Digital Intervention for Suicide Prevention in Cyberbullied Adolescents

Overseen By Candice L Biernesser, PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Pittsburgh

Disqualifiers: Intellectual challenges, low literacy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

80 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether participants must stop taking their current medications. It is best to consult with the trial coordinators or your healthcare provider for guidance.

What data supports the effectiveness of the treatment Flourish, ImHere4U, and Questionnaires for suicide prevention in cyberbullied adolescents?

Research suggests that online interventions can help adolescents develop coping skills and increase their willingness to seek help, which may reduce the impact of cyberbullying and related emotional problems. Additionally, school-based cyberbullying interventions have been shown to be effective, indicating that structured programs can positively influence mental health outcomes. ^{1 2 3 4 5}

How is the treatment Flourish, used in the trial for cyberbullied adolescents, different from other treatments for suicide prevention?

Flourish is unique because it is a digital intervention specifically designed for cyberbullied adolescents, focusing on suicide prevention by addressing the psychological impacts of cyberbullying through online support and resources, unlike traditional face-to-face therapies. ^{1 2 3 4 5}

What is the purpose of this trial?

The objective of this study is to test the feasibility and preliminary efficacy of Flourish (formerly referred to as imHere4U), a digital suicide prevention intervention for cyberbullied adolescents. The specific aims are to: Aim #1: Conduct a randomized controlled trial (RCT) comparing Flourish+Questionnaires vs. Questionnaires Alone among cyberbullied youth at-risk for suicide ages 12-17 (N=80, \>35% underserved youth). H2a. Primary outcome: Feasibility will be evidenced by recruitment/retention rates \> 80% and imHere4U engagement \> 70%. H2b. Secondary outcomes: Youth assigned to Flourish+Questionnaires will report improved problem-solving capacity, distress tolerance, and motivation and reduced distress and suicidal ideation than youth assigned to Questionnaires Alone over the 6-month follow-up period. Exploratory Aim: Examine the feasibility of delivering feedback on online interactions from machine learning algorithms. All youth assigned to Flourish may optionally provide their social media data to receive feedback from machine learning algorithms. H3a. Feedback from algorithms will have high acceptability (identified via qualitative themes and \>70% acceptance rates) and usability, defined by mean scores on Post-Study System and Usability Questionnaire (PSSUQ) \> 6.

Research Team

Candice L Biernesser, PhD

Principal Investigator

University of Pittsburgh

Eligibility Criteria

This trial is for English-speaking adolescents aged 12-17 who have experienced cyberbullying and are at risk of suicide, evidenced by distress or suicidal thoughts. They must be able to text and not require a higher level of care like hospitalization.

Inclusion Criteria

English-speaking

Access to a phone or device capable of text messaging

Past 3-month history of cyberbullying assessed by the cybervictimization subscale of the Traditional Bullying and Cyberbullying Victimization and Perpetration Scale and/or presence of online discrimination measured by a modified version of a discrimination measured developed as part of the Adolescent Brain and Cognitive Development (ABCD) study

Exclusion Criteria

Intellectual challenges, low literacy levels, or other conditions that might inhibit adolescents' ability to effectively engage with Flourish (reported by parents and, if needed, confirmed through the age-appropriate Wechsler Intelligence scale)

I need hospital care or emergency services due to my condition.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Onboarding

Adolescents and their caregivers participate in a session to onboard to Flourish, including orientation and personalization of the intervention

30 minutes

1 visit (in-person)

Intervention

Participants receive the Flourish intervention or Questionnaires Alone for 4 weeks, with interactions approximately 2-3 times per week

4 weeks

Follow-up

Participants are monitored for changes in suicidal ideation, psychological distress, and other outcomes

24 weeks

3 visits (in-person) at 4, 12, and 24 weeks

Treatment Details

Interventions

• Flourish
• Questionnaires

Trial Overview The study tests 'Flourish,' a digital intervention aimed at preventing suicide among cyberbullied youth, comparing it with just answering questionnaires. It also explores the use of machine learning feedback on social media interactions.

