A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown

Uncovering sample heterogeneity in gaming and social withdrawal behaviors in adolescent and young adult gamers in Hong Kong

OBJECTIVE

The current study aimed to examine the latent heterogeneity of gaming and social withdrawal behaviors in internet gamers and their associations with help-seeking behaviors.

METHOD

The present study recruited 3430 young people (1874 adolescents and 1556 young adults) in Hong Kong in 2019. The participants completed the Internet Gaming Disorder (IGD) Scale, Hikikomori Questionnaire, and measures on gaming characteristics, depression, help-seeking, and suicidality. Factor mixture analysis was used to classify the participants into latent classes based on their latent factors of IGD and hikikomori in separate age groups. Latent class regressions examined the associations between help-seeking and suicidality.

RESULTS

Both adolescents and young adults supported a 4-class, 2-factor model on gaming and social withdrawal behaviors. Over two-third of the sample were classified as healthy or low-risk gamers with low IGD factor means and low prevalence of hikikomori. Around one-fourth was moderate-risk gamers with elevated prevalence of hikikomori, higher IGD symptoms and psychological distress. A minority of the sample (3.8%-5.8%) belonged to high-risk gamers with the highest IGD symptoms and prevalence of hikikomori and heightened suicidal risks. Help-seeking in low-risk and moderate-risk gamers was positively associated with depressive symptoms and negatively associated with suicidal ideation. Perceived usefulness of help-seeking was significantly linked with lower likelihoods of suicidal ideation in the moderate-risk gamers and suicide attempt in the high-risk gamers.

CONCLUSIONS

The present findings explicate the latent heterogeneity of gaming and social withdrawal behaviors and associated factors on help-seeking and suicidality among internet gamers in Hong Kong.

Longitudinal Effects of Screen Time on Depressive Symptoms among Swedish Adolescents: The Moderating and Mediating Role of Coping Engagement Behavior

Studies suggest that hourly digital screen time increases adolescents' depressive symptoms and emotional regulation difficulties. However, causal mechanisms behind such associations remain unclear. We hypothesized that problem-focused and/or emotion-focused engagement coping moderates and possibly mediates this association over time. Questionnaire data were collected in three waves from a representative sample of Swedish adolescents (0, 3 and 12 months; n = 4793; 51% boys; 99% aged 13-15). Generalized Estimating Equations estimated the main effects and moderation effects, and structural regression estimated the mediation pathways. The results showed that problem-focused coping had a main effect on future depression (b = 0.030; p < 0.001) and moderated the effect of screen time (b = 0.009; p < 0.01). The effect size of this moderation was maximum 3.4 BDI-II scores. The mediation results corroborated the finding that future depression was only indirectly correlated with baseline screen time, conditional upon intermittent problem-coping interference (C'-path: Std. beta = 0.001; p = 0.018). The data did not support direct effects, emotion-focused coping effects, or reversed causality. We conclude that hourly screen time can increase depressive symptoms in adolescent populations through interferences with problem-focused coping and other emotional regulation behaviors. Preventive programs could target coping interferences to improve public health. We discuss psychological models of why screen time may interfere with coping, including displacement effects and echo chamber phenomena.

Testing the Impact of the #chatsafe Intervention on Young People's Ability to Communicate Safely About Suicide on Social Media: Protocol for a Randomized Controlled Trial

BACKGROUND

Suicide is the leading cause of death among Australians. One commonly cited explanation is the impact of social media, in particular, the ways in which young people use social media to communicate about their own experiences and their exposure to suicide-related content posted by others. Guidelines designed to assist mainstream media to safely report about suicide are widespread. Until recently, no guidelines existed that targeted social media or young people. In response, we developed the #chatsafe guidelines and a supporting social media campaign, which together make up the #chatsafe intervention. The intervention was tested in a pilot study with positive results. However, the study was limited by the lack of a control group.

OBJECTIVE

The aim of this study is to assess the impact of the #chatsafe social media intervention on young people's safety and confidence when communicating on the web about suicide.

METHODS

The study employs a pragmatic, parallel, superiority randomized controlled design. It will be conducted in accordance with the Consolidated Standards of Reporting Trials statement over 18 months. Participants will be 400 young people aged 16-25 years (200 per arm). Participants will be recruited via social media advertising and assessed at 3 time points: time 1-baseline; time 2-8-week postintervention commencement; and time 3-4-week postintervention. They will be asked to complete a weekly survey to monitor safety and evaluate each piece of social media content. The intervention comprises an 8-week social media campaign including social media posts shared on public Instagram profiles. The intervention group will receive the #chatsafe suicide prevention content and the control group will receive sexual health content. Both groups will receive 24 pieces of content delivered to their mobile phones via text message. The primary outcome is safety when communicating on the web about suicide, as measured via the purpose-designed #chatsafe online safety questionnaire. Additional outcomes include willingness to intervene against suicide, internet self-efficacy, safety, and acceptability.

RESULTS

The study was funded in November 2020, approved by the University of Melbourne Human Research Ethics Committee on October 7, 2022, and prospectively registered with the Australian New Zealand Clinical Trials registry. Trial recruitment began in November 2022 and study completion is anticipated by June 2024.

CONCLUSIONS

This will be the first randomized controlled trial internationally to test the impact of a social media intervention designed to equip young people to communicate safely on the web about suicide. Given the rising rates of youth suicide in Australia and the acceptability of social media among young people, incorporating social media-based interventions into the suicide prevention landscape is an obvious next step. This intervention, if effective, could also be extended internationally, thereby improving web-based safety for young people not just in Australia but globally.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12622001397707; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384318.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/44300.

Problematic Smartphone Use Mediates the Pathway from Suicidal Ideation to Positive Psychotic Experiences: a Large Cross-Sectional, Population-Based Study

The present study followed the newly hypothesized "suicidal drive for psychosis" suggesting that psychosis may be consequential to suicidal ideation (SI) and behavior and attempted to explain parts of the pathway between these variables. To this end, we aimed to test whether problematic smartphone use (PSU) has an indirect mediating effect in the cross-sectional relationship between SI and positive psychotic experiences (PEs). Lebanese community young adults (N=4158; 64.4% females; mean age 21.91±3.79) have been invited to participate to a cross-sectional, web-based study in the period from June to September 2022. After adjusting for potential confounders (i.e., the living situation, marital status, household crowding index, economic pressure, cannabis use, other drugs use, and past history of mental illness other than psychosis), we found that higher levels of suicidal ideation was significantly associated with greater PSU, which was also positively and significantly associated with more positive PEs. Finally, greater suicidal ideation was significantly and directly associated with more positive PEs. Our findings suggest that SPU may be regarded as a potential target for prevention and intervention in psychosis. Clinicians, educators, and school administrators ought to give greater attention to PSU among vulnerable young people who present with SI.

Scoping review: Alternatives to self-harm recommended on mental health self-help websites

Less than half of all young people with mental health difficulties will seek professional treatment. Due to the private nature of self-harm it is estimated that only 1:28 young males and 1:18 young females who self-harm ever present to hospital. Self-help supports improved coping strategies and life changes without reliance on a clinical intervention which could be used to reduce self-harming behaviours. The study objective is to review self-help alternatives to self-harm on mental health websites that can be accessed by young people. Google, Bing, and Yahoo search engines were used to search for appropriate websites. Eighty-two unique websites on mental health were identified, of which 55 met the inclusion criteria. A total of 1177 self-help suggestions were found for those struggling with self-harm urges. The average number of suggestions per site was 42 (Range 3-252). The main techniques suggested were: seeking social contact/help, physical activity, displacement/mimicking techniques, relaxing/comforting techniques, sensory techniques, fun/diverting techniques, aggressive techniques, creative/reflective techniques. This review found not all strategies were suitable for young people and that the large number of possible strategies could be challenging for a young person to navigate. However, mental health self-help websites were generally of high quality and gave a range of potentially helpful strategies. The categories created from this review could be used as a guide to consider with the young person when making an individualized self-help plan to manage self-harm urges. Further research is required to assess if and how these techniques could be used individually or in combination to reduce self-harm.

