1
|
Gleeson JFM, Koval P, Zyphur M, Lederman R, Herrman H, Eleftheriadis D, Bendall S, Cotton SM, Gorelik A, Alvarez-Jimenez M. A randomized controlled trial of moderated online social therapy for family carers of first-episode psychosis patients in a specialist treatment setting. Schizophr Res 2023; 255:203-212. [PMID: 37004332 DOI: 10.1016/j.schres.2023.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/26/2023] [Accepted: 03/11/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Family members, who provide the majority of informal care during the recovery period from first-episode psychosis (FEP), experience high levels of psychological distress. However, there is a lack of effective and accessible interventions for FEP carers. OBJECTIVE To determine the effectiveness of an online intervention ("Altitudes") in relation to the primary outcome of FEP-carer stress at 6 months follow-up. METHODS We conducted a cluster randomized controlled trial in which FEP carers were randomized to Altitudes combined with specialized treatment as usual (STAU) or STAU alone. In addition to questionnaires, we included multiple waves of intensive ecological momentary assessment (EMA) to measure carer stress and family outcomes in 164 carers of young (15-27 years) FEP patients. RESULTS Both groups improved over time on stress and a range of secondary outcomes, including mental health symptoms, self-efficacy, and expressed emotion with no group by time interactions. At 12 months there were significantly fewer visits to emergency departments by FEP patients in the Altitudes group (p = 0.022). Modelling of multiple EMA waves revealed that more time spent by carers with FEP patients predicted greater worry, expressed emotion, and adaptive coping. CONCLUSIONS Engagement and usability findings for Altitudes were positive. Further refinements to our online carer interventions may be needed to engage carers in purposeful skill development for improved management of stress and communication with the young person compared with existing specialist family interventions. TRIAL REGISTRATION ACTRN12616000968471.
Collapse
Affiliation(s)
- John F M Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Level 5, Daniel Mannix Building, Young Street, Fitzroy, VIC 3065, Australia.
| | - Peter Koval
- Melbourne School of Psychological Science, The University of Melbourne, Australia
| | - Michael Zyphur
- School of Business, Faculty of Business, Economics and Law, The University of Queensland, St Lucia, QLD, Australia
| | - Reeva Lederman
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, The University of Melbourne, Parkville, VIC, Australia
| | - Helen Herrman
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Dina Eleftheriadis
- School of Behavioural and Health Sciences, Australian Catholic University, Level 5, Daniel Mannix Building, Young Street, Fitzroy, VIC 3065, Australia
| | - Sarah Bendall
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Alexandra Gorelik
- Musculoskeletal Health and Sustainable Healthcare Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Medicine (RMH), The University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| |
Collapse
|
2
|
Contemporary Hermits: A Developmental Psychopathology Account of Extreme Social Withdrawal (Hikikomori) in Young People. Clin Child Fam Psychol Rev 2023; 26:459-481. [PMID: 36653555 PMCID: PMC9848719 DOI: 10.1007/s10567-023-00425-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/19/2023]
Abstract
Although it is widely accepted that human beings have an ingrained 'need to belong,' there seem to be a substantial subset of young people who seclude themselves for most of the time at home and no longer engage in education or work, ultimately withdrawing from participation in society. In Japan, this phenomenon has been labeled as 'hikikomori,' but given its global presence it may be preferable to use the term 'extreme social withdrawal' (ESW). In this qualitative review, we provide a description and definition of ESW, provide figures on its prevalence, and discuss a number of associated concepts, including loneliness and "aloneliness," school absenteeism and dropout, the 'new' developmental stage of adultolescence, and the labor force categories of freeter ('freelance arbeiter') and NEET (a young person not in employment, education, or training). The core of the paper is focused on the origins of ESW in young people and provides a narrative overview of relevant etiological factors, such as aberrant brain processes, unfavorable temperament, psychiatric conditions, adverse family processes including detrimental parenting, negative peer experiences, societal pressures, and excessive internet and digital media use, which are all placed within a comprehensive developmental psychopathology framework. We will close with a discussion of possible interventions for young people with ESW and formulate a guideline that describes (the temporal order of) various components that need to be included in such a treatment.
