Responding to concerning posts on social media: Insights and solutions from American Indian and Alaska Native youth

What methods are used in research of firsthand experiences with online self-harming and suicidal behavior? A scoping review

BACKGROUND

Online self-harming and suicidal behavior is a novel and rapidly increasing phenomenon warranting comprehensive mapping of used research methods.

AIM

To identify and map how knowledge on online self-harming and suicidal behavior is gathered, including how data are collected e.g. questionnaires and interviews.

METHODS

The review follows the Joanna Briggs Institute Manual for Scoping Reviews in tandem with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A keyword search of three electronic databases was conducted on two occasions, yielding 5422 records. Following duplicate removal, the records were screened based on the following inclusion criterions; (1) in English or Nordic language and published between 2011-2022, (2) presenting results for self-harming and/or suicidal behavior on social media and (3) using tools for either interview or questionnaire aiming at assessment of the experience of online self-harming and suicidal behavior from the perspective of the person who engages in the behavior. A total of 64 articles were included.

RESULTS

45 used questionnaires, 17 used interviews, and two studies mixed the two approaches. 17% of the studies had made some effort to ensure validity within the questionnaires and 15.8% gave full access to the interview guide.

CONCLUSION

Research into online self-harming and suicidal behavior is characterized by a lack of validated measurements and methodological transparency. The results emphasize a need for further development, testing, and validation of questionnaires and greater openness and reflexivity in qualitative methodology to enable cross-study comparison and advance knowledge of this complex phenomenon.

Effect of Technology and Digital Media Use on Adolescent Health and Development: Protocol for a Multimethod Longitudinal Study

BACKGROUND

Technology and digital media (TDM) use is integral to modern adolescence; adolescents have been labeled as "digital natives," since they have had exposure to digital technology for their entire lives. Previous evidence has illustrated TDM's connections with adolescent risk behaviors such as increased alcohol use and social media exposure, as well as relationships with adolescent well-being such as improved socioemotional health and social media connections with peers. Although several recent review articles have described both the benefits and risks of technology use, most individual studies adopt a singular risk-centered approach. In addition, reviews suggest that little evidence exists on the potential mediating and moderating factors between TDM use and well-being and health outcomes, which limits our understanding of what influences the outcomes of interest. Therefore, there is an urgent need to fill these gaps.

OBJECTIVE

This protocol addresses the need to understand how TDM exposure and use affect multiple developmental domains and health outcomes. We address the fragmented nature of previous research, the common focus on single behaviors or conditions, and the typical narrow lens on risks. Our approach further aligns with reviews that called for studies identifying and investigating the factors that moderate the relationships between social media and health behaviors and outcomes.

METHODS

We will address our objective by longitudinally examining over a 2-year period a common set of adolescent participants (N=400, aged 13-15 years) across 3 studies that adopt a multimethodological approach. Study 1 will use TDM to understand the mechanisms behind adolescent health and risk behaviors. Study 2 will use functional magnetic resonance imaging to understand how positive and negative TDM experiences relate to mental and behavioral health in a subsample of 150 adolescents. Study 3 will use a mixed methods design to evaluate self- and other-generated TDM content as the predictors of socioemotional well-being in sexual and gender minority and non-sexual and gender minority adolescents.

RESULTS

Recruitment is ongoing, and the initial results from the first wave of recruitment are expected in 2024.

CONCLUSIONS

This integrated approach to longitudinal data collection from a shared adolescent participant pool will lead to novel analyses and findings, allowing for the examination of the health and well-being risks and benefits associated with TDM use and factors that moderate these relationships. The findings from this study will advance conceptual models and inform new interventions to improve adolescent health.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50984.

Feasibility and Acceptability of the Social Media-Brief Alcohol Screening and Intervention for College Students Intervention

PURPOSE

Community college (CC) students represent an at-risk population for alcohol use with limited access to campus interventions. The Brief Alcohol Screening and Intervention for College Students (BASICS) is available online, though identifying CC students at risk and connecting them to interventions remains challenging. This study tested a novel approach using social media to identify at-risk students and prompt delivery of BASICS.