Young Adults' Perceptions of 2 Publicly Available Digital Resources for Self-injury: Qualitative Study of a Peer Support App and Web-Based Factsheets

BACKGROUND

Digital resources have the potential to bridge the gaps in mental health services for young people who self-injure. Most research on digital resources for this population has involved observational studies of content in web-based communities or formative studies focused on the design and early evaluation of new interventions. Far less research has sought to understand young people's experiences with publicly available digital resources or to identify specific components of these resources that are perceived to be of value in their recovery.

OBJECTIVE

This study aimed to understand young people's experiences with 2 publicly available digital resources for self-injury-a peer support app and web-based factsheets-and to disentangle potential explanatory mechanisms associated with perceived benefits and harms.

METHODS

Participants were 96 individuals (aged 16-25 years) with nonsuicidal self-injury behavior in the past month, who recently completed a pilot randomized controlled trial designed to assess the efficacy of a peer support app as compared with web-based factsheets to reduce self-injury behavior. The trial showed that participants using the peer support app reported less self-injury behavior relative to those receiving the web-based factsheets over 8 weeks. In this study, we used a conventional approach to content analysis of responses to 2 open-ended questions delivered at the end of the trial with the aims of exploring participants' overall experiences with these resources and identifying the qualities of these resources that were perceived to be beneficial to or harmful for participants' recovery.

RESULTS

Overall, participants were more likely to report benefits than harms. Participants who used the peer support app reported more harms than those who received the web-based factsheets. In the open coding phase, clear benefits were also derived from repeated weekly surveys about self-injury. Key benefits across digital resources included enhanced self-knowledge, reduction in self-injury activity, increased outreach or informal conversations, improved attitudes toward therapy, improved mood, and feeling supported and less alone. Key challenges included worsened or unchanged self-injury activity, diminished mood, and increased barriers to outreach. The most prominent benefit derived from the web-based factsheets and weekly surveys was improved self-understanding. However, the way this manifested differed, with factsheets providing insight on why participants engage in self-injury and the function it serves them and surveys making the frequency and severity of participants' behaviors more apparent. The benefits perceived from using the peer support app were general improvements in mood and feeling less alone.

CONCLUSIONS

Findings contribute a nuanced understanding of young people's experiences with these digital resources and have implications for the optimization of existing platforms and the design of novel resources to support individuals who self-injure.

Development of Internet suicide message identification and the Monitoring-Tracking-Rescuing model in Taiwan

BACKGROUND

Suicide messages can be transmitted infinitely online; the Internet is influential in suicide prevention. Identifying suicide risks online via artificial technological advances may help predict suicide.

METHODS

We built a classifier that detects open messages containing suicidal ideation or behavior-related words in social media via text mining methods and developed the Monitoring-Tracking-Rescuing model, which links data monitoring and tracking to high-risk suicide rescues. Natural language processing (NLP) techniques such as Long Short-Term Memory and Bidirectional Encoder Representations from Transformers were applied to online posts of common social media sites in Taiwan. This model uses a two-step high-risk identification procedure: an automatic prediction process using NLP to classify suicide-risk levels, followed by professional validation by a senior psychiatrist and a nursing faculty specialized in suicidology.

RESULTS

From a dataset containing 404 high-risk and 2226 no- or low-risk articles, the sensitivity and specificity of our model reached 80 %.

LIMITATIONS

The model is limited to data platforms that can be "crawled" and excludes suicide-risk content from graphics, video and audio files. Additionally, machine learning does not provide the best recognition rate from complex online messages. Keywords for high-risk suicide in long articles are difficult to interpret using this model. Finally, the model lacks keywords for suicide-protective factors.

CONCLUSIONS

Artificial intelligence techniques may help detect and monitor high-risk suicide posts and inform mental health professionals of these posts. Periodic tracking plus manual validation to determine risk levels are recommended to enhance the reliability and effectiveness of Internet suicide-prevention tasks.

The clinical implications of digital technology

The proliferation of digital technology within the lives of children and young people (CYP) provides arguably one of the most significant clinical and ethical paradigm shifts in Child and Adolescent Psychiatry. One can argue that mental health research has taken a myopic approach to understanding the interaction between young people's technology use and their mental health. Mental health clinicians also need a better understanding of the digital lives of CYP and how technology may be supporting or harming their mental health. Within this paper, we argue that greater longitudinal research is required, particularly in vulnerable groups, and that there is an essential need for a standardised digital use assessment (DUA) tool, which assimilates CYP use of technology and their vulnerabilities/resilience to online risks. We subsequently offer a series of questions clinicians can use to explore technology use by CYP. Such an aide memoire may empower clinicians to have wider discussions around digital technology use with CYP, while also helping to develop appropriate safety and management plans.

Identifying suicide ideation in mental health application posts: A random forest algorithm

The growing use of digitized mental health applications requires new reliable early screening tools to identify user suicide risk. We used a lexicon-based random forest machine learning algorithm to predict suicide ideation scores from 714 online community text posts from December 2019 to April 2020. We validated predicted scores against expert-rated suicide ideation scores. The algorithm-predicted scores offered high validity and a low error rate and correctly identified 95% of expert-rated high-risk suicide ideation posts. Our findings highlight a potential new method to detect suicidal ideation of digital mental health application users.

The relationship between smartphone addiction and aggression among Lebanese adolescents: the indirect effect of cognitive function

BACKGROUND

Despite a large body of research has shown that smartphone addiction (SA) is associated with aggressive behaviors, only a few mediators have been previously examined in this relationship among early adolescent students. No previous studies have explored, to our knowledge, the indirect role of cognitive function despite its great importance during this life period. This study is intended to verify whether cognitive function have indirect effects on the relationship between SA and aggression among high-school students in the context of Lebanese culture.

METHODS

This was a cross-sectional designed study, conducted between January and May 2022, and enrolling 379 Lebanese adolescent students (aged 13-17 years). The Cognitive Functioning Self-Assessment Scale, the Buss-Perry Aggression Questionnaire-Short Form, and the Smartphone Addiction Scale-Short form were used.

RESULTS

The bivariate analysis results revealed that higher SA and worse cognitive function were significantly associated with more physical aggression, verbal aggression, anger and hostility. The mediation analyses found that cognitive function mediated the association between SA and physical aggression, verbal aggression, anger and hostility. Higher SA was significantly associated with worse cognitive function and more physical aggression, verbal aggression, anger and hostility. Finally, worse cognitive function was significantly associated with more physical aggression, verbal aggression, anger and hostility.

CONCLUSION

Our findings cautiously suggest that, to reduce adolescent students' aggression, interventions that promote cognitive performance may be effective. Particularly, students who are addicted to smartphones and show aggressive tendencies require interventions designed to improve cognition function.

Point of view: Could social media use be contributing to rising rates of deliberate self-harm and suicide in Australian youth populations?

OBJECTIVE

A rapid clinical update on the potential interplay between social media use and rates of deliberate self-harm amongst young people in Australia.

CONCLUSIONS

Rising social media use has been associated with increasing cyberbullying and deliberate self-harm, especially in young women. On the other hand, social media use also provides beneficial support. Examination of problematic social media use in assessments of young people presenting with self-harm may be useful, along with discussion of responses to negative social media. In this point of view, we discuss these matters and the UK Royal College of Psychiatrists' recommendations for reducing the negative impact of social media.

