%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e68441 %T The Comprehensive Adaptive Multisite Prevention of University Student Suicide Trial: Protocol for a Randomized Controlled Trial %A Blalock,Kyla %A Pistorello,Jacqueline %A Rizvi,Shireen L %A Seeley,John R %A Kassing,Francesca %A Sinclair,James %A Oshin,Linda A %A Gallop,Robert J %A Fry,Cassidy M %A Snyderman,Ted %A Jobes,David A %A Crumlish,Jennifer %A Krall,Hannah R %A Stadelman,Susan %A Gözenman-Sapin,Filiz %A Davies,Kate %A Steele,David %A Goldston,David B %A Compton,Scott N %+ Duke University, 2608 Erwin Rd, Suite 300, Durham, NC, 27705, United States, 1 9196844686, kyla.machell@duke.edu %K suicide %K adaptive treatment strategies %K Collaborative Assessment and Management of Suicidality %K CAMS %K dialectical behavior therapy %K DBT %K university students %D 2025 %7 22.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicidal ideation is increasing among university students. Despite growing demand for services, university counseling centers (UCCs) face limited resources to meet the complex needs of students who are suicidal. Objective: The Comprehensive Adaptive Multisite Prevention of University Student Suicide (CAMPUS) Trial evaluates 4 treatment sequences within UCCs to develop evidence-based treatment guidelines. Methods: The CAMPUS Trial consists of a feasibility study followed by a sequential multiple-assignment randomized trial (SMART). The original CAMPUS protocol was modified during the COVID-19 pandemic to accommodate new UCC tele–mental health services, including remote treatment, assessments, and monitoring. A smaller-scale feasibility study was conducted to (1) evaluate implementation of hybrid telehealth and in-person interventions and (2) fine-tune online procedures. Following the feasibility study, university students (aged 18-25 years) seeking UCC services with moderate to severe suicidal ideation will enroll in the CAMPUS Trial. Student participants are randomly assigned to 1 of 4 treatment sequences with 2 stages of intervention. In stage 1, students receive 4 to 6 weeks of either (1) a suicide-focused treatment—Collaborative Assessment and Management of Suicidality—or (2) enhanced treatment as usual. Treatment responders enter the maintenance phase. In stage 2, nonresponders are rerandomized for an additional 1 to 8 weeks of (1) Collaborative Assessment and Management of Suicidality or (2) an intensive skills-based treatment—dialectical behavior therapy for UCC settings. UCC counselors will enroll in the CAMPUS Trial to complete measures about their experience working with students who are suicidal. CAMPUS Trial administration includes representation from all sites to facilitate cross-site coordination and an advisory board of stakeholders from all UCCs to facilitate treatment implementation. Results: Student participant recruitment began on October 25, 2022, and ended on May 16, 2024. As of November 2024, data collection for the SMART was ongoing with active study participants. Data collection was completed in November 2024, and as of April 2025, data analysis is underway. Full results will be available in 2025. Conclusions: The CAMPUS Trial offers a model for future SMARTs for the treatment of suicidal thoughts or behaviors (or both) across various settings. The results will inform treatment guidelines for students presenting with suicidality at UCCs. Trial Registration: ClinicalTrials.gov NCT04707066; http://clinicaltrials.gov/ct2/show/NCT04707066 International Registered Report Identifier (IRRID): DERR1-10.2196/68441 %M 40262131 %R 10.2196/68441 %U https://www.researchprotocols.org/2025/1/e68441 %U https://doi.org/10.2196/68441 %U http://www.ncbi.nlm.nih.gov/pubmed/40262131 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e60649 %T Exploring the Views of Young People, Including Those With a History of Self-Harm, on the Use of Their Routinely Generated Data for Mental Health Research: Web-Based Cross-Sectional Survey Study %A Dekel,Dana %A Marchant,Amanda %A Del Pozo Banos,Marcos %A Mhereeg,Mohamed %A Lee,Sze Chim %A John,Ann %+ Swansea University Medical School, Swansea University, 3rd Floor, Data Science Building, Singleton Park, Swansea, SA2 8PP, United Kingdom, 44 1792 602568, a.john@swansea.ac.uk %K self-harm %K mental health %K big data %K survey %K youth %D 2025 %7 12.3.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Secondary use of routinely collected health care data has great potential benefits in epidemiological studies primarily due to the large scale of preexisting data. Objective: This study aimed to engage respondents with and without a history of self-harm, gain insight into their views on the use of their data for research, and determine whether there were any differences in opinions between the 2 groups. Methods: We examined young people’s views on the use of their routinely collected data for mental health research through a web-based survey, evaluating any differences between those with and without a history of self-harm. Results: A total of 1765 respondents aged 16 to 24 years were included. Respondents’ views were mostly positive toward the use and linkage of their data for research purposes for public benefit, particularly with regard to the use of health care data (mental health or otherwise), and generally echoed existing evidence on the opinions of older age groups. Individuals who reported a history of self-harm and subsequently contacted health services more often reported being “extremely likely” or “likely” to share mental health data (contacted: 209/609, 34.3%; 95% CI 28.0-41.2; not contacted: 169/782, 21.6%; 95% CI 15.8-28.7) and physical health data (contacted: 117/609, 19.2%; 95% CI 12.7-27.8; not contacted: 96/782, 12.3%; 95% CI 6.7-20.9) compared with those who had not contacted services. Respondents were overall less likely to want to share their social media data, which they considered to be more personal compared to their health care data. Respondents stressed the importance of anonymity and the need for an appropriate ethical framework. Conclusions: Young people are aware, and they care about how their data are being used and for what purposes, irrespective of having a history of self-harm. They are largely positive about the use of health care data (mental or physical) for research and generally echo the opinions of older age groups raising issues around data security and the use of data for the public interest. %M 40073393 %R 10.2196/60649 %U https://mental.jmir.org/2025/1/e60649 %U https://doi.org/10.2196/60649 %U http://www.ncbi.nlm.nih.gov/pubmed/40073393 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66321 %T Online Safety When Considering Self-Harm and Suicide-Related Content: Qualitative Focus Group Study With Young People, Policy Makers, and Social Media Industry Professionals %A La Sala,Louise %A Sabo,Amanda %A Michail,Maria %A Thorn,Pinar %A Lamblin,Michelle %A Browne,Vivienne %A Robinson,Jo %+ Orygen, 35 Poplar Road, Parkville, 3052, Australia, 61 3 9966 9512, louise.lasala@orygen.org.au %K young people %K suicide prevention %K self-harm %K social media %K online safety %K policy %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Young people are disproportionately impacted by self-harm and suicide, and concerns exist regarding the role of social media and exposure to unsafe content. Governments and social media companies have taken various approaches to address online safety for young people when it comes to self-harm and suicide; however, little is known about whether key stakeholders believe current approaches are fit-for-purpose. Objective: From the perspective of young people, policy makers and professionals who work within the social media industry, this study aimed to explore (1) the perceived challenges and views regarding young people communicating on social media about self-harm and suicide, and (2) what more social media companies and governments could be doing to address these issues and keep young people safe online. Methods: This qualitative study involved 6 focus groups with Australian young people aged 12-25 years (n=7), Australian policy makers (n=14), and professionals from the global social media industry (n=7). Framework analysis was used to summarize and chart the data for each stakeholder group. Results: In total, 3 primary themes and six subthemes are presented: (1) challenges and concerns, including the reasons for, and challenges related to, online communication about self-harm and suicide as well as reasoning with a deterministic narrative of harm; (2) roles and responsibilities regarding online safety and suicide prevention, including who is responsible and where responsibility starts and stops, as well as the need for better collaborations; and (3) future approaches and potential solutions, acknowledging the limitations of current safety tools and policies, and calling for innovation and new ideas. Conclusions: Our findings highlight tensions surrounding roles and responsibilities in ensuring youth online safety and offer perspectives on how social media companies can support young people discussing self-harm and suicide online. They also support the importance of cross-industry collaborations and consideration of social media in future suicide prevention solutions intended to support young people. %M 40063940 %R 10.2196/66321 %U https://www.jmir.org/2025/1/e66321 %U https://doi.org/10.2196/66321 %U http://www.ncbi.nlm.nih.gov/pubmed/40063940 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e52928 %T Association Among BMI, Self-Esteem, and Nonsuicidal Self-Injury in Young Adults to Understand the Influence of Socioenvironmental Factors: Longitudinal Study %A Zhang,Yi %A Ying,Ruixue %A Lu,Wan %A Liu,Xuemeng %A Hu,Keyan %A Feng,Qing %A Yu,Zixiang %A Wang,Zhen %A Lu,Fangting %A Miao,Yahu %A Ma,Nanzhen %A Tao,Fangbiao %A Jiang,Tian %A Zhang,Qiu %K nonsuicidal self-injury %K chronotype %K BMI %K self-esteem %K body mass index %K adolescent %K young adult %K teenager %K social environmental factor %K self-injury %K sampling method %K undergraduate %K college student %K linear regression %K regression %K regression model %D 2025 %7 21.2.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Nonsuicidal self-injury (NSSI) is a major public health problem leading to psychological problems in adolescents and young adults, similar to disorders such as depression and anxiety. Objective: The aims of this study were to investigate (1) the interaction between BMI and socioenvironmental factors (including chronotype and mental health) that contribute to NSSI, and (2) whether self-esteem plays a mediating role in this association. Methods: From May to June 2022, the multistage cluster sampling method was used to sample college students in four grades, including freshmen and seniors. The baseline participants were followed up 6 months later, excluding those who did not qualify, and the participants included 1772 college students. Socioenvironmental factors (chronotype/mental health), self-esteem, and NSSI were measured using a questionnaire. Multivariate linear regression models and chi-square analysis were used to evaluate the linear relationship between BMI, socioenvironmental factors, and self-esteem and the NSSI status. We use a process approach (mediation-moderation analysis) to explore the complex relationships between these variables. Results: The mean age of the participants was 20.53 (SD 1.65) years at baseline. A significant association was revealed, suggesting that a high BMI (β=.056, 95% CI 0.008‐0.086, P=.018) was associated with a higher NSSI. There was also an interaction among BMI, socioenvironmental factors, and NSSI. Socioenvironmental factors played both moderating and mediating roles in the relationship between BMI and NSSI, whereas self-esteem only played a mediating role. Conclusions: Paying attention to factors such as overweight and obesity is important for early BMI control to identify other potential risk factors for NSSI and to evaluate how self-esteem can be improved considering multiple perspectives to improve the effect of BMI on NSSI in adolescents. %R 10.2196/52928 %U https://publichealth.jmir.org/2025/1/e52928 %U https://doi.org/10.2196/52928 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64615 %T Posttraumatic Growth Among Suicide-Loss Survivors: Protocol for an Updated Systematic Review and Meta-Analysis %A Whittaker,Spence %A Rasmussen,Susan %A Cogan,Nicola %A Tse,Dwight %A Martin,Bethany %A Andriessen,Karl %A Shiramizu,Victor %A Krysinska,Karolina %A Levi-Belz,Yossi %+ Department of Psychological Sciences and Health, University of Strathclyde, Graham Hills Building, 40 George St, Glasgow, G1 1QE, United Kingdom, 44 141 548 2700, spence.whittaker@strath.ac.uk %K posttraumatic growth %K suicide-loss survivors %K trauma %K systematic review %K meta-analysis %K posttraumatic %K suicidal %K systematic review %K meta-analysis protocol %K traumatic impacts %K bereaved survivor %K social support %K bereavement %K data collection %K sociodemographic %K psychological %K databases %D 2025 %7 14.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Losing a loved one to suicide is an event that can have strong and potentially traumatic impacts on the lives of the bereaved survivors, especially regarding their grief, which can be complicated. These bereaved individuals are also less likely to receive social support following their bereavement. However, besides these adverse impacts, growing evidence supports the concept of posttraumatic growth following suicide bereavement. Posttraumatic growth is the personal improvement that occurs as a consequence of experiencing a traumatic or extremely challenging event or crisis. Only 1 systematic review and meta-analysis on posttraumatic growth following suicide bereavement has been conducted; this protocol is for the planned systematic review and meta-analysis update of the original systematic review and meta-analysis, as the original review collected its data in 2018. Objective: This review aims to investigate demographic characteristics, correlational relationships, and facilitative factors of posttraumatic growth in individuals bereaved by suicide. In addition, as this is an update of a previous systematic review and meta-analysis, we aim to compare our findings with the original review and to identify any similarities or differences. Methods: This protocol outlines the planned procedures of the updated systematic review and meta-analysis. MEDLINE, PsycINFO, Embase, CINAHL, Scopus, and Web of Science (Core Collection) were examined, and the search results were imported to Covidence, where title and abstract screenings and full-text screenings occurred. The inclusion and exclusion criteria for this updated review match those in the original review: (1) the study population must contain participants bereaved by suicide, (2) the study data must be quantitative, and (3) the study must report data on posttraumatic or stress-related growth. The original review conducted its search before 2019; thus, this updated review searched databases for the timeframe of January 2019 to January 2024. The updated meta-analysis will synthesize data from both the original and updated reviews to examine trends over time. The Newcastle-Ottawa Scale (NOS) will be used to assess publication quality. Random-effects meta-analyses will be conducted using RStudio (R Foundation for Statistical Computing). Results: The review was funded in October 2023 and is currently in progress. Results are expected to be finalized in October 2024. There are 21 articles that have been included in the review and are being analyzed at this time. We aim to submit the full article for publication in December 2024. Conclusions: The results of this updated systematic review and meta-analysis will be used to examine key relationships and findings regarding posttraumatic growth in individuals bereaved by suicide. The discussion will also investigate the findings of this updated review in comparison to the findings of the original review. Any differences would be highlighted. Limitations of the current review will be discussed, such as the quality of the articles included. Trial Registration: PROSPERO CRD42024485421; https://tinyurl.com/3hzpnzr3 International Registered Report Identifier (IRRID): DERR1-10.2196/64615 %R 10.2196/64615 %U https://www.researchprotocols.org/2025/1/e64615 %U https://doi.org/10.2196/64615 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67814 %T Experiences of Peer Mentoring Sexual and Gender Minority Emerging Adults Who Are at Risk for Suicide: Mixed Methods Study %A Tran,Jennifer T %A Webster,Jessica %A Wolfe,James R %A Ben Nathan,Jennifer %A Mayinja,Lindiwe %A Kautz,Marin %A Oquendo,Maria A %A Brown,Gregory K %A Mandell,David %A Mowery,Danielle %A Bauermeister,José A %A Brown,Lily A %+ Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, United States, 1 2158983616, jtgtran@nursing.upenn.edu %K suicide prevention %K peer mentorship %K LGBTQIA health %K mental health %D 2025 %7 29.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual and Gender Diverse Youth (SGDY) are at increased risk for suicide due to unique experiences including discrimination, family or friend rejection, and low positive affect. Peer mentors (PMs) may offer a unique opportunity for intervention but are underutilized for suicide prevention among SGDY. Objective: Little is known about the training needed for PMs when working with SGDY at risk for suicide. We developed an intervention, Supporting Transitions to Adulthood and Reducing Suicide (STARS), to improve suicide prevention among SGDY and increase social support, coping, and positive effects. PMs were trained by a licensed clinical therapist and provided a manual. PMs meet virtually for 6 weeks, providing social support, strategies to diminish the impact of discrimination, connection to safe spaces, and reinforcement of intentions to use Safety Plans with mentees. Methods: To understand PMs’ experiences in their role, including distress, fidelity to the manual, and perceptions of feasibility and acceptability of STARS and mentees’ Safety Plan, we collected survey data from mentees and PMs as well as in-depth interviews with PMs after the completion of the intervention. Results: As of September 2024, all peer mentees (N=64) have completed the study and all PMs have finished providing sessions for peer mentees. PMs (n=5) reported overall high comfort (8.52) and low distress (1.93) during sessions. All 5 PMs had high fidelity (>90%) to the PM intervention training. All 5 PMs reported high feasibility (17.50), acceptability (20), and appropriateness (20) of the STARS intervention. Mentees (n=27) reported high confidence ratings (3.54) in speaking with their PMs. Conclusions: Peer mentorship for SGDY who are at risk for suicide was feasible and acceptable by PMs and mentees alike. PMs reported that they felt comfortable and confident during the sessions. Mentees also reported confidence in working with their PMs. Future research should explore the optimal strategies to support PMs and mentees as they engage in suicide prevention work as well as incorporate feedback from the PMs in this study to ensure optimal outcomes. Trial Registration: ClinicalTrials.gov NCT05018143; https://clinicaltrials.gov/study/NCT05018143 International Registered Report Identifier (IRRID): RR2-10.2196/48177 %M 39879591 %R 10.2196/67814 %U https://formative.jmir.org/2025/1/e67814 %U https://doi.org/10.2196/67814 %U http://www.ncbi.nlm.nih.gov/pubmed/39879591 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e63809 %T An Explainable Artificial Intelligence Text Classifier for Suicidality Prediction in Youth Crisis Text Line Users: Development and Validation Study %A Thomas,Julia %A Lucht,Antonia %A Segler,Jacob %A Wundrack,Richard %A Miché,Marcel %A Lieb,Roselind %A Kuchinke,Lars %A Meinlschmidt,Gunther %+ Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Missionsstrasse 60/62, Basel, 4055, Switzerland, 49 30 57714627, julia.thomas@krisenchat.de %K deep learning %K explainable artificial intelligence (XAI) %K large language model (LLM) %K machine learning %K neural network %K prevention %K risk monitoring %K suicide %K transformer model %K suicidality %K suicidal ideation %K self-murder %K self-harm %K youth %K adolescent %K adolescents %K public health %K language model %K language models %K chat protocols %K crisis helpline %K help-seeking behaviors %K German %K Shapley %K decision-making %K mental health %K health informatics %K mobile phone %D 2025 %7 29.1.2025 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Suicide represents a critical public health concern, and machine learning (ML) models offer the potential for identifying at-risk individuals. Recent studies using benchmark datasets and real-world social media data have demonstrated the capability of pretrained large language models in predicting suicidal ideation and behaviors (SIB) in speech and text. Objective: This study aimed to (1) develop and implement ML methods for predicting SIBs in a real-world crisis helpline dataset, using transformer-based pretrained models as a foundation; (2) evaluate, cross-validate, and benchmark the model against traditional text classification approaches; and (3) train an explainable model to highlight relevant risk-associated features. Methods: We analyzed chat protocols from adolescents and young adults (aged 14-25 years) seeking assistance from a German crisis helpline. An ML model was developed using a transformer-based language model architecture with pretrained weights and long short-term memory layers. The model predicted suicidal ideation (SI) and advanced suicidal engagement (ASE), as indicated by composite Columbia-Suicide Severity Rating Scale scores. We compared model performance against a classical word-vector-based ML model. We subsequently computed discrimination, calibration, clinical utility, and explainability information using a Shapley Additive Explanations value-based post hoc estimation model. Results: The dataset comprised 1348 help-seeking encounters (1011 for training and 337 for testing). The transformer-based classifier achieved a macroaveraged area under the curve (AUC) receiver operating characteristic (ROC) of 0.89 (95% CI 0.81-0.91) and an overall accuracy of 0.79 (95% CI 0.73-0.99). This performance surpassed the word-vector-based baseline model (AUC-ROC=0.77, 95% CI 0.64-0.90; accuracy=0.61, 95% CI 0.61-0.80). The transformer model demonstrated excellent prediction for nonsuicidal sessions (AUC-ROC=0.96, 95% CI 0.96-0.99) and good prediction for SI and ASE, with AUC-ROCs of 0.85 (95% CI 0.97-0.86) and 0.87 (95% CI 0.81-0.88), respectively. The Brier Skill Score indicated a 44% improvement in classification performance over the baseline model. The Shapley Additive Explanations model identified language features predictive of SIBs, including self-reference, negation, expressions of low self-esteem, and absolutist language. Conclusions: Neural networks using large language model–based transfer learning can accurately identify SI and ASE. The post hoc explainer model revealed language features associated with SI and ASE. Such models may potentially support clinical decision-making in suicide prevention services. Future research should explore multimodal input features and temporal aspects of suicide risk. %M 39879608 %R 10.2196/63809 %U https://publichealth.jmir.org/2025/1/e63809 %U https://doi.org/10.2196/63809 %U http://www.ncbi.nlm.nih.gov/pubmed/39879608 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63126 %T Applications of Large Language Models in the Field of Suicide Prevention: Scoping Review %A Holmes,Glenn %A Tang,Biya %A Gupta,Sunil %A Venkatesh,Svetha %A Christensen,Helen %A Whitton,Alexis %+ Black Dog Institute, University of New South Wales, Sydney, Hospital Road, Randwick, 2031, Australia, 61 290659046, a.whitton@unsw.edu.au %K suicide %K suicide prevention %K large language model %K self-harm %K artificial intelligence %K AI %K PRISMA %D 2025 %7 23.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Prevention of suicide is a global health priority. Approximately 800,000 individuals die by suicide yearly, and for every suicide death, there are another 20 estimated suicide attempts. Large language models (LLMs) hold the potential to enhance scalable, accessible, and affordable digital services for suicide prevention and self-harm interventions. However, their use also raises clinical and ethical questions that require careful consideration. Objective: This scoping review aims to identify emergent trends in LLM applications in the field of suicide prevention and self-harm research. In addition, it summarizes key clinical and ethical considerations relevant to this nascent area of research. Methods: Searches were conducted in 4 databases (PsycINFO, Embase, PubMed, and IEEE Xplore) in February 2024. Eligible studies described the application of LLMs for suicide or self-harm prevention, detection, or management. English-language peer-reviewed articles and conference proceedings were included, without date restrictions. Narrative synthesis was used to synthesize study characteristics, objectives, models, data sources, proposed clinical applications, and ethical considerations. This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) standards. Results: Of the 533 studies identified, 36 (6.8%) met the inclusion criteria. An additional 7 studies were identified through citation chaining, resulting in 43 studies for review. The studies showed a bifurcation of publication fields, with varying publication norms between computer science and mental health. While most of the studies (33/43, 77%) focused on identifying suicide risk, newer applications leveraging generative functions (eg, support, education, and training) are emerging. Social media was the most common source of LLM training data. Bidirectional Encoder Representations from Transformers (BERT) was the predominant model used, although generative pretrained transformers (GPTs) featured prominently in generative applications. Clinical LLM applications were reported in 60% (26/43) of the studies, often for suicide risk detection or as clinical assistance tools. Ethical considerations were reported in 33% (14/43) of the studies, with privacy, confidentiality, and consent strongly represented. Conclusions: This evolving research area, bridging computer science and mental health, demands a multidisciplinary approach. While open access models and datasets will likely shape the field of suicide prevention, documenting their limitations and potential biases is crucial. High-quality training data are essential for refining these models and mitigating unwanted biases. Policies that address ethical concerns—particularly those related to privacy and security when using social media data—are imperative. Limitations include high variability across disciplines in how LLMs and study methodology are reported. The emergence of generative artificial intelligence signals a shift in approach, particularly in applications related to care, support, and education, such as improved crisis care and gatekeeper training methods, clinician copilot models, and improved educational practices. Ongoing human oversight—through human-in-the-loop testing or expert external validation—is essential for responsible development and use. Trial Registration: OSF Registries osf.io/nckq7; https://osf.io/nckq7 %M 39847414 %R 10.2196/63126 %U https://www.jmir.org/2025/1/e63126 %U https://doi.org/10.2196/63126 %U http://www.ncbi.nlm.nih.gov/pubmed/39847414 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66181 %T Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study %A Vonderlin,Ruben %A Boritz,Tali %A Claus,Carola %A Senyüz,Büsra %A Mahalingam,Saskia %A Tennenhouse,Rachel %A Lis,Stefanie %A Schmahl,Christian %A Margraf,Jürgen %A Teismann,Tobias %A Kleindienst,Nikolaus %A McMain,Shelley %A Bohus,Martin %+ Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, Mannheim, 68159, Germany, 49 621 1703 4445, ruben.vonderlin@zi-mannheim.de %K dialectical behavior therapy %K borderline personality disorder %K online psychotherapy %K virtual psychotherapy %K telehealth %K personality disorders %K mental %K psychotherapy %K online %K internet %K telemedicine %K psychiatry %K psychiatric %K acceptance %D 2025 %7 14.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The potential of telehealth psychotherapy (ie, the online delivery of treatment via a video web-based platform) is gaining increased attention. However, there is skepticism about its acceptance, safety, and efficacy for patients with high emotional and behavioral dysregulation. Objective: This study aims to provide initial effect size estimates of symptom change from pre- to post treatment, and the acceptance and safety of telehealth dialectical behavior therapy (DBT) for individuals diagnosed with borderline personality disorder (BPD). Methods: A total of 39 individuals meeting the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria for BPD received 1 year of outpatient telehealth DBT at 3 sites in Germany and Canada. Effect size estimates were assessed using pre-post measures of BPD symptoms, dissociation, and quality of life. Safety was evaluated by analyzing suicide attempts and self-harm. Additionally, acceptance and feasibility, satisfaction with treatment, useability of the telehealth format, and the quality of the therapeutic alliance were assessed from both therapists’ and patients’ perspectives. All analyses were conducted on both the intention-to-treat (ITT) and according-to-protocol (ATP) samples. Results: Analyses showed significant and large pre-post effect sizes for BPD symptoms (d=1.13 in the ITT sample and d=1.44 in the ATP sample; P<.001) and for quality of life (d=0.65 in the ITT sample and d=1.24 in the ATP sample). Dissociative symptoms showed small to nonsignificant reductions. Self-harm behaviors decreased significantly from 80% to 28% of all patients showing at least 1 self-harm behavior in the last 10 weeks (risk ratio 0.35). A high dropout rate of 38% was observed. One low-lethality suicide attempt was reported. Acceptance, feasibility, and satisfaction measures were high, although therapists reported only moderate useability of the telehealth format. Conclusions: Telehealth DBT for BPD showed large pre-post effect sizes for BPD symptoms and quality of life. While the telehealth format appeared feasible and well-accepted, the dropout rate was relatively high. Future research should compare the efficacy of telehealth DBT with in-person formats in randomized controlled trials. Overall, telehealth DBT might offer a potentially effective alternative treatment option, enhancing treatment accessibility. However, strategies for decreasing drop-out should be considered. Trial Registration: German Clinical Trials Register DRKS00027824; https://drks.de/search/en/trial/DRKS00027824 %M 39808784 %R 10.2196/66181 %U https://formative.jmir.org/2025/1/e66181 %U https://doi.org/10.2196/66181 %U http://www.ncbi.nlm.nih.gov/pubmed/39808784 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e52083 %T The Association Between Internet Addiction and the Risk of Suicide Attempts in Chinese Adolescents Aged 11-17 Years: Prospective Cohort Study %A Li,Sihong %A Jin,Xingyue %A Song,Lintong %A Fan,Tianqing %A Shen,Yanmei %A Zhou,Jiansong %+ Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, No.139, Renmin Road Central Changsha-Hunan-China, Changsha, 410011, China, 86 15116269263, ymshen@csu.edu.cn %K adolescents %K pathological internet use %K internet addiction %K suicide attempts %K risk factors %K cohort study %D 2025 %7 3.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide is a critical public health issue in adolescents worldwide. Internet addiction may play a role in the increased rate of suicide attempts in this population. However, few studies have explored the relationship between pathological internet use and suicide attempts among adolescents. Objective: This study aimed to conduct a prospective cohort study to examine whether higher severity of pathological internet use was associated with an increased risk of suicide attempts among Chinese adolescents. Methods: A total of 782 adolescents were recruited from a middle school from November 2020 to December 2020 and followed up for 6 months. An online self-reported questionnaire was used to collect the participants’ demographic data and assess their mental health. The Depression, Anxiety, and Stress Scale–21 items (DASS-21) was used to evaluate depression, anxiety, and stress. The Chen Internet Addiction Scale–Revised (CIAS-R) was used to assess the symptoms and severity of pathological internet use. χ2 test and ANOVA were used for intergroup comparison, and logistic regression analysis was used to examine the relationship between the severity of pathological internet use and suicide attempts. We also used a restricted cubic splines model to investigate the pattern of the association. Results: The participants had an average age of 12.59 (SD 0.64) years, with the majority being of Han ethnicity (743/782, 95.01%) and more than half being male (426/782, 54.48%). Most participants had no previous history of depression (541/782, 69.18%), anxiety (415/782, 53.07%), or stress (618/782, 79.03%). The rate of newly reported suicide attempts was 4.6% (36/782). A significant positive association was observed between internet addiction and suicide attempts (odds ratio 3.88, 95% CI 1.70-8.82), which remained significant after adjusting for age, sex, ethnicity, anxiety, depression, and stress (odds ratio 2.65, 95% CI 1.07-6.55). In addition, this association exhibited a linear pattern in the restricted cubic spline regression model. Conclusions: This study suggested that internet addiction, rather than internet overuse, was associated with a higher likelihood of suicide attempts, which highlighted the importance of addressing internet addiction symptoms among Chinese adolescents for suicide prevention. %M 39752720 %R 10.2196/52083 %U https://www.jmir.org/2025/1/e52083 %U https://doi.org/10.2196/52083 %U http://www.ncbi.nlm.nih.gov/pubmed/39752720 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60879 %T A Digital Approach for Addressing Suicidal Ideation and Behaviors in Youth Mental Health Services: Observational Study %A Chong,Min K %A Hickie,Ian B %A Ottavio,Antonia %A Rogers,David %A Dimitropoulos,Gina %A LaMonica,Haley M %A Borgnolo,Luke J %A McKenna,Sarah %A Scott,Elizabeth M %A Iorfino,Frank %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, 2050, Australia, 61 (02) 9114 2199, min.chong@sydney.edu.au %K mental health service %K youth mental health %K suicide management %K clinical decision support %K primary care %K personalization %K suicide %K suicidal %K youth %K mental health %K mental health care %K suicide prevention %K digital technology %K online assessment %K clinician %K digital health %K health informatics %K clinical information %D 2024 %7 18.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Long wait times for mental health treatments may cause delays in early detection and management of suicidal ideation and behaviors, which are crucial for effective mental health care and suicide prevention. The use of digital technology is a potential solution for prompt identification of youth with high suicidality. Objective: The primary aim of this study was to evaluate the use of a digital suicidality notification system designed to detect and respond to suicidal needs in youth mental health services. Second, the study aimed to characterize young people at different levels of suicidal ideation and behaviors. Methods: Young people aged between 16 and 25 years completed multidimensional assessments using a digital platform, collecting demographic, clinical, social, functional, and suicidality information. When the suicidality score exceeded a predetermined threshold, established based on clinical expertise and service policies, a rule-based algorithm configured within the platform immediately generated an alert for treating clinicians. Subsequent clinical actions and response times were analyzed. Results: A total of 2021 individuals participated, of whom 266 (11%) triggered one or more high suicidal ideation and behaviors notification. Of the 292 notifications generated, 76% (222/292) were resolved, with a median response time of 1.9 (range 0-50.8) days. Clinical actions initiated to address suicidality included creating safety plans (60%, 134/222), conducting safety checks (18%, 39/222), psychological therapy (8%, 17/222), transfer to another service (3%, 8/222), and scheduling of new appointments (2%, 4/222). Young people with high levels of suicidality were more likely to present with more severe and comorbid symptoms, including low engagement in work or education, heterogenous psychopathology, substance misuse, and recurrent illness. Conclusions: The digital suicidality notification system facilitated prompt clinical actions by alerting clinicians to high levels of suicidal ideation and behaviors detected among youth. Further, the multidimensional assessment revealed complex and comorbid symptoms exhibited in youth with high suicidality. By expediting and personalizing care for those displaying elevated suicidality, the digital notification system can play a pivotal role in preventing rapid symptom progression and its detrimental impacts on young people’s mental health. %M 39693140 %R 10.2196/60879 %U https://www.jmir.org/2024/1/e60879 %U https://doi.org/10.2196/60879 %U http://www.ncbi.nlm.nih.gov/pubmed/39693140 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e63132 %T Ecological Momentary Assessment of Self-Harm Thoughts and Behaviors: Systematic Review of Constructs From the Integrated Motivational-Volitional Model %A Winstone,Lizzy %A Heron,Jon %A John,Ann %A Kirtley,Olivia J %A Moran,Paul %A Muehlenkamp,Jennifer %A O'Connor,Rory C %A Mars,Becky %+ Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 2PN, United Kingdom, 44 0117 928 7279, lizzy.winstone@bristol.ac.uk %K integrated motivational-volitional model %K IMV model %K ecological momentary assessment %K suicidal and nonsuicidal self-harm thoughts and behaviors %D 2024 %7 9.12.2024 %9 Review %J JMIR Ment Health %G English %X Background: The integrated motivational-volitional model (IMV) is one of the leading theoretical models of suicidal thoughts and behavior. There has been a recent proliferation in the assessment of suicidal and nonsuicidal self-harm thoughts and behaviors (SHTBs) in daily life. Objective: This systematic review synthesized evidence from ecological momentary assessment (EMA) studies in the SHTB literature to address the following questions: (1) Which constructs in the IMV model have been assessed using EMA, and how have they been assessed? (2) Do different constructs from the IMV model fluctuate in daily life? (3) What is the relationship between the different IMV constructs and SHTBs in daily life? Methods: Consistent with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted systematic searches of 5 databases—Web of Science, Embase, MEDLINE, PsycINFO, and Europe PMC Preprints—from inception to March 26, 2024. Results: Our searches resulted in the inclusion and narrative synthesis of 53 studies across 58 papers. A total of 15 IMV constructs were measured using EMA across the included papers. The most frequently measured constructs were thwarted belongingness (24/58, 41% of the papers), future thinking (20/58, 34% of the papers), and perceived burdensomeness (16/58, 28% of the papers). The least frequently measured constructs were humiliation, social problem-solving, mental imagery, and perceived capability for suicide. None of the included papers measured memory biases, goals, norms, or resilience using EMA. Comparison of intraclass correlation coefficients (45/58, 78% of the papers) revealed moderate but inconsistent within-person variance across all the examined constructs. We found evidence (39/58, 67% of the papers) of concurrent associations between almost all constructs and SHTBs in daily life, with some evidence that entrapment, shame, rumination, thwarted belongingness, hopelessness, social support, and impulsivity are additionally associated with SHTBs in lagged (ie, longitudinal) relationships. Conclusions: Comparisons were hindered by variation in methodology, including the populations studied, EMA sampling scheme, operationalization of IMV constructs and SHTBs, and statistical approach used. Our findings suggest that EMA studies are a useful methodology for examining risk factors for SHTBs; however, more research is needed for some IMV constructs. Quality assessment suggested several areas for improvement in the reporting of EMA studies in this field. Trial Registration: PROSPERO CRD42022349514; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=349514 %M 39652869 %R 10.2196/63132 %U https://mental.jmir.org/2024/1/e63132 %U https://doi.org/10.2196/63132 %U http://www.ncbi.nlm.nih.gov/pubmed/39652869 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 16 %N %P e56970 %T Self-Induced Mania Methods and Motivations Reported in Online Forums: Observational Qualitative Study %A Bostock,Emmanuelle CS %A Nevarez-Flores,Adriana G %A Neil,Amanda L %A Pontes,Halley M %A Kirkby,Kenneth C %+ Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia, 61 3 6226 7700, ebostock@utas.edu.au %K bipolar disorder %K mania %K hypomania %K self-induced %K online forums %K consumer reports %D 2024 %7 6.12.2024 %9 Original Paper %J J Particip Med %G English %X Background: In bipolar disorder (BD), mania may be self-induced by manipulation of specific precipitants, as reported in case studies. Another potential source of information on the self-induction of mania is the online postings of users with lived experience of mania. Objective: The primary aim of this study is to examine the range of methods used to self-induce mania or hypomania described by users of online forums with self-reported BD. Second, we summarize the motivations of users to engage in these behaviors. Methods: We conducted an observational study of online forum posts that discussed self-induction of mania or hypomania, either in the posters themselves or observed firsthand in others. Posts were identified using Google advanced search operators, then extracted and coded for content in NVivo (version 12 for Mac; QSR International). A total of 44 online forum threads were identified discussing self-induced mania (n=25) or hypomania (n=19). These forums contained 585 posts by 405 usernames, of which 126 usernames discussed methods for self-induction across 327 posts (number of methods per username: median 2, IQR 1-4; range 1-11). Results: In total, 36 methods were grouped by the authors. The most frequently reported were sleep reduction (n=50), caffeine (n=37), and cessation of medication (n=27). Twenty-six usernames reported their motivation to self-induce mania or hypomania; almost three-quarters (n=19) reported a desire to end a depressive episode. Almost a third of usernames (118/405) explicitly discouraged other forum users from self-inducing mania or hypomania. Conclusions: Online forums provide an additional and valuable source of information about triggers for mania that may inform relapse prevention in BD. The online forum conversations investigated were generally responsible and included cautionary advice not to pursue these methods. %M 39642359 %R 10.2196/56970 %U https://jopm.jmir.org/2024/1/e56970 %U https://doi.org/10.2196/56970 %U http://www.ncbi.nlm.nih.gov/pubmed/39642359 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49927 %T Machine Learning–Based Suicide Risk Prediction Model for Suicidal Trajectory on Social Media Following Suicidal Mentions: Independent Algorithm Validation %A Kaminsky,Zachary %A McQuaid,Robyn J %A Hellemans,Kim GC %A Patterson,Zachary R %A Saad,Mysa %A Gabrys,Robert L %A Kendzerska,Tetyana %A Abizaid,Alfonso %A Robillard,Rebecca %+ University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada, 1 6137226521 ext 7003, Zachary.Kaminsky@theroyal.ca %K suicide %K prediction %K social media %K machine learning %K suicide risk model %K validation %K prediction %K natural language processing %K suicide risk %K Twitter %K suicidal ideation %K suicidal mention %D 2024 %7 5.