METHODS

This randomized controlled trial examined the feasibility and acceptability of Social Media-BASICS. Participants were recruited from five CCs. Baseline procedures included a survey and social media friending. Social media profiles were evaluated using content analysis monthly for nine months. Intervention prompts included displayed alcohol references indicating escalation of or problematic alcohol use. Participants who displayed such content were randomized into the BASICS intervention or an active control. Measures and analyses assessed feasibility and acceptability.

RESULTS

A total of 172 CC students completed the baseline survey, mean age was 22.9 (standard deviation = 3.18) years. Most were female (81%), with many (67%) identifying as White. Among participants, 120 (70%) displayed alcohol references on social media, prompting intervention enrollment. Of randomized participants, 94 (93%) completed the preintervention survey within 28 days of the invitation. The majority of participants reported positive intervention acceptability.

DISCUSSION

This intervention combined two validated approaches: identification of problem alcohol use displays on social media, and provision of the Web-BASICS intervention. Findings demonstrate the feasibility for novel web-based interventions to reach CC populations.

Digital Technology and Media Use by Adolescents: Latent Class Analysis

BACKGROUND

Digital technology and media use is integral to adolescents' lives and has been associated with both positive and negative health consequences. Previous studies have largely focused on understanding technology behaviors and outcomes within adolescent populations, which can promote assumptions about adolescent technology use as homogeneous. Furthermore, many studies on adolescent technology use have focused on risks and negative outcomes. To better understand adolescent digital technology use, we need new approaches that can assess distinct profiles within study populations and take a balanced approach to understanding the risks and benefits of digital technology use.

OBJECTIVE

The purpose of this study was to identify profiles of adolescent technology use within a large study population focusing on four evidence-based constructs: technology ownership and use, parental involvement, health outcomes, and well-being indicators.

METHODS

Adolescent-parent dyads were recruited for a cross-sectional web-based survey using the Qualtrics (Qualtrics International, Inc) platform and panels. Technology use measures included ownership of devices, social media use frequency, and the Adolescents' Digital Technology Interactions and Importance scale. Parent involvement measures included household media rules, technology-related parenting practices, parent social media use frequency, and the parent-child relationship. Health outcome measures included physical activity, sleep, problematic internet use, and mental health assessments. Well-being indicators included mental wellness, communication, and empathy. We used latent class analysis (LCA) to identify distinct profile groups across the aforementioned 4 critical constructs.

RESULTS

Among the 3981 adolescent-parent dyads recruited, adolescent participants had a mean age of 15.0 (SD 1.43) years; a total of 46.3% (1842/3981) were female, 67.8% (2701/3981) were White, and 75% (2986/3981) lived in a household with an income above the poverty line. The LCA identified 2 discrete classes. Class 1 was made up of 62.8% (2501/3981) of the participants. Class 1 participants were more likely than Class 2 participants to report family-owned devices, have lower technology importance scores, have household technology rules often centered on content, have positive parent relationships and lower parent social media use, and report better health outcomes and well-being indicators.

CONCLUSIONS

Findings from this national cross-sectional survey using LCA led to 2 distinct profile groups of adolescent media use and their association with technology use and parent involvement as well as health and well-being outcomes. The two classes included a larger Class 1 (Family-Engaged Adolescents) and a smaller Class 2 (At-Risk Adolescents). The findings of this study can inform interventions to reinforce positive technology use and family support.

Self-harm and suicidal content online, harmful or helpful? A systematic review of the recent evidence

Purpose

There are calls for greater regulation of online content related to self-harm and suicide, particularly that which is user-generated. However, the online space is a source of support and advice, including an important sharing of experiences. This study aims to explore what it is about such online content, and how people interact with it, that may confer harm or offer benefit.

Design/methodology/approach

The authors undertook a systematic review of the published evidence, using customised searches up to February 2021 in seven databases. The authors included empirical research on the internet or online use and self-harm or suicide content that had been indexed since 2015. The authors undertook a theoretically driven narrative synthesis.