An Integrated Conceptual Model to Understand Suicidality among Queer Youth to Inform Suicide Prevention

In this article, we apply and combine elements from four theoretical frameworks (i.e., Minority Stress Theory, Person-in-Environment and Risk and Resilience Framework, Interpersonal-Psychological Theory of Suicide, and Intersectionality) to explain the problem of queer youth suicide through our integrated conceptual model, Queer Prevention of Youth Suicidality Model (Queer-PRYSM). The need for this conceptual model is based on the current state of the literature, including mixed empirical findings on factors related to queer youth suicidality, no scholarly consensus on specific contributing factors regarding high rates of suicidality among queer youth (including queer youth subgroups), and the absence of a unifying theory to explain the queer youth suicide risk. To address these limitations in theory, evidence, and scholarship explaining suicidality among queer youth we present our integrated model with growing, current, relevant research with queer youth. Queer-PRYSM includes minority stressors specific to queer youth, mental health problems, interpersonal-psychological factors, socioecological factors (i.e., family, school, peers, and community), and intersectionality concepts. Queer-PRYSM is essential to understanding the relationship of distal and proximal risk and protective factors in queer youth suicide and developing evidence-informed suicide preventive interventions that can be incorporated into practice, policy, and system structures.

High prevalence of suicide-related internet use among patients with depressive disorders - a cross-sectional study with psychiatric in-patients

The association between Internet use and suicidal behavior is a subject of intense research. Internet use patterns of patients with depressive disorders were assessed to determine the prevalence and aim of browsing for suicide-related contents and its impact on help-seeking. Self-administered questionnaire among psychiatric in-patients treated for depression was used to assess suicidal behavior, characteristics of Internet use and help-seeking preferences. 113 psychiatric in-patients with depressive disorders participated in the study. One-third had a history of life-time suicide attempt and the majority had already encountered suicide-related contents while browsing the Internet. 27.4% reported intentional and specific search for suicidal contents. This suicide-related Internet user (SRIU) group was characterized by younger age, single status, more frequent suicidal ideations, and they more likely considered that they would attempt suicide in the future. Among patients with depressive disorders, a sub-group was identified with a potential higher suicide risk. The frequent use of the Internet and online help-seeking preference may provide an opportunity to prevent suicidal behavior in this high-risk sub-group. Further research is needed into the possibilities of using the Internet more effectively for suicide prevention.

Difficulties in impulse control in adolescents with problematic use of the internet and self-injurious behaviors

Problematic use of the internet (PUI) and self-injurious behaviors (SIB) associate in adolescents and both relate to impulsivity. However, studies have not examined whether difficulties in impulse control are shared in adolescents with PUI and SIB, and how PUI relates to SIB frequency and impairment. Here, exploratory factor analysis was performed on a PUI questionnaire based on the Minnesota Impulse Disorder Interview, using survey data from 2,912 Connecticut high-school students. Regression analyses evaluated relationships between PUI factor scores and correlates of SIB. Moderation analyses examined impulsivity and sensation-seeking in relationship to PUI factors and SIB. Two PUI factors were extracted. The first PUI factor was associated with lifetime SIB, frequency, severity, urges, rising tension, and self-perceived problems with SIB. The second factor was associated with lifetime SIB and attempts to reduce SIB. Impulsivity and sensation-seeking associated with PUI factors and SIB, but did not moderate relationships between PUI and SIB. Findings suggest that PUI and SIB are related by difficulties in impulse control, and poor control over internet use is associated with more impairing SIB in adolescents who self-injure. Further research should investigate possible interventions targeting impulsivity and sensation-seeking to prevent PUI and SIB in youth.

Life problems in children and adolescents who self-harm: findings from the multicentre study of self-harm in England

BACKGROUND

Self-harm, a significant and increasing global problem in children and adolescents, is often repeated and is associated with risk of future suicide. To identify potential interventions, we need to understand the life problems faced by children and adolescents, and by sub-groups of younger people who self-harm. Our aims were to include the following: (a) investigate the type and frequency of life problems in a large sample of children and adolescents who self-harmed. (b) Examine whether problems differ between those who repeat self-harm and those who do not.

METHODS

We analysed data for 2000 to 2013 (follow up until 2014) from the Multicentre Study of Self-harm in England on individuals aged 11 to 18 years who presented to one of the five study hospitals following self-harm and received a psychosocial assessment including questions about problems, which precipitated self-harm.

RESULTS

In 5648 patients (12,261 self-harm episodes), (75.5% female, mean age 16.1 years) the most frequently reported problems at first episode of self-harm were family problems. Problems around study/employment/study and relationships with friends also featured prominently. The types of problems that precede self-harm differed between late childhood/early adolescence. Abuse, mental health problems and legal problems significantly predicted repeat self-harm for females.

CONCLUSION

The most common problems reported by both genders were social/interpersonal in nature, indicating the need for relevant services embedded in the community (e.g. in schools/colleges). Self-harm assessment and treatment choices for children and adolescents must take age and gender into account. To prevent future self-harm, individualised supports and services are particularly needed for abuse, mental health and legal problems.

Web-based support services to help prevent suicide in young people and students: A mixed-methods, user-informed review of characteristics and effective elements

The online world may provide an alternative means to engage young people and students with suicidal feelings, who are typically reluctant to seek help. We aimed to map, characterise and obtain user evaluation of current online suicide support for this group in order to assess the usefulness of current provision and how it may be improved. We conducted a mixed-methods study, comprised of an internet search, content analysis of site features and qualitative interviews with site users: 9 young people and 4 general practitioners. Data collection took place in 2019 and 2020 in the UK. Young people participants were recruited through the well-being networks of a large University in South-West England and via a national young person's mental health app. General practitioners were recruited locally through professional networks. We identified a wide range of easily accessible online support, including examples of interactive services, such as live chat and text messaging, but a lack of support that is both suicide-specific and young adult-specific, and an absence of online suicide or mental health crisis support services tailored specifically for students. Qualitative data showed that clarity, brevity and immediacy are the most important facets of engaging crisis help for young people, and that young people may prefer to use text-based rather than verbal forms of communication when seeking help. Few services provided access to active peer support, outside of lived-experience stories, which were evaluated as both valuable and potentially harmful. There is a need to further develop tailored suicide specific online crisis support for young people and students, which is able to 'speak to' their age-specific needs and preferences. While lived experience may provide a valuable means of supporting young audiences, caution is required since this may have unintended negative consequences and further research is needed to understand the safe framing of such material.

Online suicidal thoughts and/or behaviours talk: A scoping review protocol

The anonymity that the internet and social media affords users means that suicidal thoughts and/or behaviours can be talked about with a sense of freedom and disinhibition that is often not possible in face-to-face contexts. Better understanding online suicidal thoughts and/or behaviour talk is critical as more people turn to online spaces for support. Without this the potentiality of such spaces as sites for suicide prevention and intervention is likely to remain unrealised. Currently there are no scoping or systematic review syntheses focusing on internet and/or on social media suicidal thoughts and/or behaviour talk. This lack of synthesis is problematic as it makes it more difficult for online suicide prevention and intervention practices, policies, and our understanding of suicide to advance in a coherent and evidence-based manner. A scoping review protocol following Arksey and O'Malley's six-step modified framework has been developed to address this synthesis gap. It aims to systematically map the empirical literature that has investigated online suicidal thoughts and/or behaviours talk. It is anticipated that review outcomes could inform the training of health practitioners and peer/professional online moderators in how to best talk with people experiencing suicidal thoughts and/or behaviours. Outcomes could also form an evidence-base for developing policies and practices that focus on online places as safe spaces to talk about suicidal thoughts and/or behaviours. Developers of safe language guidelines could also use the outcomes to audit how well current guidelines reflect empirical evidence. Outcomes could enable researchers to design future online suicidal thoughts and/behaviours talk studies that extend our understandings of suicide leading to potential refinements of contemporary suicide theories/models.