Collapse
|
3
|
Dullur P, Joseph J, Diaz AM, Lin PI, Jairam R, Davies R, Masi A, Shulruf B, Eapen V. Screening for media use in the ED among young Australians: a cross-sectional study (Preprint). JMIR Form Res 2022; 7:e42986. [PMID: 37184914 DOI: 10.2196/42986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Research on problematic internet use has largely adhered to addiction paradigms, possibly impeding the identification of specific internet behaviors related to psychopathology. This study presents a novel approach to screening for specific problematic internet behaviors by using a new measure, the emergency department media use screener (EDMUS). OBJECTIVE The purpose of this study was to identify patterns of internet use in young people presenting with mental health concerns to the emergency department (ED), ascertain associations with their mental health, and evaluate whether the EDMUS can be used to predict subsequent ED presentations within 3 months. METHODS This cross-sectional retrospective study of Australian young people (N=149, aged 11-25 years; female: n=92, 61.7%) sought to use the EDMUS, a 24-item questionnaire, to identify problematic internet behaviors, including accessing or posting prosuicidal or proeating disorder content, cyberbullying, and inappropriate digital content. Data on each person's mental health were extracted from electronic medical records to look for associations with EDMUS responses and ED re-presentation over 3 months. EDMUS items were grouped into clusters for analysis using chi-square tests, binary logistic regression, and path analyses. RESULTS Sharing suicidal digital content was the most common problematic internet use pattern identified by the EDMUS. However, this did not correlate with having a prior mental health diagnosis or predict readmission. Most participants had families with a concern for their internet use; however, this was less likely in participants with a diagnosis of personality disorder. Diagnoses of personality disorder or posttraumatic stress disorder were independent predictors of readmission (P=.003; P=.048). CONCLUSIONS Although a history of complex psychopathology increases the likelihood of subsequent ED presentations, its links to internet use-related behaviors are still unclear. The EDMUS has potential for identifying young people who are most vulnerable to problematic internet behaviors and offers the opportunity for early intervention and potential prevention of more entrenched difficulties.
Collapse
|
4
|
Pereira CCM, Silva AC, Pedrollo LFS, do Amaral LC, Chiarelo BM, Zanetti ACG, Vedana KGG. "InspirAção": Development and use of a website to prevent suicidal behavior. Arch Psychiatr Nurs 2022; 39:54-58. [PMID: 35688544 DOI: 10.1016/j.apnu.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 01/23/2022] [Accepted: 03/06/2022] [Indexed: 11/02/2022]
Abstract
AIM To describe the development and divulgation of a website for the prevention of suicidal behavior and to analyze posted themes and access metrics. METHOD Mixed study developed from 2019 to 2020 on the "InspirAção" website. All user posts were collected from WordPress and subjected to thematic analysis. The access metrics were obtained by Google Analytics. RESULTS The development of the website contains systematically planned steps to meet international recommendations. In the initial six months of the site, there were 64,628 views and 18,161 sessions from different countries. The main themes posted by users were "Life and what gives it meaning", "Love, comfort and acceptance", "Self-knowledge, authenticity and transformation" and "Overcoming, altruism and transcendence". CONCLUSIONS "InspirAção" contains innovative features, incorporates protective factors and meets requirements for online and community suicide prevention. The study was approved by the Research Ethics Committee (CAAE: 08563019.5.0000.5393).
