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

Abstract

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

A systematic review and narrative synthesis exploring the relationship between friendships and peer relationships, and self-harm ideation and behaviour among young people

“…A significant body of evidence focuses on peer help-provision and support with mixed findings, highlighting the complexity of this relationship. Young people experiencing self-harm ideation and behaviour typically confide in friends and peers, whose support they perceive positively 65,68,79 .…”

“…Preexisting symptoms of mental health disorders, such as depression, anxiety or substance use, alongside emotion regulation difficulties were found to a) intensify peer influence on ego self-harm ideation and behaviour 57,76,86,89 , b) increase the likelihood of negative outcomes among friends and peers 44,107 and c) amplify the potential benefits of interventions 119 . However, at the same time, having personal experience of self-harm ideation and behaviour or of mental health difficulties contributed to more supportive and appropriate responding 79,93 . This has implications for research and practice especially among at-risk youth.…”

“…Six studies report online support interactions with friends and peers among clinical 79,80 , community 70,81,82 and online samples 83 . Viewing and sharing content, and talking online about selfinjury with offline friends was positively related to history of NSSI and suicidal ideation 80 .…”

“…Kruzan et al, 81 found that using a moderated peer support app was related to lower NSSI frequency. Qualitative studies of online peer support suggest that online communities provide practical support and advice, empathetic responding and the possibility of sharing experiences 79,82,83 . However, if not moderated, online peer support could normalise self-harm ideation and behaviour, be emotionally difficult and trigger urges, while also reducing offline support-seeking 83 .…”

Online Ethnography for People With Chronic Conditions: Scoping Review

“…One of the most important features of the digital platforms is that users in discussion boards can express themselves anonymously, thus providing them with sufficient privacy protection [ 7 ]. Moreover, patients are able to talk freely about particular topics which they would otherwise not mention [ 10 ]. In addition, the online platforms can store data about the patients’ perceptions and experiences, the interactions between patients, and the interactions between doctors and patients.…”