Online suicidal thoughts and/or behaviours talk: A scoping review protocol

The anonymity that the internet and social media affords users means that suicidal thoughts and/or behaviours can be talked about with a sense of freedom and disinhibition that is often not possible in face-to-face contexts. Better understanding online suicidal thoughts and/or behaviour talk is critical as more people turn to online spaces for support. Without this the potentiality of such spaces as sites for suicide prevention and intervention is likely to remain unrealised. Currently there are no scoping or systematic review syntheses focusing on internet and/or on social media suicidal thoughts and/or behaviour talk. This lack of synthesis is problematic as it makes it more difficult for online suicide prevention and intervention practices, policies, and our understanding of suicide to advance in a coherent and evidence-based manner. A scoping review protocol following Arksey and O'Malley's six-step modified framework has been developed to address this synthesis gap. It aims to systematically map the empirical literature that has investigated online suicidal thoughts and/or behaviours talk. It is anticipated that review outcomes could inform the training of health practitioners and peer/professional online moderators in how to best talk with people experiencing suicidal thoughts and/or behaviours. Outcomes could also form an evidence-base for developing policies and practices that focus on online places as safe spaces to talk about suicidal thoughts and/or behaviours. Developers of safe language guidelines could also use the outcomes to audit how well current guidelines reflect empirical evidence. Outcomes could enable researchers to design future online suicidal thoughts and/behaviours talk studies that extend our understandings of suicide leading to potential refinements of contemporary suicide theories/models.

The Role of Family Health in Mediating the Association between Smartphone Use and Health Risk Behaviors among Chinese Adolescent Students: A National Cross-Sectional Study

The direct impact of smartphones on health risk behaviors of adolescent students has been verified. However, the mediating mechanisms that underly this relationship remain largely unknown. Therefore, the aim of the study is to explore the role of family health in mediating the relationship between the frequency of smartphone use and adolescent students' health risk behaviors. A questionnaire was used to collect cross-sectional data from 693 adolescent students aged 12-18 in China and a structural equation model was analyzed. Among the nine health risk behaviors, the most frequent health risk behaviors in Chinese adolescent students were non-compliance walking behaviors (M=Mean; SD = Standard deviation) (M ± SD) (2.78 ± 1.747), eating unhygienic food (M ± SD) (2.23 ± 1.299), being subjected to physical violence (M ± SD) (2.19 ± 0.645), and leaving home (M ± SD) (2.13 ± 0.557). The SEM results showed that the adolescent students' smartphone use had a positive impact on delaying the age of first alcohol consumption (β = 0.167, CI:0.067 0.287) and a negative impact on the non-compliance walking behaviors (β = 0.176, CI:0.011 0.266). Family health plays an indirect-only mediated role (the proportions of indirect-only mediated roles are 11.2%, 12.4%, and 11.5%) in the relationship between smartphone use and adolescent students' partial health risk behaviors: (CI: -0.042 -0.002), (CI: -0.049 -0.005), and (CI: -0.043 -0.002). These findings provided a theoretical and practical basis for better interventions in adolescent health risk behaviors.

Advances in problematic usage of the internet research - A narrative review by experts from the European network for problematic usage of the internet

Global concern about problematic usage of the internet (PUI), and its public health and societal costs, continues to grow, sharpened in focus under the privations of the COVID-19 pandemic. This narrative review reports the expert opinions of members of the largest international network of researchers on PUI in the framework of the European Cooperation in Science and Technology (COST) Action (CA 16207), on the scientific progress made and the critical knowledge gaps remaining to be filled as the term of the Action reaches its conclusion. A key advance has been achieving consensus on the clinical definition of various forms of PUI. Based on the overarching public health principles of protecting individuals and the public from harm and promoting the highest attainable standard of health, the World Health Organisation has introduced several new structured diagnoses into the ICD-11, including gambling disorder, gaming disorder, compulsive sexual behaviour disorder, and other unspecified or specified disorders due to addictive behaviours, alongside naming online activity as a diagnostic specifier. These definitions provide for the first time a sound platform for developing systematic networked research into various forms of PUI at global scale. Progress has also been made in areas such as refining and simplifying some of the available assessment instruments, clarifying the underpinning brain-based and social determinants, and building more empirically based etiological models, as a basis for therapeutic intervention, alongside public engagement initiatives. However, important gaps in our knowledge remain to be tackled. Principal among these include a better understanding of the course and evolution of the PUI-related problems, across different age groups, genders and other specific vulnerable groups, reliable methods for early identification of individuals at risk (before PUI becomes disordered), efficacious preventative and therapeutic interventions and ethical health and social policy changes that adequately safeguard human digital rights. The paper concludes with recommendations for achievable research goals, based on longitudinal analysis of a large multinational cohort co-designed with public stakeholders.

Development of An Ecological Momentary Assessment of the Impact of Social Media Use Among Suicidal Adolescents

OBJECTIVE

We aimed to develop an ecological momentary assessment (EMA) measure and sampling protocol to assess the near-term impact of experiences with social media use (SMU) that are associated with risk and protective factors for adolescent suicide.

METHODS

To develop the EMA measure, we consulted literature reviews and conducted focus groups with the target population, adolescents at risk for suicide. Subsequently, we refined the measure through interviews with experts and cognitive interviews with adolescents, through which we explored adolescents' thought processes as they considered questions and response options. Data were recorded, transcribed, and analyzed using thematic analysis.

RESULTS

The initial measure had 37 items assessing a range of harmful and beneficial aspects of SMU. Through expert and cognitive interviews, we refined the measure to 4 pathways assessing positive and negative experiences with SMU as well as positive and negative in-person interactions. Each pathway included a maximum of 11 items, as well as 2 items pertaining to SMU at nighttime to be assessed once daily. Acceptable targets the EMA measure's sampling protocol included a 10-day data collection window with text message-based prompts to complete the measure triggered 2-4 times daily.

CONCLUSIONS

By assessing a range of risk and protective factors for youth suicide, while using methods to reduce participant burden, we established content validity for the EMA measure and acceptability for the sampling protocol among youth at high risk of suicide.HIGHLIGHTSDevelopment of an ecological momentary assessment measure and sampling protocolExploring brief momentary assessment of social media's impact on adolescent suicidal riskMulti-phase approach to establishing content validity and an acceptable sampling protocol.

The Influence of Social Media on Adolescent Suicide: Is It All Bad?

Current daily practices in many emergency departments throughout the United States include providing emergency stabilization and psychiatric care for adolescents presenting with suicidal ideations and attempts. Upon presentation for care, standard nursing practices are to initiate suicide precautions. These precautions include removing all personal items from the patient, including cell phones or other electronic devices and with it, their access to social media. Although many believe this removal gives adolescents a necessary break from their peers and the social pressures associated with adolescence in the 21st century, is this practice supported by current evidence? And does it benefit adolescents, or provide additional psychological stress and anxiety, thus exacerbating their current state of crisis? The current literature review examines these questions and reveals contradictory evidence supporting detrimental and constructive effects of social media removal during adolescent emergency treatment for suicidal behaviors. [Journal of Psychosocial Nursing and Mental Health Services, 61(4), 12-17.].