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous efforts to apply machine learning–based natural language processing to longitudinally collected social media data have shown promise in predicting suicide risk. Objective: Our primary objective was to externally validate our previous machine learning algorithm, the Suicide Artificial Intelligence Prediction Heuristic (SAIPH), against external survey data in 2 independent cohorts. A second objective was to evaluate the efficacy of SAIPH as an indicator of changing suicidal ideation (SI) over time. The tertiary objective was to use SAIPH to evaluate factors important for improving or worsening suicidal trajectory on social media following suicidal mention. Methods: Twitter (subsequently rebranded as X) timeline data from a student survey cohort and COVID-19 survey cohort were scored using SAIPH and compared to SI questions on the Beck Depression Inventory and the Self-Report version of the Quick Inventory of Depressive Symptomatology in 159 and 307 individuals, respectively. SAIPH was used to evaluate changing SI trajectory following suicidal mentions in 2 cohorts collected using the Twitter application programming interface. Results: An interaction of the mean SAIPH score derived from 12 days of Twitter data before survey completion and the average number of posts per day was associated with quantitative SI metrics in each cohort (student survey cohort interaction β=.038, SD 0.014; F4,94=3.3, P=.01; and COVID-19 survey cohort interaction β=.0035, SD 0.0016; F4,493=2.9, P=.03). The slope of average daily SAIPH scores was associated with the change in SI scores within longitudinally followed individuals when evaluating periods of 2 weeks or less (ρ=0.27, P=.04). Using SAIPH as an indicator of changing SI, we evaluated SI trajectory in 2 cohorts with suicidal mentions, which identified that those with responses within 72 hours exhibit a significant negative association of the SAIPH score with time in the 3 weeks following suicidal mention (ρ=–0.52, P=.02). Conclusions: Taken together, our results not only validate the association of SAIPH with perceived stress, SI, and changing SI over time but also generate novel methods to evaluate the effects of social media interactions on changing suicidal trajectory. %M 39637380 %R 10.2196/49927 %U https://www.jmir.org/2024/1/e49927 %U https://doi.org/10.2196/49927 %U http://www.ncbi.nlm.nih.gov/pubmed/39637380 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63195 %T Dynamic Simulation Models of Suicide and Suicide-Related Behaviors: Systematic Review %A Gariepy,Genevieve %A Zahan,Rifat %A Osgood,Nathaniel D %A Yeoh,Benjamin %A Graham,Eva %A Orpana,Heather %+ Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada, 1 6139527608, genevieve.gariepy@phac-aspc.gc.ca %K suicide %K agent-based modeling %K complex system %K complexity science %K discrete-event simulation %K dynamic modeling %K microsimulation %K system dynamics %K systems science %K qualitative study %K dynamic simulation %K database %K depression %K mental state %K systematic review %K stress %D 2024 %7 2.12.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Suicide remains a public health priority worldwide with over 700,000 deaths annually, ranking as a leading cause of death among young adults. Traditional research methodologies have often fallen short in capturing the multifaceted nature of suicide, focusing on isolated risk factors rather than the complex interplay of individual, social, and environmental influences. Recognizing these limitations, there is a growing recognition of the value of dynamic simulation modeling to inform suicide prevention planning. Objective: This systematic review aims to provide a comprehensive overview of existing dynamic models of population-level suicide and suicide-related behaviors, and to summarize their methodologies, applications, and outcomes. Methods: Eight databases were searched, including MEDLINE, Embase, PsycINFO, Scopus, Compendex, ACM Digital Library, IEEE Xplore, and medRxiv, from inception to July 2023. We developed a search strategy in consultation with a research librarian. Two reviewers independently conducted the title and abstract and full-text screenings including studies using dynamic modeling methods (eg, System Dynamics and agent-based modeling) for suicide or suicide-related behaviors at the population level, and excluding studies on microbiology, bioinformatics, pharmacology, nondynamic modeling methods, and nonprimary modeling reports (eg, editorials and reviews). Reviewers extracted the data using a standardized form and assessed the quality of reporting using the STRESS (Strengthening the Reporting of Empirical Simulation Studies) guidelines. A narrative synthesis was conducted for the included studies. Results: The search identified 1574 studies, with 22 studies meeting the inclusion criteria, including 15 System Dynamics models, 6 agent-based models, and 1 microsimulation model. The studies primarily targeted populations in Australia and the United States, with some focusing on hypothetical scenarios. The models addressed various interventions ranging from specific clinical and health service interventions, such as mental health service capacity increases, to broader social determinants, including employment programs and reduction in access to means of suicide. The studies demonstrated the utility of dynamic models in identifying the synergistic effects of combined interventions and understanding the temporal dynamics of intervention impacts. Conclusions: Dynamic modeling of suicide and suicide-related behaviors, though still an emerging area, is expanding rapidly, adapting to a range of questions, settings, and contexts. While the quality of reporting was overall adequate, some studies lacked detailed reporting on model transparency and reproducibility. This review highlights the potential of dynamic modeling as a tool to support decision-making and to further our understanding of the complex dynamics of suicide and its related behaviors. Trial Registration: PROSPERO CRD42022346617; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346617 %M 39622024 %R 10.2196/63195 %U https://publichealth.jmir.org/2024/1/e63195 %U https://doi.org/10.2196/63195 %U http://www.ncbi.nlm.nih.gov/pubmed/39622024 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58162 %T Talk Time Differences Between Interregional and Intraregional Calls to a Crisis Helpline: Statistical Analysis %A Turkington,Robin %A Potts,Courtney %A Mulvenna,Maurice %A Bond,Raymond %A O'Neill,Siobhán %A Ennis,Edel %A Hardcastle,Katie %A Scowcroft,Elizabeth %A Moore,Ciaran %A Hamra,Louise %K crisis helplines %K call duration %K mental health %K suicide %K suicidal %K suicide prevention %K population-based %K help-seeking behavior %K Samaritans %K UK %K telephony %K telephone %K telephones %K one-way analysis %K call %K calls %K talk time %K support %K talk time differences %D 2024 %7 19.9.2024 %9 %J JMIR Ment Health %G English %X Background: National suicide prevention strategies are general population-based approaches to prevent suicide by promoting help-seeking behaviors and implementing interventions. Crisis helplines are one of the suicide prevention resources available for public use, where individuals experiencing a crisis can talk to a trained volunteer. Samaritans UK operates on a national scale, with a number of branches located within each of the United Kingdom’s 4 countries or regions. Objectives: The aim of this study was to identify any differences in call duration across the helpline service in order to determine whether service varied interregionally and intraregionally and to determine the impact of calls answered in the same region as the caller, compared with calls answered in a different region on the duration of calls made from landlines to Samaritans UK. Methods: Calls may be routed by Samaritans, wherein the telephony system sends the call to the next available volunteer, irrespective of location; therefore, individuals may be routed to a branch within the same region as the caller’s current region (intraregional calls) or routed to a branch that is in a different region from that of the caller’s current region (interregional calls). The origin of calls by region was identified using the landline prefix of the anonymized caller identifier, along with the region of the destination branch (as branch details are recorded in the call details record). First, a Levene’s test of homogeneity of variance was carried out for each condition, that is, England calls and Scotland calls. Thereafter, for each condition, a one-way ANOVA or one-way analysis of means was carried out to evaluate any significant differences in call duration. Results: ANOVA results showed that there are significant differences in call durations between intraregional calls and interregional calls (P<.001). Across all conditions within this study, callers stayed on the phone for a shorter period of time when routed to a branch that is within the same region as the call origin than if they were put through to a branch within a different region than the call origin. Conclusions: Statistical analyses showed that there were significant differences between interregional and intraregional calls. On average, callers to crisis helplines stayed on the phone for a shorter period of time if they were routed to a branch within the same region in which the call originated than if they were routed to a branch in a different region of origin. The findings from this study have practical applications, which may allow crisis helplines to manage their resources more effectively and improve caller satisfaction with the service. %R 10.2196/58162 %U https://mental.jmir.org/2024/1/e58162 %U https://doi.org/10.2196/58162 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52293 %T A Suicide Prevention Digital Technology for Individuals Experiencing an Acute Suicide Crisis in Emergency Departments: Naturalistic Observational Study of Real-World Acceptability, Feasibility, and Safety %A Dimeff,Linda A %A Koerner,Kelly %A Heard,Kandi %A Ruork,Allison K %A Kelley-Brimer,Angela %A Witterholt,Suzanne T %A Lardizabal,Mary Beth %A Clubb,Joseph R %A McComish,Julie %A Waghray,Arpan %A Dowdy,Roger %A Asad-Pursley,Sara %A Ilac,Maria %A Lawrence,Hannah %A Zhou,Frank %A Beadnell,Blair %+ Evidence-Based Practice Institute, 9450 SW Gemini Dr, PMB 68735, Beaverton, OR, 97008-7105, United States, 1 253 765 0455, linda.dimeff@jasprhealth.com %K suicide %K emergency department %K ED %K digital technology %K suicide prevention best practices %K individual %K particular %K suicide prevention %K evidence-based intervention %K Emergency department %K hospital %K vulnerable population %K Jaspr Health %K psychiatric %K psychiatrist %K care %K safety %D 2024 %7 16.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emergency departments (EDs) are the front line in providing suicide care. Expert consensus recommends the delivery of several suicide prevention evidence-based interventions for individuals with acute suicidal ideation in the ED. ED personnel demands and staff shortages compromise delivery and contribute to long wait times and unnecessary hospitalization. Digital technologies can play an important role in helping EDs deliver suicide care without placing further demands on the care team if their use is safe to patients in a routine care context. Objective: This study evaluates the safety and effectiveness of an evidence-based digital technology (Jaspr Health) designed for persons with acute suicidal ideation seeking psychiatric crisis ED services when used as part of routine ED-based suicide care. This study deployed Jaspr Health for real-world use in 2 large health care systems in the United States and aimed to evaluate (1) how and whether Jaspr Health could be safely and effectively used outside the context of a researcher-facilitated clinical trial, and (2) that Jaspr’s use would be associated with improved patient agitation and distress. Methods: Under the auspices of a nonsignificant risk device study, ED patients with acute suicidal ideation (N=962) from 2 health care systems representing 10 EDs received access to Jaspr Health as part of their routine suicide care. Primary outcome measures included how many eligible patients were assigned Jaspr Health, which modules were assigned and completed, and finally, the number of adverse events reported by patients or by medical staff. Secondary outcome measures were patient agitation, distress, and satisfaction. Results: The most frequent modules assigned were Comfort and Skills (98% of users; n=942) and lethal means assessment (90% of patient users; n=870). Patient task completion rates for all modules ranged from 51% to 79%. No adverse events were reported, suggesting that digital technologies can be safely used for people seeking ED-based psychiatric services. Statistically significant (P<.001) reductions in agitation and distress were reported after using the app. Average patient satisfaction ratings by site were 7.81 (SD 2.22) and 7.10 (SD 2.65), with 88.8% (n=325) and 84% (n=90) of patients recommending the app to others. Conclusions: Digital technologies such as Jaspr Health may be safely and effectively integrated into existing workflows to help deliver evidence-based suicide care in EDs. These findings hold promise for the use of digital technologies in delivering evidence-based care to other vulnerable populations in complex environments. %M 39283664 %R 10.2196/52293 %U https://formative.jmir.org/2024/1/e52293 %U https://doi.org/10.2196/52293 %U http://www.ncbi.nlm.nih.gov/pubmed/39283664 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56396 %T Breaking Down Barriers to a Suicide Prevention Helpline: Web-Based Randomized Controlled Trial %A Van der Burgt,Margot C A %A Mérelle,Saskia %A Brinkman,Willem-Paul %A Beekman,Aartjan T F %A Gilissen,Renske %K barrier reduction intervention %K suicidal ideation %K self-help %K suicide prevention helpline %K randomized controlled trial %K help-seeking %K suicide %K RCT %K self-test %K effectiveness %K prevention %K middle-aged %K behavioral %K attitudinal %K website visitors %K website visitor %K website %K men %K suicide prevention %D 2024 %7 5.9.2024 %9 %J JMIR Ment Health %G English %X Background: Every month, around 3800 people complete an anonymous self-test for suicidal thoughts on the website of the Dutch suicide prevention helpline. Although 70% score high on the severity of suicidal thoughts, <10% navigate to the web page about contacting the helpline. Objective: This study aimed to test the effectiveness of a brief barrier reduction intervention (BRI) in motivating people with severe suicidal thoughts to contact the suicide prevention helpline, specifically in high-risk groups such as men and middle-aged people. Methods: We conducted a fully automated, web-based, randomized controlled trial. Respondents with severe suicidal thoughts and little motivation to contact the helpline were randomly allocated either to a brief BRI, in which they received a short, tailored message based on their self-reported barrier to the helpline (n=610), or a general advisory text (care as usual as the control group: n=612). Effectiveness was evaluated using both behavioral and attitudinal measurements. The primary outcome measure was the use of a direct link to contact the helpline after completing the intervention or control condition. Secondary outcomes were the self-reported likelihood of contacting the helpline and satisfaction with the received self-test. Results: In total, 2124 website visitors completed the Suicidal Ideation Attributes Scale and the demographic questions in the entry screening questionnaire. Among them, 1222 were randomized into the intervention or control group. Eventually, 772 respondents completed the randomized controlled trial (intervention group: n=369; control group: n=403). The most selected barrier in both groups was “I don’t think that my problems are serious enough.” At the end of the trial, 33.1% (n=122) of the respondents in the intervention group used the direct link to the helpline. This was not significantly different from the respondents in the control group (144/403, 35.7%; odds ratio 0.87, 95% CI 0.64‐1.18, P=.38). However, the respondents who received the BRI did score higher on their self-reported likelihood of contacting the helpline at a later point in time (B=0.22, 95% CI 0.12‐0.32, P≤.001) and on satisfaction with the self-test (B=0.27, 95% CI 0.01‐0.53, P=.04). For male and middle-aged respondents specifically, the results were comparable to that of the whole group. Conclusions: This trial was the first time the helpline was able to connect with high-risk website visitors who were hesitant to contact the helpline. Although the BRI could not ensure that those respondents immediately used the direct link to the helpline at the end of the trial, it is encouraging that respondents indicated that they were more likely to contact the helpline at a later point in time. In addition, this low-cost intervention provided greater insight into the perceived barriers to service. Follow-up research should be focused on identifying the added value of other components (eg, video or photo material) in the BRI and increasing its effectiveness, especially for men and middle-aged people. Trial Registration: ClinicalTrials.gov NCT05458830; https://clinicaltrials.gov/study/NCT05458830 International Registered Report Identifier (IRRID): RR2-10.2196/41078 %R 10.2196/56396 %U https://mental.jmir.org/2024/1/e56396 %U https://doi.org/10.2196/56396 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e51570 %T Development and Implementation of Postdischarge Text Messages to Adolescents With Suicidal Thoughts and Behaviors Through Caring Contacts: Implementation Study %A Thomas,Glenn V %A Camacho,Elena %A Masood,Fatimah A %A Huang,Yungui %A Valleru,Jahnavi %A Bridge,Jeffrey A %A Ackerman,John %+ Behavioral Health Services, Nationwide Children’s Hospital, 444 Butterfly Gardens Dr., 2nd Fl., Columbus, OH, 43215, United States, 1 6143550814, John.Ackerman@nationwidechildrens.org %K mental health %K suicide prevention %K adolescent %K caring contacts %K mHealth %K Zero Suicide %K quality improvement %K care transitions %K safety plan %K behavioral health %K mobile phone %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Youth suicide is a pressing public health concern, and transitions in care after a suicidal crisis represent a period of elevated risk. Disruptions in continuity of care and emotional support occur frequently. “Caring contacts” validating messages post discharge have the potential to enhance connections with patients and have been shown to improve outcomes. More recently, positive outcomes have been noted using caring contact text messages (SMS and MMS), which hold promise for engaging patients in a pediatric setting, but there are few studies describing the large-scale implementation of such an approach. Objective: This study aims to describe the process of developing and implementing automated caring contacts within a quality improvement framework, using a standardized series of supportive texts and images, for adolescents discharged from high-acuity programs at a large midwestern pediatric hospital. We describe lessons learned, including challenges and factors contributing to success. Methods: We implemented the caring contacts intervention in 3 phases. Phase 1 entailed developing supportive statements and images designed to promote hope, inclusivity, and connection in order to create 2 sets of 8 text messages and corresponding images. Phase 2 included piloting caring contacts manually in the hospital’s Psychiatric Crisis Department and Inpatient Psychiatry Unit and assessing the feasibility of implementation in other services, as well as developing workflows and addressing legal considerations. Phase 3 consisted of implementing an automated process to scale within 4 participating hospital services and integrating enrollment into the hospital’s electronic medical records. Process outcome measures included staff compliance with approaching and enrolling eligible patients and results from an optional posttext survey completed by participants. Results: Compliance data are presented for 4062 adolescent patients eligible for caring contacts. Overall, 88.65% (3601/4062) of eligible patients were approached, of whom 52.43% (1888/3601) were enrolled. In total, 94.92% (1792/1888) of enrolled participants completed the program. Comparisons of the patients eligible, approached, enrolled, and completed are presented. Primary reasons for eligible patients declining include not having access to a mobile phone (686/1705, 40.23%) and caregivers preferring to discuss the intervention at a later time (754/1705, 44.22%). The majority of patients responding to the optional posttext survey reported that the texts made them feel moderately to very hopeful (219/264, 83%), supported (232/264, 87.9%), that peers would be helped by these texts (243/264, 92%), and that they would like to keep receiving texts given the option (227/264, 86%). Conclusions: This study describes the successful implementation of automated postdischarge caring contacts texts to scale with an innovative use of images and demonstrates how a quality improvement methodology resulted in a more effective and efficient process. This paper also highlights the potential for technology to enhance care for at-risk youth and create more accessible, inclusive, and sustainable prevention strategies. %M 39137019 %R 10.2196/51570 %U https://pediatrics.jmir.org/2024/1/e51570 %U https://doi.org/10.2196/51570 %U http://www.ncbi.nlm.nih.gov/pubmed/39137019 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48907 %T Identifying Reddit Users at a High Risk of Suicide and Their Linguistic Features During the COVID-19 Pandemic: Growth-Based Trajectory Model %A Yan,Yifei %A Li,Jun %A Liu,Xingyun %A Li,Qing %A Yu,Nancy Xiaonan %+ Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, HKSAR, P. R. China, Hong Kong, 000, China (Hong Kong), 852 34429436, nancy.yu@cityu.edu.hk %K COVID-19 pandemic %K Reddit %K suicide risk %K trajectory %D 2024 %7 8.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide has emerged as a critical public health concern during the COVID-19 pandemic. With social distancing measures in place, social media has become a significant platform for individuals expressing suicidal thoughts and behaviors. However, existing studies on suicide using social media data often overlook the diversity among users and the temporal dynamics of suicide risk. Objective: By examining the variations in post volume trajectories among users on the r/SuicideWatch subreddit during the COVID-19 pandemic, this study aims to investigate the heterogeneous patterns of change in suicide risk to help identify social media users at high risk of suicide. We also characterized their linguistic features before and during the pandemic. Methods: We collected and analyzed post data every 6 months from March 2019 to August 2022 for users on the r/SuicideWatch subreddit (N=6163). A growth-based trajectory model was then used to investigate the trajectories of post volume to identify patterns of change in suicide risk during the pandemic. Trends in linguistic features within posts were also charted and compared, and linguistic markers were identified across the trajectory groups using regression analysis. Results: We identified 2 distinct trajectories of post volume among r/SuicideWatch subreddit users. A small proportion of users (744/6163, 12.07%) was labeled as having a high risk of suicide, showing a sharp and lasting increase in post volume during the pandemic. By contrast, most users (5419/6163, 87.93%) were categorized as being at low risk of suicide, with a consistently low and mild increase in post volume during the pandemic. In terms of the frequency of most linguistic features, both groups showed increases at the initial stage of the pandemic. Subsequently, the rising trend continued in the high-risk group before declining, while the low-risk group showed an immediate decrease. One year after the pandemic outbreak, the 2 groups exhibited differences in their use of words related to the categories of personal pronouns; affective, social, cognitive, and biological processes; drives; relativity; time orientations; and personal concerns. In particular, the high-risk group was discriminant in using words related to anger (odds ratio [OR] 3.23, P<.001), sadness (OR 3.23, P<.001), health (OR 2.56, P=.005), achievement (OR 1.67, P=.049), motion (OR 4.17, P<.001), future focus (OR 2.86, P<.001), and death (OR 4.35, P<.001) during this stage. Conclusions: Based on the 2 identified trajectories of post volume during the pandemic, this study divided users on the r/SuicideWatch subreddit into suicide high- and low-risk groups. Our findings indicated heterogeneous patterns of change in suicide risk in response to the pandemic. The high-risk group also demonstrated distinct linguistic features. We recommend conducting real-time surveillance of suicide risk using social media data during future public health crises to provide timely support to individuals at potentially high risk of suicide. %M 39115925 %R 10.2196/48907 %U https://www.jmir.org/2024/1/e48907 %U https://doi.org/10.2196/48907 %U http://www.ncbi.nlm.nih.gov/pubmed/39115925 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57103 %T Suicidal Ideation and Attempts Among Youth With Physical-Mental Comorbidity in Canada: Proposal for an Epidemiological Study %A Ferro,Mark A %A Chan,Christy K Y %A Browne,Dillon T %A Colman,Ian %A Dubin,Joel A %A Duncan,Laura %+ School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567, mark.ferro@uwaterloo.ca %K adolescents %K children %K chronic disease %K epidemiology %K mental health %K suicidality %D 2024 %7 4.7.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: Evidence suggests that having a chronic physical illness (CPI; eg, asthma, diabetes, and epilepsy) is an independent risk factor for suicidality (ie, suicidal ideation or attempts) among youth. Less is known about the mechanisms linking CPI and suicidality. Some evidence suggests that mental illness (eg, depression and anxiety) or neurodevelopmental disorder (eg, attention-deficit/hyperactivity disorder) mediates or moderates the CPI-suicidality association. Missing from the knowledge base is information on the association between having co-occurring CPI and mental illness or neurodevelopmental disorder (MIND) on youth suicidality. Objective: This study uses epidemiological data from the 2019 Canadian Health Survey of Children and Youth (CHSCY) to study the intersection of CPI, MIND, and suicidality in youth. We will estimate prevalence, identify predictors, and investigate psychosocial and service use outcomes for youth with CPI-MIND comorbidity versus other morbidity groups (ie, healthy, CPI only, and MIND only). Methods: Conducted by Statistics Canada, the CHSCY collected data from 47,850 children (aged 1-17 years) and their primary caregiving parent. Measures of youth CPI, MIND, family environment, and sociodemographics are available using youth and parent informants. Information on psychiatric services use is available via parent report and linkage to national administrative health data found in the National Ambulatory Care Reporting System and the Discharge Abstract Database, which allow the investigation of hospital-based mental health services (eg, emergency department visits, hospitalizations, and length of stay in hospital). Questions about suicidality were restricted to youths aged 15-17 years (n=6950), which form our analytic sample. Weighted regression-based analyses will account for the complex survey design. Results: Our study began in November 2023, funded by the American Foundation for Suicide Prevention (SRG-0-008-22). Access to the linked CHSCY microdata file was granted in May 2024. Initial examination of CHSCY data shows that approximately 20% (1390/6950) of youth have CPI, 7% (490/6950) have MIND, 7% (490/6950) seriously considered suicide in the past year, and 3% (210/6950) had attempted suicide anytime during their life. Conclusions: Findings will provide estimates of suicidality among youth with CPI-MIND comorbidity, which will inform intervention planning to prevent loss of life in this vulnerable population. Modeling correlates of suicidality will advance understanding of the relative and joint effects of factors at multiple levels—information needed to target prevention efforts and services. Understanding patterns of psychiatric service use is vital to understanding access and barriers to services. This will inform whether use matches need, identifying opportunities to advise policy makers about upstream resources to prevent suicidality. Importantly, findings will provide robust baseline of information on the link between CPI-MIND comorbidity and suicidality in youth, which can be used by future studies to address questions related to the impact of the COVID-19 pandemic and associated countermeasures in this vulnerable population of youth. International Registered Report Identifier (IRRID): DERR1-10.2196/57103 %M 38963692 %R 10.2196/57103 %U https://www.researchprotocols.org/2024/1/e57103 %U https://doi.org/10.2196/57103 %U http://www.ncbi.nlm.nih.gov/pubmed/38963692 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49879 %T News Media Framing of Suicide Circumstances and Gender: Mixed Methods Analysis %A Foriest,Jasmine C %A Mittal,Shravika %A Kim,Eugenia %A Carmichael,Andrea %A Lennon,Natalie %A Sumner,Steven A %A De Choudhury,Munmun %+ School of Interactive Computing, Georgia Institute of Technology, 225 North Ave NW, Atlanta, GA, 30332, United States, 1 7064643658, jay@gatech.edu %K suicide %K framing %K disparities %K reporting guidelines %K gender %K stigma %K glorification %K glorify %K glorifying %K suicidal %K self harm %K suicides %K stigmatizing %K stigmatization %K disparities %K reporting %K news %K journalist %K journalists %K journalism %K machine learning %K NLP %K natural language processing %K LLM %K LLMs %K language model %K language models %K linguistic %K linguistics %K reporter %K reporters %K gender %K digital mental health %K mHealth %K media %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Suicide is a leading cause of death worldwide. Journalistic reporting guidelines were created to curb the impact of unsafe reporting; however, how suicide is framed in news reports may differ by important characteristics such as the circumstances and the decedent’s gender. Objective: This study aimed to examine the degree to which news media reports of suicides are framed using stigmatized or glorified language and differences in such framing by gender and circumstance of suicide. Methods: We analyzed 200 news articles regarding suicides and applied the validated Stigma of Suicide Scale to identify stigmatized and glorified language. We assessed linguistic similarity with 2 widely used metrics, cosine similarity and mutual information scores, using a machine learning–based large language model. Results: News reports of male suicides were framed more similarly to stigmatizing (P<.001) and glorifying (P=.005) language than reports of female suicides. Considering the circumstances of suicide, mutual information scores indicated that differences in the use of stigmatizing or glorifying language by gender were most pronounced for articles attributing legal (0.155), relationship (0.268), or mental health problems (0.251) as the cause. Conclusions: Linguistic differences, by gender, in stigmatizing or glorifying language when reporting suicide may exacerbate suicide disparities. %M 38959061 %R 10.2196/49879 %U https://mental.jmir.org/2024/1/e49879 %U https://doi.org/10.2196/49879 %U http://www.ncbi.nlm.nih.gov/pubmed/38959061 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52773 %T Predicting the Population Risk of Suicide Using Routinely Collected Health Administrative Data in Quebec, Canada: Model-Based Synthetic Estimation Study %A Wang,JianLi %A Kharrat,Fatemeh Gholi Zadeh %A Gariépy,Geneviève %A Gagné,Christian %A Pelletier,Jean-François %A Massamba,Victoria Kubuta %A Lévesque,Pascale %A Mohammed,Mada %A Lesage,Alain %+ Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Ave, Halifax, NS, B3H 1V7, Canada, 1 9024736684, JianLi.Wang@dal.ca %K population risk prediction %K case-control %K development %K validation %K health administrative data %K suicide %K depression %K anxiety %K Quebec %K Canada %K mental health %K suicide prevention %K prevention %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K male %K female %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Suicide is a significant public health issue. Many risk prediction tools have been developed to estimate an individual’s risk of suicide. Risk prediction models can go beyond individual risk assessment; one important application of risk prediction models is population health planning. Suicide is a result of the interaction among the risk and protective factors at the individual, health care system, and community levels. Thus, policy and decision makers can play an important role in suicide prevention. However, few prediction models for the population risk of suicide have been developed. Objective: This study aims to develop and validate prediction models for the population risk of suicide using health administrative data, considering individual-, health system–, and community-level predictors. Methods: We used a case-control study design to develop sex-specific risk prediction models for suicide, using the health administrative data in Quebec, Canada. The training data included all suicide cases (n=8899) that occurred from January 1, 2002, to December 31, 2010. The control group was a 1% random sample of living individuals in each year between January 1, 2002, and December 31, 2010 (n=645,590). Logistic regression was used to develop the prediction models based on individual-, health care system–, and community-level predictors. The developed model was converted into synthetic estimation models, which concerted the individual-level predictors into community-level predictors. The synthetic estimation models were directly applied to the validation data from January 1, 2011, to December 31, 2019. We assessed the performance of the synthetic estimation models with four indicators: the agreement between predicted and observed proportions of suicide, mean average error, root mean square error, and the proportion of correctly identified high-risk regions. Results: The sex-specific models based on individual data had good discrimination (male model: C=0.79; female model: C=0.85) and calibration (Brier score for male model 0.01; Brier score for female model 0.005). With the regression-based synthetic models applied in the validation data, the absolute differences between the synthetic risk estimates and observed suicide risk ranged from 0% to 0.001%. The root mean square errors were under 0.2. The synthetic estimation model for males correctly predicted 4 of 5 high-risk regions in 8 years, and the model for females correctly predicted 4 of 5 high-risk regions in 5 years. Conclusions: Using linked health administrative databases, this study demonstrated the feasibility and the validity of developing prediction models for the population risk of suicide, incorporating individual-, health system–, and community-level variables. Synthetic estimation models built on routinely collected health administrative data can accurately predict the population risk of suicide. This effort can be enhanced by timely access to other critical information at the population level. %M 38941610 %R 10.2196/52773 %U https://publichealth.jmir.org/2024/1/e52773 %U https://doi.org/10.2196/52773 %U http://www.ncbi.nlm.nih.gov/pubmed/38941610 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48776 %T Investigating the Interrelationships Among Mental Health, Substance Use Disorders, and Suicidal Ideation Among Lesbian, Gay, and Bisexual Adults in the United States: Population-Based Statewide Survey Study %A Chan,Alex Siu Wing %A Tam,Hon Lon %A Wong,Florence Kwai Ching %A Wong,Gordon %A Leung,Lok Man %A Ho,Jacqueline Mei Chi %A Tang,Patrick Ming Kuen %A Yan,Elsie %+ Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, ELB704B, Hong Kong, 999077, China, 852 39439306, hltam@cuhk.edu.hk %K mental health %K adults %K lesbian, gay, and bisexual %K depression %K drug abuse %K drug dependence %K suicidality risk %K mental illness %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Mental health disparities have been documented among lesbian, gay, and bisexual (LGB) adults in the United States. Substance use disorders and suicidal ideation have been identified as important health concerns for this population. However, the interrelationships among these factors are not well understood. Objective: This study aims to investigate the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States using a population-based statewide survey. Methods: Our study was an observational cross-sectional analysis, and the data for this study were collected from a sample of LGB adults who participated in the statewide survey. The survey collected information on mental health, substance use disorders, and suicidal ideation using validated measures. Descriptive statistics and inferential data analysis were conducted to explore the interrelationships among these factors. Results: The results showed that LGB adults who reported higher levels of depression and drug abuse and dependence also reported higher levels of suicidal tendency and mental illness. Inferential data analysis using χ2 tests revealed significant differences in depression score (χ22=458.241; P<.001), drug abuse and dependence score (χ22=226.946; P<.001), suicidal tendency score (χ22=67.795; P<.001), and mental illness score (χ22=363.722; P<.001) among the 3 sexual identity groups. Inferential data analysis showed significant associations between sexual identity and mental health outcomes, with bisexual individuals reporting the highest levels of depression, drug abuse and dependence, suicidal tendency, and mental illness. Conclusions: This study provides important insights into the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States. The findings underscore the need for targeted interventions and research aimed at addressing the mental health needs of sexual minority populations. Future research should aim to better understand the underlying mechanisms driving these disparities and develop culturally sensitive and tailored interventions that meet the unique needs of LGB individuals. Reducing stigma and discrimination against sexual minority populations is also crucial to improving their mental health outcomes. %M 38916938 %R 10.2196/48776 %U https://publichealth.jmir.org/2024/1/e48776 %U https://doi.org/10.2196/48776 %U http://www.ncbi.nlm.nih.gov/pubmed/38916938 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50024 %T A Web-Based Training Program for School Staff to Respond to Self-Harm: Design and Development of the Supportive Response to Self-Harm Program %A Burn,Anne-Marie %A Hall,Poppy %A Anderson,Joanna %+ Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, United Kingdom, 44 1223336961, amb278@cam.ac.uk %K self-harm %K schools %K young people %K youth %K school staff %K training %K coproduction %K qualitative %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-harm is common among adolescents and is a major public health concern. School staff may be the first adults to notice a young person’s self-harm and are well placed to provide support or signpost students to help. However, school staff often report that they do not feel equipped or confident to support students. Despite the need, there is a lack of evidence-based training about self-harm for school staff. A web-based training program would provide schools with a flexible and cost-effective method of increasing staff knowledge, skills, and confidence in how to respond to students who self-harm. Objective: The main objective of this study was to coproduce an evidence-based training program for school staff to improve their skills and confidence in responding to students who self-harm (Supportive Response to Self-Harm [SORTS]). This paper describes the design and development process of an initial prototype coproduced with stakeholders to ensure that the intervention meets their requirements. Methods: Using a user-centered design and person-based approach, the SORTS prototype was informed by (1) a review of research literature, existing guidelines, and policies; (2) coproduction discussions with the technical provider and subject matter experts (mental health, education, and self-harm); (3) findings from focus groups with young people; and (4) coproduction workshops with school staff. Thematic analysis using the framework method was applied. Results: Coproduction sessions with experts and the technical provider enabled us to produce a draft of the training content, a wireframe, and example high-fidelity user interface designs. Analysis of focus groups and workshops generated four key themes: (1) need for a training program; (2) acceptability, practicality, and implementation; (3) design, content, and navigation; and (4) adaptations and improvements. The findings showed that there is a clear need for a web-based training program about self-harm in schools, and the proposed program content and design were useful, practical, and acceptable. Consultations with stakeholders informed the iterative development of the prototype. Conclusions: SORTS is a web-based training program for school staff to appropriately respond to students who self-harm that is based on research evidence and developed in collaboration with stakeholders. The SORTS program will equip school staff with the skills and strategies to respond in a supportive way to students who self-harm and encourage schools to adopt a whole-school approach to self-harm. Further research is needed to complete the intervention development based on the feedback from this study and evaluate the program’s effectiveness. If found to be effective, the SORTS program could be implemented in schools and other youth organizations. %M 38833286 %R 10.2196/50024 %U https://formative.jmir.org/2024/1/e50024 %U https://doi.org/10.2196/50024 %U http://www.ncbi.nlm.nih.gov/pubmed/38833286 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55913 %T Machine Learning–Based Prediction of Suicidal Thinking in Adolescents by Derivation and Validation in 3 Independent Worldwide Cohorts: Algorithm Development and Validation Study %A Kim,Hyejun %A Son,Yejun %A Lee,Hojae %A Kang,Jiseung %A Hammoodi,Ahmed %A Choi,Yujin %A Kim,Hyeon Jin %A Lee,Hayeon %A Fond,Guillaume %A Boyer,Laurent %A Kwon,Rosie %A Woo,Selin %A Yon,Dong Keon %+ Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, 23 Kyungheedae–ro, Dongdaemun–gu, Seoul, 02447, Republic of Korea, 82 2 6935 2476, yonkkang@gmail.com %K adolescent %K machine learning %K Shapley additive explanations %K SHAP value %K suicidal thinking %K XGBoost %K mental health %K predictive model %K risk behavior %D 2024 %7 17.