@Article{info:doi/10.2196/53101,
author="Li, Juanjuan
and Sun, Weidi
and Luo, Zeyu
and Liu, Yi
and Huang, Xuanyin
and Jiang, Denan
and Li, Shuting
and Meng, Jia
and Gu, Fang
and Zhang, Ronghua
and Song, Peige",
title="Dose-Response Associations of Internet Use Time and Internet Addiction With Depressive Symptoms Among Chinese Children and Adolescents: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="23",
volume="10",
pages="e53101",
keywords="internet use",
keywords="internet addiction",
keywords="depression",
keywords="children",
keywords="adolescents",
keywords="China",
keywords="depressive symptoms",
abstract="Background: Children's lives are increasingly mediated by digital technologies, yet evidence regarding the associations between internet use and depression is far from comprehensive and remains unclear. Objective: This study aimed to investigate the dose-response association between internet use, including use time and addiction behaviors, and depressive symptoms among children and adolescents in Zhejiang Province. Methods: Data were collected from a school-based health survey China Common Disease and Risk Factor Surveillance Among Students, encompassing 21,336 students in Zhejiang Province. The daily internet use time, internet addiction (IA) behaviors, and depressive symptoms were assessed with questionnaires. Logistic regression models were used to explore the associations of internet use time and IA behaviors with depressive symptoms among children and adolescents. Restricted cubic spline curves were used to determine the dose-response associations. Results: A total of 6225 (29.2\%) students had depressive symptoms. Compared to those reporting no internet use, boys using the internet for >2 hours/day (odds ratio [OR] 1.53, 95\% CI 1.34?1.74) and girls using internet for 1.1?2 hours/day (OR 1.22, 95\% CI 1.06?1.39) and >2 hours/day (OR 1.70, 95\% CI 1.50?1.93) were at higher risks of depressive symptoms. A significant J-shaped association was identified between internet use time and depressive symptoms among children and adolescents, especially in boys and primary school students (nonlinear P values were .006, .003, and <.001, respectively). Increased IA behaviors were associated with a higher odd of depressive symptoms (1 IA behavior: OR 2.01, 95\% CI 1.83?2.21; 2 IA behaviors: 2.91, 95\% CI 2.57?3.29; and ?3 IA behaviors: 4.72, 95\% CI 4.26?5.22). A positive nonlinear association between the number of IA behaviors and depressive symptoms was found in total population, girls, and primary school students (nonlinear P values were .02, .002, .007, respectively). Conclusions: Findings suggested that excessive internet use time and IA behaviors were significantly associated with an increased risk of depressive symptoms, highlighting the importance of interventions to regulate and educate about adequate internet use during childhood and adolescence. ",
doi="10.2196/53101",
url="https://publichealth.jmir.org/2024/1/e53101"
}


@Article{info:doi/10.2196/39779,
author="Joshi, Ashish
and Kaur, Kamalpreet
and Bhatt, Ashruti
and Surapaneni, Mohan Krishna
and Grover, Ashoo
and Pandya, Kumar Apurva",
title="Design, Develop, and Pilot-Test a Digital Platform to Enhance Student Well-Being: Protocol for a Mixed-Methods Study",
journal="JMIR Res Protoc",
year="2024",
month="Jul",
day="23",
volume="13",
pages="e39779",
keywords="well-being",
keywords="students",
keywords="digital interventions",
keywords="social support",
keywords="family demands",
keywords="mental well-being",
abstract="Background: Well-being is a multidimensional concept and has been extended to many areas. Student well-being has garnered attention over the last decade due to concerns that have been raised. Digital health interventions have the potential to enhance and improve student well-being. Objective: The objective of the study is to design, develop, and pilot-test a digital health platform to enhance student well-being. Methods: A sample size of 5000 participants will be recruited across Gujarat and Tamil Nadu, India. Students will be enrolled from Parul University in Vadodara, Gujarat, as well as Panimalar Medical College Hospital and Research Institute, Panimalar Engineering College, Panimalar Institute of Technology, and Panimalar College of Nursing in Chennai, Tamil Nadu. Current undergraduate and graduate students consenting to participate will be recruited using convenience sampling from these institutes. The study will collect baseline data to construct the student well-being index. Based on the risk profile, a random subset of the population will be provided access to the digital health intervention, which will deliver tailored interactive messages addressing the various dimensions of well-being among undergraduate and graduate students. The eligible study participants will be aged 18 years and older, enrolled in these institutes, and willing to give their consent to participate in the study. Results: The proposed research is an unfunded study. The enrollment of the individuals in the study began in October 2022. Data gathered will be analyzed using SAS (version 9.3; SAS Institute) and results will be reported as 95\% CIs and P values. Conclusions: The proposed study will help to determine the factors affecting well-being among college students and help in designing digital health interventions to improve the well-being of undergraduate and graduate students. International Registered Report Identifier (IRRID): PRR1-10.2196/39779 ",
doi="10.2196/39779",
url="https://www.researchprotocols.org/2024/1/e39779"
}