Psycholinguistic changes in the communication of adolescent users in a suicidal ideation online community during the COVID-19 pandemic

Since the outbreak of the COVID-19 pandemic, increases in suicidal ideation and suicide attempts in adolescents have been registered. Many adolescents experiencing suicidal ideation turn to online communities for social support. In this retrospective observational study, we investigated the communication-language style, contents and user activity-in 7975 unique posts and 51,119 comments by N = 2862 active adolescent users in a large suicidal ideation support community (SISC) on the social media website reddit.com in the onset period of the COVID-19 pandemic. We found significant relative changes in language style markers for hopelessness such as negative emotion words (+ 10.00%) and positive emotion words (- 3.45%) as well as for social disengagement such as social references (- 8.63%) and 2nd person pronouns (- 33.97%) since the outbreak of the pandemic. Using topic modeling with Latent Dirichlet Allocation (LDA), we identified significant changes in content for the topics Hopelessness (+ 23.98%), Suicide Methods (+ 17.11%), Social Support (- 14.91%), and Reaching Out to users (- 28.97%). Changes in user activity point to an increased expression of mental health issues and decreased engagement with other users. The results indicate a potential shift in communication patterns with more adolescent users expressing their suicidal ideation rather than relating with or supporting other users during the COVID-19 pandemic.

"InspirAção": Development and use of a website to prevent suicidal behavior

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).

Synthesizing Adaptive Digital Bioethics to Guide the Use of Interactive Communication Technologies in Adolescent Behavioral Medicine: A Systematic Configurative Review

Despite the continuing integration of digital outreach tools into adolescent preventive services, adaptive guidance for their ethical use remains limited. In this configurative review, we synthesize the ad hoc, applied digital bioethics developed in adolescent human immunodeficiency virus prevention science. By focusing on generalizable technological affordances, while balancing privacy and autonomy, we offer strategies for identifying potential technologically mediated harms that can transcend specific platforms, tools, or the knowledge levels of individual clinicians. Clinical vignettes illustrate the application of these strategies.

Near-Fatal Self-Harm Among Canadian Adolescents

OBJECTIVE

To evaluate the clinical features of Canadian adolescents admitted to the intensive care unit (ICU) for medically serious self-harm.

METHODS

2700 Canadian paediatricians were surveyed monthly over two years (January 2017 to December 2018) through the Canadian Paediatric Surveillance Program to ascertain data from eligible cases.

RESULTS

Ninety-three cases (73 female; age 15.2 ± 1.5) met the case definition. Four provinces reported the majority of cases: Quebec (n = 27), Ontario (n = 26), Alberta (n = 21), and British Columbia (n = 8). There were 10 deaths, 9 by hanging. Overdose and hanging were the most frequently reported methods of self-harm (74.2% and 19.4%, respectively). Overdose was more common in females (80.8% females vs. 50% males; χ² = 7.8 (1), p = .005), whereas hanging was more common in males (35% males vs. 15.1% females, χ² = 3.9 (1), p = .04). More females than males had a past psychiatric diagnosis (79% vs. 58%; χ² = 4.1 (1), p = .06), a previous suicide attempt (55.9% vs. 29.4%, χ² = 3.8 (1), p = .05), and prior use of mental health service (69.7% vs. 27.8%, χ² = 10.4 (1), p = .001). Family conflict was the most commonly identified precipitating factor (43%) of self-harm.

CONCLUSIONS

Among Canadian adolescents admitted to the ICU with medically serious self-harm, females demonstrate a higher rate of suicide attempts and prior mental health care engagement, whereas males are more likely to die by suicide. These findings are consistent with data from other adolescent samples, as well as data from working-age and older adults. Therefore, a sex-specific approach to suicide prevention is warranted as part of a national suicide prevention strategy; family conflict may be a specific target for suicide prevention interventions among adolescents.

Cross-sectional Study of Factors Associated With Suicide Ideation in Ontario Adolescents

OBJECTIVE

Suicide is the second leading cause of death in Canadian adolescents. The Interpersonal Theory of Suicide attempts to explain suicide etiology and proposes that feelings of perceived burdensomeness or thwarted belongingness lead to suicide ideation, but this has not been extensively studied in adolescents. This study aimed to use the Interpersonal Theory of Suicide to examine factors that may be associated with suicide ideation in adolescents. The factors of interest were school connectedness, perceived availability of support, self-esteem, feelings of worthlessness, feelings of hopelessness, bullying and cyberbullying victimization, substance use, and social media use.

METHODS

Data were from the 2017 Ontario Student Drug Use and Health Survey, a survey of 7th to 12th graders enrolled in a publicly funded school in Ontario. Weighted multivariate logistic regression of suicide ideation on all exposure variables was conducted.

RESULTS

13.6% of students in the sample endorsed having suicidal ideation in the preceding 12 months. Not knowing where to turn to for support, feeling worthless, endorsing low self-esteem, being bullied, and using cannabis were each associated with greater odds of suicide ideation. Feeling hopeless, social media use, using alcohol and tobacco, and being cyberbullied were not associated with suicide ideation in the weighted multivariate logistic regression model.

CONCLUSIONS

This study is consistent with the Interpersonal Theory of Suicide as low self-esteem and feelings of worthlessness, two indicators of perceived burdensomeness, and not knowing where to turn to for support, an indicator of thwarted belongingness, were associated with greater odds of suicide ideation. These findings can help guide interventions aimed at reducing the burden of suicidality during adolescence and demonstrate the need to provide accessible mental health support for youth.

Relationship between depressive symptoms and internet usage time among adolescents: Results from a nationwide survey

Adolescent depression is becoming a public health problem. In this study the association between depressive symptoms and internet usage time in adolescents was examined, with data collected from the China Education Tracking Survey (CEPS). The survey is publicly available and carried out nationwide. A logistic regression analysis was conducted with odds ratios (OR) and 95% confidence intervals (CI), the subgroup analysis examined the relationships between internet usage time and depressive symptoms. A total of 10,705 adolescents were involved, where 46.4% of them are caught by the internet for more than two hours per day. Adolescents keeping on the internet for 6-8 h per day were reported to have higher odds of depressive symptoms than adolescents who were free from it with the confounders of individual, family, and school adjusted, which were observed among groups with a medium family economic status without living with their father and with a sleep time less than nine hours. The results revealed that adolescents spending more time online had a higher risk of experiencing depression symptoms. This study suggested that it is helpful for mental health professionals to evaluate and develop prevention interventions for depressive symptoms in adolescents promptly through monitoring and managing online time.

Associations between Fear of COVID-19, Depression, and Internet Addiction in South Korean Adults

This study investigates the associations between Internet addiction and psychological distress, including fear of coronavirus disease 2019 (COVID-19), and depression in South Korean adults during the COVID-19 pandemic. A population-based cross-sectional online survey was conducted from 14 to 18 May 2021. Potential adult survey respondents aged 20 years or older were randomly extracted from one of the largest online survey panels in South Korea, matching the South Korean national demographic proportions (i.e., region, gender, and age). Subsequently, 1155 participants were included in the study. Descriptive and logistic regression analyses were performed to investigate the participants’ characteristics and analyze the adjusted odds ratios (aORs). Of the South Korean adults, 11.17%, 15.15%, and 37.23% were at risk of Internet addiction, COVID-19 fear, and depression, respectively. Internet addiction was positively associated with COVID-19 fear (aOR = 3.25, 95% CI [2.10, 5.04]) and depressive symptoms (aOR = 6.40, 95% CI [4.15, 9.86]). Addictive Internet use was significantly associated with psychological distress during the COVID-19 pandemic. The development of public health strategies that mitigate addictive Internet use and increase eHealth literacy will be useful for securing the public’s psychological well-being.

Change in suicidal ideation and associated factors among young adults in Hong Kong from 2018 to 2019: a latent transition analysis

PURPOSE

Suicide in young adulthood is a vital public health concern. There have been few systematic studies that examined the prevalence and transition of suicidal ideation classes in young adults and the factors associated with the transition.