Collapse
Affiliation(s)
- Camila Corrêa Matias Pereira
- Psychiatric Nursing and Human Sciences Department of The Ribeirão Preto Nursing School of the University of Sao Paulo, Brazil
| | - Aline Conceição Silva
- Psychiatric Nursing and Human Sciences Department of The Ribeirão Preto Nursing School of the University of Sao Paulo, Brazil
| | - Laysa Fernanda Silva Pedrollo
- Psychiatric Nursing and Human Sciences Department of The Ribeirão Preto Nursing School of the University of Sao Paulo, Brazil
| | - Larissa Castelo do Amaral
- Psychiatric Nursing and Human Sciences Department of The Ribeirão Preto Nursing School of the University of Sao Paulo, Brazil
| | - Bruna Marques Chiarelo
- Psychiatric Nursing and Human Sciences Department of The Ribeirão Preto Nursing School of the University of Sao Paulo, Brazil.
| | - Ana Carolina Guidorizzi Zanetti
- Psychiatric Nursing and Human Sciences Department of The Ribeirão Preto Nursing School of the University of Sao Paulo, Brazil
| | - Kelly Graziani Giacchero Vedana
- Psychiatric Nursing and Human Sciences Department of The Ribeirão Preto Nursing School of the University of Sao Paulo, Brazil
| |
Collapse
|
5
|
Lee SE, Yim M, Hur JW. Beneath the surface: Clinical and psychosocial correlates of posting nonsuicidal self-injury content online among female young adults. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
6
|
Abstract
Agenda-setting theory suggests the media shapes public perceptions. Guided by this theory, this study examines the effects of organizational Twitter accounts on public discourse in the Twittersphere. The tweets that mention one of three youth mental health organizations were theorized to emanate the particular focus of the organization mentioned. This was investigated by analysing: randomly selected tweets that mentioned one of three national mental health organizations-ReachOut, headspace or the Young and Well Cooperative Research Centre but not authored by these organizations (n = 600); and the population of tweets that mentioned one of these three organizations and authored by either of the two counterparts of the mentioned organization (n = 115). Findings supported anticipated patterns, whereby the tweets reflected the remit of the three organizations. These findings reveal the influential role of social media in setting a youth mental health agenda. The implications for practitioners and researchers are discussed.
Collapse
Affiliation(s)
- Ann Dadich
- School of Business, Western Sydney University, 169 Macquarie Street, Parramatta, New South Wales 2150, Australia
| | - Aila Khan
- School of Business, Western Sydney University, 169 Macquarie Street, Parramatta, New South Wales 2150, Australia
| |
Collapse
|
7
|
Bailey E, Robinson J, Alvarez-Jimenez M, Nedeljkovic M, Valentine L, Bendall S, D'Alfonso S, Gilbertson T, McKechnie B, Rice S. Moderated Online Social Therapy for Young People With Active Suicidal Ideation: Qualitative Study. J Med Internet Res 2021; 23:e24260. [PMID: 33818392 PMCID: PMC8056298 DOI: 10.2196/24260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/26/2020] [Accepted: 02/08/2021] [Indexed: 01/23/2023] Open
Abstract
Background Web-based interventions are a promising approach to support youth at risk of suicide, and those incorporating peer-to-peer social networking may have the added potential to target interpersonal states of perceived burdensomeness and thwarted belongingness. Owing to feasibility and safety concerns, including fear of contagion, this had not been tested until recently. In 2018, we conducted a pilot evaluation to test the feasibility, safety, and acceptability of a Moderated Online Social Therapy intervention, called Affinity, with a sample of young people with active suicidal ideation. Objective The aim of this study is to report qualitative data collected from study participants regarding their experience of the web-based social network and the consequent safety features. Methods Affinity is a closed website incorporating 3 key components: therapeutic content delivered via comics, peer-to-peer social networking, and moderation by peers and clinicians. Semistructured interviews were conducted with 17 young people who participated in the pilot study after 8 weeks of exposure to the intervention. Interview data from 2 young people who did not use Affinity were excluded from the analysis. The interviews were analyzed using thematic analysis, with the frequency of responses characterized using the consensual qualitative research method. The results are reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Results A total of 4 overarching themes were identified: a safe and supportive environment, the importance of mutual experiences, difficulty engaging and connecting, and the pros and cons of banning discussions about suicide. Interestingly, although Affinity was perceived to be safe and free of judgment, concerns about negative evaluation and triggering others were significant barriers to posting on the social network. Participants generally supported the banning of conversations about suicide, although for some this was perceived to reinforce stigma or was associated with frustration and distress. Conclusions The results not only support the safety and potential therapeutic benefit of the social networking aspect of Affinity but also highlight several implementation challenges. There is a need to carefully balance the need for stringent safety and design features while ensuring that the potential for therapeutic benefit is maximized.
