Acceptability, Use, and Safety of a Mobile Phone App (BlueIce) for Young People Who Self-Harm: Qualitative Study of Service Users’ Experience

Rebecca Grist; Joanna Porter; Paul Stallard

doi:10.2196/mental.8779

Acceptability, Use, and Safety of a Mobile Phone App (BlueIce) for Young People Who Self-Harm: Qualitative Study of Service Users’ Experience

JMIR Mental Health ◽

10.2196/mental.8779 ◽

2018 ◽

Vol 5 (1) ◽

pp. e16 ◽

Cited By ~ 17

Author(s):

Rebecca Grist ◽

Joanna Porter ◽

Paul Stallard

Keyword(s):

Young People ◽

Mobile Phone ◽

Lived Experience ◽

Phase 1 ◽

Face To Face ◽

History Of ◽

Self Harm ◽

Harm Prevention ◽

Familiarization Period ◽

And Control

Background 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. Objective 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). Methods 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. Results 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. Conclusions 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.

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Poisoning substances taken by young people: a population-based cohort study

British Journal of General Practice ◽

10.3399/bjgp18x698897 ◽

2018 ◽

Vol 68 (675) ◽

pp. e703-e710 ◽

Cited By ~ 6

Author(s):

Edward G Tyrrell ◽

Denise Kendrick ◽

Kapil Sayal ◽

Elizabeth Orton

Keyword(s):

Cohort Study ◽

Young People ◽

Population Based ◽

Incidence Rates ◽

Practice Research ◽

Mortality Data ◽

Clinical Practice Research Datalink ◽

Self Harm ◽

Harm Prevention ◽

Rate Ratios

BackgroundGlobally, poisonings account for most medically-attended self-harm. Recent data on poisoning substances are lacking, but are needed to inform self-harm prevention.AimTo assess poisoning substance patterns and trends among 10–24-year-olds across EnglandDesign and settingOpen cohort study of 1 736 527 young people, using linked Clinical Practice Research Datalink, Hospital Episode Statistics, and Office for National Statistics mortality data, from 1998 to 2014.MethodPoisoning substances were identified by ICD-10 or Read Codes. Incidence rates and adjusted incidence rate ratios (aIRR) were calculated for poisoning substances by age, sex, index of multiple deprivation, and calendar year.ResultsIn total, 40 333 poisoning episodes were identified, with 57.8% specifying the substances involved. The most common substances were paracetamol (39.8%), alcohol (32.7%), non-steroidal anti-inflammatory drugs (NSAIDs) (11.6%), antidepressants (10.2%), and opioids (7.6%). Poisoning rates were highest at ages 16–18 years for females and 19–24 years for males. Opioid poisonings increased fivefold from 1998–2014 (females: aIRR 5.30, 95% confidence interval (CI) = 4.08 to 6.89; males: aIRR 5.11, 95% CI = 3.37 to 7.76), antidepressant poisonings three-to fourfold (females: aIRR 3.91, 95% CI = 3.18 to 4.80, males: aIRR 2.70, 95% CI = 2.04 to 3.58), aspirin/NSAID poisonings threefold (females: aIRR 2.84, 95% CI = 2.40 to 3.36, males: aIRR 2.76, 95% CI = 2.05 to 3.72) and paracetamol poisonings threefold in females (aIRR 2.87, 95% CI = 2.58 to 3.20). Across all substances poisoning incidence was higher in more disadvantaged groups, with the strongest gradient for opioid poisonings among males (aIRR 3.46, 95% CI = 2.24 to 5.36).ConclusionIt is important that GPs raise awareness with families of the substances young people use to self-harm, especially the common use of over-the-counter medications. Quantities of medication prescribed to young people at risk of self-harm and their families should be limited, particularly analgesics and antidepressants.

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A Smartphone App (BlueIce) for Young People Who Self-Harm: Open Phase 1 Pre-Post Trial

JMIR mhealth and uhealth ◽

10.2196/mhealth.8917 ◽

2018 ◽

Vol 6 (1) ◽

pp. e32 ◽

Cited By ~ 23

Author(s):

Paul Stallard ◽

Joanna Porter ◽

Rebecca Grist

Keyword(s):

Young People ◽

Phase 1 ◽

Smartphone App ◽

Open Phase ◽

Self Harm ◽

Post Trial

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Beating Adolescent Self-Harm (BASH): a randomised controlled trial comparing usual care versus usual care plus a smartphone self-harm prevention app (BlueIce) in young adolescents aged 12–17 who self-harm: study protocol

BMJ Open ◽

10.1136/bmjopen-2021-049859 ◽

2021 ◽

Vol 11 (11) ◽

pp. e049859

Author(s):