METHODS

This two-wave survey recruited 1269 young adults (Mean age = 24.0 years, 70.1% males) in Hong Kong. The participants completed the Suicidal Ideation Attributes Scale, Chinese Health Questionnaire, and help-seeking behaviors in 2018 and 2019. Latent profile analysis was used to classify the participants into latent classes of suicidal ideation with substantive checking under the 3-step approach. Latent transition analysis with measurement invariance examined the transition among the latent classes from 2018 to 2019 and the associations with help-seeking behaviors and change in psychological distress.

RESULTS

Three latent classes of suicidal ideation were identified and over two-thirds of the participants belonged to the Low-risk class with minimal suicidal ideation. The prevalence of the High-risk class dropped from 10.2 to 7.2%, while that of the Moderate-risk class remained stable from 2018 to 2019. Increases in psychological distress predicted higher probabilities to remain at or transit into more risky classes. Engagement in help-seeking behaviors showed differential transitions in suicidal ideation across time.

CONCLUSION

The findings suggest three latent classes of suicidal ideation with distinct profiles among the young adults. Deterioration in psychological distress showed a temporal effect on worsening of suicidal ideation over a 1-year period. Future studies should elucidate the comparative effectiveness of help-seeking behaviors via online and offline channels.

Assessing the Association Between Internet Addiction Disorder and Health Risk Behaviors Among Adolescents and Young Adults: A Systematic Review and Meta-Analysis

Background

Internet addiction disorder (IAD) is a global issue that has resulted in a slew of physical and emotional consequences. Studies have indicated that health risk behaviors might be the risk factors for IAD. The published literature on the correlation between the two is lacking. Therefore, we conducted a comprehensive analysis to understand better the link between IAD and health risk behaviors among adolescents and young adults.

Methods

We searched ten electronic databases for relevant articles. Data were extracted based on IAD and health risk behaviors ( alcohol, smoking, suicidal, gambling and drug abuse). We calculated odds ratios (ORs), a pooled correlation coefficient (r) and 95% confidence intervals (CIs). A fixed-effect model was applied to summarize the pooled effects. Heterogeneity was examined using I2 statistics and Cochran's Q statistics. All analyses were conducted by using Stata version 15.0.

Results

A total of 16 studies and 61,823 participants were included in this study. Meta-analysis showed that IAD was positively correlated with drinking (r = 0.35; 95% CI 0.32–0.37) and smoking (r = 0.12; 95%CI 0.10–0.15), and was associated with an increased risk of suicidal behavior (OR= 1.95; 95% CI 1.65–2.30), drinking (OR= 1.75; 95% CI 1.65–1.85), and smoking (OR= 1.63; 95% CI 1.54–1.72) among adolescents.

Conclusion

We found significantly increased risks of suicidal behavior, drinking, and smoking in adolescents and young adults with IAD. These findings are important to expand our understanding of IAD and have great guiding significance for preventing health risk behaviors of adolescents and young adults.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021257729, identifier: PROSPERO CRD42021257729.

Emergency Department Adolescent Suicidality: A Pilot Study to Determine How Common Actual Attempts Are

OBJECTIVE

Adolescent mental health is a rapidly escalating presentation to emergency departments in the United States with depression and suicidal thoughts being the most prevalent condition. Much of the research and focus has been on preventing future attempts. However, one outcome that may be very important in addition to focus on is the impact of presentations for thoughts without self-injury. The aim was to evaluate outcomes of interest for a larger prospective observational adolescent suicidal trial including frequency of suicide attempts versus thoughts and factors associated with each outcome.

METHODS

This is a prospective pilot study of adolescents at a single pediatric emergency department between December 2016 and September 2017 with acute suicidality. We used descriptive statistics to compare chief complaint, medical history, Patient Health Questionnaire-9 (PHQ-9), and outcomes including final disposition and total emergency department length of stay (LOS). We used t tests for continuous outcomes, χ2 test for categorical data, and Fisher exact tests for categorical and sparse data (20% of cell sizes of <5).

RESULTS

Forty-one patients were enrolled, with 43.9% having an attempt; 72.2% of attempts were the result of an ingestion, and approximately 54% were over-the-counter medications. The average (SD) LOS was 30.8 (31.2) hours, and 63% were discharged home to outpatient services. There were no significant differences in age, chief complaint (except overdose), medical history, final disposition, total LOS in the ED, and the PHQ-9. Scores of the PHQ-9 were, on average (SD), 18.51 (4.7) across the entire cohort, 18.06 (5.75) in patients with an attempt, and 18.87 (3.77) in patients without an attempt (P = 0.59).

CONCLUSIONS

Adolescent mental health is a growing issue for pediatric emergency departments nationally. Prospective research to identify factors associated with worsening outcomes is important to identify and potentially modify if possible. This study did not find any specific factors associated with a suicide attempt, but found that less than half of patients presenting with suicidality actual made an attempt. Future research should focus on not only limiting suicide attempts but also using decreased emergency department visits for worsening thoughts as an outcome of interest.

Use of a Mobile Peer Support App Among Young People With Nonsuicidal Self-injury: Small-scale Randomized Controlled Trial

BACKGROUND

Nonsuicidal self-injury (NSSI) is a widespread behavior among adolescents and young adults. Although many individuals who self-injure do not seek treatment, there is evidence for web-based help-seeking through web-based communities and mobile peer support networks. However, few studies have rigorously tested the efficacy of such platforms on outcomes relevant for NSSI recovery.

OBJECTIVE

The aim of this small-scale preregistered randomized controlled trial is to provide preliminary insight into the shorter- and longer-term efficacy of the use of a peer support app, TalkLife, in reducing NSSI frequency and urges and increasing readiness to change. In addition, we explore contact with informal support, interest in therapy, and attitudes toward professional help-seeking.

METHODS

Individuals aged 16-25 years with current (within 3 months) and chronic (>6 episodes in the past year) NSSI history were eligible to participate in this study. After baseline assessments, the intervention group was instructed to use the app actively (eg, post or comment at least three times per week) and the control group received weekly psychoeducational materials through email, for 8 weeks. Follow-up was assessed at 1 month and 2 months. Linear mixed modeling was used to evaluate condition and time point effects for the primary outcomes of NSSI frequency and urges, readiness to change, contact with informal support, interest in therapy, and attitudes toward professional help-seeking.

RESULTS

A total of 131 participants were included in the analysis. We evidenced a significant effect of condition on NSSI frequency such that the participants using the peer support app self-injured less over the course of the study (mean 1.30, SE 0.18) than those in the control condition (mean 1.62, SE 0.18; P=.02; η2=0.02). We also evidenced a significant condition effect of readiness to change such that the treatment participants reported greater confidence in their ability to change their NSSI behavior (mean 6.28, SE 0.41) than the control participants (mean 5.67, SE 0.41; P=.04; η2=0.02). No significant differences were observed for contact with informal support, interest in therapy, or attitudes toward professional help-seeking.

CONCLUSIONS

Use of the peer support app was related to reduced NSSI frequency and greater confidence in one's ability to change NSSI behavior over the course of the study period, but no effects on NSSI urges, contact with informal support, interest in therapy, or attitudes toward professional help-seeking were observed. The findings provide preliminary support for considering the use of mobile peer support apps as a supplement to NSSI intervention and point to the need for larger-scale trials.

TRIAL REGISTRATION

Open Science Foundation; https://osf.io/3uay9.

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.