Collapse
Affiliation(s)
- Eleanor Bailey
- Orygen, Parkville, Australia.,Swinburne University of Technology, Hawthorn, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Jo Robinson
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | | | - Lee Valentine
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Sarah Bendall
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Simon D'Alfonso
- Orygen, Parkville, Australia.,School of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - Tamsyn Gilbertson
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | | | - Simon Rice
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| |
Collapse
|
8
|
Alvarez-Jimenez M, Rice S, D'Alfonso S, Leicester S, Bendall S, Pryor I, Russon P, McEnery C, Santesteban-Echarri O, Da Costa G, Gilbertson T, Valentine L, Solves L, Ratheesh A, McGorry PD, Gleeson J. A Novel Multimodal Digital Service (Moderated Online Social Therapy+) for Help-Seeking Young People Experiencing Mental Ill-Health: Pilot Evaluation Within a National Youth E-Mental Health Service. J Med Internet Res 2020; 22:e17155. [PMID: 32788151 PMCID: PMC7453330 DOI: 10.2196/17155] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/12/2020] [Accepted: 06/13/2020] [Indexed: 12/20/2022] Open
Abstract
Background Mental ill-health is the leading cause of disability worldwide. Moreover, 75% of mental health conditions emerge between the ages of 12 and 25 years. Unfortunately, due to lack of resources and limited engagement with services, a majority of young people affected by mental ill-health do not access evidence-based support. To address this gap, our team has developed a multimodal, scalable digital mental health service (Enhanced Moderated Online Social Therapy [MOST+]) merging real-time, clinician-delivered web chat counseling; interactive user-directed online therapy; expert and peer moderation; and peer-to-peer social networking. Objective The primary aim of this study is to ascertain the feasibility, acceptability, and safety of MOST+. The secondary aims are to assess pre-post changes in clinical, psychosocial, and well-being outcomes and to explore the correlations between system use, perceived helpfulness, and secondary outcome variables. Methods Overall, 157 young people seeking help from a national youth e-mental health service were recruited over 5 weeks. MOST+ was active for 9 weeks. All participants had access to interactive online therapy and integrated web chat counseling. Additional access to peer-to-peer social networking was granted to 73 participants (46.5%) for whom it was deemed safe. The intervention was evaluated via an uncontrolled single-group study. Results Overall, 93 participants completed the follow-up assessment. Most participants had moderate (52/157, 33%) to severe (96/157, 61%) mental health conditions. All a priori feasibility, acceptability, and safety criteria were met. Participants provided mean scores of ≥3.5 (out of 5) on ease of use (mean 3.7, SD 1.1), relevancy (mean 3.9, SD 1.0), helpfulness (mean 3.5, SD 0.9), and overall experience (mean 3.9, SD 0.8). Moreover, 98% (91/93) of participants reported a positive experience using MOST+, 82% (70/93) reported that using MOST+ helped them feel better, 86% (76/93) felt more socially connected using it, and 92% (86/93) said they would recommend it to others. No serious adverse events or inappropriate use were detected, and 97% (90/93) of participants reported feeling safe. There were statistically significant improvements in 8 of the 11 secondary outcomes assessed: psychological distress (d=−0.39; P<.001), perceived stress (d=−0.44; P<.001), psychological well-being (d=0.51; P<.001), depression (d=−0.29; P<.001), loneliness (d=−0.23; P=.04), social support (d=0.30; P<.001), autonomy (d=0.36; P=.001), and self-competence (d=0.30; P<.001). There were significant correlations between system use, perceived helpfulness, and a number of secondary outcome variables. Conclusions MOST+ is a feasible, acceptable, and safe online clinical service for young people with mental ill-health. The high level of perceived helpfulness, the significant improvements in secondary outcomes, and the correlations between indicators of system use and secondary outcome variables provide initial support for the therapeutic potential of MOST+. MOST+ is a promising and scalable platform to deliver standalone e-mental health services as well as enhance the growing international network of face-to-face youth mental health services.
