Cyberbullying Perpetration and Victimization as Risk Factors for Self-Harm: Results From a Longitudinal Cohort Study of 13-14-Year-Olds in England.

PURPOSE: Cyberbullying is a crucial issue that affects adolescent mental health, with evidence to suggest that adolescents who are victims of cyberbullying are at higher risk for self-harm. However, longitudinal evidence is lacking, meaning the direction of effects cannot be established. This study investigated longitudinal associations between levels of cyberbullying involvement (bully, victim, or both), frequency, and self-harm a year later in an adolescent sample. METHODS: Data were collected from Year 9 students (13-14-year-olds; N = 1,195) enrolled in 19 schools in Southwest England using an online questionnaire with a 1-year follow-up period (October 2019-October 2020). Multivariable logistic regression analysis was conducted to test for associations between different levels of cyberbullying involvement at baseline and the likelihood of self-harm a year later, adjusting for key covariates. A secondary regression analysis also explored the associations between the frequency of cyberbullying involvement at baseline and subsequent self-harm. RESULTS: Compared to those with no cyberbullying involvement, individuals who were both victims and perpetrators (adjusted odds ratio = 2.94, 95% confidence interval: 1.99-4.34) as well as victims only (adjusted odds ratio = 2.81, 95% confidence interval: 1.95-4.04) showed an increased risk of subsequent self-harm. In terms of frequency, associations were found between frequent and occasional cyberbullying and self-harm for both victims and perpetrators; however, associations for the perpetrator group attenuated to the null following adjustment for covariates. DISCUSSION: Our findings highlight cyberbullying in early adolescence as a risk factor for subsequent self-harm. Cyberbullying prevention should be a priority for school mental health interventions, with consideration that most perpetrators of cyberbullying may also be victims.

Investigating How People Who Self-harm Evaluate Web-Based Lived Experience Stories: Focus Group Study.

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.

A Systematic Review of Qualitative Studies Exploring Lived Experiences, Perceived Impact, and Coping Strategies of Children and Young People Whose Parents Use Substances.

Parental substance use is highly prevalent worldwide, presenting major child safeguarding and public health concerns. Qualitative research enables in-depth understanding of how young people experience parental substance use and helps inform practice and policy through illustrative cases of experiences. This review aimed to synthesize published qualitative evidence exploring the lived experiences, perceived impact, and coping strategies of children and young people whose parents use substances. International literature databases including Medline, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, International Bibliography of the Social Sciences, Social Science Database, Sociology Collection, and Scopus were searched from inception to 2022, alongside grey literature searching and relevant websites. Qualitative accounts were included, provided by participants aged below 25 years. No language, date, or geographical limits were applied. A thematic synthesis of 35 studies, across 49 papers, covering over 700 children and young people's voices, identified five overarching themes. These themes included, (a) living with the unpredictable: insecurity within the family; (b) social and emotional impact of parental substance use; (c) controlling the uncontrollable: creating safety within the family; (d) coping with and resisting the emotional and social impacts; and (e) formal and informal support. The findings emphasize that children and young people who experience parental substance use are trying to manage and mitigate vulnerabilities and be resilient to unpredictable, adverse, and often stigmatizing experiences, usually without formal support in place. Further research is needed to coproduce child-centered interventions that promote children and young people's social and emotional resilience.

Impact of School and Peer Connectedness on Adolescent Mental Health and Well-Being Outcomes during the COVID-19 Pandemic: A Longitudinal Panel Survey.