Adolescent Peer Experiences and Prospective Suicidal Ideation: The Protective Role of Online-Only Friendships

Objective: This study examined characteristics of online-only friendships among suicidal and non-suicidal adolescents. In addition, the extent to which adolescents' online-only friendships may offer a protective function, buffering the effects of peer stressors (i.e., friendship stress, relational victimization) on prospective suicidal ideation, was examined.Method: Adolescents aged 10 to 14 (n = 630) were assessed at baseline (Time 1) and one-year follow-up (Time 2). Measures of suicidal ideation, sociometric relational victimization, friendship stress, depressive symptoms, online-only friendship status and quality, and online-only friendship quality compared to in-person friendship quality, were obtained at Time 1 using sociometric procedures and self-report questionnaires. Self-report measures of suicidal ideation were collected at Time 2.Results: Descriptive results suggested that online-only friendships are relatively common among youth (38.3%), particularly for those experiencing suicidal ideation (46.3%). Suicidal and non-suicidal adolescents reported comparable levels of intimate disclosure within their online-only friendships. Although adolescents without suicidal ideation endorsed more support from in-person friendships, suicidal adolescents endorsed similar levels of support from their online-only and in-person friendships. Moderation analyses indicated that the association between both relational victimization and friendship stress and prospective suicidal ideation was attenuated among youth who reported having one or more online-only friend.Conclusion: Online-only friendships are common and may offer protective benefits for youth, particularly those experiencing suicidal ideation. Future studies should examine the specific mechanisms by which online-only friendships may confer this benefit.

Factors influencing the addiction characteristics of non-suicidal self-injurious behaviors in adolescents: A case-control study

BACKGROUND

Many studies have shown that in the context of public health emergencies, the incidence rate of adolescent non-suicidal self-injury (NSSI) patients increased dramatically. This paper aims to characterize the behavioral characteristics of adolescent NSSI and analyze the influencing factors of NSSI behavior addiction characteristics.

METHODS

Our research was a case-control study which included 84 adolescents with NSSI (female vs. male: 59 vs. 25) and 84 healthy controls (female vs. male: 53 vs. 31). All the participants enrolled were aged 12-18 years. The differences in the scores of the following five scales were compared between the case and control groups: Egna Minnen Barndoms Uppfostran (EMBU), Perceived Social Support Scale (PSSS), Perceived Stress Scale (PSS); Bergen Social Media Addiction Scale (BSMAS) and Video Game Dependence Scale (VDG-S). The characteristics of NSSI behavior of the study group were evaluated using the Ottawa Self Inventory Chinese Revised Edition (OSIC). And a binary logistic regression model was developed to analyze the factors that influence adolescent NSSI behavioral addiction characteristics.

RESULTS

In the study group, the emotional warmth scores in the father's and mother's rearing style scores in the EMBU were significantly lower than the controls. The BSMAS and VDG-S scores were significantly higher than those in the control group. 38 cases of NSSI with addiction characteristics accounted for 45.24% in the study group. The risk factors for NSSI addiction traits were as follows: female, single-child, high level of VDG-S scores, high scores of excessive interferences in father's rearing style, and high scores of punishments and excessive interferences in mother's rearing style score.

CONCLUSION

Female, only child, internet addiction, and negative parenting styles were predictors of NSSI behavioral addiction characteristics in adolescents. Targeted coping strategies should be developed to reduce the occurrence and development of self-injurious behavior, especially for female adolescents with Internet dependence in one-child families with negative parenting styles.

Advances in Research on Adolescent Suicide and a High Priority Agenda for Future Research

Suicide is the second leading cause of death for adolescents in the United States, yet remarkably little is known regarding risk factors for suicidal thoughts and behaviors (STBs), relatively few federal grants and scientific publications focus on STBs, and few evidence-based approaches to prevent or treat STBs are available. This "decade in review" article discusses five domains of recent empirical findings that span biological, environmental, and contextual systems and can guide future research in this high priority area: (1) the role of the central nervous system; (2) physiological risk factors, including the peripheral nervous system; (3) proximal acute stress responses; (4) novel behavioral and psychological risk factors; and (5) broader societal factors impacting diverse populations and several additional nascent areas worthy of further investigation.

Youth Internet Safety Education: Aligning Programs With the Evidence Base

BACKGROUND

This review critically examines the messages of youth internet safety education programs in the light of research about both the dynamics of internet dangers and the efficacy of youth prevention education.

METHODS

Using terms "internet safety education" and "digital citizenship," a Google search identified 12 multi-topic safety programs. Review articles were identified via Google Scholar for six forms of online harm to youth that have been targeted by many of these programs: cyberbullying (19 articles); online sexual exploitation (23 articles); sexting (19 articles); online fraud, hacking, and identity theft (6 articles); online suicide and self-harm promotion (18 articles); and internet overuse or addiction (15 articles).

FINDINGS

There appear to be mismatches between dynamics revealed in the research about internet harms and the messages emphasized in educational programs, particularly on the issues of sexual exploitation and sexting. Overall, the review literature also suggests major advantages to integrating internet safety into already well-established and evidence-based programs currently addressing related off-line harms, for example, programs focusing on general bullying, dating abuse, or sexual abuse prevention. The advantages stem from four factors: (1) the considerable overlap between online harms and similar off-line harms, (2) the apparent greater prevalence of off-line harms, (3) the evidence that the same risk factors lie behind both online and off-line harms, and most importantly, (4) the substantially superior evidence base for the longer standing programs developed originally around the off-line harms.

Understanding suicide clusters through exploring self-harm: Semi-structured interviews with individuals presenting with near-fatal self-harm during a suicide cluster

There was a highly publicised cluster of at least ten suicides in South Wales, United Kingdom, in 2007-2008. We carried out a qualitative descriptive study using cross-case thematic analysis to investigate the experiences and narratives of eight individuals who lived in the area where the cluster occurred and who survived an episode of near-fatal self-harm at the time of the cluster. Interviews were conducted from 01.01.2015 to 31.12.2015. All interviewees denied that the other deaths in the area had affected their own suicidal behaviour. However, in other sections of the interviews they spoke about the cluster contributing to difficulties they were experiencing at the time, including damage to social relationships, feelings of loss and being out of control. When asked about support, the interviewees emphasized the importance of counselling, which they would have found helpful but in most cases did not receive, even in the case of close contacts of individuals who had died. The findings suggest that effective prevention messaging must be subtle, since those affected may not be explicitly aware of or acknowledge the imitative aspects of their behaviour. This could be related to stigma attached to suicidal behaviour in a cluster context. Lessons for prevention include changing the message from asking if people 'have been affected by' the suicide deaths to emphasising the preventability of suicide, and directly reaching out to individuals rather than relying on people to come forward.

Googling for Suicide-Content and Quality Analysis of Suicide-Related Websites: Thematic Analysis

Background

Suicide represents a public health concern, imposing a dramatic burden. Prosuicide websites are “virtual pathways” facilitating a rise in suicidal behaviors, especially among socially isolated, susceptible individuals.

Objective

The aim of this study is to characterize suicide-related webpages in the Italian language.

Methods

The first 5 most commonly used search engines in Italy (ie, Bing, Virgilio, Yahoo, Google, and Libero) were mined using the term “suicidio” (Italian for suicide). For each search, the first 100 webpages were considered. Websites resulting from each search were collected and duplicates deleted so that unique webpages could be analyzed and rated with the HONcode instrument

Results

A total of 65 webpages were included: 12.5% (8/64) were antisuicide and 6.3% (4/64) explicitly prosuicide. The majority of the included websites had a mixed or neutral attitude toward suicide (52/64, 81.2%) and had informative content and purpose (39/64, 60.9%). Most webpages targeted adolescents as an age group (38/64, 59.4%), contained a reference to other psychiatric disorders or comorbidities (42/64, 65.6%), included medical/professional supervision or guidance (45/64, 70.3%), lacked figures or pictures related to suicide (41/64, 64.1%), and did not contain any access restraint (62/64, 96.9%). The major shortcoming to this study is the small sample size of webpages analyzed and the search limited to the keyword “suicide.”

Conclusions

Specialized mental health professionals should try to improve their presence online by providing high-quality material.

