An Enhanced Social Networking Intervention for Young People with Active Suicidal Ideation: Safety, Feasibility and Acceptability Outcomes

Bailey, Eleanor; Álvarez‐Jiménez, Mario; Robinson, Jo; D’Alfonso, Simon; Nedeljkovic, Maja; Davey, Christopher G.; Bendall, Sarah; Gilbertson, Tamsyn; Phillips, Jessica; Bloom, Lisa; Nicholls, Laura; Garland, Nicola; Cagliarini, Daniela; Phelan, Mark; McKechnie, Ben; Mitchell, Jessica; Cooke, Melanie; Rice, Simon

doi:10.3390/ijerph17072435

Cited by 44 publications

(66 citation statements)

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“…Focusing on the study design, 2 studies were randomized controlled trials (RCT) [24,25], 12 were open-label single group trials [26][27][28][29][30][31][32][33][34][35][36][37] 2 were randomized studies [38,39], 4 were retrospective cohort studies [40][41][42][43]. The overall sample consisted of 221,419 adolescents.…”

Section: Studies' Selection Characteristics and Limitationsmentioning

confidence: 99%

“…Suicidal behavior was investigated differently in the studies; nine studies focused only on suicidal ideation [25,26,[28][29][30]34,39,41,43], six on suicide attempts [24,27,32,33,40,42]; and two analyzed both suicide ideation and suicide attempts [36,38]. Given the results obtained from the literature search, three main different technological tools were found: telepsychiatry, mobile health intervention, language detection.…”

Section: Studies' Selection Characteristics and Limitationsmentioning

confidence: 99%

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The Role of New Technologies to Prevent Suicide in Adolescence: A Systematic Review of the Literature

et al. 2021

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Background and objectives: Suicide in adolescents represents a major public health concern. To date, a growing number of suicide preventive strategies based on the use of new technologies are emerging. We aimed to provide an overview of the present literature on the use of new technologies in adolescent suicide prevention. Materials and methods: An electronic search was run using the following keywords: Technology OR Technologies OR APP OR Application OR mobile application) AND (Adolescent OR youth OR puberty) AND (Suicid* OR Self-harm OR self-destruction). Inclusion criteria were: English language, published in a peer-reviewed journal, suicide prevention with the use of new technologies among adolescents. Results: Our search strategy yielded a total of 12 studies on the use of telemedicine, 7 on mobile applications, and 3 on language detection. We also found heterogeneity regarding the study design: 3 are randomized controlled trials (RCT), 13 are open-label single group trials, 2 are randomized studies, and 1 is a cross-sectional study. Telemedicine was the most adopted tool, especially web-based approaches. Mobile applications mostly focused on screening of depressive symptoms and suicidal ideation, and for clinical monitoring through the use of text messages. Although telepsychiatry and mobile applications can provide a fast and safe tool, supporting and preceding a face-to-face clinical assessment, only a few studies demonstrated efficacy in preventing suicide among adolescents through the use of these interventions. Some studies suggested algorithms able to recognize people at risk of suicide from the exploration of the language on social media posts. Conclusions: New technologies were found to be well accepted and tolerated supports for suicide prevention in adolescents. However, to date, few data support the use of such interventions in clinical practice and preventive strategies. Further studies are needed to test their efficacy in suicide prevention among adolescents and young adults.

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Section: Studies' Selection Characteristics and Limitationsmentioning

confidence: 99%

Section: Studies' Selection Characteristics and Limitationsmentioning

confidence: 99%

The Role of New Technologies to Prevent Suicide in Adolescence: A Systematic Review of the Literature

et al. 2021

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“…The MOST model merges (1) interactive web therapy, (2) peer-to-peer web-based social networking, (3) peer, and (4) clinical moderation. Successive iterations and evolutions of MOST have been successfully adapted for, and trialed with, young people with psychosis [ 42 , 50 ], at clinical risk of psychosis [ 43 ], suicidal risk [ 51 ], depression [ 44 , 52 ], and social anxiety [ 53 ], as well as relatives of young people with psychosis [ 54 ] and depression [ 55 ]. To respond to the crisis in access to care by young people who experience mental ill-health, our group has developed a new model of web-based clinical support entitled Enhanced Moderated Online Social Therapy (MOST+).…”

Section: Introductionmentioning

confidence: 99%

A Novel Multimodal Digital Service (Moderated Online Social Therapy+) for Help-Seeking Young People Experiencing Mental Ill-Health: Pilot Evaluation Within a National Youth E-Mental Health Service