School closures and social distancing measures during the pandemic have disrupted young people's daily routines and social relationships. We explored patterns of change in adolescent mental health and tested the relationship between pre-pandemic levels of school and peer connectedness and changes in mental health and well-being between the first lockdown and the return to school. This is a secondary analysis of a longitudinal 3-wave panel survey. The study sample included 603 students (aged 13-14) in 17 secondary schools across south-west England. Students completed a survey pre-pandemic (October 2019), during lockdown (May 2020) and shortly after returning to school (October 2020). Multilevel models, with random effects, were conducted for anxiety, depression and well-being outcomes with school and peer connectedness as predictor variables. Symptoms of anxiety decreased from pre-pandemic to during the first UK lockdown and increased on the return to school; anxious symptoms decreased the most for students reporting feeling least connected to school pre-pandemic. Students reporting low levels of school and peer connectedness pre-pandemic experienced poorer mental health and well-being at all time points. Low school connectedness pre-pandemic was associated with a greater increase in anxious and depressive symptoms between lockdown and the return to school when compared to students with medium levels of school connectedness. No associations were found with high school connectedness or with low/high peer connectedness. For adolescents with poor school connectedness, the enforced time away from school that the pandemic caused led to reduced anxiety. Going forwards, we need to consider ways in which to promote connection with school as a way of supporting mental health and well-being.

Adolescent Experiences of the COVID-19 Pandemic and School Closures and Implications for Mental Health, Peer Relationships and Learning: A Qualitative Study in South-West England.

The COVID-19 'lockdown' and multiple school closures disrupted the daily lives and routines of the entire UK population. However, adolescents were likely particularly impacted by such measures due to this time being key for social and educational development. This qualitative study explored young people's experiences of lockdowns and school closures. Fifteen secondary schools within south-west England were initially contacted and three schools participated in recruitment efforts. From December 2020 to March 2021, 25 students aged 14-15 participated in a combination of individual interviews (n = 5) and focus groups (n = 3). Findings revealed diverse experiences of the pandemic and highlighted the complexity of experiences according to individual student contexts. Three main themes were identified: (1) Learning environments; (2) Connection to peers; (3) Transition, adaptation and coping. These findings highlight the value young people place on face-to-face social contact with close friends, and the sense of structure provided by school, with implications for future home-based learning. Further in-depth qualitative research is needed to continue to understand the varied experiences during the course of the pandemic, particularly longer-term impacts on mental health and learning.

The mental health and well-being profile of young adults using social media.

The relationship between mental health and social media has received significant research and policy attention. However, there is little population representative data about who social media users are which limits understanding of confounding factors between mental health and social media. Here we profile users of Facebook, Twitter, Instagram, Snapchat and YouTube from the Avon Longitudinal Study of Parents and Children population cohort (N=4,083). We provide estimates of demographics and mental health and well-being outcomes by platform. We find that users of different platforms and frequencies are not homogeneous. User groups differ primarily by sex and YouTube users are the most likely to have poorer mental health outcomes. Instagram and Snapchat users tend to have higher well-being than the other social media sites considered. Relationships between use-frequency and well-being differ depending on the specific well-being construct measured. The reproducibility of future research may be improved by stratifying by sex and being specific about the well-being constructs used.

Adolescent social media user types and their mental health and well-being: Results from a longitudinal survey of 13-14-year-olds in the United Kingdom.

Background: There is mixed evidence as to the effects of different types of social media use on mental health, but previous research has been platform-specific and has focused on an oversimplified distinction between active and passive use. This study aimed to identify different underlying subgroups of adolescent social media user based on their pattern of social media activities and test associations between user type and future mental health. Methods: Students from 19 schools (N = 2456) in south-west England completed an online survey measuring 13 social media activities and four psychosocial outcomes (past year self-harm, depression, anxiety and poor well-being) at age 13 years (October 2019) and repeated a year later (October 2020; aged 14 years). Latent class analysis using Mplus identified distinct classes of social media user and stability of these classes was examined using latent transition analysis. A bias-adjusted three-step model was used to test associations between class membership at baseline and mental health at follow-up. Analyses were adjusted for gender, ethnicity, sexual orientation, socioeconomic status, disability, social media screen-time and baseline mental health. Results: A four-class model of social media user at baseline was selected based on fit statistics and interpretability. User types were labelled High Communicators; Moderate Communicators; Broadcasters; and Minimal users. Users became more active over time. Broadcasters at age 13 had the poorest mental health outcomes at age 14, with mental health and well-being generally better among the High and Moderate Communicators. Conclusions: Findings suggest that broadcasters-adolescents with high levels of content sharing in addition to messaging and browsing online-are most likely to be experiencing poor mental health a year later. Recommendations regarding social media use should expand to consider different user types, and mental health implications of their engagement with different online activities in addition to screen-time.

