Patient Perspectives on AI-Driven Predictions of Schizophrenia Relapses: Understanding Concerns and Opportunities for Self-Care and Treatment.

Early detection and intervention for relapse is important in the treatment of schizophrenia spectrum disorders. Researchers have developed AI models to predict relapse from patient-contributed data like social media. However, these models face challenges, including misalignment with practice and ethical issues related to transparency, accountability, and potential harm. Furthermore, how patients who have recovered from schizophrenia view these AI models has been underexplored. To address this gap, we first conducted semi-structured interviews with 28 patients and reflexive thematic analysis, which revealed a disconnect between AI predictions and patient experience, and the importance of the social aspect of relapse detection. In response, we developed a prototype that used patients' Facebook data to predict relapse. Feedback from seven patients highlighted the potential for AI to foster collaboration between patients and their support systems, and to encourage self-reflection. Our work provides insights into human-AI interaction and suggests ways to empower people with schizophrenia.

From formative design to service-ready therapeutic: A pragmatic approach to designing digital mental health interventions across domains.

As digital mental health interventions (DMHIs) proliferate, there is a growing need to understand the complexities of moving these tools from concept and design to service-ready products. We highlight five case studies from a center that specializes in the design and evaluation of digital mental health interventions to illustrate pragmatic approaches to the development of digital mental health interventions, and to make transparent some of the key decision points researchers encounter along the design-to-product pipeline. Case studies cover different key points in the design process and focus on partnership building, understanding the problem or opportunity, prototyping the product or service, and testing the product or service. We illustrate lessons learned and offer a series of questions researchers can use to navigate key decision points in the digital mental health intervention (DMHI) development process.

"The library is so much more than books": considerations for the design and implementation of teen digital mental health services in public libraries.

Background: Adolescence is a vulnerable developmental period, characterized by high rates of mental health concerns, yet few adolescents receive treatment. Public libraries support adolescents by providing them with access to teen programming, technological resources, and have recently been providing mental health services. Digital mental health (DMH) services may help libraries provide scalable mental health solutions for their adolescent patrons and could be well positioned to address the mental health needs of historically underrepresented racial and ethnic (HURE) adolescents; however, little research has been conducted on the compatibility of DMH services with adolescent patron mental health needs or resource needs of library workers supporting them. Methods: The research team formed a partnership with a public library, which serves a large HURE adolescent population. We conducted needs assessment and implementation readiness interviews with 17 library workers, including leadership, librarians, and workers with specialized areas of practice. Interview questions focused on library infrastructure, as well as library needs and preferences around the design and implementation of DMH services for adolescents. We used the Consolidated Framework for Implementation Research as guiding implementation determinant framework to code and analyze the interview transcripts. Results: Our findings revealed library workers play an important role in guiding patrons to desired resources and share a goal of implementing adolescent DMH resources into the library and elevating marginalized adolescents' voices. Existing library resources, such as the library's role as a safe space for adolescents in the community, close relationships with external and community organizations, and availability of no-cost technological resources, could help facilitate the implementation of DMH services. Barriers related to community buy-in, mental health stigma, and library worker confidence in supporting adolescent mental health could affect service implementation. Conclusions: Our findings suggest public libraries are highly promising settings to deploy DMH services for adolescents. We identified important determinants that may impact the implementation of DMH services in public library settings. Special considerations are needed to design services to meet the mental health needs of HURE adolescent populations and those adolescents' most experiencing health inequities.

Preparing a Workforce of Care Coordinators to Address Patient Mental Health Needs in the Digital Age: Training and Needs Identification.