Findings

From 4,493 unique records, 87 met our inclusion criteria. The literature is rapidly expanding and not all the evidence is high quality, with very few longitudinal or intervention studies so little evidence to understand possible causal links. Very little content online is classifiable as explicitly harmful or definitively helpful, with responses varying by the individual and immediate context. The authors present a framework that seeks to represent the interplay in online use between the person, the medium, the content and the outcome.

Originality/value

This review highlights that content should not be considered separately to the person accessing it, so online safety means thinking about all users. Blanket removal or unthinking regulation may be more harmful than helpful. A focus on safe browsing is important and tools that limit time and diversify content would support this.

Seeking Help From Trusted Adults in Response to Peers' Social Media Posts About Mental Health Struggles: Qualitative Interview Study Among Latinx Adolescents

BACKGROUND

Rather than confiding in adults about their mental health struggles, adolescents may use social media to disclose them to peers. Disclosure recipients are tasked with deciding whether to alert an adult and, if so, whom to alert. Few studies have examined how adolescents decide on a trusted adult to help a friend who posts on social media about his/her mental health struggles. Moreover, Latinx adolescents are underrepresented in research on social media use, which creates gaps in understanding how social media may influence their well-being.

OBJECTIVE

This qualitative study presents findings from semistructured interviews with Latinx adolescents to investigate how they seek out trusted adults when a friend posts on social media about their mental health struggles. Specifically, we sought to determine which adult ties they activated, the resources they believed the adult could provide, and the support they expected the adult to provide.

METHODS

We recruited participants through a nonprofit organization serving the Latinx community (primarily of Mexican origin) located in Milwaukee, Wisconsin. We conducted 43 semistructured interviews, each lasting 60-90 minutes, with Latinx adolescents (25 females, 18 males) aged 13-17 years. All interviews were conducted in English, at the adolescents' request. Using a grounded theory approach, we identified the nature of the relationship between the trusted adult and either the disclosure recipient or distressed friend, and the resources and support the trusted adult is expected to provide.

RESULTS

Participants nominated adults who were emotionally or physically proximate to either the disclosure recipient or distressed friend, particularly parents (of the recipient and friend) and school staff. However, some felt that not all parents and school staff were emotionally proximate. Adolescents sought trusted adults with access to two resources: experiential knowledge and authority. Some, particularly males, avoided adults with authority because of the risk of punishment and others thought their immigrant parents did not have relevant experiential knowledge to assist them. Interviewees felt that trusted adults with either resource could provide emotional and instrumental support either directly or indirectly, while those with experiential knowledge could provide informational support. Notably, interviews did not problematize the fact that the disclosure occurred on social media when deliberating about adults.

CONCLUSIONS

To assist a distressed friend posting on social media, Latinx adolescents look not only for trusted adults who are emotionally and physically proximate but also those who have key resources that facilitate support. Efforts should focus on connecting adolescents with trusted adults and training adults who hold positions of authority or experiential knowledge to offer both direct and indirect support. Additionally, efforts should consider how immigrant experiences shape parent-child relations and address the potential long-term consequences of oversurveillance of Latinx youth, particularly males, by school staff for their access to social support.

Can a social media intervention improve online communication about suicide? A feasibility study examining the acceptability and potential impact of the #chatsafe campaign

There is a need for effective and youth-friendly approaches to suicide prevention, and social media presents a unique opportunity to reach young people. Although there is some evidence to support the delivery of population-wide suicide prevention campaigns, little is known about their capacity to change behaviour, particularly among young people and in the context of social media. Even less is known about the safety and feasibility of using social media for the purpose of suicide prevention. Based on the #chatsafe guidelines, this study examines the acceptability, safety and feasibility of a co-designed social media campaign. It also examines its impact on young people's willingness to intervene against suicide and their perceived self-efficacy, confidence and safety when communicating on social media platforms about suicide. A sample of 189 young people aged 16-25 years completed three questionnaires across a 20-week period (4 weeks pre-intervention, immediately post-intervention, and at 4-week follow up). The intervention took the form of a 12-week social media campaign delivered to participants via direct message. Participants reported finding the intervention acceptable and they also reported improvements in their willingness to intervene against suicide, and their perceived self-efficacy, confidence and safety when communicating on social media about suicide. Findings from this study present a promising picture for the acceptability and potential impact of a universal suicide prevention campaign delivered through social media, and suggest that it can be safe to utilize social media for the purpose of suicide prevention.