Collapse
Affiliation(s)
- Mario Alvarez-Jimenez
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Simon Rice
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Simon D'Alfonso
- Orygen, Parkville, Australia.,The School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
| | - Steven Leicester
- headspace National Youth Mental Health Foundation, Melbourne, Australia
| | - Sarah Bendall
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Ingrid Pryor
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Penni Russon
- Orygen, Parkville, Australia.,School of Culture and Communications, The University of Melbourne, Melbourne, Australia
| | - Carla McEnery
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | | | - Gustavo Da Costa
- The School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
| | | | - Lee Valentine
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Laia Solves
- Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataro, Mataro, Spain
| | - Aswin Ratheesh
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Patrick D McGorry
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia.,Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, Australia
| |
Collapse
|
9
|
Taking Youth Suicide Prevention to the Schools: Pilot Evaluation of School-Based Clinician Outcomes and Perspectives of a Multi-Modal Program Including Post-Training Online Consultations for Management of Ongoing Suicide Risk. PSYCHIATRY INTERNATIONAL 2020. [DOI: 10.3390/psychiatryint1010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
School-based youth-specific suicide prevention and early intervention initiatives are presently underdeveloped. The current study conducted a pilot evaluation of a multi-modal suicide prevention training program for school-based social workers, ‘Management of Youth Suicidality Training for Schools’ (MYSTS). The program comprised a two-day workshop and six fortnightly post-workshop webinar online consultations. Participants were 36 social workers (years’ experience M = 11.23, SD = 8.29) employed by the Department of Education in Tasmania, Australia. Outcomes were self-rated confidence, competence, and knowledge of self-harm in young people, and attitudes toward suicide prevention and suicide-related behaviors. Exploratory quantitative results indicated significant improvements with large effect sizes for participants’ self-reported competence (d = 1.33), and confidence (d = 1.29) to identify and respond therapeutically to youth suicidality following the workshop. Confidence remained significantly higher than baseline following the online consultations (d = 0.90). Qualitative analysis of online supervision consultations indicated key themes of accessibility, communication and information sharing, and clinical management. Participants endorsed the MYSTS package as well-presented, with relevant topics, and effective learning activities. This study highlights the need for continued supervisory or implementation support to practitioners following suicide prevention training initiatives and suggests web-based teleconference technology as a feasible strategy for this. Further evaluation of the MYSTS package, including a suitable comparison or control condition, is indicated.
Collapse
|
10
|
COVID-19 Epidemic Peer Support and Crisis Intervention Via Social Media. Community Ment Health J 2020; 56:786-792. [PMID: 32378126 PMCID: PMC7202462 DOI: 10.1007/s10597-020-00624-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/29/2020] [Indexed: 01/18/2023]
Abstract
This article describes a peer support project developed and carried out by a group of experienced mental health professionals, organized to offer peer psychological support from overseas to healthcare professionals on the frontline of the COVID-19 outbreak in Wuhan, China. This pandemic extremely challenged the existing health care systems and caused severe mental distress to frontline healthcare workers. The authors describe the infrastructure of the team and a novel model of peer support and crisis intervention that utilized a popular social media application on smartphone. Such a model for intervention that can be used elsewhere in the face of current global pandemic, or future disaster response.
