Self-management, self-care, and self-help in adolescents with emotional problems: a scoping review

This study aimed to review the existing published and grey literature describing the concepts of self-management, self-care, and self-help, and to capture strategies or techniques related to these concepts, for adolescents with emotional problems. Emotional problems are rising amongst adolescents, yet timely access to specialist mental health treatment is limited to those with greater severity of mental health difficulties. Self-management, self-care, and self-help strategies may be used by adolescents with emotional problems both in terms of those waiting for treatment and to prevent relapse. Given the overlap in existing definitions and the lack of clarity around these concepts in an adolescent mental health context, a scoping review of the literature is warranted to provide clarity. Eligible studies were those involving adolescents aged 10 to 19 years with symptoms of emotional problems. Studies referenced self-management, self-care, or self-help, not involving a professional, in this population. Quantitative, qualitative, economic, and mixed methods studies, as well as systematic, scoping, and literature reviews, from 2000 onwards and in the English language, were eligible for inclusion. A systematic search was conducted of both published and grey literature. Databases searched included PsycINFO, Medline, Embase, Web of Science, and CINAHL Plus. Mednar was also searched for unpublished studies and grey literature. Tables  of themes, terms, and associated strategies are presented alongside a thematic analysis of the results. 62 articles were included. These were 20 quantitative studies, 14 systematic reviews, 10 qualitative studies, five review papers, four book chapters, four mixed methods studies, two dissertations, two meta-analyses and one scoping review and systematic review. Most of the included articles referenced self-help (n = 51), followed by self-management (n = 17) and self-care (n = 6). A total of 12 themes were identified from a reflexive thematic analysis of descriptions (and associated strategies) of self-management, self-help, or self-care in included texts. This scoping review provides clarity on the similarities and differences between how these concepts are discussed, and the strategies which are associated with each of these concepts in the relevant literature. Implications for policy and intervention development for adolescents' self-management, self-help, and self-care of their mental health are discussed. There is considerable overlap in both the ways in which these concepts are described, and the strategies or approaches proposed in relation to them, supporting previous research suggesting these strategies should be grouped under a single term, such as "self or community approaches." More research is needed for self-management, self-help, and self-care amongst marginalized groups as these adolescents may have the highest unmet need for mental health support.

Adolescent Anxiety and TikTok: An Exploratory Study

Introduction Social media is ubiquitous in adolescents' lives. TikTok is a medium primarily used by adolescents and young adults under 30 years. TikTok is thus an appropriate social media platform with which to examine discussions of anxiety among this age cohort. In this exploratory mixed-methods study we aimed to evaluate the scope of anxiety content available on TikTok in English in December 2021, and to further develop methods for analysing TikTok content. Methods We analysed a data set of 147 TikToks with the hashtag #anxiety. The data set consisted both of metadata and TikTok videos. This data set represented 18% of all TikToks featuring the hashtag #anxiety in December 2021. We examined the following research questions (RQs). RQ1: What are the creator identities reflected in the final data set in this study?; RQ2: What are the metadata characteristics of the TikToks in the final data set?; RQ3: What are the anxiety content themes in the final data set?; and RQ4: What are the characteristics of the data set based on an anxiety management reference checklist? This study involves public data that can reasonably be observed by strangers. This study does not include any identifiable human participants. Results Influencers were the most frequent creator identity in our data set. Influencers comprised 85.5% of the 147 TikToks in our final data set. We coded 79 female (54%) and 45 male (31%) influencers. We found male influencers created the most played (mean 8,114,706), and most liked (mean 1,510,585) TikToks. We found content themes varied by influencer gender. The notable findings were (a) the greater use of humour by males (22.7% males; n=10, and females 12.6%; n=10); and (b) inspiration (38.7%; males n=17; and 13.9%; females n=11). Among female influencers, we identified self-disclosure as the most common theme (n= 40 and 50.7% compared with n=11 and 25% male influencers). Overall, we found limited references to evidence-based anxiety self-care content in our final data set. Discussion We suggest that the TikToks in our data set were primarily directed at raising awareness of and de-stigmatising anxiety symptoms. TikTok anxiety content may be viewed by adolescents for emotional self-regulation beyond evidence-based health information seeking. Self-disclosure on TikTok may also provide symptomatic relief to adolescents with anxiety. We suggest that gender is a salient consideration when considering TikTok content. Conclusions Our findings are consistent with existing literature on adolescent social media use and epidemiological data on anxiety. This research also provides methodological insights for researchers and clinicians seeking to understand TikTok, and to develop engaging content targeted at the specific concerns and preferences of adolescent TikTok consumers.

