Defining the characteristics of an e-health tool for suicide primary prevention in the general population: the StopBlues case in France (Preprint)

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Abstract
BACKGROUND With more than a million deaths per year and nearly one out of two people with suicidal thoughts not receiving any form of care in high-income countries, suicide is a major public health problem and a cause of avoidable mortality which could be significantly reduced by effective prevention programs. E-health tools present the advantage of addressing a broad population including people unaware of their potential risk of suicide, and provide an opportunity to look for information and help without fearing stigmatization. This could make them an effective tool for primary prevention programs, even in some hard-to-reach populations. OBJECTIVE Our main objective was to define the overall characteristics of an e-health tool for the primary prevention of suicide in the French general population. Intermediate objectives were to define 1/ the characteristics of the IT features; 2/ the content of the information delivered; 3/ the best way to structure that information; and 4/ how the information should be relayed and by whom. METHODS The research was carried out in two phases: 1/ a literature review was conducted to gather knowledge on existing interventions that may already have proved their effectiveness, and on guidelines for suicide prevention programs; and 2/ a co-construction phase was carried out through a participative process (focus groups and interviews) with stakeholders, including the target population, to ensure that the needs of individuals would be met. RESULTS E-health tools for suicide primary prevention in the general population may be constructed around four types of strategies: education and awareness, (self-)screening, accessing support, and mental health coping. They should be accessible on different devices to reach the most users, and language and content should be adapted to the target population and to the issue being addressed. Finally, the tool should be consistent with ethical and quality best practices. StopBlues was developed following those recommendations and is the first of its kind in France, an e-health tool for prevention with numerous functionalities to help people with psychological distress. CONCLUSIONS E-health tools for suicide prevention offer many advantages when adapted to the need of the population: 1/ great accessibility, 2/ users’ anonymity with reduction of shame, 3/ adaptation of health interventions to new cultural practices, and 4/ the possibility to regroup in one tool many functionalities. Those can be an important part of users’ empowerment process, by helping them manage their illness on their own and gain autonomy, therefore improving their well-being. However, it is important to remember that this type of tools should be developed not to make up for the potential lack of healthcare services but to propose a reliable tool to help people evaluate themselves and be directed to the healthcare system at early stages of their illness. CLINICALTRIAL Preventing Psychological Distress and Suicidal Behaviours: a Web-based and Mobile Suicide Prevention Intervention in the General Population (PRINTEMPS) NCT03565562 https://clinicaltrials.gov/ct2/show/NCT03565562 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-020-04464-2
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