Isobel Greenhalgh ◽

Jessica Tingley ◽

Gordon Taylor ◽

Antonieta Medina-Lara ◽

Shelley Rhodes ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Young People ◽

Health Service ◽

Usual Care ◽

Controlled Trial ◽

South Central ◽

History Of ◽

Self Harm ◽

Randomised Controlled ◽

Utilisation Data

IntroductionA mobile app, BlueIce, was codesigned with young people with a history of self-harm to provide them with more accessible and available evidence-based support at times of distress. A preliminary evaluation found that BlueIce was acceptable, safe and used by young people and helped to reduce self-harm. The present study is designed to assess the effectiveness and cost-effectiveness of adding BlueIce to usual Child and Adolescent Mental Health Service (CAMHS).Methods and analysisThis study is a single-blind, randomised controlled trial comparing usual CAMHS care with usual care plus BlueIce. A total of 138 adolescents aged 12–17 with current or a history of self-harm will be recruited through the Oxford Health National Health Service (NHS) Foundation Trust via their CAMHS clinician. The primary outcome is self-harm at 12 weeks assessed using the Risk Taking and Self-Harm Inventory for Adolescents. Secondary outcomes include mood, anxiety, hopelessness, general behaviour, sleep and impact on everyday life at 12 weeks and 6 months. Health-related quality of life and healthcare resource utilisation data will be collected at baseline, 12 weeks and 6 months. Postuse interviews at 12 weeks will determine the acceptability, safety and usability of BlueIce.Ethics and disseminationThe study was approved by the NHS South Central—Oxford B NHS Research Ethics Committee (19/SC/0212) and by the Health Research Authority (HRA) and Health and Care Research Wales. Findings will be disseminated in peer review open-access journals and at academic conferences.Trial registration numberISRCTN10541045.

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Beyond Fear and Control: Working with Young People Who Self-Harm - Edited by Helen Spandler and Sam Warner

Health & Social Care in the Community ◽

10.1111/j.1365-2524.2007.735_5.x ◽

2007 ◽

Vol 15 (6) ◽

pp. 604-605

Author(s):

Sarah Kendal

Keyword(s):

Young People ◽

Self Harm ◽

And Control

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Youth Codesign of a Mobile Phone App to Facilitate Self-Monitoring and Management of Mood Symptoms in Young People With Major Depression, Suicidal Ideation, and Self-Harm (Preprint)

10.2196/preprints.9041 ◽

2017 ◽

Author(s):

Sarah Elisabeth Hetrick ◽

Jo Robinson ◽

Eloise Burge ◽

Ryan Blandon ◽

Bianca Mobilio ◽

...

Keyword(s):

Clinical Practice ◽

Suicidal Ideation ◽

Young People ◽

Well Being ◽

Depression Symptom ◽

Clinical Services ◽

Treatment Progress ◽

Self Monitoring ◽

Face To Face ◽

Self Harm

BACKGROUND Effective treatment of depression in young people is critical, given its prevalence, impacts, and link to suicide. Clinical practice guidelines point to the need for regular monitoring of depression symptom severity and the emergence of suicidal ideation to track treatment progress and guide intervention delivery. Yet, this is seldom integrated in clinical practice. OBJECTIVE The objective of this study was to address the gap between guidelines about monitoring and real-world practice by codesigning an app with young people that allows for self-monitoring of mood and communication of this monitoring with a clinician. METHODS We engaged young people aged 18 to 25 years who had experienced depression, suicidal ideation including those who self-harm, as well as clinicians in a codesign process. We used a human-centered codesign design studio methodology where young people designed the features of the app first individually and then as a group. This resulted in a minimal viable product design, represented through low-fidelity hand-drawn wireframes. Clinicians were engaged throughout the process via focus groups. RESULTS The app incorporated a mood monitoring feature with innovative design aspects that allowed customization, and was named a “well-being tracker” in response to the need for a positive approach to this function. Brief personalized interventions designed to support young people in the intervals between face-to-face appointments were embedded in the app and were immediately available via pop-ups generated by a back-end algorithm within the well-being tracker. Issues regarding the safe incorporation of alerts generated by the app into face-to-face clinical services were raised by clinicians (ie, responding in a timely manner) and will need to be addressed during the full implementation of the app into clinical services. CONCLUSIONS The potential to improve outcomes for young people via technology-based enhancement to interventions is enormous. Enhancing communication between young people and their clinicians about symptoms and treatment progress and increasing access to timely and evidence-based interventions are desirable outcomes. To achieve positive outcomes for young people using technology- (app) based interventions, it is critical to understand and incorporate, in a meaningful way, the expectations and motivations of both young people and clinicians.

