Overview of the iBobbly trial

Using technology to save young indigenous lives

Suicide rates in Aboriginal and Torres Strait Islander communities are amongst the highest in the world. Despite increased funding and implementation of new prevention programs, very few indigenous people will seek help before acting on suicidal thoughts.

iBobbly is a trial of the world’s first suicide prevention app designed especially for use by Indigenous people on mobile phones or tablet devices. Called iBobbly (a name derived from a Kimberley greeting), the app delivers treatment-based therapy in a culturally relevant way.

Based on psychological therapies proven to reduce suicidal thoughts, it draws heavily on Indigenous metaphors, images and stories drawn from local Aboriginal artists and performers. The app format leaps two of the major hurdles to help seeking – perceived stigma and geographical isolation. Once the app is downloaded they don’t need ongoing internet access and the program is password protected, thus maintaining confidentiality if the technology is shared amongst the community.

A pilot study conducted using Randomised Controlled Trial methodology has recently been conducted in the Kimberly, demonstrating with favourable results. A large-scale evaluation is currently being rolled out across several Australian states to determine effectiveness of the app in reducing suicidal thoughts.

iBobbly was developed in partnership with Alive and Kicking Goals Suicide Prevention Program (WA), HITnet Innovations, Thought works, Muru Marri Indigenous Health Unit UNSW, Young and Well Cooperative Research Centre, Kimberley Aboriginal Community Members (WA), Men’s Outreach Service (WA), Aboriginal Artists – Martha Lee, Danica Manado and Esah Coffin, Nyamba Buru Yawuru Aboriginal Corporation, Rubibi (Broome, WA), Goolarri Media (WA), Dr Kathy McKay and BackTrack (NSW). Samsung generously donated 150 tablets for the trial.

Interactive technology used in the trial

Mobile App

Tablet App

Aims

Primary Aim: To determine whether the app reduces levels of suicidal ideation.

Secondary Aims: To determine whether the app reduces suicide plans; to determine the effects of the program on symptoms of depression, impulsivity, hopelessness, perceived burdensomeness, thwarted belongingness, health care utilisation, disability, and help-seeking intentions.

Rationale

Suicide is the leading cause of death amongst Australians aged 15-44. Compared to their non-Indigenous counterparts, Indigenous youth aged 15-24 have four times the risk of suicide, and those aged 25-34 have almost three times the risk.

Suicide rates continue to rise amongst the Indigenous community despite many policies, programs and funding initiatives. The focus of these programs is generally at the community level. However, a public health approach that focuses on individual risk offers great promise.

An app (a program downloaded from the internet which sits on computers, smart phones or tablets) which uses evidence-based and culturally suitable content represents a feasible, cost effective way to reach young, at-risk people who have very low levels of help-seeking.
The proposed study represents the first suicide intervention within the Australian Indigenous population which uses a Randomised Controlled Trial (RCT) to test effectiveness. Indigenous Australians are not seeking face to face mental health care, more than 70% of indigenous suicides occur in people who are not previously known to health services. The app format overcomes two of the major hurdles to help seeking – perceived stigma and geographical isolation. Indigenous youth have a high rate of mobile phone usage. iBobbly allows for engagement with them on technology they are comfortable with and able to use in their own private time.

iBobbly is an indicated prevention trial investigating the efficacy of an app-based self-help intervention designed to reduce suicidal thoughts in young (16-30 years) Indigenous Australians. Individuals with suicidal ideation will be recruited from the community and provided with a Black Dog developed self-help app which delivers evidence-based automated treatment. To examine the effectiveness of this intervention, a RCT design will be used to compare the intervention with an attention-matched control app. Participants will be assessed immediately after completing the intervention, as well as at 6, 12 and 24 months post- intervention to gauge the maintenance of intervention effects.

Research

Contributors

Fiona Shand
Helen Christensen
Joe Tighe
Rebecca Ridani
Andrew Mackinnon

Research paper

http://goo.gl/ouypGU

Research Funding

– Department of Health and Ageing
– Department of Health WA
– YAWCRC PhD scholarship (Tighe)
– NHMRC CRE in Suicide Prevention APP1042580
– NHMRC Project Grant APP1060477