Psychological Distress, Suicidal Ideation
Conditions
Keywords
cyberbullying, suicide, adolescents, digital, schools, social media
Brief summary
This study will test Flourish, a digital suicide prevention intervention for cyberbullied youth, within schools. Specifically, the study aims to: 1. Examine if Flourish is effective and can be feasibly delivered within schools among middle and high school students who are experiencing cyberbullying and suicide risk factors. Feasibility will be evidenced by recruitment and retention rates to the study (\> or = 80%) and use of Flourish at least weekly among 80% of youth. Effectiveness will be evidenced by students reporting improvements in psychological distress and suicidal thoughts over the 3-month follow-up period. 2. Understand barriers or facilitators to Flourish's adoption within schools. We will conduct exit interviews and brief surveys with school personnel to inform optimal strategies for implementing Flourish within schools
Detailed description
Assessment Visits: As part of this study, adolescents will participate in four assessment visits at baseline and 2, 4, and 12 weeks following onboarding to the study intervention with the 2-week visit being a brief survey and the other visits involving questionnaires and clinical interviews. Assessments cover a range of topics including mood, anxiety, suicidal thoughts and behaviors, and social media use and experience. Study Intervention: Flourish Flourish is a text messaging and web-based intervention that will aim to improve adolescents' capacity to cope following cyberbullying and reduce their suicidal risk. The program focuses on key clinical strategies to improve capacity to adaptively cope with cyberbullying: improving capacity to tolerate distress, social problem-solving, and motivation toward help-seeking. The duration of Flourish is 4 weeks. Flourish primarily operates through an automated texting program, which is designed to be self-paced with branching logic, aiming to provide the right type of support at the right time youth need it. A website extends the content available on Flourish and also offers resources related to social media and mental health for teens, parents, and educators. The frequency with which youth interact with Flourish will differ from person to person. However, participants are expected to interact with Flourish approximately 2-3 times per week. Onboarding to Flourish and Coaching Prior to initiating Flourish, youth will complete a brief text-based survey that will provide information about Flourish, guide youth on how to use it, and provide opportunities to personalize the program toward their interests and goals. During onboarding, students will also identify key social supports, including close friends for distraction outside of a crisis, caregivers and other trusted adults, professional contacts (e.g., therapists or school-based mental health professionals), and crisis hotlines. Subsequently, students will meet with a health coach via a call, who will review the survey, verify crisis contacts, and discuss students' motivations and goals toward using Flourish over the next 4 weeks. The coach will then reconnect with students approximately at the mid-point (2 weeks) and end-point (4 weeks) of their use to discuss progress toward goal attainment and address any motivational or technical barriers toward ongoing engagement. Collaboration with Schools. Schools will refer students to the study and receive output reports of students' uptake of Flourish. School staff will communicate with students and caregivers about the study and connect with students to increase their motivation to engage with Flourish. At the conclusion of the trial, school staff will participate in interviews/surveys to offer feedback on the feasibility, acceptability, and appropriateness of Flourish's implementation within their school environment.
Interventions
DEVICEFlourish
Flourish is a text messaging and web-based program that aims to improve coping following cyberbullying and reduce suicide risk among youth.
Sponsors
Candice Biernesser
National Institute of Mental Health (NIMH)
The Pittsburgh Foundation
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
This is an open trial.