Collapse
|
11
|
Bailey E, Mühlmann C, Rice S, Nedeljkovic M, Alvarez-Jimenez M, Sander L, Calear AL, Batterham PJ, Robinson J. Ethical issues and practical barriers in internet-based suicide prevention research: a review and investigator survey. BMC Med Ethics 2020; 21:37. [PMID: 32404098 PMCID: PMC7222514 DOI: 10.1186/s12910-020-00479-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 04/30/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND People who are at elevated risk of suicide stand to benefit from internet-based interventions; however, research in this area is likely impacted by a range of ethical and practical challenges. The aim of this study was to examine the ethical issues and practical barriers associated with clinical studies of internet-based interventions for suicide prevention. METHOD This was a mixed-methods study involving two phases. First, a systematic search was conducted to identify studies evaluating internet-based interventions for people at risk of suicide, and information pertaining to safety protocols and exclusion criteria was extracted. Second, investigators on the included studies were invited to complete an online survey comprising open-ended and forced-choice responses. Quantitative and qualitative methods were used to analyse the data. RESULTS The literature search identified 18 eligible studies, of which three excluded participants based on severity of suicide risk. Half of the 15 suicide researchers who participated in the survey had experienced problems obtaining ethics approval, and none had encountered adverse events attributed to their intervention. Survey respondents noted the difficulty of managing risk in online environments and the limitations associated with implementing safety protocols, although some also reported increased confidence resulting from the ethical review process. Respondents recommended researchers pursue a collaborative relationship with their research ethics committees. CONCLUSION There is a balance to be achieved between the need to minimise the risk of adverse events whilst also ensuring interventions are being validated on populations who may be most likely to use and benefit from them (i.e., those who prefer anonymity). Further research is required to obtain the views of research ethics committees and research participants on these issues. Dialogue between researchers and ethics committees is necessary to address the need to ensure safety while also advancing the timely development of effective interventions in this critical area.
Collapse
Affiliation(s)
- Eleanor Bailey
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia.
- Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.
- Centre for Mental Health, Swinburne University of Technology, John St, Hawthorn, VIC, 3122, Australia.
| | - Charlotte Mühlmann
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 4. Sal, 2900, Hellerup, Denmark
- University of Copenhagen, Nørregade 10, 1165, København, Denmark
| | - Simon Rice
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health, Swinburne University of Technology, John St, Hawthorn, VIC, 3122, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Lasse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Engelbergerstr. 41, D-79085, Freiburg, Germany
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, 2061, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, 2061, Australia
| | - Jo Robinson
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| |
Collapse
|
12
|
Sinyor M, Williams M, Zaheer R, Loureiro R, Pirkis J, Heisel MJ, Schaffer A, Cheung AH, Redelmeier DA, Niederkrotenthaler T. The Relationship Between Suicide-Related Twitter Events and Suicides in Ontario From 2015 to 2016. CRISIS 2020; 42:40-47. [PMID: 32366171 DOI: 10.1027/0227-5910/a000684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: Many studies have demonstrated suicide contagion through mainstream journalism; however, few have explored suicide-related social media events and their potential relationship to suicide deaths. Aims: To determine whether Twitter events were associated with changes in subsequent suicides. Methods: Suicide-related Twitter events that garnered at least 100 tweets originating in Ontario, Canada (July 1, 2015 to June 30, 2016) were identified and characterized as putatively "harmful" or "innocuous" based on recommendations for responsible media reporting. The number of suicides in Ontario during the peak of each Twitter event and the subsequent 6 days ("exposure window") was compared with suicides occurring during a pre-event period of the same length ("control window"). Results: There were 17 suicide-related Twitter events during the period of study (12 putatively harmful and five putatively innocuous). The number of tweets per event ranged from 121 for "physician-assisted suicide law in Quebec" to 6,202 for the "Attawapiskat suicide crisis." No significant relationship was detected between Twitter events and actual suicides. Notably, a comprehensive examination of the details of Twitter events showed that even the putatively harmful events lacked many of the characteristics commonly associated with contagion. Limitations: This was an uncontrolled experiment in only one epoch and a single Canadian province. Discussion: This study found no evidence of suicide contagion associated with Twitter events. This finding must be interpreted with caution given the relatively innocuous content of suicide-related Tweets in Ontario during 2015-2016.