Social media use and social connectedness among adolescents in the United Kingdom: a qualitative exploration of displacement and stimulation.

BACKGROUND: Connectedness to family and peers is a key determinant of adolescent mental health. Existing research examining associations between social media use and social connectedness has been largely quantitative and has focused primarily on loneliness, or on specific aspects of peer relationships. In this qualitative study we use the displacement hypothesis and the stimulation hypothesis as competing theoretical lenses through which we examine the complex relationship between social media use and feelings of connectedness to family and peers. METHODS: In-depth paired and individual interviews were conducted with twenty-four 13-14-year-olds in two inner-city English secondary schools. Interviews were transcribed verbatim, coded and thematically analysed. RESULTS: Analysis identified four themes: (i) 'Displacement of face-to-face socialising' (ii) 'Social obligations' (iii) '(Mis)Trust' and (iv) 'Personal and group identity'. Results indicated stronger support for the stimulation hypothesis than the displacement hypothesis. We found evidence of a complex set of reciprocal and circular relationships between social media use and connectedness consistent with a 'rich-get-richer' and a 'poor-get-poorer' effect for family and peer connectedness - and a 'poor-get-richer' effect in peer connectedness for those who find face-to-face interactions difficult. CONCLUSION: Our findings suggest that parents should take a measured approach to social media use, providing clear guidance, promoting trust and responsible time management, and acknowledging the role of social media in making connections. Understanding and sharing in online experiences is likely to promote social connectedness. Supporting young people to negotiate breathing space in online interactions and prioritising trust over availability in peer relationships may optimise the role of social media in promoting peer connectedness.

Prospective associations between internet use and poor mental health: A population-based study.

OBJECTIVES: Most of the evidence on the effects of internet use on mental health derives from cross-sectional research. We set out to explore prospective associations between internet use (hours online and specific internet experiences) and future mental health problems. METHODS: Participants were 1,431 respondents from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort, who completed a questionnaire on internet use (time online and ten different internet experiences) when they were aged 18 years. Outcomes included past year self-harm, assessed at 21 years and high levels of depression and anxiety symptoms, assessed at 22 years. Associations were investigated using logistic regression models and analyses were conducted separately for males and females. RESULTS: Females reporting high levels of internet use (number of hours online) were found to be at increased risk of depression at follow-up (highest tertile vs lowest tertile OR = 1.41, 95% CI 0.90 to 2.20), whereas males with high levels of internet use were at increased risk for self-harm (highest tertile vs lowest tertile OR = 2.53, 95%CI 0.93 to 6.90). There was no evidence to suggest an association between hours spent online and anxiety. With regards to the specific internet experiences, associations were found for females but not for males. In fully adjusted models, being bullied online (OR = 1.76, 95% CI 1.09 to 2.86) and meeting someone face to face (OR = 1.55, 95% CI 1.00 to 2.41) were associated with an increased risk of future depression. Being bullied online was also associated with an increased risk of future self-harm (OR = 2.42, 95% CI 1.41 to 4.15), along with receiving unwanted sexual comments or material, and coming across pornography and violent/gruesome material. CONCLUSIONS: Our findings highlight the importance of digital citizenship training to help teach young people to use technology safely and responsibly.

Is social media screen time really associated with poor adolescent mental health? A time use diary study.

