Digital Mental Health for Youth: New Evidence but Still Much Unknown

October 26, 2018

As children raised on technology, it seems only natural that adolescents turn to the internet when they experience stress or mental health related symptoms. Turns out, this is both a good and bad thing.

The youth of today are digital natives; they have not experienced a world without the internet. They use social network sites and apps as a primary way of communicating with others in their social network as well as a means of obtaining information. Estimates from 2015 found that 67% of US teens ages 13 to 18 years old own a smartphone and engage with screen media for more than 6.5 hours each day.1 It is, therefore, only natural that the internet is one of the first places to which they turn when they experience stress or mental health related symptoms, whether they are trying to make sense of their experiences, aiming to understand possible diagnoses, gathering information about potential trajectories, evaluating treatment alternatives, or seeking peer advice. The presumed anonymity allows these youth to conduct their search and communication without feeling stigmatized by their real-world community.

Over the last several years there has been a sea of conflicting evidence regarding how youth use the internet and mobile technologies to learn about, access, and engage with mental health support. Last month a San Francisco-based social innovation group called HopeLab released a report on digital health, social media, and mental well-being among teens and young adults in the US.2 This online and telephone survey of 1,300 individuals between the ages of 18 and 22 offers an interesting single time point assessment of how younger generations are using technology in relationship to mental health (Figure). While the causal relationship between social media use and depression remains a controversial topic, this study did not find a correlation between use and self-reported depressive symptoms. However, the authors found that those with more self-reported depressive symptoms reported heightened response to social media (ie, it made them feel more positive and more negative at times) as compared to peers without any self-reported symptoms.

Another recent study published in the Journal of Pediatrics3 systematically reviewed how adolescents search for online health information and the extent to which they appraise the credibility of information they retrieve. The study found that adolescents are often not systematic in their search for online health information, if indeed they search online at all. These youth face numerous barriers in their searches, particularly in constructing appropriate search strings and then navigating vast quantities of often irrelevant or inconsistent online health information. In addition, respondents noted that they felt overwhelmed by the responsibility of prioritizing the retrieved results.

Similarly, while many adolescents are aware that websites and the information therein vary in quality, the study found the way adolescents appraised websites was highly variable across individuals. The authors also found the methods were not always maximally effective. As a result, the researchers stressed the importance of developing resources to enhance search and appraisal skills. They also emphasized the need to collaborate with adolescents to ensure they are leveraging appropriate resources.

To complicate matters, there is an increasing volume of malicious and clearly harmful content aimed at youth with mental health vulnerabilities. In early August, for example, news spread of a suicide challenges on WhatsApp.4 Similarly, in 2017, a Russian online game called the Blue Whale Challenge encouraged users to commit suicide as part of the final challenge.5 This phenomenon of dangerous social media is not new to mental health; there is a long history of pro-eating disorder online communities that continue to thrive today.6 While these phenomena are relatively rare, they reflect the importance of online like-minded social communities and networks, something that is especially important for adolescents. Yet it remains difficult to understand how these dangerous challenges or communities proliferate, who they influence, and how they can be prevented.

Parents often find themselves overwhelmed by the abundance of oftentimes contradicting and non-empirical data and recommendations available online and therefore turn to clinicians for advice. Luckily, various online resources and portals are available relating to adolescent mental health issues, some even created by young people but curated by academic institutions (Table). One such example is Healthtalk, which provides a section for issues relating to young people, created by young people. The website stems from a unique partnership between a charity (DIPEx) that manages the website and the Health Experiences Research Group at the University of Oxford’s Nuffield Department of Primary Healthcare Sciences, which produces and shares the research that appears on the site. Beacon offers a portal to online applications (eg, websites, mobile applications and internet support groups) for mental disorders reviewed and rated by health experts maintained by the Centre for Mental Health Research at the Australian National University. Globally, the Society for Adolescent Health and Medicine offers online mental health resources aimed specifically at adolescents and young adults, including online resources, support groups, peer networks, helplines, treatment locators, and advocacy opportunities.

In this digital world, it is important for mental health clinicians serving adolescents to remain up-to-date on the dynamic evolution of online mental health resources. Clinicians also should be able to offer support around/involving technology. As it becomes impossible to deny that online communities are quickly becoming the gateway for youth to learn about mental health, it becomes clear that it is time for the mental health community to follow. A generation of youth has taken the lead and created new access, information, support, and risks in the creation of online communities centered on mental health. Partnering with these youths to steer this new frontier towards benefit and away from risk is the new challenge, as well as opportunity, for the field.

Disclosures:

Dr Torous is director of the division of digital psychiatry in the department of psychiatry at the Beth Israel Deaconess Medical Center, Harvard Medical School. Information about his projects and research is available at his lab’s website www.digitalpsych.org. Dr Kossowsky is a clinician-scientist whose work focuses on integrating informatics approaches, child and adolescent mental health, and pain management in developing novel epidemiology and treatment trials for mental health in children and youth, classifying uncertain diagnoses, and predicting long-term trajectories for youth with chronic illnesses and mental illness. He is an instructor in anesthesia at Harvard Medical School and Boston Children’s Hospital.

The authors report no conflicts of interest concerning the subject matter of this article.

References:

1. Common Sense Media. The Common Sense Census: Media Use by Tweens and Teens. Available at http://go.nature.com/2c4dwew. Accessed August 28, 2018.

2. Rideout V, Fox S. Digital Health Practices, Social Media Use, and Mental Well-Being Among Teens and Young Adults in the U.S. 2018. Available at: https://www.hopelab.org/reports/pdf/a-national-survey-by-hopelab- and-well-being-trust-2018.pdf. Accessed August 28, 2018.

3. Freeman JL, Caldwell PH, Bennett PA, Scott KM. How adolescents aearch for and appraise online health information: a systematic review. The Journal of Pediatrics. 2018;195:244-255.

4. Rogers J. Sinister ‘Momo suicide challenge’ sparks fear as it spreads on WhatsApp. Available at: http://www.foxnews.com/tech/2018/08/02/sinister-momo-suicide-challenge-sparks-fear-as-it-spreads-on-whatsapp.html. Accessed August 28, 2018.

5. Rossow A. Cyberbullying Taken To A Whole New Level: Enter The ‘Blue Whale Challenge’. Available at https://www.forbes.com/sites/andrewrossow/2018/02/28/cyberbullying-taken-to-a-whole-new-level-enter-the-blue-whale-challenge/#2df926692673. Accessed August 28, 2018.

6. Boniel-Nissim M, Latzer Y. (2016) The characteristics of pro-ana community. In: Latzer Y., Stein D. (eds) Bio-Psycho-Social Contributions to Understanding Eating Disorders. Springer, Cham. Available at: https://link.springer.com/chapter/10.1007/978-3-319-32742-6_11. Accessed August 28, 2018.

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