Eligibility
Sex/Gender
ALL
Age
11 Years to 21 Years
Healthy volunteers
No
Inclusion criteria
* 11-21 years old * English-speaking * have access to a cell phone or tablet that can send/receive SMS text messages * identified as a student who could benefit from the program by a school staff member - OR - screened eligible based on experiencing cyberbullying and suicide risk factors in the past 3 months * past 3-month history of cyberbullying assessed by the cybervictimization subscale of the Traditional Bullying and Cyberbullying Victimization Scale and/or presence of online discrimination as measured by a modified measure from the Adolescent Brain and Cognitive Development (ABCD study) * past 3-month history of suicide risk factors, assessed by: psychological distress (\>13 on the 6-item Kessler Psychological Distress Scale) and/or suicidal ideation or behavior (via the Columbia Suicide Severity Rating Scale)
Exclusion criteria
* if a student has a condition that might inhibit their ability to effectively engage with Flourish (e.g., intellectual challenges or low literacy levels) * if a students' level of acuity would suggest a higher level of care or referral to emergency services * if a school staff judges the intervention is not appropriate for the student
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Recruitment rates of eligible participants | Assessed upon recruitment to the study | Feasibility will be measured through recruitment rates of eligible participants, using a cut-off score of 80% for desirable recruitment rates. |
| Retention rates of eligible participants | Assessed upon completion of the Week 12 study visits | Feasibility will be measured through retention rates of eligible participants, using a cut-off score of 80% for desirable retention rates across the 12-week study period. |
| Level of intervention usage | Assessed upon completion of the 4-week intervention period | Usage of the intervention will be assessed by engagement with Flourish at least weekly, on average, during the study period. A cut-off score of 70% of youth using the intervention at least weekly will be used as a minimum requirement for acceptable usage. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in psychological distress from baseline to 2 weeks | Assessed at the baseline and Week 2 follow-up assessment visits | Psychological distress will be measured by the Kessler 6-item psychological distress scale (K6). Total scale scores range from 0 to 24 with higher values indicating higher levels of distress and lower values indicating lower distress. |
| Change in psychological distress from baseline to 4 weeks | Assessed at the Week 4 follow-up assessment visits | Psychological distress will be measured by the Kessler 6-item psychological distress scale. Total scale scores range from 0 to 24, higher values indicating higher levels of distress and lower values indicating lower distress. |
| Change in psychological distress from baseline to 12 weeks | Assessed at the Week 12 follow-up assessment visits | Psychological distress will be measured by the Kessler 6-item psychological distress scale. Total scale scores range from 0 to 24, higher values indicating higher levels of distress and lower values indicating lower distress. |
| Change in severity of suicidal ideation and behavior from baseline to 4 weeks | Assessed at baseline and Week 4 follow-up assessment visits | Severity of suicidal ideation and behavior will be measured with the Columbia Suicide Severity Rating Scale (C-SSRS), an interviewer-rated measure. Presence of suicidal ideation and behavior will be indicated with yes/no response options. Intensity of ideation will be rated on a scale from 1-5 with higher numbers reflecting higher levels of intensity and lower numbers reflecting lower levels of intensity. |
| Change in severity of suicidal ideation and behavior from baseline to 12 weeks | Assessed at baseline and Week 12 follow-up assessment visits | Severity of suicidal ideation and behavior will be measured with the C-SSRS, an interviewer-rated measure. Presence of suicidal ideation and behavior will be indicated with yes/no response options. Intensity of ideation will be rated on a scale from 1-5 with higher numbers reflecting higher levels of intensity and lower numbers reflecting lower levels of intensity. |
| Change in suicidal ideation from baseline to 4 weeks | Assessed at the baseline and Week 4 assessment visits | Self-reported suicidal ideation will be measured with the Suicidal Ideation Questionnaire (SIQ). The SIQ has a total score of 0 to 90. Higher scores are indicative of frequent suicidal ideation, and lower scores indicative of infrequent ideation. |
| Change in suicidal ideation from baseline to 12 weeks | Assessed at the baseline and Week 12 Follow-up assessment visits | Self-reported suicidal ideation will be measured with the Suicidal Ideation Questionnaire. The SIQ has a total score of 0 to 90. Higher scores are indicative of frequent suicidal ideation, and lower scores indicative of infrequent ideation. |
Countries
United States
Contacts
CONTACTCandice L Biernesser, PhD
PRINCIPAL_INVESTIGATORCandice L Biernesser, PhD
University of Pittsburgh
Outcome results
None listed