Extracting time patterns from the lifespans of TikTok challenges to characterize non-dangerous and dangerous ones

One of the key aspects that distinguish TikTok from other social media is the presence of challenges. A challenge is a kind of competition that starts when a user posts a video with certain actions and a certain hashtag and invites other users to replicate the same video in their own way. Most challenges are fun and harmless, but sometimes dangerous challenges are launched as well. The authors of these challenges use various tricks to bypass TikTok’s controls. In this paper, we analyze the lifespans of some TikTok challenges and show how they are very different for non-dangerous and dangerous ones. Then, we deepen our analysis by identifying some time patterns that characterize the two types of challenges. Finally, we test the accuracy of the results obtained on a large set of challenges different from those used during the detection of time patterns. The focus of this paper is the detection of time patterns allowing the classification of challenges in dangerous and non-dangerous ones. This could represent a first step towards an approach for the early detection of dangerous challenges in TikTok.

Misinformation in Italian Online Mental Health Communities During the COVID-19 Pandemic: Protocol for a Content Analysis Study

Background

Social media platforms are widely used by people suffering from mental illnesses to cope with their conditions. One modality of coping with these conditions is navigating online communities where people can receive emotional support and informational advice. Benefits have been documented in terms of impact on health outcomes. However, the pitfalls are still unknown, as not all content is necessarily helpful or correct. Furthermore, the advent of the COVID-19 pandemic and related problems, such as worsening mental health symptoms, the dissemination of conspiracy narratives, and medical distrust, may have impacted these online communities. The situation in Italy is of particular interest, being the first Western country to experience a nationwide lockdown. Particularly during this challenging time, the beneficial role of community moderators with professional mental health expertise needs to be investigated in terms of uncovering misleading information and regulating communities.

Objective

The aim of the proposed study is to investigate the potentially harmful content found in online communities for mental health symptoms in the Italian language. Besides descriptive information about the content that posts and comments address, this study aims to analyze the content from two viewpoints. The first one compares expert-led and peer-led communities, focusing on differences in misinformation. The second one unravels the impact of the COVID-19 pandemic, not by merely investigating differences in topics but also by investigating the needs expressed by community members.

Methods

A codebook for the content analysis of Facebook communities has been developed, and a content analysis will be conducted on bundles of posts. Among 14 Facebook groups that were interested in participating in this study, two groups were selected for analysis: one was being moderated by a health professional (n=12,058 members) and one was led by peers (n=5598 members). Utterances from 3 consecutive calendar years will be studied by comparing the months from before the pandemic, the months during the height of the pandemic, and the months during the postpandemic phase (2019-2021). This method permits the identification of different types of misinformation and the context in which they emerge. Ethical approval was obtained by the Università della Svizzera italiana ethics committee.

Results

The usability of the codebook was demonstrated with a pretest. Subsequently, 144 threads (1534 utterances) were coded by the two coders. Intercoder reliability was calculated on 293 units (19.10% of the total sample; Krippendorff α=.94, range .72-1). Aside from a few analyses comparing bundles, individual utterances will constitute the unit of analysis in most cases.

Conclusions

This content analysis will identify deleterious content found in online mental health support groups, the potential role of moderators in uncovering misleading information, and the impact of COVID-19 on the content.

International Registered Report Identifier (IRRID)

PRR1-10.2196/35347

Social media use for health, cultural characteristics, and demographics: A survey of Pakistani millennials

Objective

Over the last 10 years, an extensive body of literature has been produced to investigate the role of social media in health. However, little is known about the impact of cultural characteristics (e.g. masculinity, collectivism, and uncertainty avoidance) on social media use regarding health-related information, especially in developing countries like Pakistan. The present study employed Hofstede’s cultural characteristics framework and uses and gratification theory to examine how Pakistani millennials’ demographic attributes and cultural characteristics are associated with their social media use for health-related information.

Method

An online survey of 722 people aged 18–35 living in Pakistan was conducted in spring 2020 to examine the intensity and frequency of social media use, health-related use of social media, cultural characteristics, and demographic attributes.