Introduction: Care coordinators (CCs) are specialized healthcare providers and often the primary point of contact for patients with multiple medical and mental health comorbidities in integrated healthcare settings. Prior work shows CCs have lower comfort addressing mental health than physical health concerns. Digital mental health interventions can support CCs' management of patient mental health needs, but training gaps must be addressed prior to a digital mental health intervention's implementation. Methods: As part of a quality improvement initiative, a 1-hour training focused on the assessment and management of depression and suicide-related thoughts and behaviors was delivered to CCs within a large midwestern healthcare system's Division of Ambulatory Care Coordination. CCs completed online surveys prior to and following the training. Conclusion: Training resulted in increased comfort working with clinical populations, including patients who experience suicide-related thoughts and behaviors. Gains around screening for suicide risk were modest. Brief trainings for CCs can address training gaps, however, ongoing training and case consultation may also be indicated.

Weight Loss Expectations of Adults With Binge Eating: Cross-sectional Study With a Human-Centered Design Approach.

BACKGROUND: People tend to overestimate their expectations for weight loss relative to what is achievable in a typical evidence-based behavioral weight management program, which can impact treatment satisfaction and outcomes. We are engaged in formative research to design a digital intervention that addresses binge eating and weight management; thus, understanding expectations among this group can inform more engaging intervention designs to produce a digital intervention that can achieve greater clinical success. Studies examining weight loss expectations have primarily focused on people who have overweight or obesity. Only one study has investigated weight loss expectations among people with binge eating disorder, a population that frequently experiences elevated weight and shape concerns and often presents to treatment with the goal of losing weight. OBJECTIVE: The aim of the study is to investigate differences in weight loss expectations among people with varying levels of binge eating to inform the design of a digital intervention for binge eating and weight management. Such an evaluation may be crucial for people presenting for a digital intervention, given that engagement and dropout are notable problems for digital behavior change interventions. We tested the hypotheses that (1) people who endorsed some or recurrent binge eating would expect to lose more weight than those who did not endorse binge eating and (2) people who endorsed a more severe versus a low or moderate overvaluation of weight and shape would have higher weight loss expectations. METHODS: A total of 760 adults (n=504, 66% female; n=441, 58% non-Hispanic White) completed a web-based screening questionnaire. One-way ANOVAs were conducted to explore weight loss expectations for binge eating status as well as overvaluation of shape and weight. RESULTS: Weight loss expectations significantly differed by binge eating status. Those who endorsed some and recurrent binge eating expected to lose more weight than those who endorsed no binge eating. Participants with severe overvaluation of weight or shape expected to lose the most weight compared to those with low or moderate levels of overvaluation of weight and shape. CONCLUSIONS: In the sample, people interested in a study to inform a digital intervention for binge eating and weight management overestimated their expectations for weight loss. Given that weight loss expectations can impact treatment completion and success, it may be important to assess and modify weight loss expectations among people with binge eating prior to enrolling in a digital intervention. Future work should design and test features that can modify these expectations relative to individuals' intended treatment goals to facilitate engagement and successful outcomes in a digital intervention.

Young Adults' Perceptions of 2 Publicly Available Digital Resources for Self-injury: Qualitative Study of a Peer Support App and Web-Based Factsheets.

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.

Exploring the Safety of a General Digital Mental Health Intervention to Effect Symptom Reduction among Individuals with and without Suicidal Ideation: A Secondary Analysis.

Trials of digital mental health interventions (DMHIs) often exclude individuals with suicide-related thoughts and behaviors precluding an understanding of whether DMHIs for affective disorders are safe for, and perform similarly within, this high-risk group. We explore the safety and performance of a DMHI for depression in participants with and without suicidal ideation (SI) at baseline. Three hundred and one participants were included in this secondary data analysis from a trial of an 8-week DMHI comprising 14 smartphone apps. We found that SI decreased across the study among participants with baseline SI and that baseline SI status did not attenuate depression treatment effects. Through a case study of the IntelliCare platform, we find that DMHIs for general affective disorders can be safe.

The Perceived Utility of Smartphone and Wearable Sensor Data in Digital Self-tracking Technologies for Mental Health.