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide is the second-leading cause of death among adolescents and is associated with clusters of suicides. Despite numerous studies on this preventable cause of death, the focus has primarily been on single nations and traditional statistical methods. Objective: This study aims to develop a predictive model for adolescent suicidal thinking using multinational data sets and machine learning (ML). Methods: We used data from the Korea Youth Risk Behavior Web-based Survey with 566,875 adolescents aged between 13 and 18 years and conducted external validation using the Youth Risk Behavior Survey with 103,874 adolescents and Norway’s University National General Survey with 19,574 adolescents. Several tree-based ML models were developed, and feature importance and Shapley additive explanations values were analyzed to identify risk factors for adolescent suicidal thinking. Results: When trained on the Korea Youth Risk Behavior Web-based Survey data from South Korea with a 95% CI, the XGBoost model reported an area under the receiver operating characteristic (AUROC) curve of 90.06% (95% CI 89.97-90.16), displaying superior performance compared to other models. For external validation using the Youth Risk Behavior Survey data from the United States and the University National General Survey from Norway, the XGBoost model achieved AUROCs of 83.09% and 81.27%, respectively. Across all data sets, XGBoost consistently outperformed the other models with the highest AUROC score, and was selected as the optimal model. In terms of predictors of suicidal thinking, feelings of sadness and despair were the most influential, accounting for 57.4% of the impact, followed by stress status at 19.8%. This was followed by age (5.7%), household income (4%), academic achievement (3.4%), sex (2.1%), and others, which contributed less than 2% each. Conclusions: This study used ML by integrating diverse data sets from 3 countries to address adolescent suicide. The findings highlight the important role of emotional health indicators in predicting suicidal thinking among adolescents. Specifically, sadness and despair were identified as the most significant predictors, followed by stressful conditions and age. These findings emphasize the critical need for early diagnosis and prevention of mental health issues during adolescence. %M 38758578 %R 10.2196/55913 %U https://www.jmir.org/2024/1/e55913 %U https://doi.org/10.2196/55913 %U http://www.ncbi.nlm.nih.gov/pubmed/38758578 %0 Journal Article %@ 2368-7959 %I %V 11 %N %P e53730 %T Emerging Trends of Self-Harm Using Sodium Nitrite in an Online Suicide Community: Observational Study Using Natural Language Processing Analysis %A Das,Sudeshna %A Walker,Drew %A Rajwal,Swati %A Lakamana,Sahithi %A Sumner,Steven A %A Mack,Karin A %A Kaczkowski,Wojciech %A Sarker,Abeed %K online suicide community %K suicide %K sodium nitrite %K sodium nitrite sources %K mental health %K adolescent %K juvenile %K self harm %K Sanctioned Suicide %K online forum %K US %K public health %K surveillance %K data mining %K natural language processing %K machine learning %K usage %K suicidal %K accuracy %K consumption %K information %K United States %D 2024 %7 2.5.2024 %9 %J JMIR Ment Health %G English %X Background: There is growing concern around the use of sodium nitrite (SN) as an emerging means of suicide, particularly among younger people. Given the limited information on the topic from traditional public health surveillance sources, we studied posts made to an online suicide discussion forum, “Sanctioned Suicide,” which is a primary source of information on the use and procurement of SN. Objective: This study aims to determine the trends in SN purchase and use, as obtained via data mining from subscriber posts on the forum. We also aim to determine the substances and topics commonly co-occurring with SN, as well as the geographical distribution of users and sources of SN. Methods: We collected all publicly available from the site’s inception in March 2018 to October 2022. Using data-driven methods, including natural language processing and machine learning, we analyzed the trends in SN mentions over time, including the locations of SN consumers and the sources from which SN is procured. We developed a transformer-based source and location classifier to determine the geographical distribution of the sources of SN. Results: Posts pertaining to SN show a rise in popularity, and there were statistically significant correlations between real-life use of SN and suicidal intent when compared to data from the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (⍴=0.727; P<.001) and the National Poison Data System (⍴=0.866; P=.001). We observed frequent co-mentions of antiemetics, benzodiazepines, and acid regulators with SN. Our proposed machine learning–based source and location classifier can detect potential sources of SN with an accuracy of 72.92% and showed consumption in the United States and elsewhere. Conclusions: Vital information about SN and other emerging mechanisms of suicide can be obtained from online forums. %R 10.2196/53730 %U https://mental.jmir.org/2024/1/e53730 %U https://doi.org/10.2196/53730 %0 Journal Article %@ 2368-7959 %I %V 11 %N %P e50192 %T Asynchronous Versus Synchronous Screening for Depression and Suicidality in a Primary Health Care System: Quality Improvement Study %A Sattler,Amelia %A Dunn,Julia %A Albarran,Marleni %A Berger,Charlotte %A Calugar,Ana %A Carper,John %A Chirravuri,Lalitha %A Jawad,Nadine %A Zein,Mira %A McGovern,Mark %K depression diagnosis %K primary health care methods %K electronic health records utilization %K quality improvement %K web-based universal screening methods %K suicide prevention and control %K screening %K depression %K asynchronous %K synchronous %K primary care %K suicide %K intervention %K prevention %D 2024 %7 1.5.2024 %9 %J JMIR Ment Health %G English %X Background: Despite being a debilitating, costly, and potentially life-threatening condition, depression is often underdiagnosed and undertreated. Previsit Patient Health Questionnaire-9 (PHQ-9) may help primary care health systems identify symptoms of severe depression and prevent suicide through early intervention. Little is known about the impact of previsit web-based PHQ-9 on patient care and safety. Objective: We aimed to investigate differences among patient characteristics and provider clinical responses for patients who complete a web-based (asynchronous) versus in-clinic (synchronous) PHQ-9. Methods: This quality improvement study was conducted at 33 clinic sites across 2 health systems in Northern California from November 1, 2020, to May 31, 2021, and evaluated 1683 (0.9% of total PHQs completed) records of patients endorsing thoughts that they would be better off dead or of self-harm (question 9 in the PHQ-9) following the implementation of a depression screening program that included automated electronic previsit PHQ-9 distribution. Patient demographics and providers’ clinical response (suicide risk assessment, triage nurse connection, medication management, electronic consultation with psychiatrist, and referral to social worker or psychiatrist) were compared for patients with asynchronous versus synchronous PHQ-9 completion. Results: Of the 1683 patients (female: n=1071, 63.7%; non-Hispanic: n=1293, 76.8%; White: n=831, 49.4%), Hispanic and Latino patients were 40% less likely to complete a PHQ-9 asynchronously (odds ratio [OR] 0.6, 95% CI 0.45-0.8; P<.001). Patients with Medicare insurance were 36% (OR 0.64, 95% CI 0.51-0.79) less likely to complete a PHQ-9 asynchronously than patients with private insurance. Those with moderate to severe depression were 1.61 times more likely (95% CI 1.21-2.15; P=.001) to complete a PHQ-9 asynchronously than those with no or mild symptoms. Patients who completed a PHQ-9 asynchronously were twice as likely to complete a Columbia-Suicide Severity Rating Scale (OR 2.41, 95% CI 1.89-3.06; P<.001) and 77% less likely to receive a referral to psychiatry (OR 0.23, 95% CI 0.16-0.34; P<.001). Those who endorsed question 9 “more than half the days” (OR 1.62, 95% CI 1.06-2.48) and “nearly every day” (OR 2.38, 95% CI 1.38-4.12) were more likely to receive a referral to psychiatry than those who endorsed question 9 “several days” (P=.002). Conclusions: Shifting depression screening from in-clinic to previsit led to a dramatic increase in PHQ-9 completion without sacrificing patient safety. Asynchronous PHQ-9 can decrease workload on frontline clinical team members, increase patient self-reporting, and elicit more intentional clinical responses from providers. Observed disparities will inform future improvement efforts. %R 10.2196/50192 %U https://mental.jmir.org/2024/1/e50192 %U https://doi.org/10.2196/50192 %0 Journal Article %@ 2291-9694 %I %V 12 %N %P e48007 %T Reducing Firearm Access for Suicide Prevention: Implementation Evaluation of the Web-Based “Lock to Live” Decision Aid in Routine Health Care Encounters %A Richards,Julie Angerhofer %A Kuo,Elena %A Stewart,Christine %A Shulman,Lisa %A Parrish,Rebecca %A Whiteside,Ursula %A Boggs,Jennifer M %A Simon,Gregory E %A Rowhani-Rahbar,Ali %A Betz,Marian E %K suicide prevention %K firearm %K internet %K implementation %K suicide %K prevention %K decision aid %K risk %K feasible %K support %K evaluation %K mental health %K electronic health record %K tool %D 2024 %7 22.4.2024 %9 %J JMIR Med Inform %G English %X Background: “Lock to Live” (L2L) is a novel web-based decision aid for helping people at risk of suicide reduce access to firearms. Researchers have demonstrated that L2L is feasible to use and acceptable to patients, but little is known about how to implement L2L during web-based mental health care and in-person contact with clinicians. Objective: The goal of this project was to support the implementation and evaluation of L2L during routine primary care and mental health specialty web-based and in-person encounters. Methods: The L2L implementation and evaluation took place at Kaiser Permanente Washington (KPWA)—a large, regional, nonprofit health care system. Three dimensions from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model—Reach, Adoption, and Implementation—were selected to inform and evaluate the implementation of L2L at KPWA (January 1, 2020, to December 31, 2021). Electronic health record (EHR) data were used to purposefully recruit adult patients, including firearm owners and patients reporting suicidality, to participate in semistructured interviews. Interview themes were used to facilitate L2L implementation and inform subsequent semistructured interviews with clinicians responsible for suicide risk mitigation. Audio-recorded interviews were conducted via the web, transcribed, and coded, using a rapid qualitative inquiry approach. A descriptive analysis of EHR data was performed to summarize L2L reach and adoption among patients identified at high risk of suicide. Results: The initial implementation consisted of updates for clinicians to add a URL and QR code referencing L2L to the safety planning EHR templates. Recommendations about introducing L2L were subsequently derived from the thematic analysis of semistructured interviews with patients (n=36), which included (1) “have an open conversation,” (2) “validate their situation,” (3) “share what to expect,” (4) “make it accessible and memorable,” and (5) “walk through the tool.” Clinicians’ interviews (n=30) showed a strong preference to have L2L included by default in the EHR-based safety planning template (in contrast to adding it manually). During the 2-year observation period, 2739 patients reported prior-month suicide attempt planning or intent and had a documented safety plan during the study period, including 745 (27.2%) who also received L2L. Over four 6-month subperiods of the observation period, L2L adoption rates increased substantially from 2% to 29% among primary care clinicians and from <1% to 48% among mental health clinicians. Conclusions: Understanding the value of L2L from users’ perspectives was essential for facilitating implementation and increasing patient reach and clinician adoption. Incorporating L2L into the existing system-level, EHR-based safety plan template reduced the effort to use L2L and was likely the most impactful implementation strategy. As rising suicide rates galvanize the urgency of prevention, the findings from this project, including L2L implementation tools and strategies, will support efforts to promote safety for suicide prevention in health care nationwide. %R 10.2196/48007 %U https://medinform.jmir.org/2024/1/e48007 %U https://doi.org/10.2196/48007 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52763 %T Translating Suicide Safety Planning Components Into the Design of mHealth App Features: Systematic Review %A Gryglewicz,Kim %A Orr,Victoria L %A McNeil,Marissa J %A Taliaferro,Lindsay A %A Hines,Serenea %A Duffy,Taylor L %A Wisniewski,Pamela J %+ School of Social Work, University of Central Florida, 12805 Pegasus Drive HS I, Orlando, FL, 32816, United States, 1 14078232954, kgryglew@ucf.edu %K suicide prevention %K suicide safety planning %K mobile health %K mHealth apps %K eHealth %K digital health %K systematic review %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses %K PRISMA %D 2024 %7 28.3.2024 %9 Review %J JMIR Ment Health %G English %X Background: Suicide safety planning is an evidence-based approach used to help individuals identify strategies to keep themselves safe during a mental health crisis. This study systematically reviewed the literature focused on mobile health (mHealth) suicide safety planning apps. Objective: This study aims to evaluate the extent to which apps integrated components of the safety planning intervention (SPI), and if so, how these safety planning components were integrated into the design-based features of the apps. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we systematically analyzed 14 peer-reviewed studies specific to mHealth apps for suicide safety planning. We conducted an analysis of the literature to evaluate how the apps incorporated SPI components and examined similarities and differences among the apps by conducting a comparative analysis of app features. An independent review of SPI components and app features was conducted by downloading the available apps. Results: Most of the mHealth apps (5/7, 71%) integrated SPI components and provided customizable features that expanded upon traditional paper-based safety planning processes. App design features were categorized into 5 themes, including interactive features, individualized user experiences, interface design, guidance and training, and privacy and sharing. All apps included access to community supports and revisable safety plans. Fewer mHealth apps (3/7, 43%) included interactive features, such as associating coping strategies with specific stressors. Most studies (10/14, 71%) examined the usability, feasibility, and acceptability of the safety planning mHealth apps. Usability findings were generally positive, as users often found these apps easy to use and visually appealing. In terms of feasibility, users preferred using mHealth apps during times of crisis, but the continuous use of the apps outside of crisis situations received less support. Few studies (4/14, 29%) examined the effectiveness of mHealth apps for suicide-related outcomes. Positive shifts in attitudes and desire to live, improved coping strategies, enhanced emotional stability, and a decrease in suicidal thoughts or self-harm behaviors were examined in these studies. Conclusions: Our study highlights the need for researchers, clinicians, and app designers to continue to work together to align evidence-based research on mHealth suicide safety planning apps with lessons learned for how to best deliver these technologies to end users. Our review brings to light mHealth suicide safety planning strategies needing further development and testing, such as lethal means guidance, collaborative safety planning, and the opportunity to embed more interactive features that leverage the advanced capabilities of technology to improve client outcomes as well as foster sustained user engagement beyond a crisis. Although preliminary evidence shows that these apps may help to mitigate suicide risk, clinical trials with larger sample sizes and more robust research designs are needed to validate their efficacy before the widespread adoption and use. %M 38546711 %R 10.2196/52763 %U https://mental.jmir.org/2024/1/e52763 %U https://doi.org/10.2196/52763 %U http://www.ncbi.nlm.nih.gov/pubmed/38546711 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e47699 %T The Journey of Engaging With Web-Based Self-Harm and Suicide Content: Longitudinal Qualitative Study %A Haime,Zoë %A Kennedy,Laura %A Grace,Lydia %A Cohen,Rachel %A Derges,Jane %A Biddle,Lucy %+ Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom, 44 01179289000, zoe.haime@bristol.ac.uk %K suicide %K self-harm %K online %K longitudinal %K qualitative %D 2024 %7 28.3.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Self-harm and suicide are major public health concerns worldwide, with attention focused on the web environment as a helpful or harmful influence. Longitudinal research on self-harm and suicide–related internet use is limited, highlighting a paucity of evidence on long-term patterns and effects of engaging with such content. Objective: This study explores the experiences of people engaging with self-harm or suicide content over a 6-month period. Methods: This study used qualitative and digital ethnographic methods longitudinally, including one-to-one interviews at 3 time points to explore individual narratives. A trajectory analysis approach involving 4 steps was used to interpret the data. Results: The findings from 14 participants established the web-based journey of people who engage with self-harm or suicide content. In total, 5 themes were identified: initial interactions with self-harm or suicide content, changes in what self-harm or suicide content people engage with and where, changes in experiences of self-harm or suicide behaviors associated with web-based self-harm or suicide content engagement, the disengagement-reengagement cycle, and future perspectives on web-based self-harm or suicide content engagement. Initial engagements were driven by participants seeking help, often when offline support had been unavailable. Some participants’ exposure to self-harm and suicide content led to their own self-harm and suicide behaviors, with varying patterns of change over time. Notably, disengagement from web-based self-harm and suicide spaces served as a protective measure for all participants, but the pull of familiar content resulted in only brief periods of disconnection. Participants also expressed future intentions to continue returning to these self-harm and suicide web-based spaces, acknowledging the nonlinear nature of their own recovery journey and aiming to support others in the community. Within the themes identified in this study, narratives revealed that participants’ behavior was shaped by cognitive flexibility and rigidity, metacognitive abilities, and digital expertise. Opportunities for behavior change arose during periods of cognitive flexibility prompted by life events, stressors, and shifts in mental health. Participants sought diverse and potentially harmful content during challenging times but moved toward recovery-oriented engagements in positive circumstances. Metacognitive and digital efficacy skills also played a pivotal role in participants’ control of web-based interactions, enabling more effective management of content or platforms or sites that posed potential harms. Conclusions: This study demonstrated the complexity of web-based interactions, with beneficial and harmful content intertwined. Participants who demonstrated metacognition and digital efficacy had better control over web-based engagements. Some attributed these skills to study processes, including taking part in reflective diaries, showing the potential of upskilling users. This study also highlighted how participants remained vulnerable by engaging with familiar web-based spaces, emphasizing the responsibility of web-based industry leaders to develop tools that empower users to enhance their web-based safety. %M 38546718 %R 10.2196/47699 %U https://infodemiology.jmir.org/2024/1/e47699 %U https://doi.org/10.2196/47699 %U http://www.ncbi.nlm.nih.gov/pubmed/38546718 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55999 %T Examining Passively Collected Smartphone-Based Data in the Days Prior to Psychiatric Hospitalization for a Suicidal Crisis: Comparative Case Analysis %A Jacobucci,Ross %A Ammerman,Brooke %A Ram,Nilam %+ Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN, 46556, United States, 1 574 631 6650, rjacobuc@nd.edu %K screenomics %K digital phenotyping %K passive assessment %K intensive time sampling %K suicide risk %K suicidal behaviors %K risk detection %K Comparative Analysis %K suicide %K suicidal %K risk %K risks %K behavior %K behaviors %K detection %K prediction %K Smartphone-Based %K screenomic %K case review %K participant %K participants %K smartphone %K smartphones %K suicidal ideation %D 2024 %7 20.3.2024 %9 Case Report %J JMIR Form Res %G English %X Background: Digital phenotyping has seen a broad increase in application across clinical research; however, little research has implemented passive assessment approaches for suicide risk detection. There is a significant potential for a novel form of digital phenotyping, termed screenomics, which captures smartphone activity via screenshots. Objective: This paper focuses on a comprehensive case review of 2 participants who reported past 1-month active suicidal ideation, detailing their passive (ie, obtained via screenomics screenshot capture) and active (ie, obtained via ecological momentary assessment [EMA]) risk profiles that culminated in suicidal crises and subsequent psychiatric hospitalizations. Through this analysis, we shed light on the timescale of risk processes as they unfold before hospitalization, as well as introduce the novel application of screenomics within the field of suicide research. Methods: To underscore the potential benefits of screenomics in comprehending suicide risk, the analysis concentrates on a specific type of data gleaned from screenshots—text—captured prior to hospitalization, alongside self-reported EMA responses. Following a comprehensive baseline assessment, participants completed an intensive time sampling period. During this period, screenshots were collected every 5 seconds while one’s phone was in use for 35 days, and EMA data were collected 6 times a day for 28 days. In our analysis, we focus on the following: suicide-related content (obtained via screenshots and EMA), risk factors theoretically and empirically relevant to suicide risk (obtained via screenshots and EMA), and social content (obtained via screenshots). Results: Our analysis revealed several key findings. First, there was a notable decrease in EMA compliance during suicidal crises, with both participants completing fewer EMAs in the days prior to hospitalization. This contrasted with an overall increase in phone usage leading up to hospitalization, which was particularly marked by heightened social use. Screenomics also captured prominent precipitating factors in each instance of suicidal crisis that were not well detected via self-report, specifically physical pain and loneliness. Conclusions: Our preliminary findings underscore the potential of passively collected data in understanding and predicting suicidal crises. The vast number of screenshots from each participant offers a granular look into their daily digital interactions, shedding light on novel risks not captured via self-report alone. When combined with EMA assessments, screenomics provides a more comprehensive view of an individual’s psychological processes in the time leading up to a suicidal crisis. %M 38506916 %R 10.2196/55999 %U https://formative.jmir.org/2024/1/e55999 %U https://doi.org/10.2196/55999 %U http://www.ncbi.nlm.nih.gov/pubmed/38506916 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50283 %T The Effect of Explicit Suicide Language in Engagement With a Suicide Prevention Search Page Help-Seeking Prompt: Nonrandomized Trial %A Onie,Sandersan %A Armstrong,Susanne Oliver %A Josifovski,Natasha %A Berlinquette,Patrick %A Livingstone,Nicola %A Holland,Sarah %A Finemore,Coco %A Gale,Nyree %A Elder,Emma %A Laggis,George %A Heffernan,Cassandra %A Theobald,Adam %A Torok,Michelle %A Shand,Fiona %A Larsen,Mark %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, 2031, Australia, 61 432359134, s.onie@blackdog.org.au %K suicide %K suicide prevention %K Google %K Google Ads %K internet search %K explicit wording %K mental health %K suicidal %K advertisement %K advertisements %K messaging %K prevention signage %K campaign %K campaigns %K distress %K engagement %K prompt %K prompts %K information seeking %K help seeking %K searching %K search %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Given that signage, messaging, and advertisements (ads) are the gateway to many interventions in suicide prevention, it is important that we understand what type of messaging works best for whom. Objective: We investigated whether explicitly mentioning suicide increases engagement using internet ads by investigating engagement with campaigns with different categories of keywords searched, which may reflect different cognitive states. Methods: We ran a 2-arm study Australia-wide, with or without ads featuring explicit suicide wording. We analyzed whether there were differences in engagement for campaigns with explicit and nonexplicit ads for low-risk (distressed but not explicitly suicidal), high-risk (explicitly suicidal), and help-seeking for suicide keywords. Results: Our analyses revealed that having explicit wording has opposite effects, depending on the search terms used: explicit wording reduced the engagement rate for individuals searching for low-risk keywords but increased engagement for those using high-risk keywords. Conclusions: The findings suggest that individuals who are aware of their suicidality respond better to campaigns that explicitly use the word “suicide.” We found that individuals who search for low-risk keywords also respond to explicit ads, suggesting that some individuals who are experiencing suicidality search for low-risk keywords. %M 38502162 %R 10.2196/50283 %U https://mental.jmir.org/2024/1/e50283 %U https://doi.org/10.2196/50283 %U http://www.ncbi.nlm.nih.gov/pubmed/38502162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51473 %T Machine Learning–Based Prediction of Suicidality in Adolescents With Allergic Rhinitis: Derivation and Validation in 2 Independent Nationwide Cohorts %A Lee,Hojae %A Cho,Joong Ki %A Park,Jaeyu %A Lee,Hyeri %A Fond,Guillaume %A Boyer,Laurent %A Kim,Hyeon Jin %A Park,Seoyoung %A Cho,Wonyoung %A Lee,Hayeon %A Lee,Jinseok %A Yon,Dong Keon %+ Department of Regulatory Science, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea, 82 2 6935 2476, yonkkang@gmail.com %K machine learning %K allergic rhinitis %K prediction %K random forest %K suicidality %D 2024 %7 14.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the additional risk of suicide-related behaviors in adolescents with allergic rhinitis (AR), it is important to use the growing field of machine learning (ML) to evaluate this risk. Objective: This study aims to evaluate the validity and usefulness of an ML model for predicting suicide risk in patients with AR. Methods: We used data from 2 independent survey studies, Korea Youth Risk Behavior Web-based Survey (KYRBS; n=299,468) for the original data set and Korea National Health and Nutrition Examination Survey (KNHANES; n=833) for the external validation data set, to predict suicide risks of AR in adolescents aged 13 to 18 years, with 3.45% (10,341/299,468) and 1.4% (12/833) of the patients attempting suicide in the KYRBS and KNHANES studies, respectively. The outcome of interest was the suicide attempt risks. We selected various ML-based models with hyperparameter tuning in the discovery and performed an area under the receiver operating characteristic curve (AUROC) analysis in the train, test, and external validation data. Results: The study data set included 299,468 (KYRBS; original data set) and 833 (KNHANES; external validation data set) patients with AR recruited between 2005 and 2022. The best-performing ML model was the random forest model with a mean AUROC of 84.12% (95% CI 83.98%-84.27%) in the original data set. Applying this result to the external validation data set revealed the best performance among the models, with an AUROC of 89.87% (sensitivity 83.33%, specificity 82.58%, accuracy 82.59%, and balanced accuracy 82.96%). While looking at feature importance, the 5 most important features in predicting suicide attempts in adolescent patients with AR are depression, stress status, academic achievement, age, and alcohol consumption. Conclusions: This study emphasizes the potential of ML models in predicting suicide risks in patients with AR, encouraging further application of these models in other conditions to enhance adolescent health and decrease suicide rates. %M 38354043 %R 10.2196/51473 %U https://www.jmir.org/2024/1/e51473 %U https://doi.org/10.2196/51473 %U http://www.ncbi.nlm.nih.gov/pubmed/38354043 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53597 %T Digital Phenotyping for Real-Time Monitoring of Nonsuicidal Self-Injury: Protocol for a Prospective Observational Study %A Ahn,Chan-Young %A Lee,Jong-Sun %+ Department of Psychology, Kangwon National University, Kangwondaehak-gil, Chuncheon-si, 24341, Republic of Korea, 82 0332506853, sunny597@gmail.com %K nonsuicidal self-injury %K NSSI %K digital phenotyping %K digital phenotype %K wearable device %K wearable %K wearables %K wrist worn %K mood %K emotion %K emotions %K heart rate %K step %K sleep %K machine learning %K multilevel modeling %K ecological momentary assessment %K EMA %K self-injury %K self-harm %K psychiatry %K psychiatric %K mental health %K predict %K prediction %K predictions %K predictor %K predictors %K predictive %D 2024 %7 8.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nonsuicidal self-injury (NSSI) is a major global health concern. The limitations of traditional clinical and laboratory-based methodologies are recognized, and there is a pressing need to use novel approaches for the early detection and prevention of NSSI. Unfortunately, there is still a lack of basic knowledge of a descriptive nature on NSSI, including when, how, and why self-injury occurs in everyday life. Digital phenotyping offers the potential to predict and prevent NSSI by assessing objective and ecological measurements at multiple points in time. Objective: This study aims to identify real-time predictors and explain an individual’s dynamic course of NSSI. Methods: This study will use a hybrid approach, combining elements of prospective observational research with non–face-to-face study methods. This study aims to recruit a cohort of 150 adults aged 20 to 29 years who have self-reported engaging in NSSI on 5 or more days within the past year. Participants will be enrolled in a longitudinal study conducted at 3-month intervals, spanning 3 long-term follow-up phases. The ecological momentary assessment (EMA) technique will be used via a smartphone app. Participants will be prompted to complete a self-injury and suicidality questionnaire and a mood appraisal questionnaire 3 times a day for a duration of 14 days. A wrist-worn wearable device will be used to collect heart rate, step count, and sleep patterns from participants. Dynamic structural equation modeling and machine learning approaches will be used. Results: Participant recruitment and data collection started in October 2023. Data collection and analysis are expected to be completed by December 2024. The results will be published in a peer-reviewed journal and presented at scientific conferences. Conclusions: The insights gained from this study will not only shed light on the underlying mechanisms of NSSI but also pave the way for the development of tailored and culturally sensitive treatment options that can effectively address this major mental health concern. International Registered Report Identifier (IRRID): DERR1-10.2196/53597 %M 38329791 %R 10.2196/53597 %U https://www.researchprotocols.org/2024/1/e53597 %U https://doi.org/10.2196/53597 %U http://www.ncbi.nlm.nih.gov/pubmed/38329791 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49755 %T Assessing the Labeling Information on Drugs Associated With Suicide Risk: Systematic Review %A Jeon,Soo Min %A Lim,HyunJoo %A Cheon,Hyo-bin %A Ryu,Juhee %A Kwon,Jin-Won %+ BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, 80 Daehak-ro, Daegu, 41566, Republic of Korea, 82 539508580, jwkwon@knu.ac.kr %K suicide %K adverse drug events %K review %K drug %K mental health %K systematic review %K drug induced suicide %K drug reaction %K substance use %K suicidal %K medication %K suicide symptoms %K suicidal risk %K drugs %K adverse drug event %D 2024 %7 30.1.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Drug-induced suicide (DIS) is a severe adverse drug reaction (ADR). Although clinical trials have provided evidence on DIS, limited investigations have been performed on rare ADRs, such as suicide. Objective: We aimed to systematically review case reports on DIS to provide evidence-based drug information. Methods: We searched PubMed to obtain case reports regarding DIS published until July 2021. Cases resulting from drugs that are no longer used or are nonapproved, substance use, and suicidal intentions were excluded. The quality of each case report was assessed using the CASE (Case Reports) checklist. We extracted data regarding demographics, medication history, suicide symptoms, and symptom improvement and evaluated the causality of DIS using the Naranjo score. Furthermore, to identify the potential suicidal risk of the unknown drugs, we compared the results of the causality assessment with those of the approved drug labels. Results: In 83 articles, we identified 152 cases involving 61 drugs. Antidepressants were reported as the most frequent causative drugs of DIS followed by immunostimulants. The causality assessment revealed 61 cases having possible, 89 cases having probable, and 2 cases having definite relationships with DIS. For approximately 85% of suspected drugs, the risk of suicidal ADRs was indicated on the approved label; however, the approved labels for 9 drugs, including lumacaftor/ivacaftor, doxycycline, clozapine, dextromethorphan, adalimumab, infliximab, piroxicam, paclitaxel, and formoterol, did not provide information about these risks. Conclusions: We found several case reports involving drugs without suicide risk information on the drug label. Our findings might provide valuable insights into drugs that may cause suicidal ADRs. %M 38289650 %R 10.2196/49755 %U https://publichealth.jmir.org/2024/1/e49755 %U https://doi.org/10.2196/49755 %U http://www.ncbi.nlm.nih.gov/pubmed/38289650 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46364 %T Determining Distinct Suicide Attempts From Recurrent Electronic Health Record Codes: Classification Study %A Bentley,Kate H %A Madsen,Emily M %A Song,Eugene %A Zhou,Yu %A Castro,Victor %A Lee,Hyunjoon %A Lee,Younga H %A Smoller,Jordan W %+ Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 185 Cambridge Street, 2nd Floor, Boston, MA, 02114, United States, 1 6177247741, kbentley@mgh.harvard.edu %K suicide %K suicide attempt %K self-injury %K electronic health record %K EHR %K prediction %K predictive model %K predict %K model %K suicidal %K informatics %K automated rule %K psychiatry %K machine learning %D 2024 %7 8.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Prior suicide attempts are a relatively strong risk factor for future suicide attempts. There is growing interest in using longitudinal electronic health record (EHR) data to derive statistical risk prediction models for future suicide attempts and other suicidal behavior outcomes. However, model performance may be inflated by a largely unrecognized form of “data leakage” during model training: diagnostic codes for suicide attempt outcomes may refer to prior attempts that are also included in the model as predictors. Objective: We aimed to develop an automated rule for determining when documented suicide attempt diagnostic codes identify distinct suicide attempt events. Methods: From a large health care system’s EHR, we randomly sampled suicide attempt codes for 300 patients with at least one pair of suicide attempt codes documented at least one but no more than 90 days apart. Supervised chart reviewers assigned the clinical settings (ie, emergency department [ED] versus non-ED), methods of suicide attempt, and intercode interval (number of days). The probability (or positive predictive value) that the second suicide attempt code in a given pair of codes referred to a distinct suicide attempt event from its preceding suicide attempt code was calculated by clinical setting, method, and intercode interval. Results: Of 1015 code pairs reviewed, 835 (82.3%) were nonindependent (ie, the 2 codes referred to the same suicide attempt event). When the second code in a pair was documented in a clinical setting other than the ED, it represented a distinct suicide attempt 3.3% of the time. The more time elapsed between codes, the more likely the second code in a pair referred to a distinct suicide attempt event from its preceding code. Code pairs in which the second suicide attempt code was assigned in an ED at least 5 days after its preceding suicide attempt code had a positive predictive value of 0.90. Conclusions: EHR-based suicide risk prediction models that include International Classification of Diseases codes for prior suicide attempts as a predictor may be highly susceptible to bias due to data leakage in model training. We derived a simple rule to distinguish codes that reflect new, independent suicide attempts: suicide attempt codes documented in an ED setting at least 5 days after a preceding suicide attempt code can be confidently treated as new events in EHR-based suicide risk prediction models. This rule has the potential to minimize upward bias in model performance when prior suicide attempts are included as predictors in EHR-based suicide risk prediction models. %M 38190236 %R 10.2196/46364 %U https://formative.jmir.org/2024/1/e46364 %U https://doi.org/10.2196/46364 %U http://www.ncbi.nlm.nih.gov/pubmed/38190236 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46579 %T Exploring Counselor Practices and Risk Assessment in a Proactive Digital Intervention Through Instagram in Young People: Qualitative Study %A Peart,Natalie %A Hetrick,Sarah %A Gibson,Kerry %A Stasiak,Karolina %+ Department of Psychology, University of Auckland, 23 Symonds Street, Auckland, 1023, New Zealand, 64 276758552, nnatalie.peart@auckland.ac.nz %K counseling %K distress %K empathize %K internet %K mental health %K online text %K proactive %K qualitative study %K risk assessment %K self-harm %K social media %K suicide %K validation %K youth %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide is one of the leading causes of preventable death in young people, and the way young people are communicating suicidality has evolved to include web-based disclosures and help-seeking. To date, mental health intervention services, both on the web and in person, have been conceived in the traditional model, whereby support is provided if a young person (or their family) actively seeks out that support when distressed. On the other hand, proactive outreach is an innovative approach to intervention that has been shown to be effective in other areas of health care. Live for Tomorrow chat was delivered on Instagram and comprised of counselors who reach out to provide brief person-centered intervention to young people who post content indicating distress or suicidality. Objective: Our aim was to explore how counselors engaged young people in a proactive digital intervention and how risk assessment was conducted in this context. Methods: We analyzed 35 transcripts of conversations between counselors and young people aged 13-25 years using the 6-step approach of Braun and Clarke’s reflexive thematic analysis. These transcripts included a counseling intervention and a follow-up chat that was aimed at collecting feedback about the counseling intervention. Results: A total of 7 themes emerged: using microskills to facilitate conversations, building confidence and capacity to cope with change, seeking permission when approaching conversations about suicidality or self-harm, conversations about suicidality following a structured approach, providing assurances of confidentiality, validation of the experience of suicidality, and using conversations about suicidality to identify interventions. Counselors were able to translate counseling microskills and structured questioning regarding suicidality into a digital context. In particular, in the digital context, counselors would use the young person’s post and emojis to further conversations and build rapport. Conclusions: The findings highlight the importance of the counselor’s role to listen, empathize, validate, and empower young people and that all these skills can be transferred to a digital text counseling intervention. Counselors used a structured approach to understanding suicidality in a permission-seeking, validating, and confidential manner to identify interventions with the young person. These practices allowed the conversation to move beyond traditional risk assessment practices to meaningful conversations about suicidality. Moving beyond traditional risk assessment practices and into conversations about suicidality allowed for the validation of the young person’s experience and exploration of interventions and support that made sense and were seen to be helpful to the young person. This study highlighted the benefits of a proactive digital chat-based intervention, which is a novel approach to engaging with young people experiencing psychological distress and suicidality. Furthermore, this research demonstrates the feasibility and benefit of moving mental health intervention and support to a medium where young people are currently disclosing distress and intervening proactively. %M 38145477 %R 10.2196/46579 %U https://formative.jmir.org/2023/1/e46579 %U https://doi.org/10.2196/46579 %U http://www.ncbi.nlm.nih.gov/pubmed/38145477 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e52336 %T Investigating the Feasibility, Acceptability, and Appropriation of a Socially Assistive Robot Among Minority Youth at Risk of Self-Harm: Results of 2 Mixed Methods Pilot Studies %A Williams,A Jess %A Townsend,Ellen %A Naeche,Nkem %A Chapman-Nisar,Amelia %A Hollis,Chris %A Slovak,Petr %A , %+ Department of Informatics, King's College London, 30 Aldwych, Bush House, Strand Campus, London, WC2B 4BG, United Kingdom, 44 020 7848 1988, amy_jess.williams@kcl.ac.uk %K digital intervention %K self-harm %K young people %K emotion regulation %K experience sampling %K interviews %D 2023 %7 22.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Minority youth are at an increased risk of experiencing self-harmful thoughts and behaviors. However, there is limited evidence of successful interventions to support young people in the moment of their distress. Digital interventions are considered a potential solution for providing in-the-moment support for those at risk of adverse mental health and self-harm. Objective: These pilot studies aim to investigate the feasibility and acceptability of a new in situ intervention tool, Purrble, among two broad groups of minority youth: (1) lesbian, gay, bisexual, transgender, queer, and similar minority (LGBTQ+) youth and (2) racial and ethnic minority youth. Purrble was designed to support in-situ emotion regulation (ER) support when individuals are facing emotionally challenging situations. Methods: This study consisted of 2 mixed methods pilot studies that followed the same mixed methods design, including 3 weeks of daily and weekly surveys and optional follow-up interviews. Inclusion criteria were (1) aged between 16 and 25 years, (2) part of a minority group, (3) had experiences of self-harmful thoughts or behaviors or elevated symptoms of depression or anxiety, and (4) living in the United Kingdom at the time of the study. The primary outcomes were (1) the feasibility of Purrble as an intervention among pilot samples (analyzed by consent rate, retention rate, adherence to surveys, and engagement with the device) and (2) the acceptability and appropriation of Purrble across pilot studies as a tool to support ER in situ (thematically analyzed qualitative open-ended questions and interview data). The secondary outcomes were descriptive pilot data concerning the mental health outcomes in each sample. Results: In total, 21 LGBTQ+ young people participated in pilot study 1, with 86% (n=18) completing the baseline and 3 weeks of daily surveys. These young people maintained engagement with Purrble across deployment, across which period there was a decrease in self-harmful thoughts and anxiety symptoms. A total of 19 ethnic and racial minority youths participated in pilot study 2, and 84% (n=16) completed the study. Although pilot study 2 participants also maintained engagement with Purrble across deployment, this was to a lesser degree than participants of pilot study 1, and perceived mental health outcomes did not indicate potential change associated with the device. The thematic analysis indicated three superordinate themes: (1) stopping the self-harm cycle, (2) adopting ER strategies, and (3) stages of change. Conclusions: These were the first pilot studies of a novel intervention that aimed to provide in situ ER support for young people at risk of self-harm. Both quantitative and qualitative findings indicate that young people found Purrble to be a feasible and acceptable intervention, as they effectively incorporated the device into their ER practices. These engagements with Purrble were described as interrupting the cycle of self-harmful ideation and behavior. %M 37991838 %R 10.2196/52336 %U https://formative.jmir.org/2023/1/e52336 %U https://doi.org/10.2196/52336 %U http://www.ncbi.nlm.nih.gov/pubmed/37991838 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48404 %T Freely Available Training Videos for Suicide Prevention: Scoping Review %A Wislocki,Katherine %A Jager-Hyman,Shari %A Brady,Megan %A Weiss,Michal %A Schaechter,Temma %A Khazanov,Gabriela %A Young,Sophia %A Becker-Haimes,Emily %+ Department of Psychological Science, University of California, Irvine, 214 Pereira Drive, Irvine, CA, 92617, United States, 1 9498246803, kwislock@uci.edu %K freely available videos %K asynchronous training %K suicide prevention %K evidence-based practice %K dissemination %K implementation %D 2023 %7 3.11.2023 %9 Review %J JMIR Ment Health %G English %X Background: Freely available and asynchronous implementation supports can reduce the resource burden of evidence-based practice training to facilitate uptake. Freely available web-based training videos have proliferated, yet there have been no efforts to quantify their breadth, depth, and content for suicide prevention. Objective: This study presents results from a scoping review of freely available training videos for suicide prevention and describes a methodological framework for reviewing such videos. Methods: A scoping review of freely available training videos (≥2 minutes) for suicide prevention practices was conducted using 4 large video-sharing platforms: YouTube, Vimeo, Bing Video, and Google Video. Identified suicide prevention training videos (N=506) were reviewed and coded. Results: Most content was targeted toward gatekeepers or other lay providers (n=370) versus clinical providers (n=136). Videos most commonly provided content related to suicidal thoughts or behaviors (n=420). Many videos (n=274, 54.2%) included content designed for certain communities or organizations. Less than half (n=232, 45.8%) of training videos included formal clinical content pertaining to assessment or intervention for suicide prevention. Conclusions: Results suggested an abundance of videos providing broad informational content (eg, “signs and symptoms of someone at risk for suicide”) and a limited portion of videos with instructional content aimed at clinical providers delivering formal evidence-based assessments or interventions for suicide prevention. Development of resources to address identified gaps may be needed. Future work may leverage machine learning techniques to expedite the review process. %M 37921847 %R 10.2196/48404 %U https://mental.jmir.org/2023/1/e48404 %U https://doi.org/10.2196/48404 %U http://www.ncbi.nlm.nih.gov/pubmed/37921847 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e49783 %T Comparing the Acceptability and Quality of Intervention Modalities for Suicidality in the Emergency Department: Randomized Feasibility Trial %A Larkin,Celine %A Tulu,Bengisu %A Djamasbi,Soussan %A Garner,Roscoe %A Varzgani,Fatima %A Siddique,Mariam %A Pietro,John %A Boudreaux,Edwin D %+ Department of Emergency Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 5084211436, celine.larkin@umassmed.edu %K suicide %K self-harm %K emergency department %K mobile app %K intervention %K mobile technology %K safety planning %K safety %K suicidal %K emergency %K mHealth %K mobile health %K mental health %K mobile phone %D 2023 %7 24.