Results

Results showed that cultural characteristics—masculinity, collectivism, and uncertainty avoidance—are strongly related with their perceptions of social media importance, usefulness, and perceived ease of access for health-related information even when controlling for demographic characteristics. Age and gender are also significantly associated with their perspectives on social media for health.

Conclusions

We found that communicating and sharing information is the most important motivation for Pakistani millennials to use social media in the area of health with WhatsApp and YouTube being most preferred social media sites for health-related issues.

"Do You Know How Much I Suffer?": How Young People Negotiate the Tellability of Their Mental Health Disruption in Anonymous Distress Narratives on Social Media

The emergence of mental distress presents significant difficulties and dilemmas for adolescents and early adults about being open with their troubles and emotions. To better understand the communication practices and challenges that reflect the lived realities of marginalized youth struggling with mental health disruption, this study examines 136 anonymous personal stories disclosing self-harm behaviors or suicidal thoughts on a Facebook "secrets" page for Hong Kong students. The narrative analysis unveils young people's anecdotal accounts of hidden grievances and struggles around their mental distress, hitherto untold not because they are too difficult to tell but because they are too negative to be heard. Extending the concept of tellability, this study illustrates how anonymous distress storytelling on social media enables silenced and isolated distressed youth to resist the denial - invisibility, discredit, and mischaracterization - of their suffering by turning their disruptive experiences into stories worth telling through disclosure, clarification, and testimony. This study further clarifies the salient interpretive frameworks that shape young people's experience and communication of mental distress: the tyranny of happiness depicted to engender distress and languages of suffering used to resist culpability and plead for social respite. It highlights the disconnection in interpretations regarding the transitory nature of distress and its controllability as a major source of communication gap and interpersonal communication breakdowns. The findings call on health communication practices around mental health promotion to refrain from highlighting individual deficiencies or messages of positivity and speak out on the structural inconsistencies and communication denial that perpetuate and silence youth distress.

Social Media Use for Health Purposes: Systematic Review

Background

Social media has been widely used for health-related purposes, especially during the COVID-19 pandemic. Previous reviews have summarized social media uses for a specific health purpose such as health interventions, health campaigns, medical education, and disease outbreak surveillance. The most recent comprehensive review of social media uses for health purposes, however, was conducted in 2013. A systematic review that covers various health purposes is needed to reveal the new usages and research gaps that emerge in recent years.

Objective

This study aimed to provide a systematic review of social media uses for health purposes that have been identified in previous studies.

Methods

The researchers searched for peer-reviewed journal articles published between 2006 and 2020 in 12 databases covering medicine, public health, and social science. After coding the articles in terms of publication year, journal area, country, method, social media platform, and social media use for health purposes, the researchers provided a review of social media use for health purposes identified in these articles.

Results

This study summarized 10 social media uses for various health purposes by health institutions, health researchers and practitioners, and the public.

Conclusions

Social media can be used for various health purposes. Several new usages have emerged since 2013 including advancing health research and practice, social mobilization, and facilitating offline health-related services and events. Research gaps exist regarding advancing strategic use of social media based on audience segmentation, evaluating the impact of social media in health interventions, understanding the impact of health identity development, and addressing privacy concerns.

Social Media, Quo Vadis? Prospective Development and Implications

Over the past two decades, social media have become a crucial and omnipresent cultural and economic phenomenon, which has seen platforms come and go and advance technologically. In this study, we explore the further development of social media regarding interactive technologies, platform development, relationships to news media, the activities of institutional and organizational users, and effects of social media on the individual and the society over the next five to ten years by conducting an international, two-stage Delphi study. Our results show that enhanced interaction on platforms, including virtual and augmented reality, somatosensory sense, and touch- and movement-based navigation are expected. AIs will interact with other social media users. Inactive user profiles will outnumber active ones. Platform providers will diversify into the WWW, e-commerce, edu-tech, fintechs, the automobile industry, and HR. They will change to a freemium business model and put more effort into combating cybercrime. Social media will become the predominant news distributor, but fake news will still be problematic. Firms will spend greater amounts of their budgets on social media advertising, and schools, politicians, and the medical sector will increase their social media engagement. Social media use will increasingly lead to individuals’ psychic issues. Society will benefit from economic growth and new jobs, increased political interest, democratic progress, and education due to social media. However, censorship and the energy consumption of platform operators might rise.