Mental health symptoms are commonly discovered in primary care. Yet, these settings are not set up to provide psychological treatment. Digital interventions can play a crucial role in stepped care management of patients' symptoms where patients are offered a low intensity intervention, and treatment evolves to incorporate providers if needed. Though digital interventions often use smartphone and wearable sensor data, little is known about patients' desires to use these data to manage mental health symptoms. In 10 interviews with patients with symptoms of depression and anxiety, we explored their: symptom self-management, current and desired use of sensor data, and comfort sharing such data with providers. Findings support the use digital interventions to manage mental health, yet they also highlight a misalignment in patient needs and current efforts to use sensors. We outline considerations for future research, including extending design thinking to wraparound services that may be necessary to truly reduce healthcare burden.

Bridging HCI and Implementation Science for Innovation Adoption and Public Health Impact.

Human computer interaction (HCI) and implementation science (IS) each have been applied to improve the adoption and delivery of innovative health interventions, and the two fields have complementary goals, foci, and methods. While the IS community increasingly draws on methods from HCI, there are many unrealized opportunities for HCI to draw from IS and to catalyze bidirectional collaborations. This workshop will explore similarities and differences between fields, with a goal of articulating a research agenda at their intersection.

Developing a Mobile App for Young Adults with Nonsuicidal Self-Injury: A Prototype Feedback Study.

Nonsuicidal self-injury (NSSI) affects approximately 13% of young adults. Though evidence-based treatments for NSSI exist, most young adults do not receive treatment. Digital interventions can provide access to evidence-based treatments for NSSI at scale. Further, preliminary research suggests the acceptability, feasibility, and potential efficacy of digital interventions for NSSI. To date, however, there are few publicly available digital interventions developed specifically for young adults who engage in NSSI. The aim of this study was to solicit young adults' impressions of early app prototypes to identify ways of improving interactive features and content needs. Building on a prior interview study which explored young adults' self-management of NSSI and their use of technology in self-management, this study involved three waves of iterative app prototype feedback sessions with 10 young adults with past month NSSI. In general, participants responded favorably and provided feedback to augment the app to better meet their needs, including adding new features and functionality as well as increasing opportunities for personalization. We discuss two key design challenges related to the roles of tracking and temporality in digital interventions for NSSI, and then frame design considerations related to these challenges within the lived informatics model.

Social media-based interventions for adolescent and young adult mental health: A scoping review.

Background: Mental health conditions are common among adolescents and young adults, yet few receive adequate mental health treatment. Many young people seek support and information online through social media, and report preferences for digital interventions. Thus, digital interventions deployed through social media have promise to reach a population not yet engaged in treatment, and at risk of worsening symptoms. Objective: In this scoping review, we aimed to identify and review empirical research on social media-based interventions aimed at improving adolescent and young adult mental health. A secondary objective was to identify the features and functionalities of platforms described as social media. Methods: Adhering to the PRISMA-ScR guidelines for scoping reviews, the search was conducted in PubMed MEDLINE; Embase Central Register of Controlled Trials (Wiley); PsycINFO (Ebsco); Scopus; Web of Science; IEEE Xplore; ACM Digital Library; and ClinicalTrials.gov from inception until November 2021. Studies were included if they involved adolescents or young adults (10-26 years of age) that meet clinical, or subclinical, levels of a mental health condition and include a pre- and post-assessment of mental health outcomes. Results: Among the 18,380 references identified, 15 met full inclusion criteria and were published between 2017 and 2021-this included four randomized controlled trials, seven non-randomized pre-post trials, and four were experimental or quasi-experimental designs. Just five studies were delivered through an existing social media site (Facebook or Pixtori), with the remainder focused on purpose-built networks. Three studies involved adolescents or young adults who self-reported a mental health condition, seven involved young people diagnosed with a mental health condition by a clinician or who scored above a clinical threshold on valid clinical measure, three involved college students without a mental health inclusion criterion, and two studies focused on young people with a cancer diagnosis. Conclusions: The review highlights innovations in the delivery of mental health interventions, provides preliminary evidence of the ability of social media interventions to improve mental health outcomes, and underscores the need for, and merit of, future work in this area. We discuss opportunities and challenges for future research, including the potential to leveragei existing peer networks, the use of just-in-time interventions, and scaling interventions to meet need.