Collapse
Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, ON, Canada
| | - Marissa Williams
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Graduate Centre for Applied Psychology, Athabasca University, AB, Canada
| | - Rabia Zaheer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Raisa Loureiro
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia
| | - Marnin J Heisel
- Department of Psychiatry, The University of Western Ontario, London, ON, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, ON, Canada
| | - Amy H Cheung
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, ON, Canada
| | - Donald A Redelmeier
- Department of Medicine, University of Toronto, ON, Canada.,Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Thomas Niederkrotenthaler
- Centre for Public Health, Department of Social and Preventive Medicine, Unit Suicide Research & Mental Health Promotion, Medical University of Vienna, Austria
| |
Collapse
|
13
|
Liu X, Huang J, Yu NX, Li Q, Zhu T. Mediation Effect of Suicide-Related Social Media Use Behaviors on the Association Between Suicidal Ideation and Suicide Attempt: Cross-Sectional Questionnaire Study. J Med Internet Res 2020; 22:e14940. [PMID: 32343249 PMCID: PMC7218592 DOI: 10.2196/14940] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/20/2019] [Accepted: 02/03/2020] [Indexed: 01/06/2023] Open
Abstract
Background A limited number of studies have examined the differences in suicide-related social media use behaviors between suicide ideators and suicide attempters or have sought to elucidate how these social media usage behaviors contributed to the transition from suicidal ideation to suicide attempt. Objective Suicide attempts can be acquired through suicide-related social media use behaviors. This study aimed to propose 3 suicide-related social media use behaviors (ie, attending to suicide information, commenting on or reposting suicide information, or talking about suicide) based on social cognitive theory, which proposes that successive processes governing behavior transition include attentional, retention, production, and motivational processes. Methods We aimed to examine the mediating role of suicide-related social media use behaviors in Chinese social media users with suicidal risks. A sample of 569 Chinese social media users with suicidal ideation completed measures on suicidal ideation, suicide attempt, and suicide-related social media use behaviors. Results The results demonstrated that suicide attempters showed a significantly higher level of suicidal ideation (t563.64=5.04; P<.001; two-tailed) and more suicide-related social media use behaviors, which included attending to suicide information (t567=1.94; P=.05; two-tailed), commenting on or reposting suicide information (t567=2.12; P=.03; two-tailed), or talking about suicide (t542.22=5.12; P<.001; two-tailed). Suicidal ideation also affected suicide attempts through the mediational chains. Conclusions Our findings thus support the social cognitive theory, and there are implications for population-based suicide prevention that can be achieved by identifying behavioral signals.
Collapse
Affiliation(s)
- Xingyun Liu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beiijng, China.,Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Jiasheng Huang
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Qing Li
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Tingshao Zhu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
14
|
Bailey E, Alvarez-Jimenez M, Robinson J, D’Alfonso S, Nedeljkovic M, Davey CG, Bendall S, Gilbertson T, Phillips J, Bloom L, Nicholls L, Garland N, Cagliarini D, Phelan M, McKechnie B, Mitchell J, Cooke M, Rice SM. An Enhanced Social Networking Intervention for Young People with Active Suicidal Ideation: Safety, Feasibility and Acceptability Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2435. [PMID: 32260111 PMCID: PMC7177782 DOI: 10.3390/ijerph17072435] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/16/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022]
Abstract
Online social networking interventions have potential to support young people who experience suicidal thoughts by specifically addressing interpersonal risk factors for suicide, but may also pose a risk of harm. This uncontrolled, single-group pilot study aimed to evaluate the safety, feasibility, and acceptability of an enhanced online social networking intervention ("Affinity") among a sample of young people who experienced active suicidal ideation, and to explore potential changes in clinical outcomes and the therapeutic targets of the intervention. Twenty young people with current or recent suicidal ideation who were receiving treatment for depression at a tertiary-level mental health service were given access to Affinity for two months. Participants were assessed at baseline and 8-week follow-up; 90 percent reported clinical suicidal ideation at baseline. A priori criteria related to feasibility, safety and acceptability were satisfied. In terms of potential clinical effects, significant and reliable pre-post improvements were found on self-report outcomes including suicidal ideation. This study provides initial world-first evidence to support the use of an online intervention incorporating social networking as an adjunct to treatment for young people who experience suicidal ideation. The effectiveness of Affinity needs to be evaluated in a randomised controlled trial.