Examining the Self-Harm and Suicide Contagion Effects of the Blue Whale Challenge on YouTube and Twitter: Qualitative Study

BACKGROUND

Research suggests that direct exposure to suicidal behaviors and acts of self-harm through social media may increase suicidality through imitation and modeling, particularly in more vulnerable populations. One example of a social media phenomenon that demonstrates how self-harming behavior could potentially be propagated is the blue whale challenge. In this challenge, adolescents and young adults are encouraged to engage in self-harm and eventually kill themselves.

OBJECTIVE

This paper aimed to investigate the way individuals portray the blue whale challenge on social media, with an emphasis on factors that could pose a risk to vulnerable populations.

METHODS

We first used a thematic analysis approach to code 60 publicly posted YouTube videos, 1112 comments on those videos, and 150 Twitter posts that explicitly referenced the blue whale challenge. We then deductively coded the YouTube videos based on the Suicide Prevention Resource Center (SPRC) safe messaging guidelines as a metric for the contagion risk associated with each video.

RESULTS

The thematic analysis revealed that social media users post about the blue whale challenge to raise awareness and discourage participation, express sorrow for the participants, criticize the participants, or describe a relevant experience. The deductive coding of the YouTube videos showed that most of the videos violated at least 50% of the SPRC safe and effective messaging guidelines.

CONCLUSIONS

These posts might have the problematic effect of normalizing the blue whale challenge through repeated exposure, modeling, and reinforcement of self-harming and suicidal behaviors, especially among vulnerable populations such as adolescents. More effort is needed to educate social media users and content generators on safe messaging guidelines and factors that encourage versus discourage contagion effects.

Facebook Groups on Chronic Obstructive Pulmonary Disease: Social Media Content Analysis

Facebook Groups facilitate information exchange and engagement for patients with chronic conditions, including those living with Chronic Obstructive Pulmonary Disease (COPD); however, little is known about how knowledge is diffused throughout these communities. This study aimed to evaluate the content that is available on COPD-related Facebook Groups, as well as the communication (self-disclosures, social support) and engagement (agreement, emotional reaction) strategies used by members to facilitate these resources. Two researchers independently searched the "Groups" category using the terms "COPD", "emphysema", and "chronic bronchitis". Twenty-six closed (n = 23) and public (n = 3) COPD Facebook Groups were identified with 87,082 total members. The vast majority of Group members belonged to closed (n = 84,684; 97.25%) as compared to open (n = 2398; 2.75%) groups. Medications were the most commonly addressed self-management topic (n = 48; 26.7%). While overall engagement with wall posts was low, the number of "likes" (an indicator of agreement) was significantly greater for wall posts that demonstrated social support as compared to posts that did not (p < 0.001). Findings from this study showed that COPD Facebook group members share specific disease-related experiences and request information about select self-management topics. This information can be used to improve the quality of self-management support provided to members of popular COPD Facebook groups.

Social Media Content Analysis of Public Diabetes Facebook Groups

INTRODUCTION

Relatively little is known about how Facebook groups are used to facilitate diabetes self-management support. This study provides a critical analysis of public diabetes Facebook groups and their content.

METHODS

Two trained researchers independently identified 34 public Facebook diabetes groups. A coding and classification scheme was applied to the 20 most recent "wall posts" within 15 of the 34 (44.1%) largest groups (n = 300 posts). Nonparametric Mann-Whiney U tests examined differences in group characteristics between groups with more (active) and less (inactive) than 50 posts in the past month. Multivariable logistic regressions evaluated associations between group purpose, post types, membership (engagement leader vs regular user), and modality.

RESULTS

We identified 193 458 members of the 34 largest diabetes Facebook groups (Mdn size = 3124 members, IQR = 1298-8523 members). Many groups (20/34, 58.8%) were created to provide instrumental support, while fewer (12/34, 35.8%) aimed to provide emotional support. Nutrition was the only diabetes self-management topic addressed in more than 30% of posts (n = 107). Posts made by engagement leaders were almost five times more likely to appear within inactive compared to active groups.

DISCUSSION

Diabetes Facebook groups are used to share both information and emotional support, with greater emphasis placed on sharing information about nutrition. While engagement leaders should theoretically increase the credibility of online forums, frequent posts by group engagement leaders may actually lead to group decay. Health and diabetes educators should consider how to more effectively leverage social media engagement leaders to disseminate valid health information on diabetes self-management.