@Article{info:doi/10.2196/26273,
author="Hamilton, Leigh Jessica
and Lee, Woanjun",
title="Associations Between Social Media, Bedtime Technology Use Rules, and Daytime Sleepiness Among Adolescents: Cross-sectional Findings From a Nationally Representative Sample",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26273",
keywords="adolescents",
keywords="social media",
keywords="daytime sleepiness",
keywords="parenting",
keywords="bedtime",
keywords="mental health",
keywords="mobile phone",
abstract="Background: Social media use is associated with poor sleep among adolescents, including daytime sleepiness, which affects adolescents' mental health. Few studies have examined the associations among specific aspects of social media, such as frequency of checking and posting, perceived importance of social media for social belonging, and daytime sleepiness. Identifying whether certain adolescents are more at risk or protected from the effects of social media on sleepiness may inform future interventions for social media, sleep, and mental health. Objective: This study aims to examine the association between social media use frequency and importance, daytime sleepiness, and whether the perceived importance of social media for social interactions and parental rules around bedtime technology moderated these relationships. Methods: This cross-sectional survey study was conducted with a sample of 4153 adolescents from across the United States. Qualtrics was used to collect data via panel recruitment from a national sample representing the US demographics of teens aged 12 to 17 years. Participants completed measures of daytime sleepiness, frequency of social media checking and posting, and the importance of social media for social interactions. Parents reported whether they had a household rule around bedtime media and screen use. Hierarchical regressions and moderation analyses were conducted, covarying for age, gender, and age at first smartphone use. Results: Participants had a mean age of 14.64 (SD 1.66) years in grades 6 to 12, 46.45\% (1929/4153) identified as female, and 67.93\% (2821/4153) identified as White. The results indicated that adolescents who posted (B=0.70, SE 0.04; P<.001) or checked (B=0.76, SE 0.04; P<.001) social media more frequently or who perceived social media to be more important for social belonging (B=0.36, SE 0.02; P<.001) had higher levels of daytime sleepiness. Moderation analyses indicated that the relationship between social media use frequency and daytime sleepiness was exacerbated by higher levels of perceived social media importance (B=0.04, SE 0.01; P<.001). Adolescents without household rules around bedtime technology use were more likely to be affected by social media checking (B=?0.34, SE 0.09; P<.001) and importance (B=?0.16, SE 0.04; P<.001) on daytime sleepiness. Conclusions: The findings suggest that social media use frequency and perceived importance of social interactions are associated with daytime sleepiness among adolescents. It is important to consider youth's perceptions of social media when assessing the potential effects of social media use frequency on youth well-being. Furthermore, youth who did not have parental rules around bedtime technology use were most likely to be affected by social media use and perceived importance. The findings may extend to other mental health outcomes and may guide future prevention and intervention programs designed to improve social media use, sleep, and mental health. ",
doi="10.2196/26273",
url="https://mental.jmir.org/2021/9/e26273",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524967"
}


@Article{info:doi/10.2196/26204,
author="Pasko, Kristen
and Arigo, Danielle",
title="The Roles of Social Comparison Orientation and Regulatory Focus in College Students' Responses to Fitspiration Posts on Social Media: Cross-sectional Study",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26204",
keywords="social media",
keywords="college",
keywords="fitspiration",
keywords="subjective well-being",
keywords="social comparison",
keywords="regulatory focus",
keywords="perception",
keywords="well-being",
keywords="young adult",
keywords="college student",
keywords="cross-sectional",
keywords="motivation",
abstract="Background: Information shared via social media influences college students' self-perceptions and behavior, particularly, ``fitspiration'' posts (ie, images of healthy food, people exercising, or fitness quotations). There are mixed findings regarding the mental health implications of fitspiration and its potential to motivate healthy behavior. Individual differences such as social comparison orientation and regulatory focus could aid in determining for whom fitspiration may be helpful versus harmful, though these characteristics have received limited attention in terms of students' fitspiration perceptions. Objective: This cross-sectional study examined associations between students' fitspiration use (ie, intentional versus unintentional exposure while using social media), response tendencies (ie, feelings about the self and motivation to be physically active), social comparison orientation, and regulatory focus. Methods: College students (N=344; 239/344, 69.5\% women) completed an electronic survey in which they self-reported demographic information, the frequency of their social media use, exposure to fitspiration posts, typical feelings in response to fitspiration posts, and typical motivation for physical activity after viewing fitspiration posts. They also completed validated self-report measures of social comparison orientation and regulatory focus. Results: College students reported frequent exposure to fitspiration posts on social media and that they experienced negative feelings in response to these posts more often than positive feelings. Average motivation for physical activity was rated as feeling motivated ``some of the time.'' However, students who reported more negative feelings after viewing fitspiration also reported greater motivation to be physically active after exposure. Associations between the frequency of intentional fitspiration use and motivation for physical activity after viewing fitspiration posts were moderated by social comparison orientation (b=?0.01, P=.03) but not by regulatory focus (b=?0.002, P=.67). Conclusions: Negative feelings about the self may be motivating for students with weak social comparison orientation, as fitspiration may highlight a discrepancy between one's real and ideal self that does not prompt dejection or disengagement. However, negative feelings for prevention-focused students might not be as motivating because there are no salient negative models to avoid. Further research into these associations is warranted and could inform future efforts to promote student health and well-being during college. ",
doi="10.2196/26204",
url="https://mental.jmir.org/2021/9/e26204",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524965"
}


