JMIR Publications

ABSTRACT

Background:

Self-injurious thoughts and behaviors (SITBs) and underlying mental health problems are increasing dramatically among children and adolescents. Crisis support is intended to provide immediate mental health care, risk mitigation, and intervention for youth experiencing SITBs and other acute mental health distress. Pediatric digital mental health interventions (DMHIs) have emerged as accessible and effective alternatives to in-person care; however, most do not provide crisis support or ongoing care for youth with SITBs.

Objective:

To inform development of digital crisis support – i.e., intervention and mitigation for crises such as SITBs and other acute mental crises delivered via a digital platform – and mental health care for SITB-presenting youth, the current study aims to 1) characterize youth with SITBs who participate in a digital crisis response service, 2) compare anxiety and depressive symptoms of SITB-presenting youth to non-SITB-presenting youth throughout care, and 3) suggest future steps for implementation of digital crisis support and mental health care to SITB-presenting youth.

Methods:

This study was conducted using retrospective data from members (children and adolescents) involved in a pediatric collaborative care DMHI. SITBs were assessed during each session with a non-licensed practitioner, including live sessions with a behavioral care manager (e.g., intake) and live coaching sessions. For members who exhibited SITBs during behavioral health coaching and other non-clinical sessions, a rapid crisis support team provided evidence-based crisis support services. Validated assessments were completed approximately monthly to measure anxiety and depressive symptom severity. Demographics, mental health symptoms, and change in mental health symptoms of members presenting an SITB during a session with a non-licensed provider (SITB group) were compared to members with no SITB (No SITB group).

Results:

Compared to the No SITB group (n=1977), the SITB group (n=184; 8.5%) was approximately two years older (12.6 ± 3.0 vs 10.7 ± 3.7), and most youth with SITBs were female (64.1%; n=118). Compared to the No SITB group at baseline, the SITB group had more severe anxiety and depressive symptoms. From before to after mental health care with the DMHI, the two groups did not differ in the rate of children and adolescents with anxiety symptom improvement ([SITB group: 77.1%; n=54] vs. [No SITB group: 83.4%; n=367]; Χ2(1)=1.24, P=.32), as well as depressive symptom improvement ([SITB group: 80.6%; n=58] vs. [No SITB group: 81.5%; n=255]; Χ2(1)=0.00, P=.99). The two groups also did not differ in the amount of change in symptom severity during care with the DMHI for anxiety (t(80.20)=1.37, P=.28) and depressive (t(83.75)=-0.08, P=.99) symptoms.

Conclusions:

The current study demonstrates that participation with a collaborative care DMHI is associated with improvements in mental health outcomes in children and adolescents experiencing SITBs. These results provide preliminary insights for the use of pediatric DMHIs in crisis support and mental health care for SITB-presenting youth, thereby addressing the public health issue of acute mental health crisis in children and adolescents.