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Emergency departments (EDs) manage many patients with suicide risk, but effective interventions for suicidality are challenging to implement in this setting. ReachCare is a technology-facilitated version of an evidence-based intervention for suicidal ED patients. Here, we present findings on the acceptability and quality of ReachCare in the ED, as well as a comparison of these measures across 3 potential delivery modalities Objective: Our aim was to test the feasibility of the ReachCare intervention in its entirety through conducting a pilot study with patients presenting with suicidality to the ED. We tested three different ways of receiving the ED-based components of ReachCare: (1) self-administered on the tablet app using a chatbot interface, (2) administered by an in-person clinician, or (3) administered by a telehealth clinician. Methods: In total, 47 ED patients who screened positive for suicide risk were randomly allocated to receive one of three delivery modalities of ReachCare in the ED: (1) self-administered on the patient-facing tablet app with a chatbot interface, (2) delivered by an in-person clinician, or (3) delivered by a telehealth clinician, with the latter two using a clinician-facing web app. We measured demographic and clinical characteristics, acceptability and appropriateness of the intervention, and quality and completeness of the resulting safety plans. Results: Patients assigned high ratings for the acceptability (median 4.00/5, IQR 4.00-4.50) and appropriateness (median 4.00/5, IQR 4.00-4.25) of ReachCare’s ED components, and there were no substantial differences across the 3 delivery modalities [H(acceptability)=3.90, P=.14; H(appropriateness)=1.05, P=.59]. The self-administered modality took significantly less time than the 2 clinician modalities (H=27.91, P<.001), and the usability of the self-administered version was in the “very high” range (median 93.75/100, IQR 80.00-97.50). The safety plans created across all 3 modalities were high-quality (H=0.60, P=.74). Conclusions: Patients rated ReachCare in the ED as highly acceptable and appropriate regardless of modality. Self-administration may be a feasible way to ensure patients with suicide risk receive an intervention in resource constrained EDs. Limitations include small sample size and demographic differences between those enrolled versus not enrolled. Further research will examine the clinical outcomes of patients receiving both the in-ED and post-ED components of ReachCare. Trial Registration: ClinicalTrials.gov NCT04720911; https://clinicaltrials.gov/ct2/show/NCT04720911 %M 37874619 %R 10.2196/49783 %U https://mental.jmir.org/2023/1/e49783 %U https://doi.org/10.2196/49783 %U http://www.ncbi.nlm.nih.gov/pubmed/37874619 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48177 %T A Suicide Prevention Intervention for Emerging Adult Sexual and Gender Minority Groups: Protocol for a Pilot Hybrid Effectiveness Randomized Controlled Trial %A Brown,Lily A %A Webster,Jessica L %A Tran,Jennifer T %A Wolfe,James R %A Golinkoff,Jesse %A Patel,Esha %A Arcomano,Amanda C %A Ben Nathan,Jennifer %A Azat O'Connor,Alexander %A Zhu,Yiqin %A Oquendo,Maria %A Brown,Gregory K %A Mandell,David %A Mowery,Danielle %A Bauermeister,José A %+ Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Suite 600 N, Philadelphia, PA, 19147, United States, 1 215 746 3346, lilybr@upenn.edu %K lesbian, gay, bisexual, transgender, queer, plus %K LGBTQ+ health %K suicide %K peer navigator %K emerging adults %K life skills %K mobile phone %D 2023 %7 29.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide attempts and suicide death disproportionately affect sexual and gender minority emerging adults (age 18-24 years). However, suicide prevention strategies tailored for emerging adult sexual and gender minority (EA-SGM) groups are not widely available. The Safety Planning Intervention (SPI) has strong evidence for reducing the risk for suicide in the general population, but it is unclear how best to support EA-SGM groups in their use of a safety plan. Our intervention (Supporting Transitions to Adulthood and Reducing Suicide [STARS]) builds on content from an existing life skills mobile app for adolescent men who have sex with men (iREACH) and seeks to target core risk factors for suicide among EA-SGM groups, namely, positive affect, discrimination, and social disconnection. The mobile app is delivered to participants randomized to STARS alongside 6 peer mentoring sessions to support the use of the safety plan and other life skills from the app to ultimately reduce suicide risk. Objective: We will pilot-test the combination of peer mentoring alongside an app-based intervention (STARS) designed to reduce suicidal ideation and behaviors. STARS will include suicide prevention content and will target positive affect, discrimination, and social support. After an in-person SPI with a clinician, STARS users can access content and activities to increase their intention to use SPI and overcome obstacles to its use. EA-SGM groups will be randomized to receive either SPI alone or STARS and will be assessed for 6 months. Methods: Guided by the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework, we will recruit and enroll a racially and ethnically diverse sample of 60 EA-SGM individuals reporting past-month suicidal ideation. Using a type-1 effectiveness-implementation hybrid design, participants will be randomized to receive SPI (control arm) or to receive SPI alongside STARS (intervention arm). We will follow the participants for 6 months, with evaluations at 2, 4, and 6 months. Preliminary effectiveness outcomes (suicidal ideation and behavior) and hypothesized mechanisms of change (positive affect, coping with discrimination, and social support) will serve as our primary outcomes. Secondary outcomes include key implementation indicators, including participants’ willingness and adoption of SPI and STARS and staff’s experiences with delivering the program. Results: Study activities began in September 2021 and are ongoing. The study was approved by the institutional review board of the University of Pennsylvania (protocol number 849500). Study recruitment began on October 14, 2022. Conclusions: This project will be among the first tailored, mobile-based interventions for EA-SGM groups at risk for suicide. This project is responsive to the documented gaps for this population: approaches that address chosen family, focus on a life-course perspective, web approaches, and focus on health equity and provision of additional services relevant to sexual and gender minority youth. Trial Registration: ClinicalTrials.gov NCT05018143; https://classic.clinicaltrials.gov/ct2/show/NCT05018143 International Registered Report Identifier (IRRID): DERR1-10.2196/48177 %M 37773618 %R 10.2196/48177 %U https://www.researchprotocols.org/2023/1/e48177 %U https://doi.org/10.2196/48177 %U http://www.ncbi.nlm.nih.gov/pubmed/37773618 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51324 %T The Effects of Suicide Exposure on Mental Health Outcomes Among Post-9/11 Veterans: Protocol for an Explanatory, Sequential, Mixed Methods Study %A Sayer,Nina A %A Nelson,David B %A Gradus,Jaimie L %A Sripada,Rebecca K %A Murdoch,Maureen %A Teo,Alan R %A Orazem,Robert J %A Cerel,Julie %+ Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, United States, 1 612 467 4623, nina.sayer@va.gov %K veterans %K suicide %K death %K posttraumatic stress disorder %K bereavement %K health services %D 2023 %7 26.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The toll associated with suicide goes well beyond the individual who died. This study focuses on a risk factor for veteran suicide that has received little previous empirical attention—exposure to the suicide death of another person. Objective: The study’s primary objective is to describe the mental health outcomes associated with suicide exposure among veterans who served on active duty after September 2001 (“post-9/11”). The secondary objective is to elucidate why some veterans develop persistent problems following suicide exposure, whereas others do not. Methods: This is an explanatory, sequential, mixed methods study of a nationally representative sample of post-9/11 veterans enrolled in Department of Veterans Affairs (VA) health care. Our sampling strategy was designed for adequate representation of female and American Indian and Alaska Native veterans to allow for examination of associations between suicide exposure and outcomes within these groups. Primary outcomes comprise mental health problems associated with trauma and loss (posttraumatic stress disorder and prolonged grief disorder) and suicide precursors (suicidal ideation, attempts, and planning). Data collection will be implemented in 3 waves. During wave 1, we will field a brief survey to a national probability sample to assess exposure history (suicide, other sudden death, or neither) and exposure characteristics (eg, closeness with the decedent) among 11,400 respondents. In wave 2, we will include 39.47% (4500/11,400) of the wave-1 respondents, stratified by exposure history (suicide, other sudden death, or neither), to assess health outcomes and other variables of interest. During wave 3, we will conduct interviews with a purposive subsample of 32 respondents exposed to suicide who differ in mental health outcomes. We will supplement the survey and interview data with VA administrative data identifying diagnoses, reported suicide attempts, and health care use. Results: The study began on July 1, 2022, and will end on June 30, 2026. This is the only national, population-based study of suicide exposure in veterans and the first one designed to study differences based on sex and race. Comparing those exposed to suicide with those exposed to sudden death for reasons other than suicide (eg, combat) and those unexposed to any sudden death may allow for the identification of the common and unique contribution of suicide exposure to outcomes and help seeking. Conclusions: Integrating survey, qualitative, and VA administrative data to address significant knowledge gaps regarding the effects of suicide exposure in a national sample will lay the foundation for interventions to address the needs of individuals affected by a suicide death, including female and American Indian and Alaska Native veterans. International Registered Report Identifier (IRRID): DERR1-10.2196/51324 %M 37751271 %R 10.2196/51324 %U https://www.researchprotocols.org/2023/1/e51324 %U https://doi.org/10.2196/51324 %U http://www.ncbi.nlm.nih.gov/pubmed/37751271 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49043 %T Blending Video Therapy and Digital Self-Help for Individuals With Suicidal Ideation: Intervention Design and a Qualitative Study Within the Development Process %A Büscher,Rebekka %A Sander,Lasse B %A Nuding,Mattis %A Baumeister,Harald %A Teismann,Tobias %+ Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstr. 29, Freiburg, 79085, Germany, 49 76120395204, rebekka.buescher@mps.uni-freiburg.de %K blended care %K digital interventions %K video therapy %K suicidal ideation %K personalized treatment %K cognitive behavioral therapy %K CBT %K suicide %K suicidal %K digital intervention %K digital health %K video %K web-based module %K blended %K self-help %D 2023 %7 21.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital formats have the potential to enhance accessibility to care for individuals with suicidal ideation. However, digital self-help interventions have faced limitations, including small effect sizes in reducing suicidal ideation, low adherence, and safety concerns. Objective: Therefore, we aimed to develop a remote blended cognitive behavioral therapy intervention that specifically targets suicidal ideation by blending video therapy with web-based self-help modules. The objective of this paper is to describe the collaborative development process and the resulting intervention and treatment rationale. Methods: First, we compiled intervention components from established treatment manuals designed for people with suicidal ideation or behavior, resulting in the development of 11 drafts of web-based modules. Second, we conducted a qualitative study, involving 5 licensed psychotherapists and 3 lay counselors specialized in individuals with suicidal ideation who reviewed these module drafts. Data were collected using the think-aloud method and semistructured interviews, and a qualitative content analysis was performed. The 4 a priori main categories of interest were blended care for individuals with suicidal ideation, contents of web-based modules, usability of modules, and layout. Subcategories emerged inductively from the interview transcripts. Finally, informed by previous treatment manuals and qualitative findings, we developed the remote blended treatment program. Results: The participants suggested that therapists should thoroughly prepare the web-based therapy with patients to tailor the therapy to each individual’s needs. Participants emphasized that the web-based modules should explain concepts in a simple manner, convey empathy and validation, and include reminders for the safety plan. In addition, participants highlighted the need for a simple navigation and layout. Taking these recommendations into account, we developed a fully remote blended cognitive behavioral therapy intervention comprising 12 video therapy sessions and up to 31 web-based modules. The treatment involves collaboratively developing a personalized treatment plan to address individual suicidal drivers. Conclusions: This remote treatment takes advantage of the high accessibility of digital formats while incorporating full sessions with a therapist. In a subsequent pilot trial, we will seek input from individuals with lived experience and therapists to test the feasibility of the treatment. %M 37733414 %R 10.2196/49043 %U https://formative.jmir.org/2023/1/e49043 %U https://doi.org/10.2196/49043 %U http://www.ncbi.nlm.nih.gov/pubmed/37733414 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e51232 %T Suicide Risk Assessments Through the Eyes of ChatGPT-3.5 Versus ChatGPT-4: Vignette Study %A Levkovich,Inbar %A Elyoseph,Zohar %+ Department of Psychology and Educational Counseling, The Center for Psychobiological Research, Max Stern Yezreel Valley College, Hatena 14b Kiryat Tivon, Emek Yezreel, 3650414, Israel, 972 54 783 6088, Zohare@yvc.ac.il %K artificial intelligence %K ChatGPT %K diagnosis %K psychological assessment %K psychological %K suicide risk %K risk assessment %K text vignette %K NLP %K natural language processing %K suicide %K suicidal %K risk %K assessment %K vignette %K vignettes %K assessments %K mental %K self-harm %D 2023 %7 20.9.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: ChatGPT, a linguistic artificial intelligence (AI) model engineered by OpenAI, offers prospective contributions to mental health professionals. Although having significant theoretical implications, ChatGPT’s practical capabilities, particularly regarding suicide prevention, have not yet been substantiated. Objective: The study’s aim was to evaluate ChatGPT’s ability to assess suicide risk, taking into consideration 2 discernable factors—perceived burdensomeness and thwarted belongingness—over a 2-month period. In addition, we evaluated whether ChatGPT-4 more accurately evaluated suicide risk than did ChatGPT-3.5. Methods: ChatGPT was tasked with assessing a vignette that depicted a hypothetical patient exhibiting differing degrees of perceived burdensomeness and thwarted belongingness. The assessments generated by ChatGPT were subsequently contrasted with standard evaluations rendered by mental health professionals. Using both ChatGPT-3.5 and ChatGPT-4 (May 24, 2023), we executed 3 evaluative procedures in June and July 2023. Our intent was to scrutinize ChatGPT-4’s proficiency in assessing various facets of suicide risk in relation to the evaluative abilities of both mental health professionals and an earlier version of ChatGPT-3.5 (March 14 version). Results: During the period of June and July 2023, we found that the likelihood of suicide attempts as evaluated by ChatGPT-4 was similar to the norms of mental health professionals (n=379) under all conditions (average Z score of 0.01). Nonetheless, a pronounced discrepancy was observed regarding the assessments performed by ChatGPT-3.5 (May version), which markedly underestimated the potential for suicide attempts, in comparison to the assessments carried out by the mental health professionals (average Z score of –0.83). The empirical evidence suggests that ChatGPT-4’s evaluation of the incidence of suicidal ideation and psychache was higher than that of the mental health professionals (average Z score of 0.47 and 1.00, respectively). Conversely, the level of resilience as assessed by both ChatGPT-4 and ChatGPT-3.5 (both versions) was observed to be lower in comparison to the assessments offered by mental health professionals (average Z score of –0.89 and –0.90, respectively). Conclusions: The findings suggest that ChatGPT-4 estimates the likelihood of suicide attempts in a manner akin to evaluations provided by professionals. In terms of recognizing suicidal ideation, ChatGPT-4 appears to be more precise. However, regarding psychache, there was an observed overestimation by ChatGPT-4, indicating a need for further research. These results have implications regarding ChatGPT-4’s potential to support gatekeepers, patients, and even mental health professionals’ decision-making. Despite the clinical potential, intensive follow-up studies are necessary to establish the use of ChatGPT-4’s capabilities in clinical practice. The finding that ChatGPT-3.5 frequently underestimates suicide risk, especially in severe cases, is particularly troubling. It indicates that ChatGPT may downplay one’s actual suicide risk level. %M 37728984 %R 10.2196/51232 %U https://mental.jmir.org/2023/1/e51232 %U https://doi.org/10.2196/51232 %U http://www.ncbi.nlm.nih.gov/pubmed/37728984 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47178 %T Developing Suicide Prevention Tools in the Context of Digital Peer Support: Qualitative Analysis of a Workshop With Multidisciplinary Stakeholders %A Cliffe,Bethany %A Gore-Rodney,Jessica %A Linton,Myles-Jay %A Biddle,Lucy %+ Population Health Sciences, Bristol Medical School, University of Bristol, Beacon House, Queens Road, Bristol, BS8 1QU, United Kingdom, 44 01179289000, bethany.cliffe@bristol.ac.uk %K digital interventions %K smartphone app %K suicide prevention %K mental health %K mobile phone %D 2023 %7 20.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide is the fourth leading cause of death among young people aged 15-29 years worldwide and suicide rates are increasing. Suicide prevention strategies can be effective but young people face barriers to accessing them. Providing support digitally can facilitate access, but this can also pose risks if there is inappropriate or harmful content. Collaborative approaches are key for developing digital suicide prevention tools to ensure support is appropriate and helpful for young people. Tellmi (previously MeeToo) is a premoderated UK-based peer-support app where people aged 11-25 years can anonymously discuss issues ranging from worries to life challenges. It has procedures to support high-risk users, nevertheless, Tellmi is interested in improving the support they provide to users with more acute mental health needs, such as young people struggling with suicide and self-harm ideation. Further research into the best ways of providing such support for this population is necessary. Objective: The aim of this study is to explore the key considerations for developing and delivering digital suicide prevention tools for young people aged 18-25 years from a multidisciplinary perspective, including the views of young people, practitioners, and academics. Methods: A full-day, in-person workshop was conducted with mental health academics (n=3) and mental health practitioners (n=2) with expertise in suicide prevention, young people with lived experience of suicidal ideation (n=4), and a computer scientist (n=1) and technical staff from the Tellmi app (n=6). Tellmi technical staff presented 14 possible evidence-based adaptations for the app as a basis for the discussions. A range of methods were used to evaluate them, including questionnaires to rate the ideas, annotating printouts of the ideas with post-it notes, and group discussions. A reflexive thematic analysis was performed on the qualitative data to explore key considerations for designing digital suicide prevention tools in the context of peer support. Results: Participants discussed the needs of both those receiving and providing support, noting several key considerations for developing and delivering digital support for high-risk young people. In total, four themes were developed: (1) the aims of the app must be clear and consistent, (2) there are unique considerations for supporting high-risk users: (subtheme) customization helps tailor support to high-risk users, (3) “progress” is a broad and multifaceted concept, and (4) considering the roles of those providing support: (subtheme) expertise required to support app users and (subtheme) mitigating the impact of the role on supporters. Conclusions: This study outlined suggestions that may be beneficial for developing digital suicide prevention tools for young people. Suggestions included apps being customizable, transparent, accessible, visually appealing, and working with users to develop content and language. Future research should further explore this with a diverse group of young people and clinicians. %M 37728967 %R 10.2196/47178 %U https://formative.jmir.org/2023/1/e47178 %U https://doi.org/10.2196/47178 %U http://www.ncbi.nlm.nih.gov/pubmed/37728967 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49325 %T An Evaluation of the Boys Do Cry Suicide Prevention Media Campaign on Twitter: Mixed Methods Approach %A Scotti Requena,Simone %A Pirkis,Jane %A Currier,Dianne %A Conway,Mike %A Lee,Simon %A Turnure,Jackie %A Cummins,Jennifer %A Nicholas,Angela %+ Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Melbourne, 3010, Australia, 61 383444951, simone.scottirequena@unimelb.edu.au %K help-seeking %K masculinity %K media campaign %K men %K men’s health %K mental health %K self-reliance %K social media %K suicide prevention %K suicide %D 2023 %7 7.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In most countries, men are more likely to die by suicide than women. Adherence to dominant masculine norms, such as being self-reliant, is linked to suicide in men in Western cultures. We created a suicide prevention media campaign, “Boys Do Cry,” designed to challenge the “self-reliance” norm and encourage help-seeking in men. A music video was at the core of the campaign, which was an adapted version of the “Boys Don’t Cry” song from “The Cure.” There is evidence that suicide prevention media campaigns can encourage help-seeking for mental health difficulties. Objective: We aimed to explore the reach, engagement, and themes of discussion prompted by the Boys Do Cry campaign on Twitter. Methods: We used Twitter analytics data to investigate the reach and engagement of the Boys Do Cry campaign, including analyzing the characteristics of tweets posted by the campaign’s hosts. Throughout the campaign and immediately after, we also used Twitter data derived from the Twitter Application Programming Interface to analyze the tweeting patterns of users related to the campaign. In addition, we qualitatively analyzed the content of Boys Do Cry–related tweets during the campaign period. Results: During the campaign, Twitter users saw the tweets posted by the hosts of the campaign a total of 140,650 times and engaged with its content a total of 4477 times. The 10 highest-performing tweets by the campaign hosts involved either a video or an image. Among the 10 highest-performing tweets, the first was one that included the campaign’s core video; the second was a screenshot of the tweet posted by Robert Smith, the lead singer of The Cure, sharing the Boys Do Cry campaign’s video and tagging the campaign’s hosts. In addition, the pattern of Twitter activity for the campaign-related tweets was considerably higher during the campaign than in the immediate postcampaign period, with half of the activity occurring during the first week of the campaign when Robert Smith promoted the campaign. Some of the key topics of discussions prompted by the Boys Do Cry campaign on Twitter involved users supporting the campaign; referencing the original song, band, or lead singer; reiterating the campaign’s messages; and having emotional responses to the campaign. Conclusions: This study demonstrates that a brief media campaign such as Boys Do Cry can achieve good reach and engagement and can prompt discussions on Twitter about masculinity and suicide. Such discussions may lead to greater awareness about the importance of seeking help and providing support to those with mental health difficulties. However, this study suggests that longer, more intensive campaigns may be needed in order to amplify and sustain these results. %M 37676723 %R 10.2196/49325 %U https://formative.jmir.org/2023/1/e49325 %U https://doi.org/10.2196/49325 %U http://www.ncbi.nlm.nih.gov/pubmed/37676723 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43719 %T One-Week Suicide Risk Prediction Using Real-Time Smartphone Monitoring: Prospective Cohort Study %A Barrigon,Maria Luisa %A Romero-Medrano,Lorena %A Moreno-Muñoz,Pablo %A Porras-Segovia,Alejandro %A Lopez-Castroman,Jorge %A Courtet,Philippe %A Artés-Rodríguez,Antonio %A Baca-Garcia,Enrique %+ Department of Psychiatry, Jimenez Diaz Foundation University Hospital, Av Reyes Católicos, 2, Madrid, 28040, Spain, 34 91 541 72 67, ebacgar2@yahoo.es %K e-health %K m-health %K Ecological Mometary Asssessment %K risk prediction %K sensor monitoring %K suicidal %K suicide attempt %K suicide %D 2023 %7 1.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide is a major global public health issue that is becoming increasingly common despite preventive efforts. Though current methods for predicting suicide risk are not sufficiently accurate, technological advances provide invaluable tools with which we may evolve toward a personalized, predictive approach. Objective: We aim to predict the short-term (1-week) risk of suicide by identifying changes in behavioral patterns characterized through real-time smartphone monitoring in a cohort of patients with suicidal ideation. Methods: We recruited 225 patients between February 2018 and March 2020 with a history of suicidal thoughts and behavior as part of the multicenter SmartCrisis study. Throughout 6 months of follow-up, we collected information on the risk of suicide or mental health crises. All participants underwent voluntary passive monitoring using data generated by their own smartphones, including distance walked and steps taken, time spent at home, and app usage. The algorithm constructs daily activity profiles for each patient according to these data and detects changes in the distribution of these profiles over time. Such changes are considered critical periods, and their relationship with suicide-risk events was tested. Results: During follow-up, 18 (8%) participants attempted suicide, and 14 (6.2%) presented to the emergency department for psychiatric care. The behavioral changes identified by the algorithm predicted suicide risk in a time frame of 1 week with an area under the curve of 0.78, indicating good accuracy. Conclusions: We describe an innovative method to identify mental health crises based on passively collected information from patients’ smartphones. This technology could be applied to homogeneous groups of patients to identify different types of crises. %M 37656498 %R 10.2196/43719 %U https://www.jmir.org/2023/1/e43719 %U https://doi.org/10.2196/43719 %U http://www.ncbi.nlm.nih.gov/pubmed/37656498 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48113 %T An mHealth-Delivered Sexual Harm Reduction Tool (PartyPack) for Men Who Have Sex With Men in Malaysia: Usability Study %A Gautam,Kamal %A Paudel,Kiran %A Jacobs,Jerome %A Wickersham,Jeffrey A %A Ikhtiaruddin,Wan Mohd %A Azwa,Iskandar %A Saifi,Rumana %A Lim,Sin How %A Shrestha,Roman %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Storrs, CT, 06269, United States, 1 860 486 2834, roman.shrestha@uconn.edu %K chemsex %K party and play %K sexualized drug use %K PartyPack %K harm reduction tool %K men who have sex with men %K Malaysia %K health promotion %K sexual health %K mHealth intervention %K HIV prevention %D 2023 %7 24.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Chemsex—the use of psychoactive drugs to enhance the sexual experience—is an increasing phenomenon globally. Despite the increasing burden and associated harms of chemsex, evidence-based interventions (ie, behavioral and pharmacological) for chemsex users are nonexistent. Objective: In this study, we assessed the usability and acceptability of a mobile health (mHealth)–delivered safer chemsex package (“PartyPack”) as a sexual harm reduction strategy among men who have sex with men in Malaysia—a setting where chemsex is becoming increasingly prevalent. Methods: This study is part of a larger smartphone app-based intervention (ie, JomPrEP; University of Connecticut) designed to improve access to HIV prevention services among Malaysian men who have sex with men. A total of 50 participants were recruited from the Greater Kuala Lumpur region of Malaysia to use the JomPrEP app, which included a feature allowing participants to order PartyPack, for 30 days (March-April 2022). The usability and acceptability of the PartyPack were assessed using self-report, app analytics, and exit interviews (n=20). Results: Overall, 8% (4/50) of participants reported having engaged in chemsex in the past 6 months; however, engagement in condomless sex (34/50, 68%) and group sex (9/50, 18%) was much higher. A total of 43 (86%) participants ordered PartyPack, of which 27 (63%) made multiple orders during the 30 days. Most participants (41/43, 95%) reported being satisfied with the PartyPack order feature in the app, with 91% (39/43) indicating the order and tracking process was easy. Thematic data exploration further revealed important information for understanding (eg, items included in the package, use of mHealth platform to order package, and discreetness of the PartyPack box and order and delivery) and refining the logistical preferences (eg, using branded items and allowing customization during order). Conclusions: Our findings provide strong evidence of the usability and acceptability of a mHealth-delivered safer chemsex package as a potential sexual harm reduction tool among this underserved population. Replication in a study with a larger sample size to test the efficacy of the PartyPack is warranted. %M 37616034 %R 10.2196/48113 %U https://formative.jmir.org/2023/1/e48113 %U https://doi.org/10.2196/48113 %U http://www.ncbi.nlm.nih.gov/pubmed/37616034 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43526 %T Effects of Community-Based Caring Contact in Reducing Thwarted Belongingness Among Postdischarge Young Adults With Self-Harm: Randomized Controlled Trial %A Law,Yik Wa %A Lok,Rita Hui Ting %A Chiang,Byron %A Lai,Carmen Chui Shan %A Tsui,Sik Hon Matthew %A Chung,Pui Yin Joseph %A Leung,Siu Chung %+ Department of Social Work and Social Administration, University of Hong Kong, RM534, The Jockey Club Tower,, The Centennial Campus, HKU, Pokfulam, Hong Kong, Hong Kong, 852 93029863, flawhk@hku.hk %K self-harm %K suicidal ideation %K volunteers %K mobile app %K thwarted belongingness %K suicide %K youth %K community %K support %K treatment %K effectiveness %K risk %K patient %K intervention %K model %K care %K hospital %D 2023 %7 16.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: For patients with self-harm behaviors, the urge to hurt themselves persists after hospital discharge, leading to costly readmissions and even death. Hence, postdischarge intervention programs that reduce self-harm behavior among patients should be part of a cogent community mental health care policy. Objective: We aimed to determine whether a combination of a self-help mobile app and volunteer support could complement treatment as usual (TAU) to reduce the risk of suicide among these patients. Methods: We conducted a pragmatic randomized controlled trial on discharged patients aged between 18 and 45 years with self-harm episodes/suicide attempts, all of whom were recruited from 4 hospital emergency departments in Hong Kong. Participants were randomly assigned to one of three groups: (1) mobile app + TAU (“apps”), (2) mobile app + volunteer support + TAU (“volunteers”), or (3) TAU only as the control group (“TAU”). They were asked to submit a mobile app–based questionnaire during 4 measurement time points at monthly intervals. Results: A total of 40 participants were recruited. Blending volunteer care with a preprogrammed mobile app was found to be effective in improving service compliance. Drawing upon the interpersonal-psychological theory of suicide, our findings suggested that a reduction in perceived burdensomeness and thwarted belongingness through community-based caring contact are linked to improvement in hopelessness, albeit a transient one, and suicide risk. Conclusions: A combination of volunteer care with a self-help mobile app as a strategy for strengthening the continuity of care can be cautiously implemented for discharged patients at risk of self-harm during the transition from the hospital to a community setting. Trial Registration: ClinicalTrials.gov NCT03081078; https://clinicaltrials.gov/study/NCT03081078 %M 37585260 %R 10.2196/43526 %U https://formative.jmir.org/2023/1/e43526 %U https://doi.org/10.2196/43526 %U http://www.ncbi.nlm.nih.gov/pubmed/37585260 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47798 %T Assessing Vulnerability to Surges in Suicide-Related Tweets Using Japan Census Data: Case-Only Study %A Mitsuhashi,Toshiharu %+ Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan, 81 86 235 6504, mitsuh-t@cc.okayama-u.ac.jp %K case-only approach %K mass media %K public health %K social media %K suicidal risk %K suicide prevention %K suicide %K suicide-related tweets %K Twitter %D 2023 %7 10.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: As the use of social media becomes more widespread, its impact on health cannot be ignored. However, limited research has been conducted on the relationship between social media and suicide. Little is known about individuals’ vulnerable to suicide, especially when social media suicide information is extremely prevalent. Objective: This study aims to identify the characteristics underlying individuals’ vulnerability to suicide brought about by an increase in suicide-related tweets, thereby contributing to public health. Methods: A case-only design was used to investigate vulnerability to suicide using individual data of people who died by suicide and tweet data from January 1, 2011, through December 31, 2014. Mortality data were obtained from Japanese government statistics, and tweet data were provided by a commercial service. Tweet data identified the days when suicide-related tweets surged, and the date-keyed merging was performed by considering 3 and 7 lag days. For the merged data set for analysis, the logistic regression model was fitted with one of the personal characteristics of interest as a dependent variable and the dichotomous exposure variable. This analysis was performed to estimate the interaction between the surges in suicide-related tweets and personal characteristics of the suicide victims as case-only odds ratios (ORs) with 95% CIs. For the sensitivity analysis, unexpected deaths other than suicide were considered. Results: During the study period, there were 159,490 suicides and 115,072 unexpected deaths, and the number of suicide-related tweets was 2,804,999. Following the 3-day lag of a highly tweeted day, there were significant interactions for those who were aged 40 years or younger (OR 1.09, 95% CI 1.03-1.15), male (OR 1.12, 95% CI 1.07-1.18), divorced (OR 1.11, 95% CI 1.03 1.19), unemployed (OR 1.12, 95% CI 1.02-1.22), and living in urban areas (OR 1.26, 95% CI 1.17 1.35). By contrast, widowed individuals had significantly lower interactions (OR 0.83, 95% CI 0.77-0.89). Except for unemployment, significant relationships were also observed for the 7-day lag. For the sensitivity analysis, no significant interactions were observed for other unexpected deaths in the 3-day lag, and only the widowed had a significantly larger interaction than those who were married (OR 1.08, 95% CI 1.02-1.15) in the 7-day lag. Conclusions: This study revealed the interactions of personal characteristics associated with susceptibility to suicide-related tweets. In addition, a few significant relationships were observed in the sensitivity analysis, suggesting that such an interaction is specific to suicide deaths. In other words, individuals with these characteristics, such as being young, male, unemployed, and divorced, may be vulnerable to surges in suicide-related tweets. Thus, minimizing public health strain by identifying people who are vulnerable and susceptible to a surge in suicide-related information on the internet is necessary. %M 37561553 %R 10.2196/47798 %U https://formative.jmir.org/2023/1/e47798 %U https://doi.org/10.2196/47798 %U http://www.ncbi.nlm.nih.gov/pubmed/37561553 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e47084 %T Assessing Detection of Children With Suicide-Related Emergencies: Evaluation and Development of Computable Phenotyping Approaches %A Edgcomb,Juliet Beni %A Tseng,Chi-hong %A Pan,Mengtong %A Klomhaus,Alexandra %A Zima,Bonnie T %+ Mental Health Informatics and Data Science (MINDS) Hub, Center for Community Health, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, United States, 1 310 794 8278, jedgcomb@mednet.ucla.edu %K child mental health %K suicide %K self-harm %K machine learning %K phenotyping %D 2023 %7 21.7.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although suicide is a leading cause of death among children, the optimal approach for using health care data sets to detect suicide-related emergencies among children is not known. Objective: This study aimed to assess the performance of suicide-related International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and suicide-related chief complaint in detecting self-injurious thoughts and behaviors (SITB) among children compared with clinician chart review. The study also aimed to examine variations in performance by child sociodemographics and type of self-injury, as well as develop machine learning models trained on codified health record data (features) and clinician chart review (gold standard) and test model detection performance. Methods: A gold standard classification of suicide-related emergencies was determined through clinician manual review of clinical notes from 600 emergency department visits between 2015 and 2019 by children aged 10 to 17 years. Visits classified with nonfatal suicide attempt or intentional self-harm using the Centers for Disease Control and Prevention surveillance case definition list of ICD-10-CM codes and suicide-related chief complaint were compared with the gold standard classification. Machine learning classifiers (least absolute shrinkage and selection operator–penalized logistic regression and random forest) were then trained and tested using codified health record data (eg, child sociodemographics, medications, disposition, and laboratory testing) and the gold standard classification. The accuracy, sensitivity, and specificity of each detection approach and relative importance of features were examined. Results: SITB accounted for 47.3% (284/600) of the visits. Suicide-related diagnostic codes missed nearly one-third (82/284, 28.9%) and suicide-related chief complaints missed more than half (153/284, 53.9%) of the children presenting to emergency departments with SITB. Sensitivity was significantly lower for male children than for female children (0.69, 95% CI 0.61-0.77 vs 0.84, 95% CI 0.78-0.90, respectively) and for preteens compared with adolescents (0.66, 95% CI 0.54-0.78 vs 0.86, 95% CI 0.80-0.92, respectively). Specificity was significantly lower for detecting preparatory acts (0.68, 95% CI 0.64-0.72) and attempts (0.67, 95% CI 0.63-0.71) than for detecting ideation (0.79, 95% CI 0.75-0.82). Machine learning–based models significantly improved the sensitivity of detection compared with suicide-related codes and chief complaint alone. Models considering all 84 features performed similarly to models considering only mental health–related ICD-10-CM codes and chief complaints (34 features) and models considering non–ICD-10-CM code indicators and mental health–related chief complaints (53 features). Conclusions: The capacity to detect children with SITB may be strengthened by applying a machine learning–based approach to codified health record data. To improve integration between clinical research informatics and child mental health care, future research is needed to evaluate the potential benefits of implementing detection approaches at the point of care and identifying precise targets for suicide prevention interventions in children. %M 37477974 %R 10.2196/47084 %U https://mental.jmir.org/2023/1/e47084 %U https://doi.org/10.2196/47084 %U http://www.ncbi.nlm.nih.gov/pubmed/37477974 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47058 %T Effects of Tobacco Versus Electronic Cigarette Usage on Nonsuicidal Self-Injury and Suicidality Among Chinese Youth: Cross-Sectional Self-Report Survey Study %A Wang,Yinzhe %A Xu,Shicun %A Zhang,Xiaoqian %A Zhang,Yanwen %A Feng,Yi %A Wang,Yuanyuan %A Chen,Runsen %+ China Center for Aging Studies and Social-Economic Development, Jilin University, Kuang Yaming Bldg, 6th Fl, Changchun, Jilin, China, 86 43185166393, xushicun@jlu.edu.cn %K electronic cigarettes %K tobacco %K conventional cigarettes %K SGM %K nonsuicidal self-injury %K suicidality %K suicidal %K cigarette %K cigarettes %K suicide %K self-harm %K mental health %K sexual minority %K gender minority %K sexual and gender minority %K transgender %K youth %K cross-sectional %K survey %K smoker %K smoking %D 2023 %7 7.