@Article{info:doi/10.2196/29318,
author="Bushman, Maggie
and Godishala, Shreya
and Hyzer, Reese
and Jerisha, Joshua
and Jolliff, Anna
and Kaji, Ethan
and Kerr, Bradley
and Mathur, Anjali
and Tsao, Owen",
title="Adolescent Health on Social Media and the Mentorship of Youth Investigators: Five Content Analysis Studies Conducted by Youth Investigators",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e29318",
keywords="social media",
keywords="anxiety",
keywords="depression",
keywords="self-esteem",
keywords="Instagram",
keywords="Reddit",
keywords="Twitter",
keywords="YouTube",
keywords="content analysis",
keywords="adolescent",
doi="10.2196/29318",
url="https://mental.jmir.org/2021/9/e29318",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524099"
}


@Article{info:doi/10.2196/26484,
author="Evans, Yolanda
and Hutchinson, Jeffrey
and Ameenuddin, Nusheen",
title="Opportunity, Challenge, or Both? Managing Adolescent Socioemotional and Mental Health During Web-Based Learning",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26484",
keywords="pandemic",
keywords="technology",
keywords="media",
keywords="bullying",
keywords="mental health",
keywords="distance learning",
doi="10.2196/26484",
url="https://mental.jmir.org/2021/9/e26484",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524094"
}


@Article{info:doi/10.2196/26207,
author="Charmaraman, Linda
and Hodes, Rachel
and Richer, M. Amanda",
title="Young Sexual Minority Adolescent Experiences of Self-expression and Isolation on Social Media: Cross-sectional Survey Study",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26207",
keywords="social media",
keywords="social networking sites",
keywords="sexual minorities",
keywords="cyberbullying",
keywords="depression",
keywords="loneliness",
keywords="self-harm",
keywords="social support",
keywords="adolescents",
abstract="Background: Early adolescent years are marked by pervasive self- and peer-regulation regarding gender and sexuality norms, which can affect the mental well-being of sexual minority youth. During this developmental period, social media use is also emerging as a dominant mode of communication with peers, allowing for both risk and resilient behaviors that can impact well-being. Objective: This exploratory study aims to examine how sexual minorities in middle school use social media, who they are connected to and for what purposes, and the associations between these behaviors and mental well-being compared with their heterosexual peers. Methods: In our cross-sectional survey study of 1033 early adolescents aged between 10 and 16 years (average age 12.7, SD 1.21 years) from 4 middle school sites in the Northeastern United States, we conducted an exploratory study comparing sexual minorities (212/873, 24.3\% of sample with known sexual orientation) with their heterosexual peers (n=661), obtaining an 84.46\% (1033/1223; total possible) response rate. Results: Sexual minorities reported having smaller networks on their favorite social media website ($\beta$=?.57; P<.001), less often responded positively when friends shared good news ($\beta$=?.35; P=.002), and less often tried to make friends feel better when they shared bad news ($\beta$=?.30; P=.01). However, sexual minorities more often reported joining a group or web-based community to make themselves feel less alone ($\beta$=.28; P=.003), unlike heterosexual youth. Sexual minorities had higher averages of loneliness and social isolation ($\beta$=.19; P<.001) than heterosexual students. Sexual minorities were also twice as likely to have tried to harm themselves in the past ($\beta$=.81; odds ratio [OR] 2.24, 95\% CI 1.64-3.06; P<.001) and were more likely to have symptoms that reached the Center for Epidemiological Studies-Depression definition of depression ($\beta$=.15; OR 1.16, 95\% CI 1.08-1.25; P<.001). About 39.1\% (83/212) of sexual minorities had no one to talk to about their sexual orientation. Sexual minorities were 1.5 times more likely to have joined a social media website their parents would disapprove ($\beta$=.41; OR 1.50, 95\% CI 1.14-1.97; P=.004) and more likely to report seeing videos related to self-harm ($\beta$=.33; OR 1.39, 95\% CI 1.06-1.83; P=.02) on the web than heterosexual youth. Conclusions: Given previous reports of supportive and safe web-based spaces for sexual minority youth, our findings demonstrated that sexual minority youth prefer to maintain small, close-knit web-based communities (apart from their families) to express themselves, particularly when reaching out to web-based communities to reduce loneliness. Future longitudinal studies could determine any bidirectional influences of mental well-being and social media use in sexual minorities during this difficult developmental period. ",
doi="10.2196/26207",
url="https://mental.jmir.org/2021/9/e26207",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524107"
}


