Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 11, 2020
Date Accepted: Feb 8, 2021
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“I feel a little bit more connected”: a qualitative study of Moderated Online Social Therapy for young people with active suicidal ideation
ABSTRACT
Background:
Online interventions are a promising approach to supporting youth at risk of suicide, and those incorporating peer-to-peer social networking may have the added potential to target interpersonal states of perceived burdensomeness and thwarted belongingness. Due to feasibility and safety concerns, including fear of contagion, this had not been tested until recently.
Objective:
In 2018 we conducted a pilot evaluation to test the feasibility, safety and acceptability of a Moderated Online Social Therapy intervention, called Affinity, with a sample of young people with active suicidal ideation. The aim of the present study is to report on qualitative data collected from study participants regarding their experience of the online social network and the consequent safety features.
Methods:
Affinity is a closed website incorporating three key components: therapeutic content delivered via comics, peer-to-peer social networking, and moderation by peers and clinicians. Semi-structured interviews were conducted with 17 young people who took part in the pilot study after eight weeks of exposure to the intervention. Interview data from two young people who did not use Affinity were excluded from the analysis. The interviews were analysed using thematic analysis, with frequency of responses characterised using the Consensual Qualitative Research Method. Results are reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist.
Results:
Four overarching themes were identified: a safe and supportive environment; the importance of mutual experiences; difficulty engaging and connecting; and, pros and cons of banning discussions about suicide. Interestingly, although Affinity was perceived to be safe and free of judgment, concerns about negative evaluation and triggering others were significant barriers to posting on the social network. Participants generally supported the banning of conversations about suicide, although for some this was perceived to reinforce stigma or was associated with frustration and distress.
Conclusions:
The results support the safety and potential therapeutic benefit of the social networking aspect of Affinity, yet also brought to light several implementation challenges to be considered. There is a need to carefully balance the need for stringent safety and design features with ensuring the potential for therapeutic benefit is maximised. Clinical Trial: NA
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