How Technologies Can Support Self-Injury Self-Management: Perspectives of Young Adults With Lived Experience of Nonsuicidal Self-Injury.

Background: There is growing interest in the design of digital interventions to improve conditions for young people who engage in high-risk behaviors, like nonsuicidal self-injury (NSSI). However, few studies have focused on how young people self-manage NSSI, or their existing, and historic, use of technologies to support their goals related to NSSI behavior change. Such an understanding has the potential to inform the design of digital interventions that meet this population's unique needs. Objectives: This study aims to (a) understand the self-management practices of young adults who engage in NSSI, (b) explore how they currently use technologies for self-injury self-management, and (c) identify the ways they can envision an app-based technology supporting their self-management. Methods and Materials: Twenty young adults (aged 18-24) with lived experience of NSSI, and who were not currently enrolled in therapy, were recruited from online venues. Participants completed baseline measures to assess mental health and NSSI characteristics, followed by a virtual 1-h semi-structured interview where they were invited to share their experience of self-management, their goals, and their thoughts on supportive technology. Interview scripts were transcribed and analyzed via thematic analysis. Results: Themes and sub-themes are organized under two broad domain areas: (1) How young adults self-manage NSSI thoughts and behaviors and (2) Opportunities and challenges for digital interventions to assist young adults in their recovery process. We found that young adults had varied experiences with, and goals related to, NSSI. Participants reported a lack of effective strategies to reduce NSSI urges and a desire for an app-based technology to track patterns and deliver personalized suggestions for self-management. Participants reported existing use of technologies as part of self-management, as well as early information and support seeking for NSSI online. Conclusions: This study contributes a greater understanding of young people's experiences with self-injury, their self-management practices, and their desire to engage with technology. Our findings highlight the need for design flexibility in developing digital interventions that support individual goals, unique presentations of NSSI, and needs at different phases of recovery. Implications for the design of highly personalized and relevant digital interventions to address NSSI are discussed.

"I Wanted to See How Bad it Was": Online Self-screening as a Critical Transition Point Among Young Adults with Common Mental Health Conditions.

Young adults have high rates of mental health conditions, yet they are the age group least likely to seek traditional treatment. They do, however, seek information about their mental health online, including by filling out online mental health screeners. To better understand online self-screening, and its role in help-seeking, we conducted focus groups with 50 young adults who voluntarily completed a mental health screener hosted on an advocacy website. We explored (1) catalysts for taking the screener, (2) anticipated outcomes, (3) reactions to the results, and (4) desired next steps. For many participants, the screener results validated their lived experiences of symptoms, but they were nevertheless unsure how to use the information to improve their mental health moving forward. Our findings suggest that online screeners can serve as a transition point in young people's mental health journeys. We discuss design implications for online screeners, post-screener feedback, and digital interventions broadly.

Identity, self-blame, and body regard in NSSI: A test of moderated-mediation.

BACKGROUND: Prior work suggests that an unstable identity is an important developmental factor impacting risk for non-suicidal self-injury (NSSI), partly because it can foster lowered self-esteem and self-blame coping styles. Theoretical models suggest that how one regards the self, including experiences of and reactions to one's body (e.g., body regard), impact how factors such as identity instability and coping styles influence NSSI behavior. This study tested whether body regard moderated the mediational effect of self-blame coping on the relationship between poor self-concept clarity and past-year NSSI. METHODS: A sample of 1906 university students had complete data from an anonymous online questionnaires measuring self-concept clarity, self-blame coping, and past-year NSSI behaviors. RESULTS: Past-year NSSI was reported by 23.5% of the sample. Moderated mediational regression analyses using the PROCESS macro for SPSS were run. Body regard significantly moderated the effects of self-blame coping and poor self-concept clarity on NSSI such that neither risk factor was associated with NSSI when body regard was high. Poor self-concept clarity also retained a significant, although weakened, direct relationship with NSSI in the full model. CONCLUSIONS: Positive body regard is protective and appears to mitigate the strength of the relationships between poor self-concept clarity and self-blame coping on past year NSSI. When body regard is low or average, poor self-concept clarity is associated with increased NSSI, partly through the effect of self-blame coping. Treatments that address body- and self-perceptions related to self-concept may enhance the effectiveness of interventions used to reduce NSSI behavior.

