Table 3 Possible unintended consequences of SERO app usage. They were collecting using the DTx risk assessment canvas

Negative impact on relatives

Overburdening and stress of family members

Using the app can cause significant stress for relatives, particularly due to the difficulty in separating from the loved one's risk situations. This can strain relationships and exacerbate emotional distress for both parties. Particularly, information in safety plans can inadvertently cause fear and anxiety among relatives when individuals at risk enter destructive items

Negative consequences for individuals with suicidality

False expectations and potential misuse

The app may create unrealistic expectations due to lack of action recommendations or feedback on self-assessment, leading to confusion and potential misuse. Safety plans might contain items that inadvertently contribute to negative outcomes if not properly managed or contextualized

Inappropriate emotional responses

Using the app might trigger false senses of well-being, delaying or complicating the seeking of professional help

Emergence of negative emotions

Frequent self-assessment and a focus on mental well-being could lead to an increased awareness of suicidal thoughts

Realization of lack of personal support

Users may become demoralized upon realizing their lack of personal support contacts or resources, counteracting the app's supportive intent. The app's effectiveness is compromised in crisis situations if users have not previously entered resources or integrated contacts

Misuse and misunderstandings by users

Misunderstandings of instructions or onboarding information can lead to misuse and frustration, originating from misplaced expectations about the app's functionality. Users may struggle with navigating the app or lack clear guidance, leading to frustration and decreased utility of the app

Involuntary disclosure of suicide risk

Using a suicide prevention app could unintentionally reveal a user's suicide risk, potentially leading to bullying, discrimination, social isolation, and stigmatization

Language barriers

The app currently supports four languages. But many explanations require good reading skills. The app's effectiveness is limited for those with limited language proficiency

Unintended consequences for society or healthcare system

Conflict between app and professional advice

Tensions might arise between the app's self-management features and professional medical advice, leading to confusion and undermined trust in the app

Increased use of support services and costs

The app might escalate users to paid emergency call services, which may not be appropriate or feasible in all situations, leading to an increase of healthcare costs