Displayed Depression Symptoms on Facebook at Two Time Points: Content Analysis

Background

Depression is a prevalent and problematic mental disorder that often has an onset in adolescence. Previous studies have illustrated that depression disclosures on social media are common and may be linked to an individual’s experiences of depression. However, most studies have examined depression displays on social media at a single time point.

Objective

This study aims to investigate displayed depression symptoms on Facebook at 2 developmental time points based on symptom type and gender.

Methods

Participants were recruited from an ongoing longitudinal cohort study. The content analysis of text-based Facebook data over 1 year was conducted at 2 time points: time 1 (adolescence; age 17-18 years) and time 2 (young adulthood; ages 20-22 years). Diagnostic criteria for depression were applied to each post to identify the displayed depression symptoms. Data were extracted verbatim. The analysis included nonparametric tests for comparisons.

Results

A total of 78 participants’ Facebook profiles were examined, of which 40 (51%) were male. At time 1, 62% (48/78) of the adolescents had a Facebook profile, and 54% (26/78) displayed depression symptom references with an average of 9.4 (SD 3.1) references and 3.3 (SD 2.3) symptom types. Of the 78 participants, 15 (19%) females and 12 (15%) males displayed depression symptom references; these prevalence estimates were not significantly different by gender (P=.59). At time 2, 35 young adults displayed symptoms of depression with an average of 4.6 (SD 2.3) references and 2.4 (SD 1.3) symptom types. There were no differences in the prevalence of symptoms of depression displayed between males (n=19) and females (n=16; P=.63).

Conclusions

This content analysis study within an ongoing cohort study illustrates the differences in depression displays on Facebook by developmental stage and symptom. This study contributes to a growing body of literature by showing that using social media to observe and understand depression during the emerging adult developmental period may be a valuable approach.

Responses to Concerning Posts on Social Media and Their Implications for Suicide Prevention Training for Military Veterans: Qualitative Study

BACKGROUND

A "concerning post" is a display of a user's emotional crisis on a social media platform. A better understanding of concerning posts is relevant to suicide prevention, but little is known about social media users' attitudes and responses to concerning posts. Military veterans in the United States are disproportionately affected by suicide, often use social media, and may have exposure to individuals with elevated suicide risk via concerning posts.

OBJECTIVE

The objective of the study was (1) to obtain insight into whether and how US military veterans respond to members of their social network on social media (ie, "friends") who are experiencing substantial emotional distress, and (2) to identify potential interventions that could assist in users' response to concerning posts.

METHODS

We recruited veterans through Facebook and conducted semistructured interviews with 30 participants between June and December 2017. We used a summary template for rapid analysis of each interview, followed by double-coding using a codebook based on topic domains from the interview guide. Members of the research team met regularly to discuss emerging patterns in the data, generate themes, and select representative quotes for inclusion in the manuscript.

RESULTS

Veterans were reluctant to disclose emotional and health issues on Facebook, but they were open to reaching out to others' concerning posts. There was a complex calculus underlying whether and how veterans responded to a concerning post, which involved considering (1) physical proximity to the person posting, (2) relationship closeness, (3) existing responses to the post, and (4) ability to maintain contact with the person. Veterans desired additional training, backed by community-based veteran organizations, in how to respond to concerning posts from peers.

CONCLUSIONS

There is a need to incorporate features that will help veterans effectively respond to concerning posts from peers into suicide prevention training and to expand access for veterans to such training.