@Article{info:doi/10.2196/26203,
author="Hwang, Juwon
and Toma, L. Catalina",
title="The Role of Mental Well-Being and Perceived Parental Supportiveness in Adolescents' Problematic Internet Use: Moderation Analysis",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26203",
keywords="problematic internet use",
keywords="PIU",
keywords="subjective mental well-being",
keywords="perceived parental supportiveness",
keywords="adolescents",
keywords="well-being",
keywords="young adult",
keywords="internet",
keywords="mental health",
keywords="support",
keywords="parent",
keywords="engagement",
keywords="social media",
abstract="Background: Given the growing number of adolescents exhibiting problematic internet use (PIU) and experiencing its harmful consequences, it is important to examine the factors associated with PIU. Existing research has identified perceived parental supportiveness and adolescents' subjective mental well-being as strong predictors of PIU. However, it is unknown how these factors work together in shaping adolescents' engagement in PIU. Objective: This paper aimed to examine the role played by adolescents' perception of parental supportiveness in conjunction with their subjective mental well-being in shaping their PIU. Methods: The study analyzed one of the Technology \& Adolescent Mental Wellness (TAM) data sets that were collected from a nationally representative cross-sectional sample. Adolescents self-reported their internet use behavior, perceived parental supportiveness, and subjective mental well-being through an online research panel survey. Hierarchical linear regression analysis with an interaction term was performed. Results: A total of 4592 adolescents, aged 12 to 17 years, completed the survey. Adolescents reported a mean age of 14.61 (SD 1.68) and were 46.4\% (2130/4592) female and 66.9\% (3370/4592) White. Findings revealed that, controlling for adolescents' demographics and social media use, higher levels of perceived parental supportiveness ($\beta$=--.285, P<.001) and higher levels of subjective mental well-being ($\beta$=--.079, P<.001) were associated with a lower likelihood of adolescent PIU. The moderation analysis showed that the negative association between perceived parental supportiveness and PIU was stronger when adolescents reported high (vs low) levels of mental well-being ($\beta$=--.191, P<.001). Conclusions: This study shows that perceived parental supportiveness was a stronger protective factor than adolescents' mental well-being against PIU. The protective power of perceived parental supportiveness against PIU was strongest when adolescents had high mental well-being. The highest risk of PIU occurred when adolescents' mental well-being was high, but parents were perceived as unsupportive. Our findings suggest that parental supportiveness should be targeted as part of PIU prevention efforts. ",
doi="10.2196/26203",
url="https://mental.jmir.org/2021/9/e26203",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524093"
}


@Article{info:doi/10.2196/26197,
author="Bickham, S. David
and Moukalled, Summer
and Inyart, K. Heather
and Zlokower, Rona",
title="Evaluating a Middle-School Digital Citizenship Curriculum (Screenshots): Quasi-Experimental Study",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26197",
keywords="digital citizenship",
keywords="cyberbullying",
keywords="evaluation",
keywords="media literacy",
keywords="middle school",
keywords="conflict resolution",
keywords="internet safety",
keywords="mobile phone",
abstract="Background: Screenshots is an in-school curriculum that seeks to develop positive digital social skills in middle school students with the long-term goal of improving their health and well-being. The program imparts knowledge and teaches skills upon which young adolescents can build a set of beliefs and behaviors that foster respectful interactions, prosocial conflict resolutions, and safe and secure use of communication technology. Intervening in this way can improve young people's mental health by limiting their exposure to cyberbullying and other forms of negative online interactions. This study reports on an evaluation of the Screenshots program conducted with seventh graders in a public school system in a midsized New England city. Objective: This study aims to determine the effectiveness of the Screenshots program in increasing participants' knowledge about key concepts of digital citizenship and in shifting beliefs and intended behaviors to align with prosocial and safe online interactions. In addition, the study examines whether the program has varying effects on males' and females' conflict and bullying resolution strategies. Methods: This quasi-experimental evaluation was conducted in four middle schools in which one group of seventh graders received the Screenshots curriculum and another did not. Before and after the curriculum, all students completed a questionnaire that measured their knowledge of and beliefs about digital citizenship and related online behavioral concepts, their attitudes regarding strategies for stopping online bullying, and their intended online conflict resolution behaviors. Results: The sample included 92 students who received the curriculum and 71 students who were included in the comparison group. Pre- to postinstruction retention rates ranged from 52\% (33/63) to 84\% (21/25), varying by school and condition. The results showed an increase in knowledge about key curricular concepts for some students (F1,32=9.97; P=.003). In response to some individual items, students decreased their belief supportive of a negative online behavior (F1,76=9.00; P=.004) and increased their belief consistent with an online safety behavior (F1,42=4.39; P=.04) compared with the comparison group. Gender moderated the results related to conflict resolution, with males from one school reducing their endorsement of an aggressive option (F2,40=5.77; P=.006) and males from another school increasing their reported tendency to pursue a nonaggressive option (F2,28=3.65; P=.04). On average, participants reported learning something new from the classes. Conclusions: This study represents a rare evaluation of an in-school digital citizenship program and demonstrates the effectiveness of Screenshots. Students' increased knowledge of key curricular concepts represents a foundation for developing future beliefs and healthy behaviors. Differences in how adolescent males and females experience and perpetrate online aggression likely explain the conflict resolution findings and emphasize the need to examine gender differences in response to these programs. Students' high ratings of the relevance of Screenshots' content reinforce the need for this type of intervention. ",
doi="10.2196/26197",
url="https://mental.jmir.org/2021/9/e26197",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524098"
}