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The increase in tobacco/conventional cigarette (CC) and electronic cigarette (EC) usage among Chinese youth has become a growing public health concern. This is the first large-scale study to compare the impact of CC and EC usage on risk for nonsuicidal self-injury (NSSI) and suicidality in cis-heterosexual and sexual and gender minority (SGM) youth populations in China. Objective: This study examines the CC and EC risks for NSSI and suicidality among Chinese youth and compares the extent to which SGM and cis-heterosexual youth’s risks for NSSI and suicidality are influenced by their CC and EC usage and dependence. Methods: A total of 89,342 Chinese participants completed a cross-sectional self-report survey in 2021. Sociodemographic information, sexual orientations, gender identities, CC and EC usage, CC and EC dependence, and risks for suicidality and NSSI were assessed. The Mann-Whitney U test and chi-square test were performed for nonnormally distributed continuous variables and categorical variables, respectively. The multivariable linear regression model was used to examine both the influence of CC and EC usage and CC and EC dependence on NSSI and suicidality as well as the interaction effects of CC and EC usage and CC and EC dependence on NSSI and suicidality by group. Results: The prevalence of CC usage (P<.001) and dependence (P<.001) among SGM participants was lower than that among their cis-heterosexual counterparts. However, the prevalence of EC usage (P=.03) and EC dependence (P<.001) among SGM participants was higher than that among their cis-heterosexual counterparts. The multivariable linear regression model showed that CC dependence and EC dependence had a unique effect on NSSI and suicidality (CCs: B=0.02, P<.001; B=0.09, P<.001; ECs: B=0.05, P<.001; B=0.14, P<.001, respectively). The interaction effects of (1) CC usage and group type on NSSI and suicidality (B=0.34, P<.001; B=0.24, P=.03, respectively) and dual usage and group type on NSSI and suicidality (B=0.54, P<.001; B=0.84, P<.001, respectively) were significant, (2) CC dependence and group type on NSSI were significant (B=0.07, P<.001), and (3) EC dependence and group type on NSSI and suicidality were significant (B=0.04, P<.001; B=0.09, P<.001, respectively). No significant interaction effect was observed between EC usage and group type on NSSI and suicidality (B=0.15, P=.12; B=0.33, P=.32, respectively) and between CC dependence and group type on suicidality (B=–0.01, P=.72). Conclusions: Our study shows evidence of intergroup differences in NSSI and suicidality risks between SGM and cis-heterosexual youth related to CC and EC usage. These findings contribute to the growing literature on CC and EC in cis-heterosexual and SGM populations. Concerted efforts are necessary at a societal level to curb the aggressive marketing strategies of the EC industry and media coverage and to maximize the impact of educational campaigns on EC prevention and intervention among the youth population. %M 37418293 %R 10.2196/47058 %U https://publichealth.jmir.org/2023/1/e47058 %U https://doi.org/10.2196/47058 %U http://www.ncbi.nlm.nih.gov/pubmed/37418293 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46464 %T Real-Time Real-World Digital Monitoring of Adolescent Suicide Risk During the Six Months Following Emergency Department Discharge: Protocol for an Intensive Longitudinal Study %A Barzilay,Shira %A Fine,Shai %A Akhavan,Shannel %A Haruvi-Catalan,Liat %A Apter,Alan %A Brunstein-Klomek,Anat %A Carmi,Lior %A Zohar,Mishael %A Kinarty,Inbar %A Friedman,Talia %A Fennig,Silvana %+ Department of Community Mental Health, University of Haifa, Abba Khoushy Ave 199, Haifa, 3498838, Israel, 972 545309759, shirabarzilay@univ.haifa.ac.il %K suicide %K suicide ideation %K suicide prevention %K adolescents %K real-time assessment %K digital phenotyping %K risk assessment %K mobile phone %D 2023 %7 26.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide is the second leading cause of death in adolescents, and self-harm is one of the strongest predictors of death by suicide. The rates of adolescents presenting to emergency departments (EDs) for suicidal thoughts and behaviors (STBs) have increased. Still, existing follow-up after ED discharge is inadequate, leaving a high-risk period for reattempts and suicide. There is a need for innovative evaluation of imminent suicide risk factors in these patients, focusing on continuous real-time evaluations with low assessment burden and minimal reliance on patient disclosure of suicidal intent. Objective: This study examines prospective longitudinal associations between observed real-time mobile passive sensing, including communication and activity patterns, and clinical and self-reported assessments of STB over 6 months. Methods: This study will include 90 adolescents recruited on their first outpatient clinic visit following their discharge from the ED due to a recent STB. Participants will complete brief weekly assessments and be monitored continuously for their mobile app usage, including mobility, activity, and communication patterns, over 6 months using the iFeel research app. Participants will complete 4 in-person visits for clinical assessment at baseline and at the 1-, 3-, and 6-month follow-ups. The digital data will be processed, involving feature extraction, scaling, selection, and dimensionality reduction. Passive monitoring data will be analyzed using both classical machine learning models and deep learning models to identify proximal associations between real-time observed communication, activity patterns, and STB. The data will be split into a training and validation data set, and predictions will be matched against the clinical evaluations and self-reported STB events (ie, labels). To use both labeled and unlabeled digital data (ie, passively collected), we will use semisupervised methods in conjunction with a novel method that is based on anomaly detection notions. Results: Participant recruitment and follow-up started in February 2021 and are expected to be completed by 2024. We expect to find prospective proximal associations between mobile sensor communication, activity data, and STB outcomes. We will test predictive models for suicidal behaviors among high-risk adolescents. Conclusions: Developing digital markers of STB in a real-world sample of high-risk adolescents presenting to ED can inform different interventions and provide an objective means to assess the risk of suicidal behaviors. The results of this study will be the first step toward large-scale validation that may lead to suicide risk measures that aid psychiatric follow-up, decision-making, and targeted treatments. This novel assessment could facilitate timely identification and intervention to save young people’s lives. International Registered Report Identifier (IRRID): DERR1-10.2196/46464 %M 37358906 %R 10.2196/46464 %U https://www.researchprotocols.org/2023/1/e46464 %U https://doi.org/10.2196/46464 %U http://www.ncbi.nlm.nih.gov/pubmed/37358906 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47225 %T Public Surveillance of Social Media for Suicide Using Advanced Deep Learning Models in Japan: Time Series Study From 2012 to 2022 %A Wang,Siqin %A Ning,Huan %A Huang,Xiao %A Xiao,Yunyu %A Zhang,Mengxi %A Yang,Ellie Fan %A Sadahiro,Yukio %A Liu,Yan %A Li,Zhenlong %A Hu,Tao %A Fu,Xiaokang %A Li,Zi %A Zeng,Ye %+ Graduate School of Interdisciplinary Information Studies, University of Tokyo, 7 Chome-3 Hongo, Bunkyo City, Tokyo, 113-0033, Japan, 81 358415938, sisiplanner@gmail.com %K suicide %K suicidal ideation %K suicide-risk identification %K natural language processing %K social media %K Japan %D 2023 %7 2.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms have been increasingly used to express suicidal thoughts, feelings, and acts, raising public concerns over time. A large body of literature has explored the suicide risks identified by people’s expressions on social media. However, there is not enough evidence to conclude that social media provides public surveillance for suicide without aligning suicide risks detected on social media with actual suicidal behaviors. Corroborating this alignment is a crucial foundation for suicide prevention and intervention through social media and for estimating and predicting suicide in countries with no reliable suicide statistics. Objective: This study aimed to corroborate whether the suicide risks identified on social media align with actual suicidal behaviors. This aim was achieved by tracking suicide risks detected by 62 million tweets posted in Japan over a 10-year period and assessing the locational and temporal alignment of such suicide risks with actual suicide behaviors recorded in national suicide statistics. Methods: This study used a human-in-the-loop approach to identify suicide-risk tweets posted in Japan from January 2013 to December 2022. This approach involved keyword-filtered data mining, data scanning by human efforts, and data refinement via an advanced natural language processing model termed Bidirectional Encoder Representations from Transformers. The tweet-identified suicide risks were then compared with actual suicide records in both temporal and spatial dimensions to validate if they were statistically correlated. Results: Twitter-identified suicide risks and actual suicide records were temporally correlated by month in the 10 years from 2013 to 2022 (correlation coefficient=0.533; P<.001); this correlation coefficient is higher at 0.652 when we advanced the Twitter-identified suicide risks 1 month earlier to compare with the actual suicide records. These 2 indicators were also spatially correlated by city with a correlation coefficient of 0.699 (P<.001) for the 10-year period. Among the 267 cities with the top quintile of suicide risks identified from both tweets and actual suicide records, 73.5% (n=196) of cities overlapped. In addition, Twitter-identified suicide risks were at a relatively lower level after midnight compared to a higher level in the afternoon, as well as a higher level on Sundays and Saturdays compared to weekdays. Conclusions: Social media platforms provide an anonymous space where people express their suicidal thoughts, ideation, and acts. Such expressions can serve as an alternative source to estimating and predicting suicide in countries without reliable suicide statistics. It can also provide real-time tracking of suicide risks, serving as an early warning for suicide. The identification of areas where suicide risks are highly concentrated is crucial for location-based mental health planning, enabling suicide prevention and intervention through social media in a spatially and temporally explicit manner. %M 37267022 %R 10.2196/47225 %U https://www.jmir.org/2023/1/e47225 %U https://doi.org/10.2196/47225 %U http://www.ncbi.nlm.nih.gov/pubmed/37267022 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e40808 %T The Relationship Between Nonsuicidal Self-injury and Attachment: Protocol for a Systematic Review and Meta-analysis %A Aghamohammadi,Soudeh %A Mazaheri,M Ali %A Fata,Ladan %A Mootabi,Fereshteh %+ Department of Clinical Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Velenjak, Daneshjou Blvd, Tehran, 1983969411, Iran, 98 2129905301, soudehmohammadi@gmail.com %K nonsuicidal self-injury %K NSSI %K attachment %K emotion regulation %K systematic review %K review methodology %K search strategy %K library science %K librarian %K self-injury %K self-harm %K self-injurious %K self-destructive %K self-mutilation %K review protocol %K meta-analysis %K meta-analyses %D 2023 %7 31.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of nonsuicidal self-injury (NSSI) is a major concern in public health. Two main factors (individual and environmental) cause NSSI. Studies addressing NSSI often consider it as an emotion regulation strategy. Studying NSSI within the framework of attachment theory is reasonable since the capacities to regulate emotion come into existence in the framework of attachment in the first periods of a child’s growth. Primary studies addressing this topic are not frequent, and no systematic review has been conducted. Objective: This systematic review and meta-analysis protocol aims to investigate the relationship between NSSI and attachment style and finding its relationship based on study design, study type, different types of attachments, and gender. Methods: All studies on the relationship between NSSI and attachment will be included in this systematic review. We will include observational studies (cross-sectional, cohort, and case control) through searches in electronic databases via PubMed, CINAHL, Embase, Web of Science, ProQuest, Scopus, PsycINFO, and Google Scholar as complementary search. Qualitative studies, case studies, case series, and letters to the editor will be excluded. There will be no language limitation. Moreover, there will be no limitations regarding the study participants’ age, gender, nationality, sexual orientation, and psychological problems. Funnel plots were examined if 10 or more studies are included, and the Begg and Egger statistical tests were used to assess the risk of bias. All similar data will be combined through the “metan” command by Stata statistical package (StataCorp). A fixed-effects or random-effects model, considering methodological similarities or differences, will be selected to determine a combination model. Results: We will summarize the selection of the eligible studies using a flowchart. The results will be presented in a table of evidence. The results of the meta-analysis will be depicted using diagrams and tables. Conclusions: It seems necessary to carry out such systematic and comprehensive meta-analysis to present a summary of the published articles in terms of the relationship between NSSI and attachment. The results from this review will be used to improve our knowledge of the role of the upbringing of children and NSSI behavior and will help design appropriate interventions to address NSSI. Trial Registration: PROSPERO CRD42021226455; https://tinyurl.com/yc77wny8 International Registered Report Identifier (IRRID): PRR1-10.2196/40808 %M 37256657 %R 10.2196/40808 %U https://www.researchprotocols.org/2023/1/e40808 %U https://doi.org/10.2196/40808 %U http://www.ncbi.nlm.nih.gov/pubmed/37256657 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41078 %T Breaking Down Barriers to a Suicide Prevention Helpline: Protocol for a Web-Based Randomized Controlled Trial %A van der Burgt,Margot C A %A Mérelle,Saskia %A Brinkman,Willem-Paul %A Beekman,Aartjan T F %A Gilissen,Renske %+ Department of Research, 113 Suicide Prevention, Paasheuvelweg 25, Amsterdam, 1105 BP, Netherlands, 31 203113883, m.vanderburgt@113.nl %K barrier reduction intervention %K suicidal ideation %K self-help %K suicide prevention helpline %K randomized controlled trial %K help-seeking %D 2023 %7 24.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, suicide is among the leading causes of death, with men being more at risk to die from suicide than women. Research suggests that people with suicidal ideation often struggle to find adequate help. Every month, around 4000 people fill in the anonymous self-test for suicidal thoughts on the website of the Dutch suicide prevention helpline. This self-test includes the Suicidal Ideation Attributes Scale (SIDAS), which educates users about the severity of their suicidal thoughts. The vast majority (70%) of people who complete the self-test score higher than the cutoff point (≥21) for severe suicidal thoughts. Unfortunately, despite this, less than 10% of test-takers navigate to the web page about contacting the helpline. Objective: This protocol presents the design of a web-based randomized controlled trial that aims to reduce barriers to contacting the suicide prevention helpline. The aim of this study is 2-fold: (1) to measure the effectiveness of a brief barrier reduction intervention (BRI) provided in the self-test motivating people with severe suicidal thoughts to contact the Dutch suicide prevention helpline and (2) to specifically evaluate the effectiveness of the BRI in increasing service use by high-risk groups for suicide such as men and middle-aged people. Methods: People visiting the self-test for suicidal thoughts on the website of the suicide prevention helpline will be asked to participate in a study to improve the self-test. Individuals with severe suicidal thoughts and little motivation to contact the helpline will be randomly allocated either to a brief BRI, in which they will receive a short tailored message based on their self-reported barrier to the helpline (n=388) or care as usual (general advisory text, n=388). The primary outcome measure is the use of a direct link to contact the helpline after receiving the intervention or control condition. Secondary outcomes are the self-reported likelihood of contacting the helpline (on a 5-point scale) and satisfaction with the self-test. In the BRI, participants receive tailored information to address underlying concerns and misconceptions of barriers to the helpline. A pilot study was conducted among current test-takers to identify these specific barriers. Results: The pilot study (N=1083) revealed multiple barriers to contacting the helpline. The most prominent were the belief that a conversation with a counselor would not be effective, fear of the conversation itself, and emotional concerns about talking about suicidal thoughts. Conclusions: Our study will provide insight into the effectiveness of a brief BRI designed to increase the use of a suicide prevention helpline provided in a self-test on suicidal thoughts. If successful, this intervention has the potential to be a low-cost, easily scalable, and feasible method to increase service use for helplines across the world. Trial Registration: ClinicalTrials.gov NCT05458830; https://clinicaltrials.gov/ct2/show/NCT05458830 International Registered Report Identifier (IRRID): PRR1-10.2196/41078 %M 37093641 %R 10.2196/41078 %U https://www.researchprotocols.org/2023/1/e41078 %U https://doi.org/10.2196/41078 %U http://www.ncbi.nlm.nih.gov/pubmed/37093641 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45796 %T Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities–Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment %A Berry,Katie R %A Gliske,Kate %A Schmidt,Clare %A Cray,Ley David Elliette %A Killian,Michael %A Fenkel,Caroline %+ Charlie Health, Inc, 233 E Main St, Ste. 401, Bozeman, MT, 59715, United States, 1 9545527671, krberry@fsu.edu %K lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities %K LGBTQIA+ %K youth %K mental health %K affirming health care %K suicidal ideation %K depression %K nonsuicidal self-harm %K NSSI %D 2023 %7 21.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) youth have disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors. In addition, LGBTQIA+ youth frequently report lower levels of satisfaction or comfort with their health care providers because of stigmatization, which may prevent continuation of care, yet there is a lack of mental health treatment and outcome research addressing these disparities. However, there is some indication that LGBTQIA+ individuals feel more comfortable with web-based formats, indicating that telehealth services may be beneficial for this population. Objective: This program evaluation explored the effectiveness of a remote intensive outpatient program with a curriculum tailored specifically to LGBTQIA+ youth with high-acuity depression, anxiety, and suicidality. This study sought to understand baseline acuity differences between LGBTQIA+ and non-LGBTQIA+ youth and young adult patients and to determine if there were differences in clinically significant improvement by subtypes within the LGBTQIA+ population following participation in LGBTQIA+-specific programming. Methods: Data were collected from intake and discharge outcome surveys measuring depression, suicidality, and nonsuicidal self-injury (NSSI) in 878 patients who attended at least six sessions of a remote intensive outpatient program for youth and young adults. Of these 878 clients, 551 (62.8%) were identified as having at least one LGBTQIA+ identity; they participated in an LGBTQIA+-adapted program of the general curriculum. Results: LGBTQIA+ patients had more clinically severe intake for depression, NSSI, and suicidal ideation. Nonbinary clients had greater NSSI within the LGBTQIA+ sample at intake than their binary counterparts, and transgender clients had significantly higher depressive scores at intake than their nontransgender counterparts. LGBTQIA+ patients demonstrated improvements in all outcomes from intake to discharge. The Patient Health Questionnaire for Adolescents depression scores improved from 18.15 at intake to 10.83 at discharge, representing a 41.5% reduction in depressive symptoms. Overall, 50.5% (149/295) of the LGBTQIA+ youth who endorsed passive suicidal ideation at intake no longer reported it at discharge, 72.1% (160/222) who endorsed active suicidal ideation at intake no longer reported it at discharge, and 55.1% (109/198) of patients who met the criteria for clinical NSSI no longer met the criteria at discharge. In the subgroup analysis, transgender patients were still 2 times more likely to report clinical NSSI at discharge. Conclusions: This program evaluation found substantial differences in rates of depression, NSSI, and suicidal ideation between LGBTQIA+ clients compared with their non-LGBTQIA+ counterparts. In addition, this evaluation showed a considerable decrease in symptoms when clients attended LGBTQIA+-affirming care. The findings provide support for the role of LGBTQIA+-specific programming to meet the elevated mental health needs of these youth and that more research is needed to understand barriers that may negatively affect transgender clients, specifically. %M 37083637 %R 10.2196/45796 %U https://formative.jmir.org/2023/1/e45796 %U https://doi.org/10.2196/45796 %U http://www.ncbi.nlm.nih.gov/pubmed/37083637 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46254 %T Association Between Internet Searches Related to Suicide/Self-harm and Adolescent Suicide Death in South Korea in 2016-2020: Secondary Data Analysis %A Choi,Won-Seok %A Han,Junhee %A Hong,Hyun Ju %+ Department of Psychiatry, Hallym University Sacred Heart Hospital, College of Medicine, Hallym Univerisity, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Gyeonggi-do, Anyang, 14068, Republic of Korea, 82 010 8880 8769, honghj88@gmail.com %K adolescent %K suicide %K self-mutilation %K internet %K search engine %K Korea %K suicide death %K surveillance %K monitoring %K internet search %D 2023 %7 20.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies have investigated the association between suicide and internet search volumes of terms related to suicide or self-harm. However, the results varied by people’s age, period, and country, and no study has exclusively investigated suicide or self-harm rates among adolescents. Objective: This study aims to determine the association between the internet search volumes of terms related to suicide/self-harm and the number of suicides among South Korean adolescents. We investigated gender differences in this association and the time lag between the internet search volumes of the terms and the connected suicide deaths. Methods: We selected 26 search terms related to suicide and self-harm among South Korean adolescents, and the search volumes of these terms for adolescents aged 13-18 years were obtained from the leading internet search engine in South Korea (Naver Datalab). A data set was constructed by combining data from Naver Datalab and the number of suicide deaths of adolescents on a daily basis from January 1, 2016, to December 31, 2020. Spearman rank correlation and multivariate Poisson regression analyses were performed to identify the association between the search volumes of the terms and the suicide deaths during that period. The time lag between suicide death and the increasing trend in the search volumes of the related terms was estimated from the cross-correlation coefficients. Results: Significant correlations were observed within the search volumes of the 26 terms related to suicide/self-harm. The internet search volumes of several terms were associated with the number of suicide deaths among South Korean adolescents, and this association differed by gender. The search volume for “dropout” showed a statistically significant correlation with the number of suicides in all adolescent population groups. The correlation between the internet search volume for “dropout” and the connected suicide deaths was the strongest for a time lag of 0 days. In females, self-harm and academic score showed significant associations with suicide deaths, but academic score showed a negative correlation, and the time lags with the strongest correlations were 0 and –11 days, respectively. In the total population, self-harm and suicide method were associated with the number of suicides, and the time lags with the strongest correlations were +7 and 0 days, respectively. Conclusions: This study identifies a correlation between suicides and internet search volumes related to suicide/self-harm among South Korean adolescents, but the relatively weak correlation (incidence rate ratio 0.990-1.068) should be interpreted with caution. %M 37079349 %R 10.2196/46254 %U https://www.jmir.org/2023/1/e46254 %U https://doi.org/10.2196/46254 %U http://www.ncbi.nlm.nih.gov/pubmed/37079349 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42316 %T Suicide Prevention Using Google Ads: Randomized Controlled Trial Measuring Engagement %A Onie,Sandersan %A Berlinquette,Patrick %A Holland,Sarah %A Livingstone,Nicola %A Finemore,Coco %A Gale,Nyree %A Elder,Emma %A Laggis,George %A Heffernan,Cassandra %A Armstrong,Susanne Oliver %A Theobald,Adam %A Josifovski,Natasha %A Torok,Michelle %A Shand,Fiona %A Larsen,Mark %+ Black Dog Institute, 1 Hospital Rd, Randwick, 2031, Australia, 61 (02) 9382 4530, s.onie@blackdog.org.au %K suicide prevention %K suicide %K suicidal %K self harm %K digital advertising %K Google Ads %K search %K suicide hotline %K advertise %K advertising %K campaign %K mental health %K prevention %K digital intervention %K online intervention %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Studies have shown that individuals may search for suicide-related terms on the internet prior to an attempt. Objective: Thus, across 2 studies, we investigated engagement with an advertisement campaign designed to reach individuals contemplating suicide. Methods: First, we designed the campaign to focus on crisis, running a campaign for 16 days in which crisis-related keywords would trigger an ad and landing page to help individuals find the national suicide hotline number. Second, we expanded the campaign to also help individuals contemplating suicide, running the campaign for 19 days with a wider range of keywords through a co-designed website with a wider range of offerings (eg, lived experience stories). Results: In the first study, the ad was shown 16,505 times and was clicked 664 times (4.02% click rate). There were 101 calls to the hotline. In the second study, the ad was shown 120,881 times and clicked 6227 times (5.15% click rate); of these 6227 clicks, there were 1419 (22.79%) engagements with the site, a substantially higher rate than the industry average of 3%. The number of clicks on the ad was high despite a suicide hotline banner likely being present. Conclusions: Search advertisements are a quick, far-reaching, and cost-efficient way of reaching those contemplating suicide and are needed despite suicide hotline banners being present. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000084684; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385209 %M 37079348 %R 10.2196/42316 %U https://mental.jmir.org/2023/1/e42316 %U https://doi.org/10.2196/42316 %U http://www.ncbi.nlm.nih.gov/pubmed/37079348 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e41261 %T Investigation of the Relationship Between Psychiatry Visit and Suicide After Deliberate Self-harm: Longitudinal National Cohort Study %A Kim,Hye Hyeon %A Ko,Chanyoung %A Park,Ji Ae %A Song,In Han %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea, 82 2 2228 2494, YURANGPARK@yuhs.ac %K deliberate self-harm %K suicide %K psychiatry %K suicidal %K death %K mortality %K psychiatric %K Korea %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Deliberate self-harm (DSH) along with old age, physical disability, and low socioeconomic status are well-known contributors to suicide-related deaths. In recent years, South Korea has the highest suicide death rate among all Organization for Economic Co-operation and Development countries. Owing to the difficulty of accessing data of individuals with DSH behavior who died by suicide, the factors associated with suicide death in these high-risk individuals have not been sufficiently explored. There have been conflicting findings with regard to the relationship between previous psychiatric visits and suicidal death. Objective: We aimed to address the following 3 questions: Are there considerable differences in demographics, socioeconomic status, and clinical features in individuals who received psychiatric diagnosis (either before DSH or after DSH event) and those who did not? Does receiving a psychiatric diagnosis from the Department of Psychiatry, as opposed to other departments, affect survival? and Which factors related to DSH contribute to deaths by suicide? Methods: We used the Korean National Health Insurance Service Database to design a cohort of 5640 individuals (3067/5640, 54.38% women) who visited the hospital for DSH (International Classification of Diseases codes X60-X84) between 2002 and 2020. We analyzed whether there were significant differences among subgroups of individuals with DSH behavior based on psychiatric diagnosis status (whether they had received a psychiatric diagnosis, either before or after the DSH event) and the department from which they had received the psychiatric diagnosis. Another main outcome of the study was death by suicide. Cox regression models yielded hazard ratios (HRs) for suicide risk. Patterns were plotted using Kaplan-Meier survival curves. Results: There were significant differences in all factors including demographic, health-related, socioeconomic, and survival variables among the groups that were classified according to psychiatric diagnosis status (P<.001). The group that did not receive a psychiatric diagnosis had the lowest survival rate (867/1064, 81.48%). Analysis drawn using different departments from where the individual had received a psychiatric diagnosis showed statistically significant differences in all features of interest (P<.001). The group that had received psychiatric diagnoses from the Department of Psychiatry had the highest survival rate (888/951, 93.4%). These findings were confirmed using the Kaplan-Meier survival curves (P<.001). The severity of DSH (HR 4.31, 95% CI 3.55-5.26) was the most significant contributor to suicide death, followed by psychiatric diagnosis status (HR 1.84, 95% CI 1.47-2.30). Conclusions: Receiving psychiatric assessment from a health care professional, especially a psychiatrist, reduces suicide death in individuals who had deliberately harmed themselves before. The key characteristics of individuals with DSH behavior who die by suicide are male sex, middle age, comorbid physical disabilities, and higher socioeconomic status. %M 37043262 %R 10.2196/41261 %U https://publichealth.jmir.org/2023/1/e41261 %U https://doi.org/10.2196/41261 %U http://www.ncbi.nlm.nih.gov/pubmed/37043262 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44862 %T The Effectiveness of a Smartphone Intervention Targeting Suicidal Ideation in Young Adults: Randomized Controlled Trial Examining the Influence of Loneliness %A McGillivray,Lauren %A Keng-Meng Hui,Nicholas %A Wong,Quincy J J %A Han,Jin %A Qian,Jiahui %A Torok,Michelle %+ Black Dog Institute, University of New South Wales, Hospital Rd, Sydney, 2031, Australia, 61 2 9065 9133, m.torok@unsw.edu.au %K loneliness %K suicidal ideation %K suicide prevention %K digital therapeutics %K smartphone intervention %K apps %D 2023 %7 30.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is commonly reported by young people and has been shown to contribute to the rapid onset and escalation of depression and suicidal ideation during adolescence. Lonely people may also be particularly susceptible to disengaging from treatment early given the likelihood of their more complex clinical profiles leading to cognitive fatigue. While a smartphone intervention (LifeBuoy) has been shown to effectively reduce suicidal ideation in young adults, poor engagement is a well-documented issue for this therapeutic modality and has been shown to result in poorer treatment outcomes. Objective: This study aims to determine whether loneliness affects how young people experiencing suicidal ideation engage with and benefit from a therapeutic smartphone intervention (LifeBuoy). Methods: A total of 455 community-based Australian young adults (aged 18-25 years) experiencing recent suicidal ideation were randomized to use a dialectical behavioral therapy–based smartphone intervention (LifeBuoy) or an attention-matched control app (LifeBuoy-C) for 6 weeks. Participants completed measures of suicidal ideation, depression, anxiety, and loneliness at baseline (T0), post intervention (T1), and 3 months post intervention (T2). Piecewise linear mixed models were used to examine whether loneliness levels moderated the effect of LifeBuoy and LifeBuoy-C on suicidal ideation and depression across time (T0 to T1; T1 to T2). This statistical method was then used to examine whether app engagement (number of modules completed) influenced the relationship between baseline loneliness and suicidal ideation and depression across time. Results: Loneliness was positively associated with higher levels of overall suicidal ideation (B=0.75, 95% CI 0.08-1.42; P=.03) and depression (B=0.88, 95% CI 0.45-1.32; P<.001), regardless of time point or allocated condition. However, loneliness did not affect suicidal ideation scores across time (time 1: B=1.10, 95% CI –0.25 to 2.46; P=.11; time 2: B=0.43, 95% CI –1.25 to 2.12; P=.61) and depression scores across time (time 1: B=0.00, 95% CI –0.67 to 0.66; P=.99; time 2: B=0.41, 95% CI –0.37 to 1.18; P=.30) in either condition. Similarly, engagement with the LifeBuoy app was not found to moderate the impact of loneliness on suicidal ideation (B=0.00, 95% CI –0.17 to 0.18; P=.98) or depression (B=–0.08, 95% CI –0.19 to 0.03; P=.14). Conclusions: Loneliness was not found to affect young adults’ engagement with a smartphone intervention (LifeBuoy) nor any clinical benefits derived from the intervention. LifeBuoy, in its current form, can effectively engage and treat individuals regardless of how lonely they may be. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001671156; https://tinyurl.com/yvpvn5n8 International Registered Report Identifier (IRRID): RR2-10.2196/23655 %M 36995752 %R 10.2196/44862 %U https://mental.jmir.org/2023/1/e44862 %U https://doi.org/10.2196/44862 %U http://www.ncbi.nlm.nih.gov/pubmed/36995752 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41273 %T Acceptability and Feasibility of “Village,” a Digital Communication App for Young People Experiencing Low Mood, Thoughts of Self-harm, and Suicidal Ideation to Obtain Support From Family and Friends: Mixed Methods Pilot Open Trial %A Thabrew,Hiran %A Kumar,Harshali %A Steadman,Evandah %+ Department of Psychological Medicine, The University go Auckland, 20-22 Park Road, Grafton, Auckland, 1142, New Zealand, 64 021402055, h.thabrew@auckland.ac.nz %K youth %K suicide %K self-harm %K depression %K support %K application %K mobile phone %D 2023 %7 13.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people experiencing low mood, thoughts related to self-harm, and suicidal ideation often struggle to communicate their emotions and receive timely support from family and friends. Technologically delivered support interventions may be useful in addressing this need. Objective: This paper aimed to evaluate the acceptability and feasibility of “Village,” a communication app co-designed with young people and their family and friends from New Zealand. Methods: A mixed methods pilot open trial design was adopted. Participants were primarily recruited via social media advertisements and clinicians in specialist mental health services over an 8-month period. The primary outcomes were acceptability of the app (via thematically analyzed qualitative feedback and retention rates) and feasibility of conducting a larger randomized controlled trial gauged via effectiveness of recruitment methods, completion of chosen outcome measures, and occurrence of unanticipated operational issues. Secondary outcomes were app usability, safety, and changes in symptoms of depression (via the Patient Health Questionnaire–9 modified for adolescents), suicidal ideation (on the Suicidal Ideation Questionnaire), and functioning (using the World Health Organization Disability Assessment Schedule 2.0 or Child and Youth version). Results: A total of 26 young people (“users”) were enrolled in the trial, of which 21 recruited friends and family members (“buddies”) and completed quantitative outcome measures at baseline, 4 weeks, and 3 months. Furthermore, 13 users and 12 buddies also provided qualitative feedback about the app, identifying the key themes of appeal of app features and layout, usefulness of its content, and technological challenges (primarily with onboarding and notifications). Users gave Village a mean rating of 3.8 (range 2.7-4.6) out of 5 on a 5-point scale for app quality and an overall star rating of 3.4 out of 5 for subjective quality. Within this limited sample, users reported a clinically significant reduction in depressive symptoms (P=.007), but nonsignificant changes in suicidal ideation and functioning. The embedded risk detection software was activated on 3 occasions, and no additional support was required for users. Conclusions: During this open trial, Village was found to be acceptable, usable, and safe. The feasibility of a larger randomized controlled trial was also confirmed after some modifications to the recruitment strategy and app. Trial Registration: Australian New Zealand Clinical Trials Network Registry ACTRN12620000241932p; https://tinyurl.com/ya6t4fx2 %M 36912882 %R 10.2196/41273 %U https://formative.jmir.org/2023/1/e41273 %U https://doi.org/10.2196/41273 %U http://www.ncbi.nlm.nih.gov/pubmed/36912882 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39675 %T Statewide Assessment of North Carolina Nurse Practitioners' Knowledge of and Attitudes Toward Suicide Awareness and Prevention: Protocol for a Statewide Mixed Methods Study %A Whitaker-Brown,Charlene %A Cornelius,Judith Bacchus %A Smoot,Jaleesa %A Khadka,Anjala %A Patil,Arundhati %+ School of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, United States, 1 704 687 7964, cdwhitak@uncc.edu %K mixed methods %K suicide awareness %K suicide prevention %K nurse practitioner %K knowledge and skills %K stigma %K suicide %K awareness %K nurse %K public health %K treatment %K prevention %K metal health %K mental illness %K United States %K skills %D 2023 %7 7.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide is a major public health problem, which affects people of all ages and ethnicities. Despite being preventable, the rates of suicide have steadily climbed (more than a third) over the past 2 decades. Objective: Nurse practitioners (NPs) must be responsible for recognizing suicide risk and providing appropriate treatment referrals in addition to having an important role in suicide prevention. The reasons why NPs may not pursue suicide prevention training are their lack of suicide awareness and prevention, limited experiences with suicidal patients, and the stigma associated with mental illness. Before we begin to address the gaps within suicide awareness and prevention skills, we need to first examine NPs’ knowledge of and attitudes (stigma) toward suicide prevention. Methods: This study will comprise a mixed methods approach. First, quantitative data will be collected using the Suicide Knowledge and Skills Questionnaireand the Suicide Stigma Scale (Brief version) questionnaire. An email will be sent to the NPs explaining the purpose of the study. If they consent, they will click on a link to access the surveys on a secure site. In our previous research with this sample, email reminders to nonresponders after 2 and 4 weeks were sent. The quantitative component will be used to inform the qualitative interviews of this study. The Suicide Knowledge and Skills Questionnaire is a 13-item questionnaire comprising 2 subscales: suicide knowledge and suicide skills. All questions are rated on a 5-point Likert scale (1=completely disagree to 5=completely agree). The survey has been shown to differentiate between those with suicide training and those without and has a Cronbach α score of .84. The Suicide Stigma Scale (Brief version) is a 16-item survey that assesses stigma regarding suicide. The items are measured on a 5-point Likert scale (1: strongly disagree to 5: strongly agree) and have a Cronbach α of .98. Results: This study was funded by the Faculty Research Grants program through the Office of the Vice Chancellor for Research and Economic Development at the University of North Carolina at Charlotte. Institutional review board approval was obtained in April 2022. Recruitment occurred between summer and winter 2022. Interview conduction began in December 2022 and will conclude in March 2023. Data will be analyzed during spring and summer 2023. Conclusions: The study results will add to the literature on NPs’ knowledge of and attitudes (stigma) toward suicide prevention. It represents a first step in addressing gaps within suicide awareness and prevention skills, among NPs in their respective practice settings. International Registered Report Identifier (IRRID): PRR1-10.2196/39675 %M 36881461 %R 10.2196/39675 %U https://www.researchprotocols.org/2023/1/e39675 %U https://doi.org/10.2196/39675 %U http://www.ncbi.nlm.nih.gov/pubmed/36881461 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44205 %T Using a Safety Planning Mobile App to Address Suicidality in Young People Attending Community Mental Health Services in Ireland: Protocol for a Pilot Randomized Controlled Trial %A Melia,Ruth %A Francis,Kady %A Duggan,Jim %A Bogue,John %A O'Sullivan,Mary %A Young,Karen %A Chambers,Derek %A McInerney,Shane J %A O'Dea,Edmond %A Bernert,Rebecca %+ Department of Psychology, University of Limerick, Castletroy, Limerick, V94 T9PX, Ireland, 353 61 202 700, ruth.melia@ul.ie %K suicide prevention %K mobile health %K mHealth %K safety planning %K SafePlan %K mobile phone %D 2023 %7 21.