Social Media Use and Deliberate Self-Harm Among Youth: A Systematized Narrative Review

BACKGROUND

Suicide is now the 2^nd leading cause of death among adolescents and young adults. Social media's influence on youth suicidal risk or attenuation of risk is a novel and rapidly expanding topic of research that requires attention from a broad range of mental health services professionals. We aimed to provide an updated review of social media-related risk and protective factors to youth deliberate-self harm (DSH) to guide mental health services professionals in offering care and support to youth vulnerable to suicide.

METHODS

Studies on which primary research was conducted that evaluated young people's use of social media platforms related to DSH were systematically searched via Scopus and identified through expert recommendation and the Association for Computing Machinery's digital library of conference materials. The search focused on the timeframe June 2014 to September 2019, to offer an update since the time the most recent systematic reviews on this topic concluded their literatures searches. Quality was reviewed using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

A total of 38 articles were eligible, and 24 articles rated as high quality were included in a narrative review. Of the included articles, 19 explored DSH risk and 8 explored DSH protection. Most articles reported on cross-sectional quantitative or qualitative studies. Opportunities for both risks and benefits were explored, and potential influences of social media use were considered for subgroups of youth who may be especially vulnerable to suicide.

CONCLUSIONS

In the relatively short period of review, the association between social media use and youth DSH was tested in population-based studies, offering preliminary evidence for suicide prevention and treatment efforts. Further research is needed to understand the contribution of social media use to youth DSH, particularly among youth most vulnerable to suicidal risk.

Assessing the Usability, Appeal, and Impact of a Web-Based Training for Adults Responding to Concerning Posts on Social Media: Pilot Suicide Prevention Study

BACKGROUND

Suicide prevention remains challenging among youth, as many do not disclose suicidal ideation. Nearly one-third of American Indian and Alaska Native (AI and AN, tribal, or native) youth see concerning messages on social media at least weekly.

OBJECTIVE

To prepare adults to support AI and AN youth who post or view concerning messages, our team designed an hour-long training: Responding to Concerning Posts on Social Media. This study tested the usability, appeal, and impact of the training.

METHODS

A purposive sample of 70 adults was recruited to participate in the pilot, which included 2 study arms. Arm 1 participants completed a 30-min training video and reviewed accompanying handouts, including the Viewer Care Plan (VCP). The VCP provided a 3-step planning and response tool: (1) Start the Conversation, (2) Listen, Gather Information, and Assess Viewer Experience, and (3) Plan and Act. The intent of the VCP was to support and connect AI and AN youth who either view or post concerning messages on social media to life-saving resources. Those enrolled in arm 2 participated in an additional interactive role-play scenario with a coach that took place after the training, via text message. Participants provided qualitative and quantitative feedback on the training's relevance, appeal, and utility. Paired t tests were used to assess confidence in addressing concerning posts between pre- and postsurveys. Content analysis of the role-play transcripts was used to assess the quality and completion of the coached role-plays, in relation to the recommended VCP.

RESULTS

Altogether, 35 participants finished the training and completed pre- and postsurveys; 22 participants completed the 6-month follow-up survey. Pre-post analyses of differences in means found significant improvement across several efficacy measures, including confidence starting a conversation about social media (P=.003), confidence contacting the person who posted something concerning (P<.001), and confidence recommending support services to youth who view (P=.001) or youth who post concerning messages (P<.001). Similarly, pre- to 6-month analyses found significant positive improvement across multiple measures, including confidence contacting the youth who posted (P<.001), confidence starting a conversation about social media with youth (P=.003), and an increase in the number of experiences recommending resources for youth who viewed concerning social media posts (P=.02). Of the 3 steps of the VCP, the least followed step in coached role-plays was sharing tools and resources, which is a part of the third Plan and Act step.

CONCLUSIONS

Findings indicate that the Responding to Concerning Posts on Social Media training is a promising tool to prepare adults to intervene and complete the VCP. Additional evaluation with a larger cohort of participants is needed to determine the unique impact of the role-play scenario and changes in mental health referral rates, behaviors, and skills.