Participant Groups

Group I: Flourish + Questionnaires Experimental Treatment 2 Interventions

Participants will be onboarded to Flourish by a research study clinician, following which they will receive a text messaging program for 4 weeks as well as an accompanying resources website. As part of the text messaging program, participants will receive brief questionnaires evaluating their online experiences once every 3 days.

Group II: Questionnaires Alone Active Control 1 Intervention

Participants will be onboarded to a text message program that solely will send participants brief questionnaires evaluating their online experiences once every 3 days.

Who Is Running the Clinical Trial?

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Findings from Research

In a study of 19,406 European children aged 11-16, it was found that cybervictims and cyberbully-victims were more likely to view suicide-related web content compared to those not involved in cyberbullying, highlighting a potential risk factor for these groups.

All roles in cyberbullying, especially cyberbully-victims, showed increased viewing of self-harm content and higher rates of emotional, peer, and conduct problems, suggesting that targeted interventions could help address the specific needs of each group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adolescents' Viewing of Suicide-Related Web Content and Psychological Problems: Differentiating the Roles of Cyberbullying Involvement. Görzig, A.[2022]

Cyberbullying significantly increases the risk of suicidal and self-harm behaviors in children and adolescents, with various risk factors identified, such as mental health issues, substance abuse, and specific conditions like Autism Spectrum Disorder.

Protective factors, including strong school connections, parental support, and personal skills, can mitigate the negative effects of cyberbullying, suggesting that interventions focused on these areas may help reduce suicide risk in affected youth.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Systematic review of risk and protective factors for suicidal and self-harm behaviors among children and adolescents involved with cyberbullying. Dorol-Beauroy-Eustache, O., Mishara, BL.[2021]

A systematic review of 30 studies on cyberbullying interventions found that school-based programs are effective in reducing both perpetration and victimization, highlighting the importance of context in intervention delivery.

The review identified a need for longer follow-up periods to assess the lasting impact of these interventions and called for more research on the effectiveness of programs delivered in home settings and through digital platforms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Dosage, Context, and Modality of Interventions to Prevent Cyberbullying Perpetration and Victimization: a Systematic Review. Doty, JL., Girón, K., Mehari, KR., et al.[2022]

In a study of 1,037 adolescents, negative bystander responses to cyberbullying were linked to worse mental health outcomes for victims, highlighting the importance of bystander behavior in the context of cyberbullying.

The research suggests that current prevention programs should focus not only on encouraging positive bystander actions but also on reducing negative responses, as positive behaviors did not significantly impact victims' mental health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Associations Between Bystander Reactions to Cyberbullying and Victims' Emotional Experiences and Mental Health. DeSmet, A., De Bourdeaudhuij, I., Walrave, M., et al.[2019]

The IRCB program, an online self-guided cognitive behavioral therapy intervention, significantly improved adolescents' likelihood of using coping skills like self-compassion and challenging negative thoughts related to cyberbullying, based on a pilot study with 54 participants.

Participants also showed increased help-seeking attitudes towards counseling services, indicating that the program may effectively encourage adolescents to seek support when facing cyberbullying, although it did not significantly boost their confidence in coping abilities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Pilot Study of an Online Psychoeducational Program on Cyberbullying That Aims to Increase Confidence and Help-Seeking Behaviors Among Adolescents. Chillemi, K., Abbott, JM., Austin, DW., et al.[2020]

References

1. United States pubmed.ncbi.nlm.nih.gov

Adolescents' Viewing of Suicide-Related Web Content and Psychological Problems: Differentiating the Roles of Cyberbullying Involvement. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Systematic review of risk and protective factors for suicidal and self-harm behaviors among children and adolescents involved with cyberbullying. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

The Dosage, Context, and Modality of Interventions to Prevent Cyberbullying Perpetration and Victimization: a Systematic Review. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Associations Between Bystander Reactions to Cyberbullying and Victims' Emotional Experiences and Mental Health. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

A Pilot Study of an Online Psychoeducational Program on Cyberbullying That Aims to Increase Confidence and Help-Seeking Behaviors Among Adolescents. [2020]