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Over 700,000 people die by suicide annually, making it the fourth leading cause of death among those aged 15-29 years globally. Safety planning is recommended best practice when individuals at risk of suicide present to health services. A safety plan, developed in collaboration with a health care practitioner, details the steps to be taken in an emotional crisis. SafePlan, a safety planning mobile app, was designed to support young people experiencing suicidal thoughts and behaviors and to record their plan in a way that is accessible immediately and in situ. Objective: The aim of this study is to assess the feasibility and acceptability of the SafePlan mobile app for patients experiencing suicidal thoughts and behaviors and their clinicians within Irish community mental health services, examine the feasibility of study procedures for both patients and clinicians, and determine if the SafePlan condition yields superior outcomes when compared with the control condition. Methods: A total of 80 participants aged 16-35 years accessing Irish mental health services will be randomized (1:1) to receive the SafePlan app plus treatment as usual or treatment as usual plus a paper-based safety plan. The feasibility and acceptability of the SafePlan app and study procedures will be evaluated using both qualitative and quantitative methodologies. The primary outcomes are feasibility outcomes and include the acceptability of the app to participants and clinicians, the feasibility of delivery in this setting, recruitment, retention, and app use. The feasibility and acceptability of the following measures in a full randomized controlled trial will also be assessed: the Beck Scale for Suicide Ideation, Columbia Suicide Severity Rating Scale, Coping Self-Efficacy Scale, Interpersonal Needs Questionnaire, and Client Service Receipt Inventory. A repeated measures design with outcome data collected at baseline, post intervention (8 weeks), and at 6-month follow-up will be used to compare changes in suicidal ideation for the intervention condition relative to the waitlist control condition. A cost-outcome description will also be undertaken. Thematic analyses will be used to analyze the qualitative data gathered through semistructured interviews with patients and clinicians. Results: As of January 2023, funding and ethics approval have been acquired, and clinician champions across mental health service sites have been established. Data collection is expected to commence by April 2023. The submission of completed manuscript is expected by April 2025. Conclusions: The framework for Decision-making after Pilot and feasibility Trials will inform the decision to progress to a full trial. The results will inform patients, researchers, clinicians, and health services of the feasibility and acceptability of the SafePlan app in community mental health services. The findings will have implications for further research and policy regarding the broader integration of safety planning apps. Trial Registration: OSF Registries osf.io/3y54m; https://osf.io/3y54m International Registered Report Identifier (IRRID): PRR1-10.2196/44205 %M 36809171 %R 10.2196/44205 %U https://www.researchprotocols.org/2023/1/e44205 %U https://doi.org/10.2196/44205 %U http://www.ncbi.nlm.nih.gov/pubmed/36809171 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43840 %T Investigating How People Who Self-harm Evaluate Web-Based Lived Experience Stories: Focus Group Study %A Winstone,Lizzy %A Mars,Becky %A Ferrar,Jennifer %A Moran,Paul %A Penton-Voak,Ian %A Grace,Lydia %A Biddle,Lucy %+ Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom, 44 07843301453, lizzy.winstone@bristol.ac.uk %K self-harm %K lived experience stories %K web-based support %K self-help %K recovery %K focus groups %D 2023 %7 31.1.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The positive and negative effects of interacting with web-based content on mental health, and especially self-harm, are well documented. Lived experience stories are one such type of static web-based content, frequently published on health care or third-sector organization websites, as well as social media and blogs, as a form of support for those seeking help via the web. Objective: This study aimed to increase understanding about how people who self-harm engage with and evaluate web-based lived experience stories. Methods: Overall, 4 web-based focus groups were conducted with 13 people with recent self-harm experience (aged 16-40 years). In total, 3 example lived experience stories were read aloud to participants, who were then asked to share their reactions to the stories. Participants were also encouraged to reflect on stories previously encountered on the web. Data were analyzed thematically. Results: Overall, 5 themes were generated: stories of recovery from self-harm and their emotional impact, impact on self-help and help-seeking behaviors, identifying with the narrator, authenticity, and language and stereotyping. Conclusions: Lived experience stories published on the web can provide a valuable form of support for those experiencing self-harm. They can be motivating and empowering for the reader, and they have the potential to distract readers from urges to self-harm. However, these effects may be moderated by age, and narratives of recovery may demoralize older readers. Our findings have implications for organizations publishing lived experience content and for community guidelines and moderators of web-based forums in which users share their stories. These include the need to consider the narrator’s age and the relatability and authenticity of their journey and the need to avoid using stigmatizing language. %M 36719729 %R 10.2196/43840 %U https://mental.jmir.org/2023/1/e43840 %U https://doi.org/10.2196/43840 %U http://www.ncbi.nlm.nih.gov/pubmed/36719729 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41422 %T ReachCare Mobile Apps for Patients Experiencing Suicidality in the Emergency Department: Development and Usability Testing Using Mixed Methods %A Larkin,Celine %A Djamasbi,Soussan %A Boudreaux,Edwin D %A Varzgani,Fatima %A Garner,Roscoe %A Siddique,Mariam %A Pietro,John %A Tulu,Bengisu %+ Department of Emergency Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave, Worcester, MA, 01655, United States, 1 7743291688, celine.larkin@umassmed.edu %K suicide %K emergency department %K mobile app %K usability %K engagement %K mobile phone %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Many individuals with suicide risk present to acute care settings such as emergency departments (EDs). However, staffing and time constraints mean that many EDs are not well equipped to deliver evidence-based interventions for patients experiencing suicidality. An existing intervention initiated in the ED for patients with suicide risk (Emergency Department Safety Assessment and Follow-up Evaluation [ED-SAFE]) has been found to be effective but faces trenchant barriers for widespread adoption. Objective: On the basis of the ED-SAFE intervention, we aimed to develop 2 apps for patients with suicide risk: a web app guiding patients through safety planning in the ED (ED app) and a smartphone app providing patients components of the ED-SAFE program on their phones after discharge (patient app). We then tested the usability of these apps with patients presenting to the ED with suicide risk. Methods: Using a user-centered design framework, we first developed user personas to explore the needs and characteristics of patients who are at risk for suicide using inputs from clinicians (n=3) and suicidologists (n=4). Next, we validated these personas during interviews with individuals with lived experience of suicidality (n=6) and used them to inform our application designs. We field-tested the apps with ED patients presenting with suicide risk (n=14) in 2 iterative cycles to assess their usability and engagement using a mixed methods approach. We also rated the quality and fidelity of the safety plans created. Results: We developed 2 interoperable and complementary apps. The first is a web app designed for use on a tablet device during ED admission that guides the patient by creating a safety plan using a chatbot-style interface. The second is a smartphone app for use after discharge and allows the patient to view, edit, and share their completed safety plan; access self-care education, helplines, and behavioral health referrals; and track follow-up appointments with the study clinician. The initial prototype usability testing (n=9) demonstrated satisfactory scores (ED app System Usability Scale [SUS], mean 78.6/100, SD 24.1; User Engagement Scale, mean 3.74/5, SD 0.72; patient app SUS, mean 81.7/100, SD 20.1). After refining the apps based on participant feedback, the second cycle testing (n=5) showed improvement (ED app SUS, mean 90.5/100, SD 9.9; User Engagement Scale, mean 4.07/5, SD 0.36; patient app SUS, mean 97.0/100, SD 1.9). The quality ratings for completed safety plans were satisfactory (Safety Planning Intervention Scoring Algorithm-Brief, mean 27.4, SD 3.4). Conclusions: By adopting a user-centered approach and creating personas to guide development, we were able to create apps for ED patients with suicide risk and obtain satisfactory usability, engagement, and quality scores. Developing digital health tools based on user-centered design principles that deliver evidence-based intervention components may help overcome trenchant implementation barriers in challenging health care settings. %M 36705961 %R 10.2196/41422 %U https://formative.jmir.org/2023/1/e41422 %U https://doi.org/10.2196/41422 %U http://www.ncbi.nlm.nih.gov/pubmed/36705961 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41546 %T Young Adults’ Perceptions of 2 Publicly Available Digital Resources for Self-injury: Qualitative Study of a Peer Support App and Web-Based Factsheets %A Kruzan,Kaylee Payne %A Whitlock,Janis %A Chapman,Julia %A Bhandari,Aparajita %A Bazarova,Natalya %+ Department of Preventive Medicine, Northwestern University, 750 N Lakeshore Drive, Chicago, IL, 60611, United States, 1 312 503 3114, kaylee.kruzan@northwestern.edu %K nonsuicidal self-injury %K self-harm %K digital mental health %K mobile app %K design %K intervention %K peer support %K psychoeducation %D 2023 %7 12.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital resources have the potential to bridge the gaps in mental health services for young people who self-injure. Most research on digital resources for this population has involved observational studies of content in web-based communities or formative studies focused on the design and early evaluation of new interventions. Far less research has sought to understand young people’s experiences with publicly available digital resources or to identify specific components of these resources that are perceived to be of value in their recovery. Objective: This study aimed to understand young people’s experiences with 2 publicly available digital resources for self-injury—a peer support app and web-based factsheets—and to disentangle potential explanatory mechanisms associated with perceived benefits and harms. Methods: Participants were 96 individuals (aged 16-25 years) with nonsuicidal self-injury behavior in the past month, who recently completed a pilot randomized controlled trial designed to assess the efficacy of a peer support app as compared with web-based factsheets to reduce self-injury behavior. The trial showed that participants using the peer support app reported less self-injury behavior relative to those receiving the web-based factsheets over 8 weeks. In this study, we used a conventional approach to content analysis of responses to 2 open-ended questions delivered at the end of the trial with the aims of exploring participants’ overall experiences with these resources and identifying the qualities of these resources that were perceived to be beneficial to or harmful for participants’ recovery. Results: Overall, participants were more likely to report benefits than harms. Participants who used the peer support app reported more harms than those who received the web-based factsheets. In the open coding phase, clear benefits were also derived from repeated weekly surveys about self-injury. Key benefits across digital resources included enhanced self-knowledge, reduction in self-injury activity, increased outreach or informal conversations, improved attitudes toward therapy, improved mood, and feeling supported and less alone. Key challenges included worsened or unchanged self-injury activity, diminished mood, and increased barriers to outreach. The most prominent benefit derived from the web-based factsheets and weekly surveys was improved self-understanding. However, the way this manifested differed, with factsheets providing insight on why participants engage in self-injury and the function it serves them and surveys making the frequency and severity of participants’ behaviors more apparent. The benefits perceived from using the peer support app were general improvements in mood and feeling less alone. Conclusions: Findings contribute a nuanced understanding of young people’s experiences with these digital resources and have implications for the optimization of existing platforms and the design of novel resources to support individuals who self-injure. %M 36633896 %R 10.2196/41546 %U https://formative.jmir.org/2023/1/e41546 %U https://doi.org/10.2196/41546 %U http://www.ncbi.nlm.nih.gov/pubmed/36633896 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 7 %N 2 %P e42386 %T Detection of Suicide Risk Using Vocal Characteristics: Systematic Review %A Iyer,Ravi %A Meyer,Denny %+ Centre for Mental Health, Swinburne University of Technology, 34 Wakefield Street, Hawthorn, 3122, Australia, 61 456565575, raviiyer@swin.edu.au %K voice %K suicide %K suicidal %K biological signal processing %K machine learning %K systematic review %K review methodology %K risk %K speech %K mental health %D 2022 %7 22.12.2022 %9 Review %J JMIR Biomed Eng %G English %X Background: In an age when telehealth services are increasingly being used for forward triage, there is a need for accurate suicide risk detection. Vocal characteristics analyzed using artificial intelligence are now proving capable of detecting suicide risk with accuracies superior to traditional survey-based approaches, suggesting an efficient and economical approach to ensuring ongoing patient safety. Objective: This systematic review aimed to identify which vocal characteristics perform best at differentiating between patients with an elevated risk of suicide in comparison with other cohorts and identify the methodological specifications of the systems used to derive each feature and the accuracies of classification that result. Methods: A search of MEDLINE via Ovid, Scopus, Computers and Applied Science Complete, CADTH, Web of Science, ProQuest Dissertations and Theses A&I, Australian Policy Online, and Mednar was conducted between 1995 and 2020 and updated in 2021. The inclusion criteria were human participants with no language, age, or setting restrictions applied; randomized controlled studies, observational cohort studies, and theses; studies that used some measure of vocal quality; and individuals assessed as being at high risk of suicide compared with other individuals at lower risk using a validated measure of suicide risk. Risk of bias was assessed using the Risk of Bias in Non-randomized Studies tool. A random-effects model meta-analysis was used wherever mean measures of vocal quality were reported. Results: The search yielded 1074 unique citations, of which 30 (2.79%) were screened via full text. A total of 21 studies involving 1734 participants met all inclusion criteria. Most studies (15/21, 71%) sourced participants via either the Vanderbilt II database of recordings (8/21, 38%) or the Silverman and Silverman perceptual study recording database (7/21, 33%). Candidate vocal characteristics that performed best at differentiating between high risk of suicide and comparison cohorts included timing patterns of speech (median accuracy 95%), power spectral density sub-bands (median accuracy 90.3%), and mel-frequency cepstral coefficients (median accuracy 80%). A random-effects meta-analysis was used to compare 22 characteristics nested within 14% (3/21) of the studies, which demonstrated significant standardized mean differences for frequencies within the first and second formants (standardized mean difference ranged between −1.07 and −2.56) and jitter values (standardized mean difference=1.47). In 43% (9/21) of the studies, risk of bias was assessed as moderate, whereas in the remaining studies (12/21, 57%), the risk of bias was assessed as high. Conclusions: Although several key methodological issues prevailed among the studies reviewed, there is promise in the use of vocal characteristics to detect elevations in suicide risk, particularly in novel settings such as telehealth or conversational agents. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD420200167413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020167413 %M 38875684 %R 10.2196/42386 %U https://biomedeng.jmir.org/2022/2/e42386 %U https://doi.org/10.2196/42386 %U http://www.ncbi.nlm.nih.gov/pubmed/38875684 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e42146 %T Passive Sensing in the Prediction of Suicidal Thoughts and Behaviors: Protocol for a Systematic Review %A Winkler,Tanita %A Büscher,Rebekka %A Larsen,Mark Erik %A Kwon,Sam %A Torous,John %A Firth,Joseph %A Sander,Lasse B %+ Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstraße 29, Freiburg, 79104, Germany, 49 7612035519, Lasse.Sander@mps.uni-freiburg.de %K suicide prediction %K passive sensing %K review %K systematic review %K sensors %K suicidal thoughts and behaviors %K digital markers %K behavioral markers %D 2022 %7 29.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide is a severe public health problem, resulting in a high number of attempts and deaths each year. Early detection of suicidal thoughts and behaviors (STBs) is key to preventing attempts. We discuss passive sensing of digital and behavioral markers to enhance the detection and prediction of STBs. Objective: The paper presents the protocol for a systematic review that aims to summarize existing research on passive sensing of STBs and evaluate whether the STB prediction can be improved using passive sensing compared to prior prediction models. Methods: A systematic search will be conducted in the scientific databases MEDLINE, PubMed, Embase, PsycINFO, and Web of Science. Eligible studies need to investigate any passive sensor data from smartphones or wearables to predict STBs. The predictive value of passive sensing will be the primary outcome. The practical implications and feasibility of the studies will be considered as secondary outcomes. Study quality will be assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). If studies are sufficiently homogenous, we will conduct a meta-analysis of the predictive value of passive sensing on STBs. Results: The review process started in July 2022 with data extraction in September 2022. Results are expected in December 2022. Conclusions: Despite intensive research efforts, the ability to predict STBs is little better than chance. This systematic review will contribute to our understanding of the potential of passive sensing to improve STB prediction. Future research will be stimulated since gaps in the current literature will be identified and promising next steps toward clinical implementation will be outlined. Trial Registration: OSF Registries osf-registrations-hzxua-v1; https://osf.io/hzxua International Registered Report Identifier (IRRID): DERR1-10.2196/42146 %M 36445737 %R 10.2196/42146 %U https://www.researchprotocols.org/2022/11/e42146 %U https://doi.org/10.2196/42146 %U http://www.ncbi.nlm.nih.gov/pubmed/36445737 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e39807 %T Using Voice Biomarkers to Classify Suicide Risk in Adult Telehealth Callers: Retrospective Observational Study %A Iyer,Ravi %A Nedeljkovic,Maja %A Meyer,Denny %+ Centre for Mental Health, Swinburne University of Technology, 34 Wakefield Street, Hawthorn, 3122, Australia, 61 454565575, raviiyer@swin.edu.au %K voice biometrics %K suicide prevention %K machine learning %K telehealth %K suicide %K telehealth %K risk prediction %K prediction model %K voice biomarker %K mental health %D 2022 %7 15.8.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Artificial intelligence has the potential to innovate current practices used to detect the imminent risk of suicide and to address shortcomings in traditional assessment methods. Objective: In this paper, we sought to automatically classify short segments (40 milliseconds) of speech according to low versus imminent risk of suicide in a large number (n=281) of telephone calls made to 2 telehealth counselling services in Australia. Methods: A total of 281 help line telephone call recordings sourced from On The Line, Australia (n=266, 94.7%) and 000 Emergency services, Canberra (n=15, 5.3%) were included in this study. Imminent risk of suicide was coded for when callers affirmed intent, plan, and the availability of means; level of risk was assessed by the responding counsellor and reassessed by a team of clinical researchers using the Columbia Suicide Severity Rating Scale (=5/6). Low risk of suicide was coded for in an absence of intent, plan, and means and via Columbia suicide Severity Scale Ratings (=1/2). Preprocessing involved normalization and pre-emphasis of voice signals, while voice biometrics were extracted using the statistical language r. Candidate predictors were identified using Lasso regression. Each voice biomarker was assessed as a predictor of suicide risk using a generalized additive mixed effects model with splines to account for nonlinearity. Finally, a component-wise gradient boosting model was used to classify each call recording based on precoded suicide risk ratings. Results: A total of 77 imminent-risk calls were compared with 204 low-risk calls. Moreover, 36 voice biomarkers were extracted from each speech frame. Caller sex was a significant moderating factor (β=–.84, 95% CI –0.85, –0.84; t=6.59, P<.001). Candidate biomarkers were reduced to 11 primary markers, with distinct models developed for men and women. Using leave-one-out cross-validation, ensuring that the speech frames of no single caller featured in both training and test data sets simultaneously, an area under the precision or recall curve of 0.985 was achieved (95% CI 0.97, 1.0). The gamboost classification model correctly classified 469,332/470,032 (99.85%) speech frames. Conclusions: This study demonstrates an objective, efficient, and economical assessment of imminent suicide risk in an ecologically valid setting with potential applications to real-time assessment and response. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000486729; https://www.anzctr.org.au/ACTRN12622000486729.aspx %M 35969444 %R 10.2196/39807 %U https://mental.jmir.org/2022/8/e39807 %U https://doi.org/10.2196/39807 %U http://www.ncbi.nlm.nih.gov/pubmed/35969444 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 3 %P e34979 %T Representing Physician Suicide Claims as Nanopublications: Proof-of-Concept Study Creating Claim Networks %A Leung,Tiffany I %A Kuhn,Tobias %A Dumontier,Michel %+ Care and Public Health Research Institute, Maastricht University, Postbus 5800, Maastricht, 6202AZ, Netherlands, 31 43 388 2222, t.leung@maastrichtuniversity.nl %K physician suicide %K suicide %K suicide prevention %K physician well-being %K physician mental health %K nanopublication %K physician %K doctor %K mental health %K semantic publishing %K bibliometrics %K claim network %K information distortion %K misinformation %D 2022 %7 1.7.2022 %9 Original Paper %J JMIRx Med %G English %X Background: In the poorly studied field of physician suicide, various factors can contribute to misinformation or information distortion, which in turn can influence evidence-based policies and prevention of suicide in this unique population. Objective: The aim of this paper is to use nanopublications as a scientific publishing approach to establish a citation network of claims in peer-reviewed publications about the rate of suicide among US physicians. Methods: A list of articles from a previously published scoping literature review on physician suicide was used to identify those articles that commented on or investigated suicidal behaviors of physician populations, including students, postgraduate trainees, and practicing physicians. The included articles were from peer-reviewed publications and asserted a claim about the annual rate of physician suicide. Manual data extraction was performed to collect article (or resource) type, title, authors, digital object identifier or URI, publication year, claim (about annual physician suicide rate), data of last access of the article (eg, for a webpage), and citations supporting the claim. Additional articles, websites, or other links were only added to the set of claims if they were cited by a peer-reviewed article already included in the data set. A nanopublication was created for each article or resource using Nanobench with an investigator-developed literature-based claim nanopublication template. Results: A set of 49 claims concerning the rate of US physician suicide was represented as nanopublications. Analysis of the claim network revealed that (1) the network is not fully connected, (2) no single primary source of the claim could be identified, and (3) all end-point citations had a claim with no further citation, had no apparent claim, or could not be accessed to verify the claim. The nanopublication strategy also enabled the capture of variant claims published on a website. Conclusions: Nanopublications remain to be adopted in broader scientific publishing in medicine, especially in publishing about physician mental health and suicide. This proof-of-concept study highlights an opportunity for more coordinated research efforts in the subject of physician suicide. Our work integrates these various claims and enables the verification of nonauthoritative assertions, thereby better equipping researchers to advance evidence-based knowledge and to make informed statements in the advocacy of physician suicide prevention. Representing physician suicide rate claims as nanopublications can be extended and improved in future work. %M 27725715 %R 10.2196/34979 %U https://med.jmirx.org/2022/3/e34979 %U https://doi.org/10.2196/34979 %U http://www.ncbi.nlm.nih.gov/pubmed/27725715 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35194 %T Possible Contribution of Meaning in Life in Patients With Chronic Pain and Suicidal Ideation: Observational Study %A Chytas,Vasileios %A Costanza,Alessandra %A Mazzola,Viridiana %A Luthy,Christophe %A Galani,Vasiliki %A Bondolfi,Guido %A Cedraschi,Christine %+ Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland, 41 079 553 41 55, Vasileios.Chytas@hcuge.ch %K meaning in life %K suicidal ideation %K chronic pain %K pain %K suicide %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain is associated with an elevated risk of suicidal ideation (SI). Objective: We aimed to examine if the presence or the search for Meaning in Life (MiL) are associated with less SI and explore whether MiL profiles emerge in our cohort. These profiles can be described as high presence–high search, high presence–low search, low presence–low search, and low presence–high search. Methods: In this observational study, we recruited 70 patients who were referred to the Multidisciplinary Pain Center of the Geneva University Hospitals and who answered positively to question 9 on the Beck Depression Inventory, 2nd Edition, investigating SI. Patients who agreed to participate in the study were further investigated; they participated in a structured diagnostic interview to screen for psychiatric diagnoses. During this interview, they completed the Meaning in Life Questionnaire and the semistructured Scale for Suicide Ideation (SSI) to assess the characteristics and severity of SI. Results: There was a statistically significant correlation between the presence of MiL subscale and the SSI. These 2 scales had a negative and statistically highly significant correlation (R=–.667; P<.001). The results also showed a negative and statistically highly significant correlation between the score of the search for MiL and the SSI (R=–.456; P<.001). The results thus pointed to the presence of MiL as a potential protective factor against the severity of SI, while the search for MiL is also a possible resiliency factor, although to a lesser extent. The profile low presence–low search grouped the vast majority (47%) of the patients; in these patients, the mean SSI score was 14.36 (SD 5.86), much higher compared with that of the other subgroups. Conclusions: This study’s results point to MiL as a concept of interest regarding devising psychotherapeutic interventions for chronic pain patients in order to reduce the suicidal risk and more accurately determine patients’ suffering. %M 35699974 %R 10.2196/35194 %U https://formative.jmir.org/2022/6/e35194 %U https://doi.org/10.2196/35194 %U http://www.ncbi.nlm.nih.gov/pubmed/35699974 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e32140 %T Patterns of Suicide Ideation Across Eight Countries in Four Continents During the COVID-19 Pandemic Era: Repeated Cross-sectional Study %A Schluter,Philip J %A Généreux,Mélissa %A Hung,Kevin KC %A Landaverde,Elsa %A Law,Ronald P %A Mok,Catherine Pui Yin %A Murray,Virginia %A O'Sullivan,Tracey %A Qadar,Zeeshan %A Roy,Mathieu %+ School of Health Sciences, University of Canterbury - Te Whare Wananga o Waitaha, Private Bag 4800, Christchurch, 8140, New Zealand, 64 275106239, philip.schluter@canterbury.ac.nz %K pandemic %K infodemic %K psychosocial impacts %K sense of coherence %K suicide ideation %K epidemiology %K suicide %K pattern %K COVID-19 %K cross-sectional %K mental health %K misinformation %K risk %K prevalence %K gender %K age %K sociodemographic %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and countries’ response measures have had a globally significant mental health impact. This mental health burden has also been fueled by an infodemic: an information overload that includes misinformation and disinformation. Suicide, the worst mental health outcome, is a serious public health problem that can be prevented with timely, evidence-based, and often low-cost interventions. Suicide ideation, one important risk factor for suicide, is thus important to measure and monitor, as are the factors that may impact on it. Objective: This investigation had 2 primary aims: (1) to estimate and compare country-specific prevalence of suicide ideation at 2 different time points, overall and by gender and age groups, and (2) to investigate the influence of sociodemographic and infodemic variables on suicide ideation. Methods: A repeated, online, 8-country (Canada, the United States, England, Switzerland, Belgium, Hong Kong, Philippines, and New Zealand), cross-sectional study was undertaken with adults aged ≥18 years, with measurement wave 1 conducted from May 29, 2020 to June 12, 2020 and measurement wave 2 conducted November 6-18, 2021. Self-reported suicide ideation was derived from item 9 of the Patient Health Questionnaire-9 (PHQ-9). Age-standardized suicide ideation rates were reported, a binomial regression model was used to estimate suicide ideation indication rates for each country and measurement wave, and logistic regression models were then employed to relate sociodemographic, pandemic, and infodemic variables to suicide ideation. Results: The final sample totaled 17,833 adults: 8806 (49.4%) from measurement wave 1 and 9027 (50.6%) from wave 2. Overall, 24.2% (2131/8806) and 27.5% (2486/9027) of participants reported suicide ideation at measurement waves 1 and 2, respectively, a difference that was significant (P<.001). Considerable variability was observed in suicide ideation age-standardized rates between countries, ranging from 15.6% in Belgium (wave 1) to 42.9% in Hong Kong (wave 2). Frequent social media usage was associated with increased suicide ideation at wave 2 (adjusted odds ratio [AOR] 1.47, 95% CI 1.25-1.72; P<.001) but not wave 1 (AOR 1.11, 95% CI 0.96-1.23; P=.16). However, having a weaker sense of coherence (SOC; AOR 3.80, 95% CI 3.18-4.55 at wave 1 and AOR 4.39, 95% CI 3.66-5.27 at wave 2; both P<.001) had the largest overall effect size. Conclusions: Suicide ideation is prevalent and significantly increasing over time in this COVID-19 pandemic era, with considerable variability between countries. Younger adults and those residing in Hong Kong carried disproportionately higher rates. Social media appears to have an increasingly detrimental association with suicide ideation, although having a stronger SOC had a larger protective effect. Policies and promotion of SOC, together with disseminating health information that explicitly tackles the infodemic’s misinformation and disinformation, may importantly reduce the rising mental health morbidity and mortality triggered by this pandemic. %M 34727524 %R 10.2196/32140 %U https://publichealth.jmir.org/2022/1/e32140 %U https://doi.org/10.2196/32140 %U http://www.ncbi.nlm.nih.gov/pubmed/34727524 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e26526 %T Use of a Mobile Peer Support App Among Young People With Nonsuicidal Self-injury: Small-scale Randomized Controlled Trial %A Kruzan,Kaylee Payne %A Whitlock,Janis %A Bazarova,Natalya N %A Bhandari,Aparajita %A Chapman,Julia %+ Center for Behavioral Intervention Technologies, Northwestern University, 750 N Lake Shore Drive, Chicago, IL, 60611, United States, 1 312 503 6585, kaylee.kruzan@northwestern.edu %K nonsuicidal self-injury %K randomized controlled trial %K mobile app %K peer support %K urges %K digital intervention %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Nonsuicidal self-injury (NSSI) is a widespread behavior among adolescents and young adults. Although many individuals who self-injure do not seek treatment, there is evidence for web-based help-seeking through web-based communities and mobile peer support networks. However, few studies have rigorously tested the efficacy of such platforms on outcomes relevant for NSSI recovery. Objective: The aim of this small-scale preregistered randomized controlled trial is to provide preliminary insight into the shorter- and longer-term efficacy of the use of a peer support app, TalkLife, in reducing NSSI frequency and urges and increasing readiness to change. In addition, we explore contact with informal support, interest in therapy, and attitudes toward professional help–seeking. Methods: Individuals aged 16-25 years with current (within 3 months) and chronic (>6 episodes in the past year) NSSI history were eligible to participate in this study. After baseline assessments, the intervention group was instructed to use the app actively (eg, post or comment at least three times per week) and the control group received weekly psychoeducational materials through email, for 8 weeks. Follow-up was assessed at 1 month and 2 months. Linear mixed modeling was used to evaluate condition and time point effects for the primary outcomes of NSSI frequency and urges, readiness to change, contact with informal support, interest in therapy, and attitudes toward professional help–seeking. Results: A total of 131 participants were included in the analysis. We evidenced a significant effect of condition on NSSI frequency such that the participants using the peer support app self-injured less over the course of the study (mean 1.30, SE 0.18) than those in the control condition (mean 1.62, SE 0.18; P=.02; η2=0.02). We also evidenced a significant condition effect of readiness to change such that the treatment participants reported greater confidence in their ability to change their NSSI behavior (mean 6.28, SE 0.41) than the control participants (mean 5.67, SE 0.41; P=.04; η2=0.02). No significant differences were observed for contact with informal support, interest in therapy, or attitudes toward professional help–seeking. Conclusions: Use of the peer support app was related to reduced NSSI frequency and greater confidence in one’s ability to change NSSI behavior over the course of the study period, but no effects on NSSI urges, contact with informal support, interest in therapy, or attitudes toward professional help–seeking were observed. The findings provide preliminary support for considering the use of mobile peer support apps as a supplement to NSSI intervention and point to the need for larger-scale trials. Trial Registration: Open Science Foundation; https://osf.io/3uay9 %M 35006076 %R 10.2196/26526 %U https://formative.jmir.org/2022/1/e26526 %U https://doi.org/10.2196/26526 %U http://www.ncbi.nlm.nih.gov/pubmed/35006076 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e31367 %T Centering Lived Experience in Developing Digital Interventions for Suicide and Self-injurious Behaviors: User-Centered Design Approach %A Kruzan,Kaylee Payne %A Meyerhoff,Jonah %A Biernesser,Candice %A Goldstein,Tina %A Reddy,Madhu %A Mohr,David C %+ Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr, Chicago, IL, 60611, United States, 1 3125036585, kaylee.kruzan@northwestern.edu %K user-centered design %K intervention %K suicide %K nonsuicidal self-injury %K lived experience %K technology-enabled services %K digital intervention %K engagement %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The prevalence of self-injurious thoughts and behaviors (SITB) signals a growing public health crisis. Despite a recognized need for improved and scalable interventions, the field of SITB intervention faces several challenges: existing interventions are often time and resource intensive, most individuals with SITB do not seek formal mental health care, and efficacious treatments are characterized by small effects. Combined, these challenges indicate a need for improved SITB interventions for individuals in formal treatment and those who are not treatment engaged but are at high risk of worsening mental health and future suicide attempts. Objective: We present a methodological approach and set of techniques that may address these challenges by centering the lived experience of individuals with SITB in the process of developing needed services: user-centered design (UCD). Methods: We highlight the value of UCD in the context of digital interventions for SITB by describing the UCD approach and explicating how it can be leveraged to include lived experience throughout the development and evaluation process. We provide a detailed case example highlighting 3 phases of the early development process that can be used to design an intervention that is engaging and meets end-user needs. In addition, we point to novel applications of UCD to complement new directions in SITB research. Results: In this paper, we offer a 2-pronged approach to meet these challenges. First, in terms of addressing access to effective interventions, digital interventions hold promise to extend the reach of evidence-based treatments outside of brick-and-mortar health care settings. Second, to address challenges related to treatment targets and engagement, we propose involving individuals with lived experience in the design and research process. Conclusions: UCD offers a well-developed and systematic process to center the unique needs, preferences, and perceived barriers of individuals with lived SITB experience in the development and evaluation of digital interventions. %M 34951602 %R 10.2196/31367 %U https://mental.jmir.org/2021/12/e31367 %U https://doi.org/10.2196/31367 %U http://www.ncbi.nlm.nih.gov/pubmed/34951602 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e30915 %T Opening the Black Box of Daily Life in Nonsuicidal Self-injury Research: With Great Opportunity Comes Great Responsibility %A Kiekens,Glenn %A Robinson,Kealagh %A Tatnell,Ruth %A Kirtley,Olivia J %+ Faculty of Psychology and Educational Sciences, Clinical Psychology, KU Leuven, Tiensestraat 102, Leuven, 3720, Belgium, 32 16372852, glenn.kiekens@kuleuven.be %K real-time monitoring %K nonsuicidal self-injury %K NSSI %K experience sampling %K ecological momentary assessment %K digital psychiatry %D 2021 %7 19.11.2021 %9 Viewpoint %J JMIR Ment Health %G English %X Although nonsuicidal self-injury (NSSI)—deliberate damaging of body tissue without suicidal intent—is a behavior that occurs in interaction with real-world contexts, studying NSSI in the natural environment has historically been impossible. Recent advances in real-time monitoring technologies have revolutionized our ability to do exactly that, providing myriad research and clinical practice opportunities. In this viewpoint paper, we review new research pathways to improve our ability to understand, predict, and prevent NSSI, and provide critical perspectives on the responsibilities inherent to conducting real-time monitoring studies on NSSI. Real-time monitoring brings unique opportunities to advance scientific understanding about (1) the dynamic course of NSSI, (2) the real-time predictors thereof and ability to detect acute risk, (3) the ecological validity of theoretical models, (4) the functional mechanisms and outcomes of NSSI, and (5) the promotion of person-centered care and novel technology-based interventions. By considering the opportunities of real-time monitoring research in the context of the accompanying responsibilities (eg, inclusive recruitment, sound and transparent research practices, participant safety and engagement, measurement reactivity, researcher well-being and training), we provide novel insights and resources to open the black box of daily life in the next decade(s) of NSSI research. %M 34807835 %R 10.2196/30915 %U https://mental.jmir.org/2021/11/e30915 %U https://doi.org/10.2196/30915 %U http://www.ncbi.nlm.nih.gov/pubmed/34807835 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e24471 %T Suicide Risk and Protective Factors in Online Support Forum Posts: Annotation Scheme Development and Validation Study %A Chancellor,Stevie %A Sumner,Steven A %A David-Ferdon,Corinne %A Ahmad,Tahirah %A De Choudhury,Munmun %+ Department of Computer Science & Engineering, University of Minnesota - Twin Cities, 200 Union Street SE, 4-189 Keller Hall, Minneapolis, MN, 55455, United States, 1 612 625 4002, steviec@umn.edu %K online communities %K suicide crisis %K construct validity %K annotation scheme %K Reddit %K annotation %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Online communities provide support for individuals looking for help with suicidal ideation and crisis. As community data are increasingly used to devise machine learning models to infer who might be at risk, there have been limited efforts to identify both risk and protective factors in web-based posts. These annotations can enrich and augment computational assessment approaches to identify appropriate intervention points, which are useful to public health professionals and suicide prevention researchers. Objective: This qualitative study aims to develop a valid and reliable annotation scheme for evaluating risk and protective factors for suicidal ideation in posts in suicide crisis forums. Methods: We designed a valid, reliable, and clinically grounded process for identifying risk and protective markers in social media data. This scheme draws on prior work on construct validity and the social sciences of measurement. We then applied the scheme to annotate 200 posts from r/SuicideWatch—a Reddit community focused on suicide crisis. Results: We documented our results on producing an annotation scheme that is consistent with leading public health information coding schemes for suicide and advances attention to protective factors. Our study showed high internal validity, and we have presented results that indicate that our approach is consistent with findings from prior work. Conclusions: Our work formalizes a framework that incorporates construct validity into the development of annotation schemes for suicide risk on social media. This study furthers the understanding of risk and protective factors expressed in social media data. This may help public health programming to prevent suicide and computational social science research and investigations that rely on the quality of labels for downstream machine learning tasks. %M 34747705 %R 10.2196/24471 %U https://mental.jmir.org/2021/11/e24471 %U https://doi.org/10.2196/24471 %U http://www.ncbi.nlm.nih.gov/pubmed/34747705 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e27676 %T Professional Care Experiences of Persons With Suicidal Ideation and Behavior: Model Development Based on a Qualitative Meta-Synthesis %A Hechinger,Mareike %A Fringer,André %+ Institute of Nursing, School of Health Professions, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, 8400, Switzerland, 41 58 934 64 79, andre.fringer@zhaw.ch %K nursing care %K health care professionals %K suicidal behavior %K suicidal inclinations %K suicidal ideation %K inpatient %K outpatient %K eHealth %K mHealth %K mental health %K suicide %K stress %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care professionals (HCPs) are challenged in caring for persons with suicidal ideation or behavior. For affected persons, professional care is essential, and being interviewed about their experiences can be stressful. The experiences of persons ideating or attempting suicide are essential to designing eHealth products to support them in crises and provide