@Article{info:doi/10.2196/26188,
author="Gewali, Anupa
and Lopez, Alana
and Dachelet, Kristin
and Healy, Elise
and Jean-Baptiste, Marimirca
and Harridan, Holly
and Evans, Yolanda
and Unger, A. Jennifer
and Bhat, Amritha
and Tandon, Darius
and Ronen, Keshet",
title="A Social Media Group Cognitive Behavioral Therapy Intervention to Prevent Depression in Perinatal Youth: Stakeholder Interviews and Intervention Design",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26188",
keywords="depression",
keywords="mental health",
keywords="perinatal",
keywords="pregnancy",
keywords="postpartum",
keywords="adolescent",
keywords="youth",
keywords="social media",
keywords="group",
keywords="mobile phone",
abstract="Background: Adolescents and young adults aged <25 years (youth) are at a higher risk of perinatal depression than older adults, and they experience elevated barriers to in-person care. Digital platforms such as social media offer an accessible avenue to deliver group cognitive behavioral therapy (CBT) to perinatal youth. Objective: We aim to develop the Interactive Maternal Group for Information and Emotional Support (IMAGINE) intervention, a facilitated social media group CBT intervention to prevent perinatal depression in youth in the United States, by adapting the Mothers and Babies (MB) course, an evidence-based in-person group CBT intervention. In this study, we report perspectives of youth and health care providers on perinatal youths' mental health needs and document how they informed IMAGINE design. Methods: We conducted 21 semistructured in-depth individual interviews with 10 pregnant or postpartum youths aged 14-24 years and 6 health care workers. All interviews were recorded, transcribed, and analyzed using deductive and inductive approaches to characterize perceptions of challenges and facilitators of youth perinatal mental health. Using a human-centered design approach, stakeholder perspectives were incorporated into the IMAGINE design. We classified MB adaptations to develop IMAGINE according to the Framework for Modification and Adaptation, reporting the nature, timing, reason, and goal of the adaptations. Results: Youth and health care workers described stigma associated with young pregnancy and parenting, social isolation, and lack of material resources as significant challenges to youth mental wellness. They identified nonjudgmental support, peer companionship, and access to step-by-step guidance as facilitators of youth mental wellness. They endorsed the use of a social media group to prevent perinatal depression and recommended that IMAGINE facilitate peer support, deliver content asynchronously to accommodate varied schedules, use a confidential platform, and facilitate the discussion of topics beyond the MB curriculum, such as navigating support resources or asking medical questions. IMAGINE was adapted from MB to accommodate stakeholder recommendations and facilitate the transition to web-based delivery. Content was tailored to be multimodal (text, images, and video), and the language was shortened and simplified. All content was designed for asynchronous engagement, and redundancy was added to accommodate intermittent access. The structure was loosened to allow the intervention facilitator to respond in real time to topics of interest for youth. A social media platform was selected that allows multiple conversation channels and conceals group member identity. All adaptations sought to preserve the fidelity of the MB core components. Conclusions: Our findings highlight the effect of stigmatization of young pregnancy and social determinants of health on youth perinatal mental health. Stakeholders supported the use of a social media group to create a supportive community and improve access to evidence-based depression prevention. This study demonstrates how a validated intervention can be tailored to this unique group. ",
doi="10.2196/26188",
url="https://mental.jmir.org/2021/9/e26188",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524086"
}


@Article{info:doi/10.2196/26176,
author="Campos-Castillo, Celeste
and Thomas, Jason Brian
and Reyes, Felipe
and Laestadius, Irina Linnea",
title="Seeking Help From Trusted Adults in Response to Peers' Social Media Posts About Mental Health Struggles: Qualitative Interview Study Among Latinx Adolescents",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26176",
keywords="adolescents",
keywords="confidants",
keywords="ethnicity",
keywords="gender",
keywords="network resources",
keywords="privacy",
keywords="race",
keywords="social media",
keywords="social support",
keywords="tie activation",
keywords="trust",
abstract="Background: Rather than confiding in adults about their mental health struggles, adolescents may use social media to disclose them to peers. Disclosure recipients are tasked with deciding whether to alert an adult and, if so, whom to alert. Few studies have examined how adolescents decide on a trusted adult to help a friend who posts on social media about his/her mental health struggles. Moreover, Latinx adolescents are underrepresented in research on social media use, which creates gaps in understanding how social media may influence their well-being. Objective: This qualitative study presents findings from semistructured interviews with Latinx adolescents to investigate how they seek out trusted adults when a friend posts on social media about their mental health struggles. Specifically, we sought to determine which adult ties they activated, the resources they believed the adult could provide, and the support they expected the adult to provide. Methods: We recruited participants through a nonprofit organization serving the Latinx community (primarily of Mexican origin) located in Milwaukee, Wisconsin. We conducted 43 semistructured interviews, each lasting 60-90 minutes, with Latinx adolescents (25 females, 18 males) aged 13-17 years. All interviews were conducted in English, at the adolescents' request. Using a grounded theory approach, we identified the nature of the relationship between the trusted adult and either the disclosure recipient or distressed friend, and the resources and support the trusted adult is expected to provide. Results: Participants nominated adults who were emotionally or physically proximate to either the disclosure recipient or distressed friend, particularly parents (of the recipient and friend) and school staff. However, some felt that not all parents and school staff were emotionally proximate. Adolescents sought trusted adults with access to two resources: experiential knowledge and authority. Some, particularly males, avoided adults with authority because of the risk of punishment and others thought their immigrant parents did not have relevant experiential knowledge to assist them. Interviewees felt that trusted adults with either resource could provide emotional and instrumental support either directly or indirectly, while those with experiential knowledge could provide informational support. Notably, interviews did not problematize the fact that the disclosure occurred on social media when deliberating about adults. Conclusions: To assist a distressed friend posting on social media, Latinx adolescents look not only for trusted adults who are emotionally and physically proximate but also those who have key resources that facilitate support. Efforts should focus on connecting adolescents with trusted adults and training adults who hold positions of authority or experiential knowledge to offer both direct and indirect support. Additionally, efforts should consider how immigrant experiences shape parent-child relations and address the potential long-term consequences of oversurveillance of Latinx youth, particularly males, by school staff for their access to social support. ",
doi="10.2196/26176",
url="https://mental.jmir.org/2021/9/e26176",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524088"
}