Commentary: Worshipping the internet - the perils of serving an unpredictable master - a commentary on Aboujaoude and Gega (2021)

Numerous links have been established between cybertechnology and mental health problems. Although the direction of causality in the relationship between internet misuse and mental disturbance remains unclear, the cyberworld may contribute to the shaping of psychopathology in various ways. These include internet-enhanced impulsivity, disinhibition and aggression, attentional problems, difficulties in coping with online information and selective and constraining online interactions with likeminded individuals. One of the imperatives of public health is to help internet users, especially those who are vulnerable such as children and adolescents, to be aware of the risks involved in interactions with the digital technologies and educate them about circumventing the dangers and seeking help.

Internet Search Activity of Young People With Mood Disorders Who Are Hospitalized for Suicidal Thoughts and Behaviors: Qualitative Study of Google Search Activity

BACKGROUND

Little is known about the internet search activity of people with suicidal thoughts and behaviors (STBs). This data source has the potential to inform both clinical and public health efforts, such as suicide risk assessment and prevention.

OBJECTIVE

We aimed to evaluate the internet search activity of suicidal young people to find evidence of suicidal ideation and behavioral health-related content.

METHODS

Individuals aged between 15 and 30 years (N=43) with mood disorders who were hospitalized for STBs provided access to their internet search history. Searches that were conducted in the 3-month period prior to hospitalization were extracted and manually evaluated for search themes related to suicide and behavioral health.

RESULTS

A majority (27/43, 63%) of participants conducted suicide-related searches. Participants searched for information that exactly matched their planned or chosen method of attempting suicide in 21% (9/43) of cases. Suicide-related search queries also included unusual suicide methods and references to suicide in popular culture. A majority of participants (33/43, 77%) had queries related to help-seeking themes, including how to find inpatient and outpatient behavioral health care. Queries related to mood and anxiety symptoms were found among 44% (19/43) of participants and included references to panic disorder, the inability to focus, feelings of loneliness, and despair. Queries related to substance use were found among 44% (19/43) of participants. Queries related to traumatic experiences were present among 33% (14/43) of participants. Few participants conducted searches for crisis hotlines (n=3).

CONCLUSIONS

Individuals search the internet for information related to suicide prior to hospitalization for STBs. The improved understanding of the search activity of suicidal people could inform outreach, assessment, and intervention strategies for people at risk. Access to search data may also benefit the ongoing care of suicidal patients.

The association between problematic Internet use, eating disorder behaviors, and well-being among Palestinian university students

Objectives

The current study aimed to test the correlation between problematic Internet use, eating disorder behaviors, and well-being among Palestinian university students.

Methods

To examine the relationship between the study variables, a correlational study was conducted. The geographical representation of the study sample showed that 48.1% of participants were from urban populations, 48.1% were from rural villages, and 3.8% were from internally displaced people’s camps.

Results

Pearson’s correlation coefficient was used to test the relationship between problematic Internet use, eating disorder behaviors, and well-being. Results showed that problematic Internet use was negatively correlated to well-being (r = − .32, p < .01), and positively correlated to eating disorder behaviors (r = .39, p < .01). The regression analysis found that problematic Internet use contributes statistically and significantly towards explaining variance in eating disorder behaviors (B = .46, SE = .08, β = .32). Moreover, well-being contributed in a way that was statistically significant towards explaining variance in eating disorders behaviors (B = − .39, SE = .09, β = − .25).

Conclusion

The results of our study support previous studies that indicated that problematic Internet use was significantly and positively correlated with eating disorder behaviors, while it was significantly and negatively correlated to well-being among Palestinian university students. Further studies testing this relationship will be crucial in developing interventions to both reduce problematic Internet use and eating disorder behaviors and increase well-being among university students.

Mediation of Internet addiction on association between childhood maltreatment and suicidal behaviours among Chinese adolescents

Aims

The associations between suicidal behaviours and childhood maltreatment (CM), as well as Internet addiction (IA) have been extensively examined. However, few studies pay attention to different types of CM and all stages of suicidality, including suicidal ideation (SI), suicidal plans (SP) and suicidal attempts (SA). Moreover, little is known regarding the mediation of IA on the relationship between CM and suicidal behaviours. The study aims to explore the direct effect of CM and IA on three stages of suicidal behaviours, and the indirect effect of CM on suicidality via IA.

Methods

A total of 16 130 high-school students aged 12–18 were recruited using a stratified cluster sampling strategy across five representative provinces in China. Relevant information was collected by a self-administered anonymous questionnaire. Multinomial logistic regression analysis and structural equation model were used to examine the associations.

Results

During the last year, 16.0% of participants reported suicidal behaviours. Specifically, 7.9% reported SI only, 4.6% reported SP but no SA, and 3.5% reported SA. The prevalence of neglect, physical abuse and IA in moderate to severe were 28.9, 19.9 and 33.1%, respectively. After controlling for demographic characteristics and confounding factors, such as loneliness, psychological resilience, and social support, moderate and severe neglect, physical abuse and IA were associated with an increased risk of SI, SP and SA (p < 0.01). The total effect of neglect and physical abuse on suicidal behaviours were 0.152 and 0.172, respectively (p < 0.001). The mediation proportion of IA on the association between neglect and suicidal behaviours, as well as physical abuse and suicidal behaviours were 22.4 and 18.0%, respectively.

Conclusions

CM and IA are independently associated with suicidal behaviours among Chinese adolescents. Moreover, IA plays a mediating role on the relationship between CM and suicidality. Targeted interventions for adolescents’ suicidal behaviours should focus on those who have experience of CM and IA.

Automated Monitoring of Suicidal Adolescents' Digital Media Use: Qualitative Study Exploring Acceptability Within Clinical Care

BACKGROUND

Monitoring linguistic cues from adolescents' digital media use (DMU; ie, digital content transmitted on the web, such as through text messages or social media) that could denote suicidal risk offers a unique opportunity to protect adolescents vulnerable to suicide, the second leading cause of death among youth. Adolescents communicate through digital media in high volumes and frequently express emotionality. In fact, web-based disclosures of suicidality are more common than in-person disclosures. The use of automated methods of digital media monitoring triggered by a natural language processing algorithm offers the potential to detect suicidal risk from subtle linguistic units (eg, negatively valanced words, phrases, or emoticons known to be associated with suicidality) present within adolescents' digital media content and to use this information to respond to alerts of suicidal risk. Critical to the implementation of such an approach is the consideration of its acceptability in the clinical care of adolescents at high risk of suicide.

OBJECTIVE

Through data collection among recently suicidal adolescents, parents, and clinicians, this study examines the current context of digital media monitoring for suicidal adolescents seeking clinical care to inform the need for automated monitoring and the factors that influence the acceptance of automated monitoring of suicidal adolescents' DMU within clinical care.

METHODS

A total of 15 recently suicidal adolescents (aged 13-17 years), 12 parents, and 10 clinicians participated in focus groups, qualitative interviews, and a group discussion, respectively. Data were recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Participants described important challenges to the current strategies for monitoring the DMU of suicidal youth. They felt that automated monitoring would have advantages over current monitoring approaches, namely, by protecting web-based environments and aiding adolescent disclosure and support seeking about web-based suicidal risk communication, which may otherwise go unnoticed. However, they identified barriers that could impede implementation within clinical care, namely, adolescents' and parents' concerns about unintended consequences of automated monitoring, that is, the potential for loss of privacy or false alerts, and clinicians' concerns about liability to respond to alerts of suicidal risk. On the basis of the needs and preferences of adolescents, parents, and clinicians, a model for automated digital media monitoring is presented that aims to optimize acceptability within clinical care for suicidal youth.

CONCLUSIONS

Automated digital media monitoring offers a promising means to augment detection and response to suicidal risk within the clinical care of suicidal youth when strategies that address the preferences of adolescents, parents, and clinicians are in place.