 20 | ||
Mean (SD) | 18.1 (5.6) | 15.7 (6.6) | 12.7 (5.7) | 77.7 (48.4) | 68.9 (45.8) | 57.3 (44.2) | 46.2 (16.5) | 45.2 (16.3) | 36.7 (19.4) | ||
Range | 6.0-27.0 | 6.0-27.0 | 3.0-27.0 | 0-159.0 | 3.0-148.0 | 3.0-180 | 18.5-73.6 | 22.2-75.4 | 13.9-98.6 | ||
Mean difference (95% CI)e | N/Af | −2.4 (−6.3 to 0.9) | −5.4 (−9.2 to −2.2) | N/A | −8.8 (−42.7 to 13.2) | −20.4 (−53.9 to 1.2) | N/A | −1.0 (−13.2 to 8.9) | −9.5 (−21.7 to 0.2) | ||
N/A | .14 | <.001 | N/A | .29 | .06 | N/A | .69 | .05 | |||
Effect size (Cohen |
N/A | N/A | 0.9 | N/A | N/A | 0.4 | N/A | N/A | 0.5 | ||
Overall |
N/A | N/A | .001 | N/A | N/A | .16 | N/A | N/A | .13 |
aPHQ-A: Patient Health Questionnaire–9 modified for adolescents.
bSIQ: Suicidal Ideation Questionnaire.
cWHODAS 2.0: World Health Organization Disability Assessment Schedule 2.0.
dWHODAS-CY: World Health Organization Disability Assessment Schedule–Children and Youth.
eEstimated marginal mean differences from a repeated measures analysis with pairwise comparisons between time points.
fN/A: not applicable.
gEffect sizes were calculated using baseline and 3-month follow-up means and SDs.
During this open trial, we found that Village was acceptable and usable to both users and buddies, and that a larger RCT appeared feasible, providing the following changes were made to the current version of the app and study protocol: (1) improved app onboarding instruction and notifications, (2) recruitment focused either directly on potential participants via social media or via collaborative clinicians at clinical services, and (3) all outcome measures being made mandatory on REDCap. Young people who experienced preexisting difficulty communicating with available support in person or via social media and buddies (families or friends) with limited mental health knowledge found the app most useful. The feedback suggested that some improvements to onboarding and notifications would further increase the appeal of the app. Short-term, statistically significant improvements in mood and nonsignificant changes in functioning or suicidal ideation need to be interpreted with caution given the small number of participants and the preliminary nature of the trial. Embedded risk detection software was appropriately activated on a few occasions and there were no reported episodes of self-harm or hospitalization among participants, suggesting the Village was safe to use with a clinically “high risk” cohort.
Although there is a plethora of digital interventions for supporting young people’s well-being and mental health, only a handful of other digital interventions have been specifically developed for young people experiencing self-harm and suicidal ideation. These are As Safe As Possible, during which young people complete a 3-hour safety-planning, emotion regulation session and then use an app to review their mood, safety plan, and learned skills [
Given that most young people these days regularly use texting and multiple social media apps to keep in touch with family and friends, it is reasonable to wonder about the necessity for a new vehicle with which to communicate distress. Previous research has shown that although social media can make it easier to maintain contact with others, young people are very careful about how to use such networks for support [
Most young people in this trial chose friends, rather than family members, as buddies. This is consistent with previously identified age-related preferences for support among young people with depression [
Although conceptualized by an individual of Māori descent (ES), consciously designed to enhance “Whanau Ora,” and co-designed with a number of Māori young people and families (“whanau”), we did not conduct any specific evaluation of the cultural appeal or safety of the app during this open trial. Given the higher rates of depression, self-harm, and suicide among New Zealand Māori young people (consistent with rates among Indigenous groups in other countries [
Despite the functionality of Village being rated above average, uMARS ratings were comparable with other recently developed mental health apps for young people [
The strengths of this trial include the exploration of both user and buddy perspectives on the app and the combined use of quantitative and qualitative analyses to provide a richer understanding of its appeal and function. Weaknesses include the limited sample size, lack of a control group, and lack of complete follow-up measures for 20% of participants, which might have led to biased results. In addition, not all users and buddies agreed to be interviewed, and interviews were conducted by a member of the research team who had been involved in participant recruitment and data analysis, and objective data regarding app use were not collected for privacy reasons. The exclusion of participants aged <16 years (owing to ethics committee constraints) and those from outside New Zealand also means that our results may not be generalizable to younger users or those from other countries.
On the basis of the preliminary results from this open trial, Village appears to be an acceptable, usable, and safe communication app with which young people experiencing low mood, self-harm, and suicidal ideation can receive support from their family and friends. A larger RCT to confirm the current findings and evaluate the efficacy of the app appears to be feasible with minor modifications to the app and study protocol.
Higher resolution version of
Semistructured interview questions.
Severity scores for depression, suicidal ideation, and functioning.
cognitive behavioral therapy
dialectical behavioral therapy
randomized controlled trial
Research Electronic Data Capture
Suicidal Ideation Questionnaire
user version of the Mobile Application Rating Scale
World Health Organization Disability Assessment Schedule
World Health Organization Disability Assessment Schedule–Children and Youth
The authors wish to thank all the young people, families, and friends who participated in the co-design and open trial of Village. The authors also wish to thank Dr Alana Cavadino, a biostatistician at the University of Auckland, for her assistance with the study design and data analysis.
This work was supported by the New Zealand Starship Foundation (grant number SF 1960).
Data are presented in the multimedia appendices.
The study was conceptualized by all authors (HT and ES). The study results were analyzed by 2 authors (HT and HK). All the authors contributed to the drafting and review of the paper.
HT and ES are developers of the Village app. HK does not have any conflict of interest to declare.