continuous care. Objective: This study aimed to synthesize published qualitative research about how persons with suicidal thoughts or behavior experience inpatient or outpatient care. A model will be derived from the meta-synthesis to guide HCPs in their work with affected persons and provide a thorough needs assessment for eHealth development. Methods: A qualitative meta-synthesis was conducted using an inductive approach, as proposed by Sandelowski and Barroso. The inclusion criteria were studies in English and German that dealt with persons who ideated or attempted suicide. Relevant articles were identified by searching the PubMed and Cinahl databases and by hand searching relevant journals and reference lists. The findings of each study were analyzed using initial and axial coding, followed by selective coding. Finally, a conceptual model was derived. Results: In total, 3170 articles were identified in the systematic literature search. Articles were screened independently by 2 researchers based on the eligibility criteria. Finally, 12 studies were included. The central phenomenon observed among persons ideating or attempting suicide is their process from feeling unanchored to feeling anchored in life again. During inpatient and outpatient care, they experience being dependent on the skills and attitudes of HCPs. While helpful skills and attitudes support persons ideating or attempting suicide to reach their feeling of being anchored in life again, adverse interactions are experienced negatively and might lead to prolonging or maintaining the feeling of being unanchored in life. Conclusions: The study promotes a differentiated view of the experiences of persons ideating or attempting suicide. The derived conceptual model can guide HCPs in their work with affected persons to support affected persons during their recovery. Moreover, the conceptual model is useable as a springboard to develop eHealth solutions for crisis situations and long-term care. %M 34709191 %R 10.2196/27676 %U https://formative.jmir.org/2021/10/e27676 %U https://doi.org/10.2196/27676 %U http://www.ncbi.nlm.nih.gov/pubmed/34709191 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e28262 %T Internet Search Activity of Young People With Mood Disorders Who Are Hospitalized for Suicidal Thoughts and Behaviors: Qualitative Study of Google Search Activity %A Moon,Khatiya C %A Van Meter,Anna R %A Kirschenbaum,Michael A %A Ali,Asra %A Kane,John M %A Birnbaum,Michael L %+ Department of Psychiatry, Zucker Hillside Hospital, 75-59 263rd Street, Kaufmann Building, Suite k204, Glen Oaks, NY, 11004, United States, 1 7184704367, kmoon2@northwell.edu %K suicide %K mood disorders %K depression %K internet %K search engine %K Google search %K digital health %K mobile health %K adolescent %K young adult %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Little is known about the internet search activity of people with suicidal thoughts and behaviors (STBs). This data source has the potential to inform both clinical and public health efforts, such as suicide risk assessment and prevention. Objective: We aimed to evaluate the internet search activity of suicidal young people to find evidence of suicidal ideation and behavioral health–related content. Methods: Individuals aged between 15 and 30 years (N=43) with mood disorders who were hospitalized for STBs provided access to their internet search history. Searches that were conducted in the 3-month period prior to hospitalization were extracted and manually evaluated for search themes related to suicide and behavioral health. Results: A majority (27/43, 63%) of participants conducted suicide-related searches. Participants searched for information that exactly matched their planned or chosen method of attempting suicide in 21% (9/43) of cases. Suicide-related search queries also included unusual suicide methods and references to suicide in popular culture. A majority of participants (33/43, 77%) had queries related to help-seeking themes, including how to find inpatient and outpatient behavioral health care. Queries related to mood and anxiety symptoms were found among 44% (19/43) of participants and included references to panic disorder, the inability to focus, feelings of loneliness, and despair. Queries related to substance use were found among 44% (19/43) of participants. Queries related to traumatic experiences were present among 33% (14/43) of participants. Few participants conducted searches for crisis hotlines (n=3). Conclusions: Individuals search the internet for information related to suicide prior to hospitalization for STBs. The improved understanding of the search activity of suicidal people could inform outreach, assessment, and intervention strategies for people at risk. Access to search data may also benefit the ongoing care of suicidal patients. %M 34677139 %R 10.2196/28262 %U https://mental.jmir.org/2021/10/e28262 %U https://doi.org/10.2196/28262 %U http://www.ncbi.nlm.nih.gov/pubmed/34677139 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e29454 %T School-Based Suicide Risk Assessment Using eHealth for Youth: Systematic Scoping Review %A Exner-Cortens,Deinera %A Baker,Elizabeth %A Gray,Shawna %A Fernandez Conde,Cristina %A Rivera,Rocio Ramirez %A Van Bavel,Marisa %A Vezina,Elisabeth %A Ambrose,Aleta %A Pawluk,Chris %A Schwartz,Kelly D %A Arnold,Paul D %+ Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N1N4, Canada, 1 4032208871, deinera.exner2@ucalgary.ca %K suicide %K risk assessment %K youth %K eHealth %K school mental health %K mobile phone %D 2021 %7 21.9.2021 %9 Review %J JMIR Ment Health %G English %X Background: Suicide is a leading cause of death among youth and a prominent concern for school mental health providers. Indeed, schools play a key role in suicide prevention, including participating in risk assessments with students expressing suicidal ideation. In the context of the COVID-19 pandemic, many schools now need to offer mental health services, including suicide risk assessment, via eHealth platforms. Post pandemic, the use of eHealth risk assessments will support more accessible services for youth living in rural and remote areas. However, as the remote environment is a new context for many schools, guidance is needed on best practices for eHealth suicide risk assessment among youth. Objective: This study aims to conduct a rapid, systematic scoping review to explore promising practices for conducting school-based suicide risk assessment among youth via eHealth (ie, information technologies that allow for remote communication). Methods: This review included peer-reviewed articles and gray literature published in English between 2000 and 2020. Although we did not find studies that specifically explored promising practices for school-based suicide risk assessment among youth via eHealth platforms, we found 12 peer-reviewed articles and 23 gray literature documents that contained relevant information addressing our broader study purpose; thus, these 35 sources were included in this review. Results: We identified five key recommendation themes for school-based suicide risk assessment among youth via eHealth platforms in the 12 peer-reviewed studies. These included accessibility, consent procedures, session logistics, safety planning, and internet privacy. Specific recommendation themes from the 23 gray literature documents substantially overlapped with and enhanced three of the themes identified in the peer-reviewed literature—consent procedures, session logistics, and safety planning. In addition, based on findings from the gray literature, we expanded the accessibility theme to a broader theme termed youth engagement, which included information on accessibility and building rapport, establishing a therapeutic space, and helping youth prepare for remote sessions. Finally, a new theme was identified in the gray literature findings, specifically concerning school mental health professional boundaries. A second key difference between the gray and peer-reviewed literature was the former’s focus on issues of equity and access and how technology can reinforce existing inequalities. Conclusions: For school mental health providers in need of guidance, we believe that these six recommendation themes (ie, youth engagement, school mental health professional boundaries, consent procedures, session logistics, safety planning, and internet privacy) represent the most promising directions for school-based suicide risk assessment among youth using eHealth tools. However, suicide risk assessment among youth via eHealth platforms in school settings represents a critical research gap. On the basis of the findings of this review, we provide specific recommendations for future research, including the need to focus on the needs of diverse youth. %M 34546178 %R 10.2196/29454 %U https://mental.jmir.org/2021/9/e29454 %U https://doi.org/10.2196/29454 %U http://www.ncbi.nlm.nih.gov/pubmed/34546178 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26207 %T Young Sexual Minority Adolescent Experiences of Self-expression and Isolation on Social Media: Cross-sectional Survey Study %A Charmaraman,Linda %A Hodes,Rachel %A Richer,Amanda M %+ Wellesley Centers for Women, Wellesley College, 106 Central Street, Wellesley, MA, 02481, United States, 1 7812832542, lcharmar@wellesley.edu %K social media %K social networking sites %K sexual minorities %K cyberbullying %K depression %K loneliness %K self-harm %K social support %K adolescents %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X 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 (β=−.57; P<.001), less often responded positively when friends shared good news (β=−.35; P=.002), and less often tried to make friends feel better when they shared bad news (β=−.30; P=.01). However, sexual minorities more often reported joining a group or web-based community to make themselves feel less alone (β=.28; P=.003), unlike heterosexual youth. Sexual minorities had higher averages of loneliness and social isolation (β=.19; P<.001) than heterosexual students. Sexual minorities were also twice as likely to have tried to harm themselves in the past (β=.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 (β=.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 (β=.41; OR 1.50, 95% CI 1.14-1.97; P=.004) and more likely to report seeing videos related to self-harm (β=.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. %M 34524107 %R 10.2196/26207 %U https://mental.jmir.org/2021/9/e26207 %U https://doi.org/10.2196/26207 %U http://www.ncbi.nlm.nih.gov/pubmed/34524107 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26035 %T Perceived Facilitators of and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: Focus Group and Interview Study %A Radovic,Ana %A Anderson,Nathan %A Hamm,Megan %A George-Milford,Brandie %A Fascetti,Carrie %A Engster,Stacey %A Lindhiem,Oliver %+ Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA, 15213, United States, 1 4126927227, ana.radovic@chp.edu %K depression %K adolescent %K suicidality %K screening %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 34524090 %R 10.2196/26035 %U https://mental.jmir.org/2021/9/e26035 %U https://doi.org/10.2196/26035 %U http://www.ncbi.nlm.nih.gov/pubmed/34524090 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28931 %T Perceptions of Alerts Issued by Social Media Platforms in Response to Self-injury Posts Among Latinx Adolescents: Qualitative Analysis %A Laestadius,Linnea I %A Craig,Katherine A %A Campos-Castillo,Celeste %+ Zilber School of Public Health, University of Wisconsin-Milwaukee, P O Box 413, Milwaukee, WI, 53201, United States, 1 414 251 5607, llaestad@uwm.edu %K adolescents %K social media %K mental health %K NSSI %K race and ethnicity %K mobile phone %D 2021 %7 10.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is growing interest in using social media data to detect and address nonsuicidal self-injury (NSSI) among adolescents. Adolescents often do not seek clinical help for NSSI and may adopt strategies to obscure detection; therefore, social media platforms may be able to facilitate early detection and treatment by using machine learning models to screen posts for harmful content and subsequently alert adults. However, such efforts have raised privacy and ethical concerns among health researchers. Little is currently known about how adolescents perceive these efforts. Objective: The aim of this study is to examine perceptions of automated alerts for NSSI posts on social media among Latinx adolescents, who are at risk for NSSI yet are underrepresented in both NSSI and health informatics research. In addition, we considered their perspectives on preferred recipients of automated alerts. Methods: We conducted semistructured, qualitative interviews with 42 Latinx adolescents between the ages of 13 and 17 years who were recruited from a nonprofit organization serving the Latinx community in Milwaukee, Wisconsin. The Latinx population in Milwaukee is largely of Mexican descent. All interviews were conducted between June and July 2019. Transcripts were analyzed using framework analysis to discern their perceptions of automated alerts sent by social media platforms and potential alert recipients. Results: Participants felt that automated alerts would make adolescents safer and expedite aid before the situation escalated. However, some worried that hyperbolic statements would generate false alerts and instigate conflicts. Interviews revealed strong opinions about ideal alert recipients. Parents were most commonly endorsed, but support was conditional on perceptions that the parent would respond appropriately. Emergency services were judged as safer but inappropriate for situations considered lower risk. Alerts sent to school staff generated the strongest privacy concerns. Altogether, the preferred alert recipients varied by individual adolescents and perceived risks in the situation. None raised ethical concerns about the collection, analysis, or storage of personal information regarding their mental health status. Conclusions: Overall, Latinx adolescents expressed broad support for automated alerts for NSSI on social media, which indicates opportunities to address NSSI. However, these efforts should be co-constructed with adolescents to ensure that preferences and needs are met, as well as embedded within broader approaches for addressing structural and cultural barriers to care. %M 34383683 %R 10.2196/28931 %U https://www.jmir.org/2021/8/e28931 %U https://doi.org/10.2196/28931 %U http://www.ncbi.nlm.nih.gov/pubmed/34383683 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e17910 %T Experiences of an Online Treatment for Adolescents With Nonsuicidal Self-injury and Their Caregivers: Qualitative Study %A Simonsson,Olivia %A Engberg,Hedvig %A Bjureberg,Johan %A Ljótsson,Brjánn %A Stensils,Julia %A Sahlin,Hanna %A Hellner,Clara %+ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 7th Fl, Stockholm, SE-113 64, Sweden, 46 76 142 65 65, olivia.simonsson@ki.se %K nonsuicidal self-injury %K self-injurious behavior %K online treatment %K internet %K digital health %K emotion regulation %K emotion regulation individual therapy for adolescents %K adolescent %K qualitative %K experience %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Nonsuicidal self-injury (NSSI) is common in adolescence and is associated with several adverse outcomes. Despite this, few established treatment options exist. Online treatment seems promising for several conditions; however, knowledge on NSSI is scarce. It is important to explore how online treatment for NSSI is experienced to improve such interventions and learn more about factors that are important in the treatment of adolescents with NSSI. Objective: This study aims to explore the experiences of a novel online treatment for adolescents with NSSI and their caregivers. Methods: A qualitative study using thematic analysis was conducted through semistructured interviews with 9 adolescents and 11 caregivers at treatment termination or at the 6-month follow-up of the online emotion regulation individual therapy for adolescents. Results: A total of 3 overarching themes were identified. The theme support can come in different shapes showed how support could be attained through both interaction with the therapist as well as through the format itself (such as through the fictional characters in the material and the mobile app). Caregivers found it helpful to have their own online course, and adolescents accepted their involvement. The theme self-responsibility can be empowering as well as distressing showed that self-responsibility was highly appreciated (such as deciding when and how to engage in treatment) but also challenging; it caused occasional distress for some. The theme acquiring new skills and treatment effects showed the advantages and challenges of learning several different emotion regulation skills and that decreased emotion regulation difficulties were important treatment outcomes for adolescents. In addition, several different skills seemed to facilitate emotion regulation, and having access to such skills could hinder NSSI. Conclusions: Online emotion regulation individual therapy for adolescents seems to offer an accepted way to deliver family interventions for this target group; facilitate skills training with several means of support, including support from both the mobile app and the therapist; contribute to decreasing emotion regulation difficulties and teaching skills that could hinder NSSI; and cause (in some individuals) distress because of the self-responsibility that is inherent to online formats, which needs to be addressed. %M 34297001 %R 10.2196/17910 %U https://formative.jmir.org/2021/7/e17910 %U https://doi.org/10.2196/17910 %U http://www.ncbi.nlm.nih.gov/pubmed/34297001 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e15551 %T Typology and Impact of YouTube Videos Posted in Response to a Student Suicide Crisis: Social Media Metrics and Content Analyses %A Cheng,Qijin %A Lui,Carrie %A Ip,Flora Wai Lam %A Yip,Paul Siu Fai %+ Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 2/F, 5 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 28315232, sfpyip@hku.hk %K suicide %K suicide prevention %K social media %K infodemiology %K internet %K digital health %K YouTube %K impact evaluation %K network visualization %D 2021 %7 18.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Videos relating to suicide are available on YouTube, but their characteristics and impacts have seldom been examined. Objective: This study aimed to examine YouTube videos posted in response to a sudden spate of student suicides in Hong Kong during the 2015-2016 school year and evaluate the impacts of those videos. Methods: Keyword search was performed on YouTube, and relevant videos were identified. Video typology was examined through content analysis, specifically grouping the videos by who uploaded the videos, what presentation formats were used in the videos, whether the videos were originally created by the uploaders, and whether the videos disclosed the uploaders’ personal experiences with suicide. Impacts of the videos were assessed in terms of reach (measured by view count), engagement (measured by comment count), and insights (measured as to what extent the comments to each video could reveal personal suicide risk and attitude toward help-seeking). Statistical analysis was conducted to compare the impacts of different types of videos. The 7 most impactful videos that were originally created by the YouTubers were selected for further analysis. They were compared with 7 videos uploaded by the same YouTubers right before the student suicide videos and 7 right after the student suicide videos. The comparison focused on their impacts and the network structure of the comments to those videos. Results: A total of 162 relevant YouTube videos were identified. They were uploaded by 7 types of stakeholders, and the most common format was one person talking to the camera. A total of 87.0% (141/162) of the videos were originally created by the uploaders and only 8.0% (13/162) of the videos disclosed uploader personal experiences with suicide. The uploader profiles being popular or top YouTubers and the video containing disclosure of the uploader’s personal experiences were found to be significantly correlated with greater impacts (P<.001). Focusing on the 7 most impactful original videos, it is found that those videos generated more engagement, especially more interactions between the viewers, and more insights than regular videos uploaded by the same YouTubers. Conclusions: When responding to a youth suicide crisis, videos made by key opinion leaders on YouTube sharing their own experiences of overcoming suicide risks could generate significant positive impacts. These types of videos offer a precious opportunity to craft online campaigns and activities to raise suicide prevention awareness and engage vulnerable youth. %R 10.2196/15551 %U https://mental.jmir.org/2021/6/e15551/ %U https://doi.org/10.2196/15551 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e29365 %T Meaning in Life Among Patients With Chronic Pain and Suicidal Ideation: Mixed Methods Study %A Costanza,Alessandra %A Chytas,Vasileios %A Piguet,Valérie %A Luthy,Christophe %A Mazzola,Viridiana %A Bondolfi,Guido %A Cedraschi,Christine %+ Department of Psychiatry, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, Geneva, 1211, Switzerland, 41 223795900, alessandra.costanza@unige.ch %K suicide %K suicidal behavior %K suicidal ideation %K suicide attempt %K chronic pain %K meaning in life %K protective factors %K risk factors %K mental health %D 2021 %7 4.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with chronic pain have elevated risk of suicidal ideation and behavior, including suicide attempts and completed suicides. In most studies, associations between chronic pain and suicidal ideation/suicidal behavior are robust even after adjusting for the effect of sociodemographics and psychiatric comorbidity. However, to refine the risk profile of these patients, further exploration of other possible risk and protective factors is necessary. Objective: There is a common clinical observation that experiencing chronic pain often requires a revision of life goals and expectations, and hence, it impacts the existential domain including one’s perception of the meaning in life (MiL). This study aimed to characterize the main domains that constitute the personal MiL, including the “presence of” and “search for” constructs, in a group of patients with chronic pain and suicidal ideation. Methods: Seventy participants were enlisted by ongoing recruitment through a larger project anchored in daily clinical practice at the Multidisciplinary Pain Center of the Geneva University Hospitals. It was an observational mixed method study. Data were recorded through both validated quantitative questionnaires and qualitative open-ended questions. Results: The total sample consisted of 70 patients. Responses to questionnaires showed a depressive episode in 68 (97%) patients and anxious disorders in 25 (36%) patients. With a score threshold for positive MiL of 24, the mean score for the “presence of” construct was 20.13 (SD 8.23), and 63% (44/70) of respondents had a score <24. The mean score for the “search for” construct was lower at 18.14 (SD 8.64), and 70% (49/70) of respondents had a score <24. The “presence of” and “search for” constructs were significantly positively correlated (R=0.402; P=.001). An open question addressed the “presence of” construct by inviting the respondents to cite domains they consider as providing meaning in their life at the present time. All patients responded to this question, citing one or more domains. The three main dimensions that emerged from content analysis of this qualitative section were as follows: the domain of relationships, the domain of personal activities, and pain and its consequences on MiL. Conclusions: The study results provide insights into patients with chronic pain and suicidal ideation, including the domains that provide them with meaning in their lives and the impact of pain on these domains with regard to suicidal ideation. The main clinical implications concern both prevention and supportive/psychotherapeutic interventions. They are based on a narrative approach aiming to explore with the patients the content of their suffering and the MiL domains that they could identify to mitigate it, in order to restructure/reinforce these domains and thus possibly reduce suicidal ideation. Specifically, a focus on maintaining the domains of interpersonal relationships and personal activities can allow patients to ultimately escape the biopsychosocial vicious cycle of chronic pain–induced deep moral suffering. %M 34003136 %R 10.2196/29365 %U https://formative.jmir.org/2021/6/e29365 %U https://doi.org/10.2196/29365 %U http://www.ncbi.nlm.nih.gov/pubmed/34003136 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e26948 %T Suicide Prevention Among College Students Before and During the COVID-19 Pandemic: Protocol for a Systematic Review and Meta-analysis %A Xiao,Yunyu %A Hinrichs,Rachel %A Johnson,Nina %A McKinley,Amanda %A Carlson,Joan %A Agley,Jon %A Yip,Paul Siu Fai %+ School of Social Work, Indiana University–Purdue University Indianapolis, 902 W New York St, 4F, Education/Social Work Building, ES 4119, Indianapolis, IN, 46202, United States, 1 201 253 7264, yx18@iu.edu %K suicide %K suicidal prevention %K college %K university %K health disparities %K equity %K suicidal ideation %K suicide attempt %K COVID-19 %K college student %K young adult %K disparity %K review %D 2021 %7 17.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide is the second leading cause of death for college-aged individuals worldwide and in the United States. Recent studies have identified preliminary evidence of widening disparities in suicidal behaviors across sex, sexual orientation, race/ethnicity, age, and socioeconomic status among college students. Few systematic reviews and meta-analyses offer a comprehensive understanding of on-campus and off-campus suicide interventions, nor is collated information available for different types of screening, assessment, treatment, and postvention plans. Further challenges have been identified since the COVID-19 pandemic, calling for cost-effective and innovative interventions to address increased rates of suicidal behaviors among college students facing unprecedented stressors. Objective: This research protocol describes the first systematic review and meta-analysis to identify the most effective and cost-effective intervention components for universal and targeted (indicated and selected) suicide prevention among college students in a global context. Special attention will be placed on disparities in suicide prevention across sociodemographic subgroups, inclusive interventions beyond campus, global context, and intervention responses to the COVID-19 pandemic. Methods: A sensitive search strategy will be executed across MEDLINE (Ovid), EMBASE, PsycINFO (EBSCO), ERIC (EBSCO), Cochrane Library, Dissertations and Theses Global (ProQuest), Scopus, Global Index Medicus, SciELO, African Journals Online, Global Health (CABI), and Google Scholar. Data extraction and evaluation will be conducted by three independent researchers. Risk of bias will be assessed. A multilevel meta-regression model and subgroup analysis will be used to analyze the data and estimate effect sizes. Results: The initial search was completed in December 2020 and updated with additional other-language studies in March 2020. We expect the results to be submitted for publication in mid-2021. Conclusions: Despite increasing rates of suicidal behaviors among college students, few preventative efforts have targeted this population, and fewer focus on factors that might place specific demographic groups at heightened risk. The impact of COVID-19 on suicidal behaviors among college students highlights and exacerbates the urgent need for rapid and effective interventions that might differ from traditional approaches. This equity-focused study will address these gaps and provide a valuable analysis of the effectiveness of suicide prevention programs and interventions. Findings will inform clinicians, researchers, policy makers, families, and organizations about evidence-based interventions for reducing the gaps in the suicide crisis among college students from different sociodemographic groups. Trial Registration: PROSPERO CRD42020225429; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=225429 International Registered Report Identifier (IRRID): DERR1-10.2196/26948 %M 33878016 %R 10.2196/26948 %U https://www.researchprotocols.org/2021/5/e26948 %U https://doi.org/10.2196/26948 %U http://www.ncbi.nlm.nih.gov/pubmed/33878016 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 5 %P e26654 %T Assessing Suicide Reporting in Top Newspaper Social Media Accounts in China: Content Analysis Study %A Lai,Kaisheng %A Li,Dan %A Peng,Huijuan %A Zhao,Jingyuan %A He,Lingnan %+ School of Communication and Design, Sun Yat-Sen University, No. 132 Waihuan East Road, Higher Education Mega Center, Guangzhou, , China, 86 020 3933 1935, heln3@mail.sysu.edu.cn %K suicide %K suicide reporting %K mainstream publishers %K social media %K WHO guidelines %D 2021 %7 13.5.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Previous studies have shown that suicide reporting in mainstream media has a significant impact on suicidal behaviors (eg, irresponsible suicide reporting can trigger imitative suicide). Traditional mainstream media are increasingly using social media platforms to disseminate information on public-related topics, including health. However, there is little empirical research on how mainstream media portrays suicide on social media platforms and the quality of their coverage. Objective: This study aims to explore the characteristics and quality of suicide reporting by mainstream publishers via social media in China. Methods: Via the application programming interface of the social media accounts of the top 10 Chinese mainstream publishers (eg, People’s Daily and Beijing News), we obtained 2366 social media posts reporting suicide. This study conducted content analysis to demonstrate the characteristics and quality of the suicide reporting. According to the World Health Organization (WHO) guidelines, we assessed the quality of suicide reporting by indicators of harmful information and helpful information. Results: Chinese mainstream publishers most frequently reported on suicides stated to be associated with conflict on their social media (eg, 24.47% [446/1823] of family conflicts and 16.18% [295/1823] of emotional frustration). Compared with the suicides of youth (730/1446, 50.48%) and urban populations (1454/1588, 91.56%), social media underreported suicides in older adults (118/1446, 8.16%) and rural residents (134/1588, 8.44%). Harmful reporting practices were common (eg, 54.61% [1292/2366] of the reports contained suicide-related words in the headline and 49.54% [1172/2366] disclosed images of people who died by suicide). Helpful reporting practices were very limited (eg, 0.08% [2/2366] of reports provided direct information about support programs). Conclusions: The suicide reporting of mainstream publishers on social media in China broadly had low adherence to the WHO guidelines. Considering the tremendous information dissemination power of social media platforms, we suggest developing national suicide reporting guidelines that apply to social media. By effectively playing their separate roles, we believe that social media practitioners, health institutions, social organizations, and the general public can endeavor to promote responsible suicide reporting in the Chinese social media environment. %M 33983127 %R 10.2196/26654 %U https://mental.jmir.org/2021/5/e26654 %U https://doi.org/10.2196/26654 %U http://www.ncbi.nlm.nih.gov/pubmed/33983127 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25140 %T mHealth Interventions for Self-Harm: Scoping Review %A Cliffe,Bethany %A Tingley,Jessica %A Greenhalgh,Isobel %A Stallard,Paul %+ Department for Health, University of Bath, Claverton Down, Bath, , United Kingdom, 44 01225 388388, bc731@bath.ac.uk %K mHealth %K self-harm %K digital interventions %K self-injury %K NSSI %K mobile phone %D 2021 %7 30.4.2021 %9 Review %J J Med Internet Res %G English %X Background: Self-harm is a growing issue with increasing prevalence rates; however, individuals who self-harm do not often receive treatment. Mobile health (mHealth) interventions are a possible solution to some of the barriers that individuals face when seeking support, and they have also been found to be effective in improving mental health. Thus far, reviews of mHealth interventions for self-harm have been limited by study type. Therefore, we determined that a broader scoping review will provide a more exhaustive understanding of mHealth interventions for self-harm. Objective: This scoping review aims to identify mHealth interventions for self-harm within the literature, understand the types and features of interventions that have been developed and evaluated, highlight research findings around mHealth interventions for self-harm, and determine what outcomes are typically used to assess the efficacy of interventions. Methods: A search was conducted using Embase, PubMed, PsycINFO, PsycEXTRA, Web of Science, and the Cochrane Library. Studies were included if they described an mHealth intervention designed to have a direct (ie, if the intervention was designed for self-harm or for people who self-harm) or indirect (ie, if self-harm was measured as an outcome) treatment effect and if the paper was available in English. There were no exclusion criteria based on the study design. Results: A total of 36 papers were included in the review, and most of them were randomized controlled trials published within the last 4 years. The interventions were mostly smartphone apps and calling or texting services, with 62% (21/34) having underlying therapeutic models to inform the intervention content. They were generally shown to be promising and appealing, but only 5 were widely available for use. Outcomes focused on a reduction of self-harm and suicidality, mood, and the users’ experiences of the intervention. Samples were typically nondiverse, and there was limited variety in the study designs and in the measurements of self-harm recovery. Conclusions: Promising and appealing mHealth interventions have been developed but are not widely available. Research could benefit from greater diversity as well as a broader and more nuanced understanding of recovery from self-harm. %M 33929329 %R 10.2196/25140 %U https://www.jmir.org/2021/4/e25140 %U https://doi.org/10.2196/25140 %U http://www.ncbi.nlm.nih.gov/pubmed/33929329 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e24522 %T Using Machine Learning Imputed Outcomes to Assess Drug-Dependent Risk of Self-Harm in Patients with Bipolar Disorder: A Comparative Effectiveness Study %A Nestsiarovich,Anastasiya %A Kumar,Praveen %A Lauve,Nicolas Raymond %A Hurwitz,Nathaniel G %A Mazurie,Aurélien J %A Cannon,Daniel C %A Zhu,Yiliang %A Nelson,Stuart James %A Crisanti,Annette S %A Kerner,Berit %A Tohen,Mauricio %A Perkins,Douglas J %A Lambert,Christophe Gerard %+ Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, 915 Camino de Salud NE, Albuquerque, NM, United States, 1 5052729709, cglambert@unm.edu %K bipolar %K mood %K mania %K depression %K pharmacotherapy %K self-harm %K suicide %K machine learning %K psychotherapy %D 2021 %7 21.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Incomplete suicidality coding in administrative claims data is a known obstacle for observational studies. With most of the negative outcomes missing from the data, it is challenging to assess the evidence on treatment strategies for the prevention of self-harm in bipolar disorder (BD), including pharmacotherapy and psychotherapy. There are conflicting data from studies on the drug-dependent risk of self-harm, and there is major uncertainty regarding the preventive effect of monotherapy and drug combinations. Objective: The aim of this study was to compare all commonly used BD pharmacotherapies, as well as psychotherapy for the risk of self-harm, in a large population of commercially insured individuals, using self-harm imputation to overcome the known limitations of this outcome being underrecorded within US electronic health care records. Methods: The IBM MarketScan administrative claims database was used to compare self-harm risk in patients with BD following 65 drug regimens and drug-free periods. Probable but uncoded self-harm events were imputed via machine learning, with different probability thresholds examined in a sensitivity analysis. Comparators included lithium, mood-stabilizing anticonvulsants (MSAs), second-generation antipsychotics (SGAs), first-generation antipsychotics (FGAs), and five classes of antidepressants. Cox regression models with time-varying covariates were built for individual treatment regimens and for any pharmacotherapy with or without psychosocial interventions (“psychotherapy”). Results: Among 529,359 patients, 1.66% (n=8813 events) had imputed and/or coded self-harm following the exposure of interest. A higher self-harm risk was observed during adolescence. After multiple testing adjustment (P≤.012), the following six regimens had higher risk of self-harm than lithium: tri/tetracyclic antidepressants + SGA, FGA + MSA, FGA, serotonin-norepinephrine reuptake inhibitor (SNRI) + SGA, lithium + MSA, and lithium + SGA (hazard ratios [HRs] 1.44-2.29), and the following nine had lower risk: lamotrigine, valproate, risperidone, aripiprazole, SNRI, selective serotonin reuptake inhibitor (SSRI), “no drug,” bupropion, and bupropion + SSRI (HRs 0.28-0.74). Psychotherapy alone (without medication) had a lower self-harm risk than no treatment (HR 0.56, 95% CI 0.52-0.60; P=8.76×10-58). The sensitivity analysis showed that the direction of drug-outcome associations did not change as a function of the self-harm probability threshold. Conclusions: Our data support evidence on the effectiveness of antidepressants, MSAs, and psychotherapy for self-harm prevention in BD. Trial Registration: ClinicalTrials.gov NCT02893371; https://clinicaltrials.gov/ct2/show/NCT02893371 %M 33688834 %R 10.2196/24522 %U https://mental.jmir.org/2021/4/e24522 %U https://doi.org/10.2196/24522 %U http://www.ncbi.nlm.nih.gov/pubmed/33688834 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e18048 %T Impact of Web-Based Sharing and Viewing of Self-Harm–Related Videos and Photographs on Young People: Systematic Review %A Marchant,Amanda %A Hawton,Keith %A Burns,Lauren %A Stewart,Anne %A John,Ann %+ Swansea University Medical School, Singleton Park, Swansea, SA2 8PP, United Kingdom, 44 1792602568, A.John@swansea.ac.uk %K self-harm %K suicide %K social media %K internet %K systematic review %D 2021 %7 19.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Given recent moves to remove or blur self-harm imagery or content on the web, it is important to understand the impact of posting, viewing, and reposting self-harm images on young people. Objective: The aim of this study is to systematically review research related to the emotional and behavioral impact on children and young people who view or share web-based self-harm–related videos or images. Methods: We searched databases (including Embase, PsychINFO, and MEDLINE) from January 1991 to February 2019. Search terms were categorized into internet use, images nonspecific and specific to the internet, and self-harm and suicide. Stepwise screening against specified criteria and data extraction were completed by two independent reviewers. Eligible articles were quality assessed, and a narrative synthesis was conducted. Results: A total of 19 independent studies (20 articles) were included. Of these, 4 studies focused on images, 10 (11 articles) on videos, and 5 on both. There were 4 quantitative, 9 qualitative, and 7 mixed methods articles. In total, 11 articles were rated as high quality. There has been an increase in graphic self-harm imagery over time. Potentially harmful content congregated on platforms with little moderation, anonymity, and easy search functions for images. A range of reactions and intentions were reported in relation to posting or viewing images of self-harm: from empathy, a sense of solidarity, and the use of images to give or receive help to potentially harmful ones suggesting new methods, normalization, and exacerbation of self-harm. Viewing images as an alternative to self-harm or a creative outlet were regarded in 2 studies as positive impacts. Reactions of anger, hostility, and ambivalence have been reported. There was some evidence of the role of imitation and reinforcement, driven partly by the number of comments and wound severity, but this was not supported by time series analyses. Conclusions: Although the results of this review support concern related to safety and exacerbation of self-harm through viewing images of self-harm, there may be potential for positive impacts in some of those exposed. Future research should evaluate the effectiveness and potential harms of current posting restrictions, incorporate user perspectives, and develop recovery-oriented content. Clinicians assessing distressed young people should ask about internet use, including access to self-harm images, as part of their assessment. %M 33739289 %R 10.2196/18048 %U https://www.jmir.org/2021/3/e18048 %U https://doi.org/10.2196/18048 %U http://www.ncbi.nlm.nih.gov/pubmed/33739289 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e23892 %T Acceptability, Safety, and Resonance of the Pilot Digital Suicide Prevention Campaign “Better Off With You”: Qualitative Study %A Carrotte,Elise Rose %A Webb,Marianne %A Flego,Anna %A Vincent,Bonnie %A Heath,Jack %A Blanchard,Michelle %+ Anne Deveson Research Centre, SANE Australia, PO Box 226, South Melbourne, 3205, Australia, 61 3 9682 5933, elise.carrotte@sane.org %K suicide %K interpersonal theory of suicide %K social media %K co-design %K lived experience %D 2021 %7 3.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Interpersonal Theory of Suicide posits that there are three key elements of suicidal behavior: perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. The digital campaign Better Off With You was developed to directly challenge the idea of perceived burdensomeness among people who are contemplating suicide in 2 communities within Australia. Objective: The aim of this study is to explore the needs and preferences of people with lived experience of suicidal thoughts and actions to inform the development of Better Off With You. Methods: This study involved a series of focus groups that aimed to discuss campaign messaging, scope, and approach. People with lived experience of suicidal thoughts and actions attended the focus groups. After the completion of initial focus groups, the results informed the creation of campaign collateral by creative agencies. Early versions of the campaign collateral were then presented in the user testing sessions. Transcriptions were analyzed via thematic analysis. Results: In total, 13 participants attended the focus groups and 14 attended the user testing sessions. The following three overarching themes were presented: acceptability, safety, and resonance. Participants believed that suicide is a serious and ongoing issue in their communities and welcomed a localized suicide prevention focus via peer-to-peer storytelling. The idea of perceived burdensomeness required clarification but was perceived as acceptable and relevant. Participants seemed drawn toward peer narratives that they perceived to be authentic, genuine, and believable as given by real people with lived experience. Campaign messaging needs to be clear and empathetic while directly talking about suicide. Participants did not anticipate any significant negative or harmful impact from any campaign videos and highlighted the importance of providing appropriate help-seeking information. Conclusions: This iterative study provided important insights and knowledge about peer-to-peer storytelling in suicide prevention campaigns. Future campaigns should involve simple messaging, be validating and empathetic, and consider including a lived experience perspective. %M 33656441 %R 10.2196/23892 %U https://formative.jmir.org/2021/3/e23892 %U https://doi.org/10.2196/23892 %U http://www.ncbi.nlm.nih.gov/pubmed/33656441 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e21854 %T Examining the Relationship Between the Use of a Mobile Peer-Support App and Self-Injury Outcomes: Longitudinal Mixed Methods Study %A Kruzan,Kaylee Payne %A Whitlock,Janis %A Bazarova,Natalya N %+ Center for Behavioral Intervention Technologies, Northwestern University, 750 N Lake Shore Dr, 10th Fl, Chicago, IL, United States, 1 312 503 6585, kaylee.kruzan@northwestern.edu %K self-injury %K mobile apps %K peer support %K mHealth %D 2021 %7 28.