Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK.
The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
BMC Psychiatry. 2022 Jul 19;22(1):485. doi: 10.1186/s12888-022-04093-w.
Online activity has been linked to poor mental health in children and young people, particularly those with existing vulnerability who may inadvertently or otherwise access harmful content. It is suggested health and social care practitioners should address online activity during mental health consultations, but guidance about acceptable or effective ways to do this is lacking. This study sought to derive good practice guidance to support mental health practitioners to engage young people in conversations about their online activities and impact on mental health.
A mixed-methods Delphi (consensus) study was conducted with a panel of mental health practitioners (n = 21) and a panel of young people (n = 22). Practitioners worked with children or young adults in the UK, mostly in statutory services (80.9%), in varied clinical roles, with 2 - 30 years of experience and most were female (87.5%). Young people were mostly female (77.3%), 13-22 years old, reported varied mental health diagnoses and had sought help from services. Across 3 rounds, panellists completed questionnaires which involved rating agreement with statements and answering open-ended questions. Iterative analysis informed subsequent questionnaire content. The percentage of participants rating their level of agreement with each statement was calculated. The threshold for inclusion as a good practice indicator (GPI) was 75% across both panels. Thematic analysis was used for free-text data.
Twenty-seven GPIs emerged covering 'who' (which young people) should be asked about online activities, 'when', 'what' should be discussed, and with what 'outcome'. Panels agreed conversations should be initiated with all young people from first meeting and regularly thereafter, with 'red flags' indicating a conversation may be pertinent. Core topics were identified with additional areas for patients presenting with disordered eating or self-harm. Panels emphasised conversations should be fluid, normalised, and encourage reflection and self-awareness.
Mental health practitioners could empower young people to exercise agency in relation to online safety and capitalise on positive features. Findings also identify training needs for practitioners. Further research should explore real-world application of the GPIs and transferability to underrepresented groups within our panels, such as males and younger children. Ethnicity and deprivation were not recorded.
在线活动与儿童和青少年的心理健康不良有关，尤其是那些可能无意中或其他方式接触到有害内容的已有脆弱性的人。有人建议卫生和社会保健从业人员应在心理健康咨询期间解决在线活动问题，但缺乏关于可接受或有效的方法的指导。本研究旨在制定良好的实践指导，以支持心理健康从业人员与年轻人就其在线活动及其对心理健康的影响进行对话。
对一组心理健康从业人员（n=21）和一组年轻人（n=22）进行了混合方法德尔菲（共识）研究。从业人员在英国为儿童或年轻人工作，大多数在法定服务机构（80.9%）中，担任各种临床角色，具有 2-30 年的经验，大多数是女性（87.5%）。年轻人主要为女性（77.3%），年龄在 13-22 岁之间，报告了不同的心理健康诊断，并曾向服务机构寻求帮助。在三轮中，小组成员完成了问卷调查，其中包括对陈述的同意程度进行评分和回答开放式问题。迭代分析为后续问卷内容提供了信息。计算了每个陈述的同意度评分达到 75%的参与者比例。作为良好实践指标（GPI）的纳入标准是两个小组均达到 75%。使用主题分析对自由文本数据进行分析。
出现了 27 个 GPI，涵盖了“谁”（哪些年轻人）应该被问及在线活动，“何时”，“应该讨论什么”，以及“什么结果”。专家组一致认为，应该在第一次见面时就开始与所有年轻人进行对话，并定期进行对话，“危险信号”表明对话可能是恰当的。确定了核心主题，并为出现饮食失调或自残的患者增加了其他讨论领域。专家组强调，对话应该是流畅的、正常化的，并鼓励反思和自我意识。
心理健康从业人员可以使年轻人能够在网络安全方面行使代理权，并利用积极的特征。研究结果还确定了从业人员的培训需求。进一步的研究应该探索 GPI 在现实世界中的应用及其在我们小组中代表性不足的群体（例如男性和年幼的儿童）中的可转移性。小组没有记录种族和贫困情况。
