The Role of Technology and the Continuum of Care for Youth Suicidality: A Systematic Review

Background: Youth suicide is a global public health crisis. Therefore, it is essential to engage youth in the continuum of mental health services, which ranges from illness recognition to follow-up services. Technology is one medium to increase youth engagement in interventions. Few systematic reviews discuss how technology-enhanced youth suicide interventions fit into the continuum of care.

As one of the largest mental health professions, social work plays an important role in youth suicide prevention. Yet, social work is underrepresented in suicidology. Since the use and application of technology is a social work grand challenge and a priority of suicidology, it is opportune time for our field to increase its presence in the science of youth suicide prevention.

To address these gaps in the literature, this systematic review aims to examine how technology is used throughout the continuum of care of care for suicidal youth and to understand the current contribution of social work science.

Methods: Four electronic databases were searched for youth suicide preventive interventions that used technology. Studies that had a primary focus on suicidality, were in English, and had participants between the ages of 12-24 years old were included. Technology could be used to deliver or serve as a component of an intervention. Studies about assisted suicide, non-suicidal self-injury, postvention and/or only had outcomes for gatekeepers were excluded from the final sample. The review was not restricted by study design and eligible studies could report outcomes on suicidality and/or related behaviors, such as treatment initiation. An adapted version of the Methodological Quality Ratings Scale was used to assess study quality.

Results: Twenty-six studies were identified. Only two studies had a first author who represented social work. The mean age of study participants was 17.4 years old. Females represented the majority of participants. Of the studies that did report youth ethnicity, most identified as White; no study reported sexual or gendered minority identity. Thirteen studies were conducted in an educational setting. Phones and online platforms were the predominant technologies use.

Across the continuum of care, most studies (12) were targeted to increase youth help-seeking for services, followed by illness recognition (10). The outcomes of the adapted MQRS tool could range from 0 (lowest quality) to 20 (highest quality): the average score was 10.4, ranging from 3 to 16. Nine studies reported significant decreases in suicidal ideation post intervention, nine studies reported significant decreases in other mental health issues, and eight studies reported significant increases in help-seeking behaviors. One study reported a significant increase in coping behaviors, and three studies reported significant increases in treatment initiation.

Conclusions: Findings support the emerging efficacy of technology-enhanced interventions, including declines in suicidality and increases in proactive behaviors. Despite its minimal presence, social work science has the potential to contribute a social justice lens to technology-enhanced youth suicide interventions. Social work scholars are well positioned to develop and implement interventions that target limitations of the current literature, particularly to extend services beyond illness recognition and help-seeking and to engage and support diverse youth populations.