Employing Position Generators to Assess Social Capital and Health: A Scoping Review of the Literature and Recommendations for Measurement in Future Population-Based Surveillance

Beneficial social connections are critical to individual-level health because they can be used to avoid or minimize the risks and consequences associated with diseases. How to best measure beneficial social connections to inform social network-level health interventions remains poorly understood. A scoping review of health surveillance studies was conducted to highlight the utility of employing position generators to assess how access to beneficial social connections was associated with population health and disparities. Our review yielded 39 articles conducted across 14 predominantly high-income countries. Most studies (77%) with composite measures for beneficial social connections exhibited health-protective associations. Of the remaining articles, half found that greater diversity within one’s network was associated with positive health outcomes. Only eight articles accounted for differences by advantaged statuses, indicating that beneficial connections elicited greater health-protective associations among disadvantaged groups. Employing position generators may inform interventions that seek to reduce health disparities by enhancing social capital in individuals from disadvantaged backgrounds

Social media and adolescent suicide: exploring risks, benefits, and opportunities for prevention

During the same time period that suicide rose to the 2nd leading cause of death among adolescents, the proportion of youth who use social media multiple times per day has doubled, and now encompasses 70% of US adolescents. These are concerning trends, because maladaptive use of social media is associated with adverse mental health effects with particularly concerning ramifications for adolescent suicidal risk. While this linkage to suicidal risk remains evident, adolescents report notable benefits to use of social media, including the provision of social support and connectedness. This dissertation focuses on three critical gaps in the literature aimed to explore the association between adolescent suicidal risk and social media use. First, since the most recently conducted systematic reviews on this topic ended their searches, the literature is estimated to have doubled in size. To address this gap, the first paper presents the results of a literature review which provides an update of social media-related risk and protective factors for adolescent suicide through May 20th, 2018. Second, effective methods to monitor at-risk adolescents’ use of social media are needed. The dissertation paper offers the results from a formative study that aims to develop an acceptable approach to social media monitoring for suicidal youth. The results of a mixed methods study are presented that explore the social media experiences of suicidal adolescents and their parents. Third, longitudinal studies evaluating the relationship between adolescent suicide and social media use have measured a limited scope of risk and protective factors and have focused on youth within the general population. The third paper presents the iterative development of an ecological momentary assessment tool that aims to measure a range of risk and protective factors for adolescent suicide associated with distressing social media experiences. This dissertation offers public health significance through formative investigation aimed to expand our understanding of social media’s influence on youth suicidal risk and explore avenues for prevention. It does so through a current evaluation of the literature, a measure that could provide insights on proximal suicidal risk, and suggestions for an acceptable monitoring approach for youth at risk of suicide

Automated Monitoring of Suicidal Adolescents’ Digital Media Use: Qualitative Study Exploring Acceptability Within Clinical Care

BackgroundMonitoring linguistic cues from adolescents’ digital media use (DMU; ie, digital content transmitted on the web, such as through text messages or social media) that could denote suicidal risk offers a unique opportunity to protect adolescents vulnerable to suicide, the second leading cause of death among youth. Adolescents communicate through digital media in high volumes and frequently express emotionality. In fact, web-based disclosures of suicidality are more common than in-person disclosures. The use of automated methods of digital media monitoring triggered by a natural language processing algorithm offers the potential to detect suicidal risk from subtle linguistic units (eg, negatively valanced words, phrases, or emoticons known to be associated with suicidality) present within adolescents’ digital media content and to use this information to respond to alerts of suicidal risk. Critical to the implementation of such an approach is the consideration of its acceptability in the clinical care of adolescents at high risk of suicide. ObjectiveThrough data collection among recently suicidal adolescents, parents, and clinicians, this study examines the current context of digital media monitoring for suicidal adolescents seeking clinical care to inform the need for automated monitoring and the factors that influence the acceptance of automated monitoring of suicidal adolescents’ DMU within clinical care. MethodsA total of 15 recently suicidal adolescents (aged 13-17 years), 12 parents, and 10 clinicians participated in focus groups, qualitative interviews, and a group discussion, respectively. Data were recorded, transcribed, and analyzed using thematic analysis. ResultsParticipants described important challenges to the current strategies for monitoring the DMU of suicidal youth. They felt that automated monitoring would have advantages over current monitoring approaches, namely, by protecting web-based environments and aiding adolescent disclosure and support seeking about web-based suicidal risk communication, which may otherwise go unnoticed. However, they identified barriers that could impede implementation within clinical care, namely, adolescents’ and parents’ concerns about unintended consequences of automated monitoring, that is, the potential for loss of privacy or false alerts, and clinicians’ concerns about liability to respond to alerts of suicidal risk. On the basis of the needs and preferences of adolescents, parents, and clinicians, a model for automated digital media monitoring is presented that aims to optimize acceptability within clinical care for suicidal youth. ConclusionsAutomated digital media monitoring offers a promising means to augment detection and response to suicidal risk within the clinical care of suicidal youth when strategies that address the preferences of adolescents, parents, and clinicians are in place

Development and codesign of flourish: A digital suicide prevention intervention for LGBTQ+ youth who have experienced online victimization

Background: LGBTQ+ youth experience disproportionately high rates of online victimization (OV), referring to harmful remarks, images, or behaviors in online settings, which is associated with suicidal risk. Current services have gaps in supporting LGBTQ+ youth facing OV events. To address these gaps, this study aims to develop Flourish, a digital suicide prevention intervention for LGBTQ+ youth who have experienced OV. Methods: Qualitative interviews were conducted with 20 LGBTQ+ youth with past-year history of OV and lifetime history of suicidality, 11 of their parents, and 10 LGBTQ+-serving professionals. Subsequently, an iterative codesign process was conducted with 22 youth through individual and group design sessions, followed by usability testing. Data were recorded and transcribed. Qualitative interviews were analyzed using a qualitative description approach, and data from design sessions and usability testing were analyzed using rapid qualitative techniques. Results: Interviews with youth, parents, and professionals suggested preferences for Flourish to be a partially automated, text message intervention leveraging web-based content that is a safe space for LGBTQ+ youth to seek support for OV through education, coping skills, and help-seeking resources. School and mental health services professionals considered the potential for implementing Flourish within youth services settings. Usability testing, assessed through the System Usability Scale, yielded an average rating of 91, indicating excellent perceived usability. Conclusions: Flourish has potential to be an acceptable intervention to support LGBTQ+ youth following OV. Future steps will include testing the feasibility and efficacy of Flourish and further examining Flourish's potential for implementation within services for LGBTQ+ youth