BACKGROUND: There is increasing concern regarding the potential impact of social media use on the mental health of young people. Previous research has relied heavily on retrospective accounts of social media screen-time. Yet recent evidence suggests that such self-report measures are unreliable, correlating poorly with more objective measures of social media use. In principle, time use diaries provide a less biased measure of social media use. METHODS: We analysed cross-sectional data from the Millennium Cohort Study to explore associations between social media screen-time as recorded in time use diaries (TUD) and key mental health outcomes - self-harm in the past year, depressive symptoms (Short Mood and Feelings Questionnaire), self-esteem (shortened Rosenberg scale) - in adolescence. Social media TUD data were available for 4,032 participants (25.4% aged 13; 73.5% aged 14; 1.1% aged 15). RESULTS: Following adjustment for confounders, a greater amount of time spent on social media was associated with an increased risk of self-harm (adjusted OR per 30-minute increase in weekday use: 1.13, 95%CI 1.06 to 1.21) and depression (adjusted B ==0.36, 95%CI 0.22 to 0.50) and lower levels of self-esteem (adjusted B = -0.12, 95%CI -0.20 to -0.04) in females. Findings were similar for weekday and weekend use. LIMITATIONS: The cross-sectional nature of the data limits inference in relation to the causal direction of these associations. CONCLUSIONS: Future research should examine the direction of the associations with self-harm and other mental health outcomes and explore gender differences in how adolescents engage with social media as well as how much time they spend online.

Social media use, economic recession and income inequality in relation to trends in youth suicide in high-income countries: a time trends analysis.

BACKGROUND: Suicide rates have risen in young people in several high-income countries over the last decade. Reasons for the increases are unclear. METHODS: We analysed trends in suicide rates in 15-24 year olds over the period 2000-2017 in high-income countries with populations >20 million using Joinpoint analysis. We investigated differences in the following population-level exposures between countries that are and are not experiencing suicide rates rises: 1) 2008 economic recession as indexed by changes in GDP; 2) Gini income inequality; 3) daily social media use. RESULTS: Four of the 11 countries studied are experiencing youth suicide rate rises: Australia, Canada, the UK, the USA. The year the increase began ranged from 2003 (95% confidence interval: 2002, 2007) in the UK to 2009 (95% CI: 2007, 2012) in Australia. There was little evidence of an association between social media use and youth suicide trends, and inconsistent evidence regarding the impact of the 2008 economic recession. Suicide rate rises were seen in countries with higher GDP per capita (Wilcoxon rank sum (WRS) z=-2.27; p=0.02) and income inequality (WRS z=-2.45; p=0.01) in 2008. LIMITATIONS: Suicide data were only available until 2016/2017. Social media and income inequality data were not available for all study years. The effect of other important factors were not investigated due to a lack of comparable data. CONCLUSIONS: Our analyses indicate that the most populous high-income countries experiencing a rise in youth suicide rates are predominantly English-speaking, with higher levels of income inequality and GDP. These findings provide preliminary evidence regarding possible contributory factors to guide further research.

Informal care in Europe: findings from the European Social Survey (2014) special module on the social determinants of health.

Background: Against the background of a rising demand for informal care in European societies, this study sets out to provide descriptive information by gender on (i) prevalence rates of (intensive) informal caregiving, (ii) characteristics of (intensive) informal caregivers and (iii) consequences of (intensive) informal caregiving in terms of mental well-being. Results: On average, 34.3% of the population in 20 European countries were informal caregivers and 7.6% were intensive caregivers (providing care for minimum 11 h a week). Countries with high numbers of caregivers had low numbers of intensive caregivers. Caregiving was most prevalent among women, 50­59 year olds, non-employed­especially those doing housework­and religious persons. Determinants of providing care hardly differed by gender. Caregivers, especially female and intensive caregivers, reported lower mental well-being than non-caregivers. Conclusions: Our results suggest support for both crowding-in and crowding-out effects of the welfare state. Middle-aged women may become increasingly time squeezed as they are likely to be the first to respond to higher demands for informal care, while they are also the major target groups in employment policies aiming for increased labour market participation. Caregivers, and especially female and intensive caregivers, report lower levels of mental well-being. Supportive policies such as respite care or training and counselling may therefore be needed in order to sustain informal care as an important resource of our health care systems.