BACKGROUND There are an estimated 800,000 suicides per year globally, and approximately 16,000,000 suicide attempts. Mobile apps may help address the unmet needs of people at risk. We assessed adherence of suicide prevention advice in depression management and suicide prevention apps to six evidence-based clinical guideline recommendations: mood and suicidal thought tracking, safety plan development, recommendation of activities to deter suicidal thoughts, information and education, access to support networks, and access to emergency counseling. METHODS A systematic assessment of depression and suicide prevention apps available in Google Play and Apple's App Store was conducted. Apps were identified by searching 42matters in January 2019 for apps launched or updated since January 2017 using the terms "depression," "depressed," "depress," "mood disorders," "suicide," and "self-harm." General characteristics of apps, adherence with six suicide prevention strategies identified in evidence-based clinical guidelines using a 50-question checklist developed by the study team, and trustworthiness of the app based on HONcode principles were appraised and reported as a narrative review, using descriptive statistics. RESULTS The initial search yielded 2690 potentially relevant apps. Sixty-nine apps met inclusion criteria and were systematically assessed. There were 20 depression management apps (29%), 3 (4%) depression management and suicide prevention apps, and 46 (67%) suicide prevention apps. Eight (12%) depression management apps were chatbots. Only 5/69 apps (7%) incorporated all six suicide prevention strategies. Six apps (6/69, 9%), including two apps available in both app stores and downloaded more than one million times each, provided an erroneous crisis helpline number. Most apps included emergency contact information (65/69 apps, 94%) and direct access to a crisis helpline through the app (46/69 apps, 67%). CONCLUSIONS Non-existent or inaccurate suicide crisis helpline phone numbers were provided by mental health apps downloaded more than 2 million times. Only five out of 69 depression and suicide prevention apps offered all six evidence-based suicide prevention strategies. This demonstrates a failure of Apple and Google app stores, and the health app industry in self-governance, and quality and safety assurance. Governance levels should be stratified by the risks and benefits to users of the app, such as when suicide prevention advice is provided.

中文翻译：

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自杀预防和抑郁应用程序的自杀风险评估和管理：对临床指南依从性的系统评估。

背景技术据估计，全球每年有80万自杀，大约有1600万自杀企图。移动应用程序可能有助于解决有风险人群的未满足需求。我们评估了抑郁症管理和自杀预防应用程序中自杀预防建议对六项循证临床指南的依从性：情绪和自杀念头跟踪，安全计划制定，活动建议以阻止自杀念头，信息和教育，获得支持网络，并获得紧急咨询。方法对Google Play和Apple的App Store中提供的预防抑郁和自杀预防应用程序进行了系统评估。通过从2019年1月开始的42个事项中搜索2017年1月以来启动或更新的应用程序来识别应用程序，这些应用程序使用“抑郁”，“沮丧，9％），包括两个在两个应用商店中都可用且每个应用下载超过一百万次的应用，提供了错误的危机热线电话号码。大多数应用程序都包含紧急联系信息（65/69应用程序，占94％），并通过该应用程序直接访问危机帮助热线（46/69应用程序，占67％）。结论超过200万次的心理健康应用程序提供了不存在或不准确的自杀危机求助热线电话号码。在69个抑郁症和自杀预防应用程序中，只有五个提供了所有六种循证自杀预防策略。这表明苹果和Google应用商店以及健康应用行业在自治，质量和安全保证方面均失败。治理级别应根据应用程序用户的风险和利益进行分层，例如在提供自杀预防建议时。包括错误的求助热线电话号码，包括两个在两个应用商店中都可用的应用程序，每个应用程序都下载了超过一百万次。大多数应用程序都包含紧急联系信息（65/69应用程序，占94％），并通过该应用程序直接访问危机帮助热线（46/69应用程序，占67％）。结论超过200万次的心理健康应用程序提供了不存在或不准确的自杀危机求助热线电话号码。在69个抑郁症和自杀预防应用程序中，只有五个提供了所有六种循证自杀预防策略。这表明苹果和Google应用商店以及健康应用行业在自治，质量和安全保证方面均失败。治理级别应根据应用程序用户的风险和利益进行分层，例如在提供自杀预防建议时。包括错误的求助热线电话号码，包括两个在两个应用商店中都可用的应用程序，每个应用程序都下载了超过一百万次。大多数应用程序都包含紧急联系信息（65/69应用程序，占94％），并通过该应用程序直接访问危机帮助热线（46/69应用程序，占67％）。结论超过200万次的心理健康应用程序提供了不存在或不准确的自杀危机求助热线电话号码。在69个抑郁症和自杀预防应用程序中，只有五个提供了所有六种循证自杀预防策略。这表明苹果和Google应用商店以及健康应用行业在自治，质量和安全保证方面均失败。治理级别应根据应用程序用户的风险和利益进行分层，例如在提供自杀预防建议时。