Use of a Mobile Peer Support App Among Young People With Nonsuicidal Self-injury: Small-scale Randomized Controlled Trial.

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.

Uptake and effectiveness of a self-guided mobile app platform for college student mental health.

BACKGROUND: College students endorse high rates of mental health problems. While many colleges offer on-campus services, many students who could benefit from mental health services do not receive care. Indeed, nearly half of students who screen positive for depression, for example, do not receive treatment. Digital mental health programs, such as those delivered via mobile apps, may help expand access to mental health care and resources. This mixed-methods study aims to examine the uptake and effectiveness of an implementation of IntelliCare for College Students, a self-guided app-based mental health platform, on two university campuses. METHODS: Data on counseling center utilization was collected prior to the implementation of the app (pre-implementation phase) and while the app was available on campus (implementation phase). Data on app usage was collected throughout the implementation phase. A subset of participants (n = 20), along with counseling center staff members (n = 10), completed feedback interviews. RESULTS: Overall, uptake of the app platform was low. A total of 117 participants downloaded the app and registered their study ID during the implementation phase. Approximately 24% (28/117) of participants used the app only once. The number of days between the first and last day of app use ranged from 0 to 299, with a mean of 35.01 days and a median of 14 days. A relatively small portion of the sample (26.5%; 31/117) downloaded one or more of the IntelliCare interactive apps. In examining counseling center utilization, there were no significant changes in intake appointments, individual therapy sessions, or crisis appointments observed from the pre-implementation phase to the implementation phase of the study. Feedback interviews highlighted the significant level of disruption caused by the COVID-19 pandemic and shift to remote learning, including challenges disseminating information to students and a preference to spend less time with digital devices outside of class time. CONCLUSIONS: Findings from this study indicate that there is an ongoing need to identify ways to reach college students and support student mental health and wellness for the remainder of the COVID-19 pandemic and beyond.

Developing, Deploying, and Evaluating Digital Mental Health Interventions in Spaces of Online Help- and Information-Seeking.

The internet is frequently the first point of contact for people seeking support for their mental health symptoms. Digital interventions designed to be deployed through the internet have significant promise to reach diverse populations who may not have access to, or are not yet engaged in, treatment and deliver evidence-based resources to address symptoms. The liminal nature of online interactions requires designing to prioritize needs detection, intervention potency, and efficiency. Real-world implementation, data privacy and safety are equally important and can involve transparent partnerships with stakeholders in industry and non-profit organizations. This commentary highlights challenges and opportunities for research in this space, grounded in learnings from multiple research projects and teams aligned with this effort.

Centering Lived Experience in Developing Digital Interventions for Suicide and Self-injurious Behaviors: User-Centered Design Approach.

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.

Examining the Relationship Between the Use of a Mobile Peer-Support App and Self-Injury Outcomes: Longitudinal Mixed Methods Study.

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.

Investigating Self-injury Support Solicitations and Responses on a Mobile Peer Support Application.

Online informal support networks may provide a critical source of support for young people who self-injure. While these platforms are often intended to mitigate digital harm, there is limited understanding of how individuals use peer support venues to seek self-injury related support and the specific contingencies of supportive exchanges. The present mixed-methods study was designed to explore the types of concerns members express on a mobile peer support application and the types of responses that they receive. Specifically, our aims were to (1) understand the prevalence of peer support types exchanged and (2) surface more nuanced themes within these categories of support. We also explore the relationship between support sought through posts and received through comments. Findings have important theoretical implications for understanding support seeking and provision through a mobile peer support app, which can help guide the design and optimization of peer-driven platforms for individuals who self-injure.