@Article{info:doi/10.2196/26158,
author="Craig Rushing, Stephanie
and Kelley, Allyson
and Bull, Sheana
and Stephens, David
and Wrobel, Julia
and Silvasstar, Joshva
and Peterson, Roger
and Begay, Corey
and Ghost Dog, Thomas
and McCray, Celena
and Love Brown, Danica
and Thomas, Morgan
and Caughlan, Colbie
and Singer, Michelle
and Smith, Paige
and Sumbundu, Kanku",
title="Efficacy of an mHealth Intervention (BRAVE) to Promote Mental Wellness for American Indian and Alaska Native Teenagers and Young Adults: Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26158",
keywords="American Indian",
keywords="Alaska Native",
keywords="adolescent",
keywords="mental health",
keywords="help-seeking skills, text messaging",
keywords="mHealth, behavioral intervention",
keywords="Indian health",
keywords="mobile phone",
abstract="Background: Culturally relevant interventions are needed to help American Indian and Alaska Native (AI/AN) teenagers and young adults navigate common risky situations involving family and friends, including drug and alcohol misuse, dating violence, and suicidality. Leveraging We R Native, a multimedia health resource for Native teenagers and young adults, staff of the Northwest Portland Area Indian Health Board designed the BRAVE intervention for Native youth. The program is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. Objective: We aim to conduct a randomized controlled trial of the BRAVE intervention among AI/AN teenagers and young adults (aged 15-24 years) to assess its impact on their physical, mental, and spiritual health; their resilience and self-esteem; and their coping and help-seeking skills. Methods: From October to December 2019, we recruited 2334 AI/AN teenagers and young adults nationwide via social media channels and SMS text messages and enrolled 1044 participants. AI/AN teenagers and young adults enrolled in the study received either BRAVE SMS text messages, designed to improve mental health, help-seeking skills, and cultural resilience, or 8 weeks of science, technology, engineering, and math (STEM) SMS text messages, designed to elevate and reaffirm Native voices in STEM and medicine and then received the BRAVE SMS text messages. The impacts of the BRAVE intervention were tested using linear mixed-effect models and linear regressions. Results: A total of 833 AI/AN teenagers and young adults were included in the analysis. Individuals in the BRAVE and STEM arms showed significant positive trends over the course of the study for all outcomes, except cultural identity and help-seeking behavior. Mean scores were significantly different for health (P<.001), resilience (P<.001), negative coping (P=.03), positive coping (P<.001), self-efficacy (P=.02), and self-esteem (P<.001). Changes in help-seeking self-efficacy were significant in those exhibiting risky behaviors at baseline to exit (P=.01). Those who reported positive coping scores at baseline also reported better health on average; however, no difference was found in risky drug and alcohol use (P<.001). The number of participants who used SMS text messages to help themselves increased from 69.1\% (427/618) at 3 months to 76\% (381/501; P<.001) at 8 months. Similarly, the number of participants who used SMS text messages to help friends or family members increased from 22.4\% (138/616) at 3 months to 54.6\% (272/498) at 8 months. Conclusions: This is the first national randomized controlled trial of a mobile health intervention among AI/AN teenagers and young adults to test the efficacy of a mental wellness intervention in relation to STEM career messages. This study provides new insights for supporting the next generation of AI/AN changemakers. Trial Registration: ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481 ",
doi="10.2196/26158",
url="https://mental.jmir.org/2021/9/e26158",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524092"
}


@Article{info:doi/10.2196/26154,
author="Fadiran, Babayosimi
and Lee, Jessica
and Lemminger, Jared
and Jolliff, Anna",
title="How Our Technology Use Changed in 2020: Perspectives From Three Youths",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26154",
keywords="mental health",
keywords="social media",
keywords="digital technology",
keywords="youth",
keywords="adolescent",
keywords="commentary",
keywords="technology",
keywords="wellness",
doi="10.2196/26154",
url="https://mental.jmir.org/2021/9/e26154",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524108"
}