Álvarez‐Jiménez¹,

Rice²,

D’Alfonso³

et al. 2020

J Med Internet Res

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Background Mental ill-health is the leading cause of disability worldwide. Moreover, 75% of mental health conditions emerge between the ages of 12 and 25 years. Unfortunately, due to lack of resources and limited engagement with services, a majority of young people affected by mental ill-health do not access evidence-based support. To address this gap, our team has developed a multimodal, scalable digital mental health service (Enhanced Moderated Online Social Therapy [MOST+]) merging real-time, clinician-delivered web chat counseling; interactive user-directed online therapy; expert and peer moderation; and peer-to-peer social networking. Objective The primary aim of this study is to ascertain the feasibility, acceptability, and safety of MOST+. The secondary aims are to assess pre-post changes in clinical, psychosocial, and well-being outcomes and to explore the correlations between system use, perceived helpfulness, and secondary outcome variables. Methods Overall, 157 young people seeking help from a national youth e-mental health service were recruited over 5 weeks. MOST+ was active for 9 weeks. All participants had access to interactive online therapy and integrated web chat counseling. Additional access to peer-to-peer social networking was granted to 73 participants (46.5%) for whom it was deemed safe. The intervention was evaluated via an uncontrolled single-group study. Results Overall, 93 participants completed the follow-up assessment. Most participants had moderate (52/157, 33%) to severe (96/157, 61%) mental health conditions. All a priori feasibility, acceptability, and safety criteria were met. Participants provided mean scores of ≥3.5 (out of 5) on ease of use (mean 3.7, SD 1.1), relevancy (mean 3.9, SD 1.0), helpfulness (mean 3.5, SD 0.9), and overall experience (mean 3.9, SD 0.8). Moreover, 98% (91/93) of participants reported a positive experience using MOST+, 82% (70/93) reported that using MOST+ helped them feel better, 86% (76/93) felt more socially connected using it, and 92% (86/93) said they would recommend it to others. No serious adverse events or inappropriate use were detected, and 97% (90/93) of participants reported feeling safe. There were statistically significant improvements in 8 of the 11 secondary outcomes assessed: psychological distress (d=−0.39; P<.001), perceived stress (d=−0.44; P<.001), psychological well-being (d=0.51; P<.001), depression (d=−0.29; P<.001), loneliness (d=−0.23; P=.04), social support (d=0.30; P<.001), autonomy (d=0.36; P=.001), and self-competence (d=0.30; P<.001). There were significant correlations between system use, perceived helpfulness, and a number of secondary outcome variables. Conclusions MOST+ is a feasible, acceptable, and safe online clinical service for young people with mental ill-health. The high level of perceived helpfulness, the significant improvements in secondary outcomes, and the correlations between indicators of system use and secondary outcome variables provide initial support for the therapeutic potential of MOST+. MOST+ is a promising and scalable platform to deliver standalone e-mental health services as well as enhance the growing international network of face-to-face youth mental health services.

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“…To address these gaps while also mitigating the potential risks, researchers at Orygen in Melbourne, Australia, developed and pilot tested Affinity, a Moderated Online Social Therapy (MOST) [24][25][26] intervention designed as an adjunct to face-to-face treatment for young people with active suicidal ideation. Quantitative data, reported elsewhere [27], revealed Affinity to be safe, feasible, and acceptable, with exploratory correlations indicating associations between clinical improvement and key aspects of Affinity usage. Given the novel nature of the Affinity intervention, particularly its inclusion of a web-based social network, quantitative data alone are insufficient to understand important aspects of the user experience of the platform.…”

Section: Objectivesmentioning

confidence: 82%

Moderated Online Social Therapy for Young People With Active Suicidal Ideation: Qualitative Study

Bailey¹,

Robinson²,

Álvarez‐Jiménez³

et al. 2021

J Med Internet Res

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Background Web-based interventions are a promising approach to support youth at risk of suicide, and those incorporating peer-to-peer social networking may have the added potential to target interpersonal states of perceived burdensomeness and thwarted belongingness. Owing to feasibility and safety concerns, including fear of contagion, this had not been tested until recently. In 2018, we conducted a pilot evaluation to test the feasibility, safety, and acceptability of a Moderated Online Social Therapy intervention, called Affinity, with a sample of young people with active suicidal ideation. Objective The aim of this study is to report qualitative data collected from study participants regarding their experience of the web-based social network and the consequent safety features. Methods Affinity is a closed website incorporating 3 key components: therapeutic content delivered via comics, peer-to-peer social networking, and moderation by peers and clinicians. Semistructured interviews were conducted with 17 young people who participated in the pilot study after 8 weeks of exposure to the intervention. Interview data from 2 young people who did not use Affinity were excluded from the analysis. The interviews were analyzed using thematic analysis, with the frequency of responses characterized using the consensual qualitative research method. The results are reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Results A total of 4 overarching themes were identified: a safe and supportive environment, the importance of mutual experiences, difficulty engaging and connecting, and the pros and cons of banning discussions about suicide. Interestingly, although Affinity was perceived to be safe and free of judgment, concerns about negative evaluation and triggering others were significant barriers to posting on the social network. Participants generally supported the banning of conversations about suicide, although for some this was perceived to reinforce stigma or was associated with frustration and distress. Conclusions The results not only support the safety and potential therapeutic benefit of the social networking aspect of Affinity but also highlight several implementation challenges. There is a need to carefully balance the need for stringent safety and design features while ensuring that the potential for therapeutic benefit is maximized.

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An Enhanced Social Networking Intervention for Young People with Active Suicidal Ideation: Safety, Feasibility and Acceptability Outcomes

Cited by 44 publications

References 50 publications

The Role of New Technologies to Prevent Suicide in Adolescence: A Systematic Review of the Literature

The Role of New Technologies to Prevent Suicide in Adolescence: A Systematic Review of the Literature

A Novel Multimodal Digital Service (Moderated Online Social Therapy+) for Help-Seeking Young People Experiencing Mental Ill-Health: Pilot Evaluation Within a National Youth E-Mental Health Service

Moderated Online Social Therapy for Young People With Active Suicidal Ideation: Qualitative Study

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