Efficacy and usability of an AI-enhanced mobile app for non-suicidal self-injury (NSSI): Development of the BE N.I.C.E protocols

Abstract

People who engage in non-suicidal self-injury (NSSI) face a heightened risk of future suicide attempts, highlighting the critical need for early and accessible intervention strategies. This study evaluates the effectiveness and usability of the smartphone application BE N.i.C.E (BElajar daN Latih Sehingga Cekap Emosi), which is tailored for individuals engaged in non-suicidal self-injury (NSSI). The app is intended not only for those who self-harm but also as an educational resource for healthcare practitioners, medical students, and allied health professionals to learn about and practice effective management strategies for NSSI. In this Phase I open trial, we assess the AI-enhanced BE N.i.C.E. app, aimed at early intervention for individuals displaying NSSI behaviours. This research utilises a single-arm pre- and post-test intervention design. The app features a mood-monitoring diary, cognitive-behavioural therapy-based mood-enhancing techniques, and direct access to emergency contacts. Fifteen individuals with a history of self-harm will be recruited from the psychiatry clinics of Hospital Sultanah Nur Zahirah (HSNZ) and Hospital Sultan Zainal Abidin (HOSZA). Data collection will occur through questionnaires and interviews at baseline and after a four-week follow-up to evaluate the app's effectiveness and usability. Additionally, clinicians will be interviewed to determine the app's feasibility in clinical settings. Recruitment is scheduled from December 1, 2024, to June 31, 2025. This study represents the first attempt to evaluate an AI-enhanced mobile app specifically designed for individuals who self-harm. The findings will guide whether a feasibility trial is needed to test recruitment, randomisation, retention, and outcome measures.