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Many individuals who self-injure seek support and information through online communities and mobile peer-support apps. Although researchers have identified risks and benefits of participation, empirical work linking participation in these web-based spaces to self-injury behaviors and thoughts is limited. Objective: This study aims to investigate the relationship between behavioral and linguistic traces on a mobile peer support app and self-injury outcomes. Methods: Natural use data and web-based surveys (N=697) assessing self-injury outcomes were collected from 268 users (aged 13-38 years; median 19; 149/268, 55.6% female) of a mobile peer-support app for 4 months. Participants were identified as having posted self-injury content using an internal classifier. Natural log data was used to predict self-injury outcomes in a series of multilevel logistic and linear regressions. Results: Greater engagement on a mobile peer-support app was associated with a decreased likelihood of self-injury thoughts (odds ratio [OR] 0.25, 95% CI 0.09-0.73) and fewer intentions to self-injure (b=−0.37, SE 0.09), whereas posting triggering content was associated with an increased likelihood of engaging in behaviors (OR 5.37, 95% CI 1.25-23.05) and having self-injury thoughts (OR 17.87, 95% CI 1.64-194.15). Moreover, viewing triggering content was related to both a greater ability to resist (b=1.39, SE 0.66) and a greater intention to self-injure (b=1.50, SE 0.06). Conclusions: To our knowledge, this is the first study to connect naturally occurring log data to survey data assessing self-injury outcomes over time. This work provides empirical support for the relationship between participation in online forums and self-injury outcomes, and it articulates mechanisms contributing to this relationship. %M 33507154 %R 10.2196/21854 %U http://mental.jmir.org/2021/1/e21854/ %U https://doi.org/10.2196/21854 %U http://www.ncbi.nlm.nih.gov/pubmed/33507154 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 7 %P e17784 %T Identifying and Predicting Intentional Self-Harm in Electronic Health Record Clinical Notes: Deep Learning Approach %A Obeid,Jihad S %A Dahne,Jennifer %A Christensen,Sean %A Howard,Samuel %A Crawford,Tami %A Frey,Lewis J %A Stecker,Tracy %A Bunnell,Brian E %+ Medical University of South Carolina, 135 Cannon St. Suite 405 MSC200, Charleston, SC, 29425, United States, 1 8437920272, jobeid@musc.edu %K machine learning %K deep learning %K suicide %K suicide, attempted %K electronic health records %K natural language processing %D 2020 %7 30.7.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Suicide is an important public health concern in the United States and around the world. There has been significant work examining machine learning approaches to identify and predict intentional self-harm and suicide using existing data sets. With recent advances in computing, deep learning applications in health care are gaining momentum. Objective: This study aimed to leverage the information in clinical notes using deep neural networks (DNNs) to (1) improve the identification of patients treated for intentional self-harm and (2) predict future self-harm events. Methods: We extracted clinical text notes from electronic health records (EHRs) of 835 patients with International Classification of Diseases (ICD) codes for intentional self-harm and 1670 matched controls who never had any intentional self-harm ICD codes. The data were divided into training and holdout test sets. We tested a number of algorithms on clinical notes associated with the intentional self-harm codes using the training set, including several traditional bag-of-words–based models and 2 DNN models: a convolutional neural network (CNN) and a long short-term memory model. We also evaluated the predictive performance of the DNNs on a subset of patients who had clinical notes 1 to 6 months before the first intentional self-harm event. Finally, we evaluated the impact of a pretrained model using Word2vec (W2V) on performance. Results: The area under the receiver operating characteristic curve (AUC) for the CNN on the phenotyping task, that is, the detection of intentional self-harm in clinical notes concurrent with the events was 0.999, with an F1 score of 0.985. In the predictive task, the CNN achieved the highest performance with an AUC of 0.882 and an F1 score of 0.769. Although pretraining with W2V shortened the DNN training time, it did not improve performance. Conclusions: The strong performance on the first task, namely, phenotyping based on clinical notes, suggests that such models could be used effectively for surveillance of intentional self-harm in clinical text in an EHR. The modest performance on the predictive task notwithstanding, the results using DNN models on clinical text alone are competitive with other reports in the literature using risk factors from structured EHR data. %M 32729840 %R 10.2196/17784 %U https://medinform.jmir.org/2020/7/e17784 %U https://doi.org/10.2196/17784 %U http://www.ncbi.nlm.nih.gov/pubmed/32729840 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e19008 %T Assessing Digital Risk in Psychiatric Patients: Mixed Methods Study of Psychiatry Trainees’ Experiences, Views, and Understanding %A Aref-Adib,Golnar %A Landy,Gabriella %A Eskinazi,Michelle %A Sommerlad,Andrew %A Morant,Nicola %A Johnson,Sonia %A Graham,Richard %A Osborn,David %A Pitman,Alexandra %+ Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom, 44 7968035509, a.pitman@ucl.ac.uk %K risk assessment %K internet %K suicide %K self-injurious behavior %K mental health %K psychiatrists %K mixed methods %K mobile phone %D 2020 %7 29.7.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: The use of digital technology can help people access information and provide support for their mental health problems, but it can also expose them to risk, such as bullying or prosuicide websites. It may be important to consider internet-related risk behavior (digital risk) within a generic psychiatric risk assessment, but no studies have explored the practice or acceptability of this among psychiatrists. Objective: This study aimed to explore psychiatry trainees’ experiences, views, and understanding of digital risk in psychiatry. We predicted that clinician awareness would be highest among trainees who work in child and adolescent mental health services. Methods: We conducted a cross-sectional survey of psychiatry trainees attending a UK regional trainees’ conference to investigate how they routinely assess patients’ internet use and related risk of harm and their experience and confidence in assessing these risks. We conducted focus groups to further explore trainees’ understandings and experiences of digital risk assessment. Descriptive statistics and chi-squared tests were used to present the quantitative data. A thematic analysis was used to identify the key themes in the qualitative data set. Results: The cross-sectional survey was completed by 113 out of 312 psychiatry trainees (response rate 36.2%), from a range of subspecialties and experience levels. Half of the trainees (57/113, 50.4%) reported treating patients exposed to digital risk, particularly trainees subspecializing in child and adolescent psychiatry (17/22, 77% vs 40/91, 44%;P=.02). However, 67.3% (76/113) reported not feeling competent to assess digital risk. Child and adolescent psychiatrists were more likely than others to ask patients routinely about specific digital risk domains, including reckless web-based behavior (18/20, 90% vs 54/82, 66%; P=.03), prosuicide websites (20/21, 95% vs 57/81, 70%; P=.01), and online sexual behavior (17/21, 81% vs 44/81, 54%; P=.02). Although 84.1% (95/113) of the participants reported using a proforma to record general risk assessment, only 5% (5/95) of these participants prompted an assessment of internet use. Only 9.7% (11/113) of the trainees had received digital risk training, and 73.5% (83/113) reported that they would value this. Our thematic analysis of transcripts from 3 focus groups (comprising 11 trainees) identified 2 main themes: barriers to assessment and management of digital risk, and the double-edged sword of web use. Barriers reported included the novelty and complexity of the internet, a lack of confidence and guidance in addressing internet use directly, and ongoing tension between assessment and privacy. Conclusions: Although it is common for psychiatrists to encounter patients subject to digital risk, trainee psychiatrists lack competence and confidence in their assessment. Training in digital risk and the inclusion of prompts in standardized risk proformas would promote good clinical practice and prevent a potential blind spot in general risk assessment. %M 32726288 %R 10.2196/19008 %U http://mental.jmir.org/2020/7/e19008/ %U https://doi.org/10.2196/19008 %U http://www.ncbi.nlm.nih.gov/pubmed/32726288 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 2 %P e17112 %T Effect of Pokémon Go on Self-Harm Using Population-Based Interrupted Time-Series Analysis: Quasi-Experimental Study %A Wong,Rosa Sze Man %A Ho,Frederick Ka Wing %A Tung,Keith Tsz Suen %A Fu,King-Wa %A Ip,Patrick %+ Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Room 123, 1/F, New Clinical Building, Queen Mary Hospital, Pokfulam, Hong Kong, , China (Hong Kong), 852 22554090, patricip@hku.hk %K Pokémon Go %K self-harm %K mobile game %K injury %K mHealth interventions %K interrupted time-series analysis %D 2020 %7 12.6.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Pokémon Go is a very popular location-based augmented reality game with widespread influences over the world. An emerging body of research demonstrates that playing Pokémon Go can lead to improvements in physical activity and psychosocial well-being; however, whether Pokémon Go reduces self-harm incidence at the population-level is still questionable. Objective: This study aimed to quantify how the launch of Pokémon Go in Hong Kong affected the incidence of self-harm using a quasi-experimental design. Methods: An interrupted time-series design with Poisson segmented regression adjusted for time and seasonality trends was used on data from 2012 to 2018 to detect any changes in the number of accident and emergency attendances due to self-harm, after Pokémon Go was launched. The findings were validated using a baseline control period and using other intentional injuries and minor noninjuries as control outcomes. We also assessed intervention effects by age group. Results: From January 1, 2012 to July 31, 2018, there were 13,463 accident and emergency attendances due to self-harm in Hong Kong. During the period after launching Pokémon Go, self-harm attendances dropped by 34% (adjusted incidence rate ratio: 0.66, 95% CI 0.61-0.73). When analyzed by age group, a reduction in self-harm incidence was only apparent in adults (18 to 24 years of age: adjusted incidence rate ratio: 0.78, P=.02; 25 to 39 years of age: adjusted incidence rate ratio: 0.75, P<.001; 40 years of age and older: adjusted incidence rate ratio: 0.57, P<.001). Conclusions: Self-harm incidence in the population, particularly in adults, showed a significant decline in the period after Pokémon Go was launched. Augmented reality games such as Pokémon Go show great promise as a tool to enhance psychosocial well-being and improve mental health. %M 32530429 %R 10.2196/17112 %U http://games.jmir.org/2020/2/e17112/ %U https://doi.org/10.2196/17112 %U http://www.ncbi.nlm.nih.gov/pubmed/32530429 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16963 %T Developing a Text Messaging Intervention to Reduce Deliberate Self-Harm in Chinese Adolescents: Qualitative Study %A Duan,Suqian %A Wang,Haoran %A Wilson,Amanda %A Qiu,Jiexi %A Chen,Guanmei %A He,Yuqiong %A Wang,Yuanyuan %A Ou,Jianjun %A Chen,Runsen %+ Department of Psychiatry, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Rd, Yuan Jia Ling Shang Quan, Furong District, Changsha, China, 86 731 85292158, Runsen.chen@psych.ox.ac.uk %K text messaging %K deliberate self-harm %K adolescents %K qualitative research %K mental health %D 2020 %7 11.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Deliberate self-harm is common during adolescence and can have detrimental consequences for the well-being of adolescents. Although it is sometimes difficult to engage adolescents in traditional psychotherapies for deliberate self-harm, SMS text messaging has been shown to be promising for cost-effective and low-intensity interventions. Objective: This study aimed to investigate the views of Chinese adolescents with deliberate self-harm about SMS text messaging interventions in order to develop an acceptable and culturally competent intervention for adolescents with deliberate self-harm. Methods: Semistructured interviews were conducted with 23 adolescents who had experience with deliberate self-harm. The transcripts of the interviews were analyzed using thematic analysis. Results: Four themes were identified: beneficial perception of receiving messages, short frequency and duration of messages, caring content in messages, and specific times for sending messages. Most of the participants perceived SMS text messaging interventions to be beneficial. The key factors that emerged for the content of the intervention included encouragement and company, feeling like a virtual friend, providing coping strategies, and individualized messages. In addition, the preferred frequency and duration of the SMS text messaging intervention were identified. Conclusions: Our study will help in the development of a culturally appropriate SMS text messaging intervention for adolescents with deliberate self-harm. It has the potential to decrease deliberate self-harm instances by providing acceptable support for adolescents with deliberate self-harm who may be reluctant to seek face-to-face psychotherapies. %M 32392173 %R 10.2196/16963 %U https://mhealth.jmir.org/2020/6/e16963 %U https://doi.org/10.2196/16963 %U http://www.ncbi.nlm.nih.gov/pubmed/32392173 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e15973 %T Examining the Self-Harm and Suicide Contagion Effects of the Blue Whale Challenge on YouTube and Twitter: Qualitative Study %A Khasawneh,Amro %A Chalil Madathil,Kapil %A Dixon,Emma %A Wiśniewski,Pamela %A Zinzow,Heidi %A Roth,Rebecca %+ Department of Anesthesiology and Critical Care, Johns Hopkins University, 750 E Pratt St, 15th Fl, Baltimore, MD, 21202, United States, 1 410 637 4365, akhasaw1@jhmi.edu %K suicide %K suicidal ideation %K self-mutilation %K mental health %K self-injurious behavior %K behavioral symptoms %D 2020 %7 5.6.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 32515741 %R 10.2196/15973 %U https://mental.jmir.org/2020/6/e15973 %U https://doi.org/10.2196/15973 %U http://www.ncbi.nlm.nih.gov/pubmed/32515741 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e18043 %T Association of Social Media Use and High-Risk Behaviors in Adolescents: Cross-Sectional Study %A Vente,Teresa %A Daley,Mary %A Killmeyer,Elizabeth %A Grubb,Laura K %+ Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 16, Chicago, IL, United States, 1 518 339 5440, tvente@luriechildrens.org %K self-harm %K social media %K nonsuicidal self-injury %K sexting %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Previous studies have demonstrated the prevalence of social media use and identified the presence of high-risk behaviors among adolescents, including self-harm and sharing of sexually explicit messages. Objective: This study aimed to identify patterns in the amount of time spent on social media by adolescents who engage in high-risk behavior and the extent to which they use social media as a platform for sharing such behaviors. Methods: This was a descriptive cross-sectional study of 179 adolescents seen in a pediatric clinic at an urban medical center. We used an anonymous self-report survey to obtain demographic characteristics, rates of self-harm thoughts and behaviors, sharing of sexually explicit messages, and social media use as determined by total hours spent on social media per day and the number of applications used. Results: Most adolescents reported spending 3 to 5 hours on social media each day and using 3 or more social media applications. Almost 1 in 8 (22/179, 12.3%) adolescents self-reported having ever engaged in self-injury with a mean age of onset of 11.8 years. Over a quarter (49/179, 27.4%) of adolescents reported sharing sexually explicit messages. Relative risk of engaging in self-injury and or sharing sexually explicit messages increased with the use of 4 or more social media applications (1.66; CI 1.11-2.48). Conclusions: Results show a relationship between the number of social media applications used and increased rates of high-risk behaviors. We identified relevant risk factors that clinicians can use to screen for high-risk behavior and parents can monitor to encourage education about healthy online practices. %M 32452820 %R 10.2196/18043 %U http://pediatrics.jmir.org/2020/1/e18043/ %U https://doi.org/10.2196/18043 %U http://www.ncbi.nlm.nih.gov/pubmed/32452820 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e15188 %T The True Colours Remote Symptom Monitoring System: A Decade of Evolution %A Goodday,Sarah M %A Atkinson,Lauren %A Goodwin,Guy %A Saunders,Kate %A South,Matthew %A Mackay,Clare %A Denis,Mike %A Hinds,Chris %A Attenburrow,Mary-Jane %A Davies,Jim %A Welch,James %A Stevens,William %A Mansfield,Karen %A Suvilehto,Juulia %A Geddes,John %+ Department of Psychiatry, University of Oxford, Warneford Lane, Oxford, OX3 7JX, United Kingdom, 44 (0)1865 618200, sarah.goodday@psych.ox.ac.uk %K symptom assessment %K signs and symptoms %K digital health %K ecological momentary assessment %K mood disorders %D 2020 %7 15.1.2020 %9 Viewpoint %J J Med Internet Res %G English %X The True Colours remote mood monitoring system was developed over a decade ago by researchers, psychiatrists, and software engineers at the University of Oxford to allow patients to report on a range of symptoms via text messages, Web interfaces, or mobile phone apps. The system has evolved to encompass a wide range of measures, including psychiatric symptoms, quality of life, and medication. Patients are prompted to provide data according to an agreed personal schedule: weekly, daily, or at specific times during the day. The system has been applied across a number of different populations, for the reporting of mood, anxiety, substance use, eating and personality disorders, psychosis, self-harm, and inflammatory bowel disease, and it has shown good compliance. Over the past decade, there have been over 36,000 registered True Colours patients and participants in the United Kingdom, with more than 20 deployments of the system supporting clinical service and research delivery. The system has been adopted for routine clinical care in mental health services, supporting more than 3000 adult patients in secondary care, and 27,263 adolescent patients are currently registered within Oxfordshire and Buckinghamshire. The system has also proven to be an invaluable scientific resource as a platform for research into mood instability and as an electronic outcome measure in randomized controlled trials. This paper aimed to report on the existing applications of the system, setting out lessons learned, and to discuss the implications for tailored symptom monitoring, as well as the barriers to implementation at a larger scale. %M 31939746 %R 10.2196/15188 %U https://www.jmir.org/2020/1/e15188 %U https://doi.org/10.2196/15188 %U http://www.ncbi.nlm.nih.gov/pubmed/31939746 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e10732 %T Efficacy of Acceptance and Commitment Therapy in Reducing Suicidal Ideation and Deliberate Self-Harm: Systematic Review %A Tighe,Joseph %A Nicholas,Jennifer %A Shand,Fiona %A Christensen,Helen %+ Black Dog Institute, School of Psychiatry, University of New South Wales, Hospital Road, Randwick, Sydney, 2031, Australia, 61 416747998, j.tighe@blackdog.org.au %K suicidal ideation %K suicide %K deliberate self-harm %K depression %K mental health %K acceptance and commitment therapy %K cognitive behavioral therapy %K mHealth %K psychology %K ACT %D 2018 %7 25.06.2018 %9 Review %J JMIR Ment Health %G English %X Background: Since its emergence in the 1980s, acceptance and commitment therapy (ACT) has become a reputable evidence-based psychological therapy for certain disorders. Trials examining the efficacy of ACT are spread across a broad spectrum of presentations, such as chronic pain, anxiety, and depression. Nevertheless, ACT has very rarely been trialed as an intervention for suicidal ideation (SI) or deliberate self-harm (DSH). Objective: The objective of this review is to assess the efficacy of ACT in reducing SI and DSH and to examine the suitability of reported SI, DSH, and other measures in determining the efficacy of ACT. Methods: We systematically reviewed studies on ACT as intervention for SI and self-harm. Electronic databases, including MEDLINE, PubMed, EMBASE, PsycINFO, SCOPUS, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, were searched. The reference lists of included studies and relevant systematic reviews were examined to identify additional publications. Search terms were identified with reference to the terminology used in previous review papers on ACT and suicide prevention. The study design was not restricted to randomized controlled trials. Screening was completed by 2 reviewers, and all duplicates were removed. Publications were excluded if they were not published in English, were multicomponent therapy or were not based on ACT, or lacked a validated measure or structured reporting of SI/DSH outcomes. Results: After removing the duplicates, 554 articles were screened for relevance. Following the screening, 5 studies that used ACT as an intervention for suicidal or self-harming individuals were identified. The studies used diverse methodologies and included 2 case studies, 2 pre–post studies, and 1 mHealth randomized controlled trial. Conclusions: The review found that ACT is effective in reducing SI in the 2 pre–post studies but not in other studies. However, given the small number and lack of methodological rigor of the studies included in this review, insufficient evidence exists for the recommendation of ACT as an intervention for SI or DSH. %M 29941419 %R 10.2196/10732 %U http://mental.jmir.org/2018/2/e10732/ %U https://doi.org/10.2196/10732 %U http://www.ncbi.nlm.nih.gov/pubmed/29941419 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e129 %T Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review %A John,Ann %A Glendenning,Alexander Charles %A Marchant,Amanda %A Montgomery,Paul %A Stewart,Anne %A Wood,Sophie %A Lloyd,Keith %A Hawton,Keith %+ Population Psychiatry, Suicide and Informatics, Medical School, Swansea University, Institute of Life Science 2, Swansea, SA2 8PP, United Kingdom, 44 01792602568 ext 2568, A.John@swansea.ac.uk %K cyberbullying %K bullying %K self-injurious behavior %K suicide %K suicide, attempted %K suicidal ideation %D 2018 %7 19.04.2018 %9 Review %J J Med Internet Res %G English %X Background: Given the concerns about bullying via electronic communication in children and young people and its possible contribution to self-harm, we have reviewed the evidence for associations between cyberbullying involvement and self-harm or suicidal behaviors (such as suicidal ideation, suicide plans, and suicide attempts) in children and young people. Objective: The aim of this study was to systematically review the current evidence examining the association between cyberbullying involvement as victim or perpetrator and self-harm and suicidal behaviors in children and young people (younger than 25 years), and where possible, to meta-analyze data on the associations. Methods: An electronic literature search was conducted for all studies published between January 1, 1996, and February 3, 2017, across sources, including MEDLINE, Cochrane, and PsycINFO. Articles were included if the study examined any association between cyberbullying involvement and self-harm or suicidal behaviors and reported empirical data in a sample aged under 25 years. Quality of included papers was assessed and data were extracted. Meta-analyses of data were conducted. Results: A total of 33 eligible articles from 26 independent studies were included, covering a population of 156,384 children and young people. A total of 25 articles (20 independent studies, n=115,056) identified associations (negative influences) between cybervictimization and self-harm or suicidal behaviors or between perpetrating cyberbullying and suicidal behaviors. Three additional studies, in which the cyberbullying, self-harm, or suicidal behaviors measures had been combined with other measures (such as traditional bullying and mental health problems), also showed negative influences (n=44,526). A total of 5 studies showed no significant associations (n=5646). Meta-analyses, producing odds ratios (ORs) as a summary measure of effect size (eg, ratio of the odds of cyber victims who have experienced SH vs nonvictims who have experienced SH), showed that, compared with nonvictims, those who have experienced cybervictimization were OR 2.35 (95% CI 1.65-3.34) times as likely to self-harm, OR 2.10 (95% CI 1.73-2.55) times as likely to exhibit suicidal behaviors, OR 2.57 (95% CI 1.69-3.90) times more likely to attempt suicide, and OR 2.15 (95% CI 1.70-2.71) times more likely to have suicidal thoughts. Cyberbullying perpetrators were OR 1.21 (95% CI 1.02-1.44) times more likely to exhibit suicidal behaviors and OR 1.23 (95% CI 1.10-1.37) times more likely to experience suicidal ideation than nonperpetrators. Conclusions: Victims of cyberbullying are at a greater risk than nonvictims of both self-harm and suicidal behaviors. To a lesser extent, perpetrators of cyberbullying are at risk of suicidal behaviors and suicidal ideation when compared with nonperpetrators. Policy makers and schools should prioritize the inclusion of cyberbullying involvement in programs to prevent traditional bullying. Type of cyberbullying involvement, frequency, and gender should be assessed in future studies. %M 29674305 %R 10.2196/jmir.9044 %U http://www.jmir.org/2018/4/e129/ %U https://doi.org/10.2196/jmir.9044 %U http://www.ncbi.nlm.nih.gov/pubmed/29674305 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e16 %T Acceptability, Use, and Safety of a Mobile Phone App (BlueIce) for Young People Who Self-Harm: Qualitative Study of Service Users’ Experience %A Grist,Rebecca %A Porter,Joanna %A Stallard,Paul %+ Child and Adolescent Mental Health Group, Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 2253850 ext 86, rg626@bath.ac.uk %K self-injurious behavior %K mobile apps %K adolescents %K telemedicine %K qualitative research %K cognitive therapy %K behavior therapy %D 2018 %7 23.02.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Self-harm is common among adolescents and is associated with a number of negative psychosocial outcomes including a higher risk of suicide. Recent reviews highlight the lack of research into specific interventions for children and young people who self-harm. Developing innovative interventions that are coproduced with individuals with lived experience and that reduce self-harm are key challenges for self-harm prevention. Objective: The aim of this study was to explore the acceptability, use, and safety of BlueIce, a mobile phone app for young people who self-harm and who are attending child and adolescent mental health services (CAMHS). Methods: This study is part of a mixed methods phase 1 trial of BlueIce. Young people aged 12-17 years attending specialist CAMHS were recruited. Clinicians were invited to refer young people who were self-harming or who had a history of self-harm. On consent being obtained and baseline measures taken, participants used BlueIce as an adjunct to usual care for an initial familiarization period of 2 weeks. If after this time they wanted to continue, they used BlueIce for a further 10 weeks. Semistructured interviews were conducted at postfamiliarization (2 weeks after using BlueIce) and postuse (12 weeks after using BlueIce) to assess the acceptability, use, and safety of BlueIce. We undertook a qualitative analysis using a deductive approach, and then an inductive approach, to investigate common themes. Results: Postfamiliarization interviews were conducted with 40 participants. Of these, 37 participants elected to use BlueIce, with postuse interviews being conducted with 33 participants. Following 6 key themes emerged from the data: (1) appraisal of BlueIce, (2) usability of BlueIce, (3) safety, (4) benefits of BlueIce, (5) agency and control, and (6) BlueIce less helpful. The participants reported that BlueIce was accessible, easy to use, and convenient. Many highlighted the mood diary and mood lifter sections as particularly helpful in offering a way to track their moods and offering new strategies to manage their thoughts to self-harm. No adverse effects were reported. For those who did not find BlueIce helpful, issues around motivation to stop self-harming impeded their ability to use the app. Conclusions: BlueIce was judged to be a helpful and safe way of supporting adolescents to manage thoughts of self-harming. Adolescents reported numerous benefits of using BlueIce, and all would recommend the app to other young people who were struggling with self-harm. These preliminary findings are encouraging and provide initial support for the acceptability of BlueIce as a self-help intervention used in conjunction with the traditional face-to-face therapy. %M 29475823 %R 10.2196/mental.8779 %U http://mental.jmir.org/2018/1/e16/ %U https://doi.org/10.2196/mental.8779 %U http://www.ncbi.nlm.nih.gov/pubmed/29475823 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e32 %T A Smartphone App (BlueIce) for Young People Who Self-Harm: Open Phase 1 Pre-Post Trial %A Stallard,Paul %A Porter,Joanna %A Grist,Rebecca %+ Child and Adolescent Mental Health Group, Department for Health, University of Bath, Wessex House 6.10, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 1225 383282, p.stallard@bath.ac.uk %K self-injury %K smartphone %K mobile apps %K BlueIce %K adolescents %K cognitive behavioral therapy %K mHealth %D 2018 %7 30.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent years have seen a significant increase in the availability of smartphone apps for mental health problems. Despite their proliferation, few apps have been specifically developed for young people, and almost none have been subject to any form of evaluation. Objective: This study aimed to undertake a preliminary evaluation of a smartphone app (BlueIce), coproduced with young people and designed to help young people manage distress and urges to self-harm. We aimed to assess the acceptability, safety, and use of BlueIce and to explore the effects on the primary outcome of self-harm and the secondary outcomes of psychological functioning. Methods: We undertook an open trial where we recruited young people aged 12 to 17 years attending specialist child and adolescent mental health services (CAMHS) who were currently self-harming or had a history of self-harm. Eligible participants were assessed at baseline and then given BlueIce. They were assessed 2 weeks later (post familiarization) and again at 12 weeks (post use). A behavior-screening questionnaire (Strengths and Difficulties Questionnaire) was completed along with standardized measures of depression (Mood and Feelings Questionnaire or MFQ) and anxiety (Revised Child Anxiety and Depression Scale or RCADS), taking into account self-reports of self-harm, app helpfulness, and safety. Results: All core CAMHS professional groups referred at least 1 young person. Out of 40 young people recruited, 37 (93%) elected to use BlueIce after familiarization, with 29 out of 33 (88%) wanting to keep it at the end of the study. No young person called the emergency numbers during the 12-week trial, and no one was withdrawn by his or her clinician due to increased risk of suicide. Almost three-quarters (73%) of those who had recently self-harmed reported reductions in self-harm after using BlueIce for 12 weeks. There was a statistically significant mean difference of 4.91 (t31=2.11; P=.04; 95% CI 0.17-9.64) on postuse symptoms of depression (MFQ) and 13.53 on symptoms of anxiety (RCADS) (t30=3.76; P=.001; 95% CI 6.17-20.90), which was evident across all anxiety subscales. Ratings of app acceptability and usefulness were high. Conclusions: Our study has a number of methodological limitations, particularly the absence of a comparison group and a prospective way of assessing self-harm. Nonetheless, our findings are encouraging and suggest that BlueIce, used alongside a traditional CAMHS face-to-face intervention, can help young people manage their emotional distress and urges to self-harm. %M 29382632 %R 10.2196/mhealth.8917 %U http://mhealth.jmir.org/2018/1/e32/ %U https://doi.org/10.2196/mhealth.8917 %U http://www.ncbi.nlm.nih.gov/pubmed/29382632 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e10 %T Web-Based Decision Aid to Assist Help-Seeking Choices for Young People Who Self-Harm: Outcomes From a Randomized Controlled Feasibility Trial %A Rowe,Sarah L %A Patel,Krisna %A French,Rebecca S %A Henderson,Claire %A Ougrin,Dennis %A Slade,Mike %A Moran,Paul %+ Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, 6th Floor, London, W1T 7NF, United Kingdom, 44 07415078280, s.rowe@ucl.ac.uk %K adolescent %K self-harm %K decision aid %K intervention %K schools %K feasibility %K randomized controlled trials %K ethics %D 2018 %7 30.01.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adolescents who self-harm are often unsure how or where to get help. We developed a Web-based personalized decision aid (DA) designed to support young people in decision making about seeking help for their self-harm. Objective: The aim of this study was to evaluate the feasibility and acceptability of the DA intervention and the randomized controlled trial (RCT) in a school setting. Methods: We conducted a two-group, single blind, randomized controlled feasibility trial in a school setting. Participants aged 12 to 18 years who reported self-harm in the past 12 months were randomized to either a Web-based DA or to general information about mood and feelings. Feasibility of recruitment, randomization, and follow-up rates were assessed, as was acceptability of the intervention and study procedures. Descriptive data were collected on outcome measures examining decision making and help-seeking behavior. Qualitative interviews were conducted with young people, parents or carers, and staff and subjected to thematic analysis to explore their views of the DA and study processes. Results: Parental consent was a significant barrier to young people participating in the trial, with only 17.87% (208/1164) of parents or guardians who were contacted for consent responding to study invitations. Where parental consent was obtained, we were able to recruit 81.7% (170/208) of young people into the study. Of those young people screened, 13.5% (23/170) had self-harmed in the past year. Ten participants were randomized to receiving the DA, and 13 were randomized to the control group. Four-week follow-up assessments were completed with all participants. The DA had good acceptability, but qualitative interviews suggested that a DA that addressed broader mental health problems such as depression, anxiety, and self-harm may be more beneficial. Conclusions: A broad-based mental health DA addressing a wide range of psychosocial problems may be useful for young people. The requirement for parental consent is a key barrier to intervention research on self-harm in the school setting. Adaptations to the research design and the intervention are needed before generalizable research about DAs can be successfully conducted in a school setting. Trial Registration: International Standard Randomized Controlled Trial registry: ISRCTN11230559; http://www.isrctn.com/ISRCTN11230559 (Archived by WebCite at http://www.webcitation.org/6wqErsYWG) %M 29382626 %R 10.2196/mental.8098 %U http://mental.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/mental.8098 %U http://www.ncbi.nlm.nih.gov/pubmed/29382626 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e44 %T Exploring the Therapeutic Affordances of Self-Harm Online Support Communities: An Online Survey of Members %A Coulson,Neil S %A Bullock,Emma %A Rodham,Karen %+ University of Nottingham, Division of Rehabilitation & Ageing, School of Medicine, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom, 44 01158466642, neil.coulson@nottingham.ac.uk %K self-harm %K social network %K social support %K qualitative research %K online support group %D 2017 %7 13.10.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: A growing number of online communities have been established to support those who self-harm. However, little is known about the therapeutic affordances arising from engagement with these communities and resulting outcomes. Objective: The aim of this study was to explore the presence of therapeutic affordances as reported by members of self-harm online support communities. Methods: In total, 94 respondents (aged 13-63 years, mean=23.5 years; 94% female) completed an online survey exploring their experiences of engaging with a self-harm online support community. Respondents varied in terms of how long they had been accessing an online community, with 22% (21/94) accessing less than 1 year, 39% (37/94) 1 to 2 years, 14% (13/94) 2 to 3 years, and 24.5% (23/94) more than 3 years. Responses were analyzed using deductive thematic analysis. Results: The results of our analysis describe each of the five therapeutic affordances that were present in the data, namely (1) connection, the ability to make contact with others who self-harm for the purposes of mutual support and in so doing reduce feelings of loneliness and isolation; (2) adaptation, that is, how use of online support varies in relation to the personal circumstances of the individual user; (3) exploration, that is, the ability to learn about self-harm and learn about strategies to reduce or stop self-harming behavior; (4) narration, that is, the ability to share experiences, as well as read about the experiences of others; and (5) self-presentation, that is, how and what users present about themselves to others in the online community. Conclusions: Our findings suggest that engagement with self-harm online support communities may confer a range of therapeutic benefits for some users, which may serve to minimize the psychosocial burden of self-harm and promote positive coping strategies. In addition, the online nature of the support available may be helpful to those who are unable to access face-to-face support. %M 29030324 %R 10.2196/mental.8084 %U http://mental.jmir.org/2017/4/e44/ %U https://doi.org/10.2196/mental.8084 %U http://www.ncbi.nlm.nih.gov/pubmed/29030324 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e217 %T Safety, Acceptability, and Use of a Smartphone App, BlueIce, for Young People Who Self-Harm: Protocol for an Open Phase I Trial %A Stallard,Paul %A Porter,Joanna %A Grist,Rebecca %+ Child and Adolescent Mental Health Group, Department for Health, University of Bath, Wessex House, Claverton Down, Bath, United Kingdom, 44 1225 383282, p.stallard@bath.ac.uk %K self-harm %K smartphone app %K BlueIce %K adolescents %K CBT %K DBT %D 2016 %7 16.11.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Up to 18% of adolescents will engage in an act of self-harm before young adulthood, with the majority of acts occurring in private. Mobile apps may offer a way of providing support for young people at times of distress to prevent self-harm. Objective: This is a proof-of-concept study designed to explore the safety, acceptability, feasibility, and usability of a smartphone app, BlueIce, with young people who are self-harming. Methods: In this phase I open trial we will evaluate BlueIce, a smartphone app developed and coproduced with young people with lived experience of self-harm. BlueIce includes a mood-monitoring diary, selection of mood-lifting techniques based on cognitive behavior therapy and dialectical behavior therapy, and direct access to emergency telephone numbers. We will recruit young people (n=50) attending specialist child and adolescent mental health services with a current or past history of self-harm to trial BlueIce as an adjunct to their usual care. Questionnaires and interviews will be completed at baseline, postfamiliarization (2 weeks), and at follow-up (12 weeks after baseline) to assess safety, app use, and acceptability. Interviews will be undertaken with clinicians to assess the feasibility of BlueIce within a clinical setting. Results: Recruitment occurred between May and November 2016. The recruitment target was 50, and by the beginning of November 54 young people had been referred. Conclusions: This study is the first to evaluate an app specifically developed with young people for young people (under the age of 18 years) who self-harm. It will determine whether BlueIce is acceptable, how often it is used, and whether it is safe and does not have any unintentional adverse effects. This information will determine whether a feasibility trial to test recruitment, randomization, retention, and appropriate outcome measures should be pursued. %M 27852560 %R 10.2196/resprot.6525 %U http://www.researchprotocols.org/2016/4/e217/ %U https://doi.org/10.2196/resprot.6525 %U http://www.ncbi.nlm.nih.gov/pubmed/27852560 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 12 %P e285 %T Exploring the Use and Effects of Deliberate Self-Harm Websites: An Internet-Based Study %A Harris,Isobel Marion %A Roberts,Lesley Martine %+ Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, 90 Vincent Drive, Birmingham, B15 2TT, United Kingdom, 44 01214143356, l.m.roberts@bham.ac.uk %K Internet %K websites %K deliberate self-harm %K self-injury %D 2013 %7 20.12.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: In the United Kingdom, rates of deliberate self-harm (DSH) are rising. Alongside this, there has been an increase in the number of websites available with DSH content, and the Internet is known as a valuable resource for those who feel isolated by their condition(s). However, there is little and contradictory evidence available on the effects of using such websites. Further research is therefore required to examine the use and effects of DSH websites. Objective: Our objectives were to explore (1) the reasons people engage in the use of self-harm forums/websites, (2) the beliefs of users of self-harm forums regarding the role of such websites, (3) how the use of self-harm forums/websites modulates self-harm behaviors, and (4) other ways that self-harm forums affect the lives of individuals who use them. Methods: Data were collected by a questionnaire hosted on 20 websites with self-harm content. Participants were self-selected from users of these sites. Results were analyzed using descriptive statistics and simple thematic analysis. Results: In total, 329 responses were received with 91.8% (302/329) from female site users. The majority of participants (65.6%, 187/285) visited these sites at least twice per week, and most participants used the sites to find information (78.2%, 223/285) or participate in the forums (68.4%, 195/285). Positive effects of website use such as gaining help and support, isolation reduction, and a reduction in self-harm behaviors were reported by a large number of participants. However, smaller but important numbers reported negative effects including worsened self-harm, being triggered to self-harm, and additional negative physical and psychological effects. Conclusions: This is the first multisite study to explore DSH website use in depth. There are clear and important benefits to engaging in website use for many individuals; however, these are not experienced by all website users. Negative effects were experienced by moderate numbers following website use, and clinicians should consider the impact of a patient’s website use when consulting. %M 24362563 %R 10.2196/jmir.2802 %U http://www.jmir.org/2013/12/e285/ %U https://doi.org/10.2196/jmir.2802 %U http://www.ncbi.nlm.nih.gov/pubmed/24362563