Collapse
Affiliation(s)
- Eleanor Bailey
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria 3010, Australia
- Swinburne University of Technology, Hawthorn, Victoria 3122, Australia;
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Jo Robinson
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Simon D’Alfonso
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Maja Nedeljkovic
- Swinburne University of Technology, Hawthorn, Victoria 3122, Australia;
| | - Christopher G. Davey
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Sarah Bendall
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Tamsyn Gilbertson
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Jessica Phillips
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
| | - Lisa Bloom
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
| | - Laura Nicholls
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
| | - Nicola Garland
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
| | - Daniela Cagliarini
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Mark Phelan
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
| | - Ben McKechnie
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
| | - Jessica Mitchell
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
| | - Melanie Cooke
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
| | - Simon M. Rice
- Orygen, Parkville, Victoria 3052, Australia; (E.B.); (M.A.-J.); (J.R.); (S.D.); (C.G.D.); (S.B.); (T.G.); (J.P.); (L.B.); (L.N.); (N.G.); (D.C.); (M.P.); (B.M.); (J.M.); (M.C.)
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria 3010, Australia
| |
Collapse
|
15
|
Shafi RM, Nakonezny PA, Romanowicz M, Nandakumar AL, Suarez L, Croarkin PE. The Differential Impact of Social Media Use on Middle and High School Students: A Retrospective Study. J Child Adolesc Psychopharmacol 2019; 29:746-752. [PMID: 31233343 PMCID: PMC6885760 DOI: 10.1089/cap.2019.0071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Social media use is now a central aspect of adolescent life and development. Little is known about the clinical implications of social media use in children and adolescents presenting in acute crisis for psychiatric admission. This study sought to compare the potential effects of social media use among middle and high school students on outcomes of psychiatric morbidity. It was hypothesized that among social media users, high school students would have greater psychiatric morbidity compared with middle school students. Methods: The research team extracted clinical and demographic data from adolescents (aged 12-17 years) presenting for acute psychiatric admission who also had documented social media use (N = 56). Educational status, middle school (n = 21) versus high school (n = 35), was examined as an independent variable. Psychotropic medication use, self-injurious behavior, suicide risk, and suicidal ideation were examined as dependent variables in logistic regression models. Results: High school students using social media had significantly greater predicted odds of psychotropic medication use and self-injurious behavior compared with students in middle school who used social media. High school students using social media had greater, although not statistically significant, predicted odds of suicide risk and suicidal ideation compared with middle school students using social media. Conclusions: Social media use is likely an important factor to consider in psychiatric evaluations. The present findings suggest that social media use in high school students is associated with greater psychiatric morbidity compared with middle school students. Further research could illuminate the developmental lines of social media use and age-specific risks.
Collapse
Affiliation(s)
- Reem M.A. Shafi
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota.,Address correspondence to: Reem M.A. Shafi, MBBS, BSc, Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Paul A. Nakonezny
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas.,Division of Biostatistics, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Magdalena Romanowicz
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota
| | - Aiswarya L. Nandakumar
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota
| | - Laura Suarez
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
16
|
Valentine L, McEnery C, D’Alfonso S, Phillips J, Bailey E, Alvarez-Jimenez M. Harnessing the Potential of Social Media to Develop the Next Generation of Digital Health Treatments in Youth Mental Health. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40501-019-00184-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
17
|
Journal of Affective Disorders Special Issue on Suicide-Related Research: Hopeful progress but much research urgently needed. J Affect Disord 2019; 251:39-41. [PMID: 30901600 PMCID: PMC6953378 DOI: 10.1016/j.jad.2019.03.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|