@Article{info:doi/10.2196/26134,
author="Rutter, A. Lauren
and Thompson, M. Holly
and Howard, Jacqueline
and Riley, N. Tennisha
and De Jes{\'u}s-Romero, Robinson
and Lorenzo-Luaces, Lorenzo",
title="Social Media Use, Physical Activity, and Internalizing Symptoms in Adolescence: Cross-sectional Analysis",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26134",
keywords="social media",
keywords="depression",
keywords="anxiety",
keywords="physical activity",
keywords="adolescence",
keywords="mobile phone",
abstract="Background: Most American adolescents have access to smartphones, and recent estimates suggest that they spend considerable time on social media compared with other physical and leisure activities. A large body of literature has established that social media use is related to poor mental health, but the complicated relationship between social media and symptoms of depression and anxiety in adolescents is yet to be fully understood. Objective: We aim to investigate the relationship between social media use and depression and anxiety symptoms in adolescents by exploring physical activity as a mediator. Methods: A Qualtrics survey manager recruited adult panel participants between February and March 2019, who indicated that they had adolescent children who spoke English. A total of 4592 adolescent-parent dyads completed the survey that took approximately 39 minutes. The survey entailed completing web-based questionnaires assessing various aspects of social media use, psychological symptoms, and psychosocial factors. The average age of the adolescent participants was 14.62 (SD 1.68; range 12-17) years, and the majority of the adolescent sample was male (2392/4592, 52.09\%). Results: Total social media use was associated with more depressive symptoms (multiple R2=0.12; F3,4480=207.1; P<.001), anxiety (multiple R2=0.09; F3,4477=145.6; P<.001), and loneliness (multiple R2=0.06; F3,4512=98.06; P<.001), controlling for age and gender. Physical activity was associated with decreased depression and anxiety symptoms after controlling for other extracurricular activities and social media use (multiple R2=0.24; F5,4290=266.0; P<.001). There were significant differences in symptoms based on gender: female adolescents reported higher rates of social media use and males reported higher rates of depression. Nonbinary and transgender adolescents had higher rates of depression, anxiety, and loneliness than the female and male adolescents in the sample. Conclusions: In a nationally representative sample of adolescents, more social media use was associated with more severe symptoms of depression, anxiety, and loneliness. Increased physical activity was associated with decreased depression and anxiety symptoms. Physical activity partially mediated the relationship between social media use and depression and anxiety. As this was a cross-sectional study, we cannot conclude that social media use causes internalizing symptoms or that physical activity leads to decreased internalizing symptoms---there may be additional confounding variables producing the relationships we observed. Physical activity may protect against the potentially harmful effect of social media on some adolescents. The effect sizes were small to medium, and the results should be interpreted with caution. Other limitations of this study include our reliance on self-reporting. Future work should examine social media use beyond how much time adolescents spend using social media and instead focus on the nature of social media activity. ",
doi="10.2196/26134",
url="https://mental.jmir.org/2021/9/e26134",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524096"
}


@Article{info:doi/10.2196/26035,
author="Radovic, Ana
and Anderson, Nathan
and Hamm, Megan
and George-Milford, Brandie
and Fascetti, Carrie
and Engster, Stacey
and Lindhiem, Oliver",
title="Perceived Facilitators of and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: Focus Group and Interview Study",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26035",
keywords="depression",
keywords="adolescent",
keywords="suicidality",
keywords="screening",
abstract="Background: Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents' and parents' reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision-making to increase the utilization of evidence-based treatments. Objective: This qualitative study aims to describe multi-stakeholder perspectives of adolescents, parents, and providers to understand the potential barriers to the implementation of SW. Methods: We interviewed 11 parents and 11 adolescents and conducted two focus groups with 18 health care providers (PCPs, nurses, therapists, and staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks were inductively developed based on content. Transcripts were double coded, and disagreements were adjudicated to full agreement. Completed coding was used to produce thematic analyses of the interviews and focus groups. Results: We identified five main themes across the interviews and focus groups: parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; there is concern that accurate self-disclosure does not always occur during depression screening; SW is viewed as a tool that could facilitate depression screening and that might encourage more honesty in screening responses; parents, adolescents, and providers do not want SW to replace mental health discussions with providers; and providers want to maintain autonomy in treatment decisions. Conclusions: We identified that providers, parents, and adolescents are all concerned with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. Although SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead, SW focuses on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve the future implementation of SW. ",
doi="10.2196/26035",
url="https://mental.jmir.org/2021/9/e26035",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524090"
}


@Article{info:doi/10.2196/26031,
author="Biernesser, Candice
and Zelazny, Jamie
and Brent, David
and Bear, Todd
and Mair, Christina
and Trauth, Jeanette",
title="Automated Monitoring of Suicidal Adolescents' Digital Media Use: Qualitative Study Exploring Acceptability Within Clinical Care",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26031",
keywords="adolescents",
keywords="parents",
keywords="digital media",
keywords="social media",
keywords="technology",
keywords="monitoring",
keywords="suicide prevention",
keywords="implementation in clinical care",
keywords="natural language processing",
keywords="qualitative",
abstract="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. ",
doi="10.2196/26031",
url="https://mental.jmir.org/2021/9/e26031",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524104"
}


