Grist Rebecca, Porter Joanna, Stallard Paul
Child and Adolescent Mental Health Group, Department for Health, University of Bath, Bath, United Kingdom.
Child and Family Mental Health, Temple House, Oxford Health National Health Service Foundation Trust, Keynsham, United Kingdom.
JMIR Ment Health. 2018 Feb 23;5(1):e16. doi: 10.2196/mental.8779.
Self-harm is common among adolescents and is associated with a number of negative psychosocial outcomes including a higher risk of suicide. Recent reviews highlight the lack of research into specific interventions for children and young people who self-harm. Developing innovative interventions that are coproduced with individuals with lived experience and that reduce self-harm are key challenges for self-harm prevention.
The aim of this study was to explore the acceptability, use, and safety of BlueIce, a mobile phone app for young people who self-harm and who are attending child and adolescent mental health services (CAMHS).
This study is part of a mixed methods phase 1 trial of BlueIce. Young people aged 12-17 years attending specialist CAMHS were recruited. Clinicians were invited to refer young people who were self-harming or who had a history of self-harm. On consent being obtained and baseline measures taken, participants used BlueIce as an adjunct to usual care for an initial familiarization period of 2 weeks. If after this time they wanted to continue, they used BlueIce for a further 10 weeks. Semistructured interviews were conducted at postfamiliarization (2 weeks after using BlueIce) and postuse (12 weeks after using BlueIce) to assess the acceptability, use, and safety of BlueIce. We undertook a qualitative analysis using a deductive approach, and then an inductive approach, to investigate common themes.
Postfamiliarization interviews were conducted with 40 participants. Of these, 37 participants elected to use BlueIce, with postuse interviews being conducted with 33 participants. Following 6 key themes emerged from the data: (1) appraisal of BlueIce, (2) usability of BlueIce, (3) safety, (4) benefits of BlueIce, (5) agency and control, and (6) BlueIce less helpful. The participants reported that BlueIce was accessible, easy to use, and convenient. Many highlighted the mood diary and mood lifter sections as particularly helpful in offering a way to track their moods and offering new strategies to manage their thoughts to self-harm. No adverse effects were reported. For those who did not find BlueIce helpful, issues around motivation to stop self-harming impeded their ability to use the app.
BlueIce was judged to be a helpful and safe way of supporting adolescents to manage thoughts of self-harming. Adolescents reported numerous benefits of using BlueIce, and all would recommend the app to other young people who were struggling with self-harm. These preliminary findings are encouraging and provide initial support for the acceptability of BlueIce as a self-help intervention used in conjunction with the traditional face-to-face therapy.
自我伤害在青少年中很常见，并且与许多负面的心理社会后果相关，包括更高的自杀风险。最近的综述强调了对自我伤害的儿童和青少年的特定干预措施缺乏研究。开发与有实际经验的个体共同产生且能减少自我伤害的创新干预措施是自我伤害预防的关键挑战。
本研究的目的是探讨BlueIce这款手机应用程序对于自我伤害且正在接受儿童和青少年心理健康服务（CAMHS）的年轻人的可接受性、使用情况和安全性。
本研究是BlueIce混合方法1期试验的一部分。招募了年龄在12至17岁、正在接受CAMHS专科服务的年轻人。临床医生被邀请推荐正在自我伤害或有自我伤害史的年轻人。在获得同意并进行基线测量后，参与者将BlueIce作为常规护理的辅助工具，进行为期2周的初始熟悉期。如果在此之后他们想继续使用，他们会再使用BlueIce 10周。在熟悉期后（使用BlueIce 2周后）和使用后（使用BlueIce 12周后）进行半结构化访谈，以评估BlueIce的可接受性、使用情况和安全性。我们采用演绎法，然后是归纳法进行定性分析，以调查共同主题。
对40名参与者进行了熟悉期后访谈。其中，37名参与者选择使用BlueIce，对33名参与者进行了使用后访谈。数据中出现了6个关键主题：（1）对BlueIce的评价，（2）BlueIce的可用性，（3）安全性，（4）BlueIce的益处，（5）自主性和控制权，以及（6）BlueIce帮助不大。参与者报告称BlueIce易于获取、易于使用且方便。许多人强调情绪日记和情绪提升部分在提供跟踪情绪的方法以及提供管理自我伤害想法的新策略方面特别有帮助。未报告不良反应。对于那些认为BlueIce帮助不大的人来说，停止自我伤害的动机问题阻碍了他们使用该应用程序的能力。
BlueIce被认为是支持青少年管理自我伤害想法的一种有用且安全的方式。青少年报告了使用BlueIce的诸多益处，并且所有人都愿意将该应用程序推荐给其他正在与自我伤害作斗争的年轻人。这些初步发现令人鼓舞，并为BlueIce作为与传统面对面治疗结合使用的自助干预措施的可接受性提供了初步支持。