@Article{info:doi/10.2196/26029,
author="Kutok, R. Emily
and Dunsiger, Shira
and Patena, V. John
and Nugent, R. Nicole
and Riese, Alison
and Rosen, K. Rochelle
and Ranney, L. Megan",
title="A Cyberbullying Media-Based Prevention Intervention for Adolescents on Instagram: Pilot Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26029",
keywords="cyberbullying",
keywords="adolescents",
keywords="mobile application",
keywords="messaging",
keywords="brief interventions",
keywords="social media",
keywords="recruitment",
keywords="mobile phone",
abstract="Background: Between 15\% and 70\% of adolescents report experiencing cybervictimization. Cybervictimization is associated with multiple negative consequences, including depressed mood. Few validated, easily disseminated interventions exist to prevent cybervictimization and its consequences. With over 97\% of adolescents using social media (such as YouTube, Facebook, Instagram, or Snapchat), recruiting and delivering a prevention intervention through social media and apps may improve accessibility of prevention tools for at-risk youth. Objective: This study aims to evaluate the feasibility and acceptability of and obtain preliminary outcome data on IMPACT (Intervention Media to Prevent Adolescent Cyber-Conflict Through Technology), a brief, remote app-based intervention to prevent and reduce the effect of cyberbullying. Methods: From January 30, 2020, to May 3, 2020, a national sample of 80 adolescents with a history of past-year cybervictimization was recruited through Instagram for a randomized control trial of IMPACT, a brief, remote research assistant--led intervention and a fully automated app-based program, versus enhanced web-based resources (control). Feasibility and acceptability were measured by consent, daily use, and validated surveys. Although not powered for efficacy, outcomes (victimization, bystander self-efficacy, and well-being) were measured using validated measures at 8 and 16 weeks and evaluated using a series of longitudinal mixed models. Results: Regarding feasibility, 24.5\% (121/494) of eligible participants provided contact information; of these, 69.4\% (84/121) completed full enrollment procedures. Of the participants enrolled, 45\% (36/80) were randomized into the IMPACT intervention and 55\% (44/80) into the enhanced web-based resources groups. All participants randomized to the intervention condition completed the remote intervention session, and 89\% (77/80) of the daily prompts were answered. The retention rate was 99\% (79/80) at 8 weeks and 96\% (77/80) at 16 weeks for all participants. Regarding acceptability, 100\% (36/36) of the intervention participants were at least moderately satisfied with IMPACT overall, and 92\% (33/36) of the participants were at least moderately satisfied with the app. At both 8 and 16 weeks, well-being was significantly higher ($\beta$=1.17, SE 0.87, P=.02 at 8 weeks and $\beta$=3.24, SE 0.95, P<.001 at 16 weeks) and psychological stress was lower ($\beta$=?.66, SE 0.08, P=.04 at 8 weeks and $\beta$=?.89, SE 0.09, P<.001 at 16 weeks) among IMPACT users than among control group users. Participants in the intervention group attempted significantly more bystander interventions than those in the control group at 8 weeks ($\beta$=.82, SE 0.42; P=.02). Conclusions: This remote app-based intervention for victims of cyberbullying was feasible and acceptable, increased overall well-being and bystander interventions, and decreased psychological stress. Our findings are especially noteworthy given that the trial took place during the COVID-19 pandemic. The use of Instagram to recruit adolescents can be a successful strategy for identifying and intervening with those at the highest risk of cybervictimization. Trial Registration: ClinicalTrials.gov NCT04259216; http://clinicaltrials.gov/ct2/show/NCT04259216. ",
doi="10.2196/26029",
url="https://mental.jmir.org/2021/9/e26029",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524103"
}


@Article{info:doi/10.2196/25782,
author="Uhls, T. Yalda
and Felt, Laurel
and Wartella, Ellen
and Sanders, Andrew",
title="Investigating Viewership of Season 3 of ``13 Reasons Why'' and the Mental Wellness of Adolescents: Partially Randomized Preference Trial",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e25782",
keywords="media",
keywords="adolescence",
keywords="mental health",
keywords="narrative",
keywords="13 Reasons Why",
keywords="conversation",
keywords="television",
keywords="depression",
keywords="sexual assault",
abstract="Background: A conflicting body of research suggests that additional investigation is needed to understand how globally watched television shows featuring social and mental health issues, such as 13 Reasons Why, might affect adolescents' mental wellness. Objective: This study aims to investigate adolescents' viewership of the third season of the Netflix drama 13 Reasons Why (13RW-3) and their engagement with show-related content, paying special attention to mental health outcomes and conversational partners. Methods: A panel-based research platform operated by the National Opinion Research Center at the University of Chicago recruited 157 adolescents aged 13 to 17 years from its nationally representative pool of participants. Participants answered questions about how they discussed and learned about social and mental health issues portrayed in 13RW-3 (eg, masculine role pressure and sexual assault) and questions about mental wellness (eg, mental health self-efficacy and depression). After the participants completed the survey (T1), they were directed to either watch 13RW-3 as it aired for the first time (intervention group) or not watch 13RW-3 (control group). Approximately one month later (T2), all the participants were asked to complete the postsurvey. Additional survey questions about conversational partners, information seeking because of watching the show, and use of show-related content were included in the intervention postsurvey. Results: Our sample (N=157) was 52.2\% (n=82) female and 54.8\% (n=86) White, with a mean age of 14.99 (SD 1.4) years. At T2, viewers of 13RW-3 spoke about suicide significantly more frequently than nonviewers (P=.007). From T1 to T2, viewers increasingly discussed issues explored by 13RW-3 (P=.002), especially suicide, mental health, and bullying. Adolescent viewers were most likely to speak with friends, and parents were the second most commonly named. Two variables emerged as consistent moderators of conversational choices---having depressive symptoms and being impacted by sexual assault. There was no association between conversational frequency and information seeking around social and mental health issues, and neither mental health self-efficacy scores nor masculine role pressure scores significantly differed between viewers and nonviewers at T2. Conclusions: Viewing 13RW-3, a globally watched television show featuring social and mental health issues, led to adolescent conversations and information searches about topics explored by the show. Depressive symptoms and the impact of sexual assault moderated several relationships, guiding participants toward engaging with certain issues and seeking out specific conversational partners. As 13RW-3's stories drove conversations---and story-driven conversations can raise awareness, reduce stigma, shift attitudes, normalize certain behaviors, and strengthen supportive relationships---potential wellness implications for television shows featuring social and mental health issues are considerable. ",
doi="10.2196/25782",
url="https://mental.jmir.org/2021/9/e25782",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524097"
}