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Predicting self-harm within six months after initial presentation to youth mental health services: A machine learning study

PLoS ONE ◽

10.1371/journal.pone.0243467 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243467

Author(s):

Frank Iorfino ◽

Nicholas Ho ◽

Joanne S. Carpenter ◽

Shane P. Cross ◽

Tracey A. Davenport ◽

...

Keyword(s):

Mental Health ◽

Machine Learning ◽

Mental Health Services ◽

Young People ◽

Health Services ◽

Prediction Models ◽

Youth Mental Health ◽

Net Benefit ◽

History Of ◽

Self Harm

Background A priority for health services is to reduce self-harm in young people. Predicting self-harm is challenging due to their rarity and complexity, however this does not preclude the utility of prediction models to improve decision-making regarding a service response in terms of more detailed assessments and/or intervention. The aim of this study was to predict self-harm within six-months after initial presentation. Method The study included 1962 young people (12–30 years) presenting to youth mental health services in Australia. Six machine learning algorithms were trained and tested with ten repeats of ten-fold cross-validation. The net benefit of these models were evaluated using decision curve analysis. Results Out of 1962 young people, 320 (16%) engaged in self-harm in the six months after first assessment and 1642 (84%) did not. The top 25% of young people as ranked by mean predicted probability accounted for 51.6% - 56.2% of all who engaged in self-harm. By the top 50%, this increased to 82.1%-84.4%. Models demonstrated fair overall prediction (AUROCs; 0.744–0.755) and calibration which indicates that predicted probabilities were close to the true probabilities (brier scores; 0.185–0.196). The net benefit of these models were positive and superior to the ‘treat everyone’ strategy. The strongest predictors were (in ranked order); a history of self-harm, age, social and occupational functioning, sex, bipolar disorder, psychosis-like experiences, treatment with antipsychotics, and a history of suicide ideation. Conclusion Prediction models for self-harm may have utility to identify a large sub population who would benefit from further assessment and targeted (low intensity) interventions. Such models could enhance health service approaches to identify and reduce self-harm, a considerable source of distress, morbidity, ongoing health care utilisation and mortality.

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Suicide attempts and non-suicidal self-harm: national prevalence study of young adults

BJPsych Open ◽

10.1192/bjo.2018.14 ◽

2018 ◽

Vol 4 (3) ◽

pp. 142-148 ◽

Cited By ~ 24

Author(s):

Rory C. O'Connor ◽

Karen Wetherall ◽

Seonaid Cleare ◽

Sarah Eschle ◽

Julie Drummond ◽

...

Keyword(s):

Young Adults ◽

Young People ◽

Suicide Attempt ◽

Suicide Attempts ◽

Age At Onset ◽

First Episode ◽

Prevalence Studies ◽

History Of ◽

Self Harm ◽

National Prevalence

BackgroundThere are few prevalence studies of suicide attempts and non-suicidal self-harm (NSSH).AimsWe aimed to estimate the prevalence of thoughts of NSSH, suicidal thoughts, NSSH and suicide attempts among 18- to 34-year-olds in Scotland.MethodWe interviewed a representative sample of young adults from across Scotland.ResultsWe interviewed 3508 young people; 11.3 and 16.2% reported a lifetime history of suicide attempts and NSSH, respectively. The first episode of NSSH tended to precede the first suicide attempt by about 2 years. Age at onset of NSSH and suicide attempt was younger in females. Earlier age at onset was associated with more frequent NSSH/suicide attempts. Women are significantly more likely to report NSSH and suicide attempts compared with men.ConclusionsOne in nine young people has attempted suicide and one in six has engaged in NSSH. Clinicians should be vigilant, as suicide attempts and NSSH are relatively common.Declaration of interestNone.

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Adolescents with suicidal behaviour: attendance at A&E and six month follow-up

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700008405 ◽

2004 ◽

Vol 21 (3) ◽

pp. 78-84 ◽

Cited By ~ 8

Author(s):

Sharon Bolger ◽

Peter O'Connor ◽

Kevin Malone ◽

Carol Fitzpatrick

Keyword(s):

Mental Health ◽

Suicidal Ideation ◽

Young People ◽

Psychological Functioning ◽

Suicidal Behaviour ◽

Deliberate Self Harm ◽

History Of ◽

Self Harm ◽

Suicidal Crisis

AbstractObjectives: To review the clinical presentation, and Accident and Emergency Department clinical response to 14-20 year olds in suicidal crisis in inner city Dublin and to carry out a six month follow up of these young people.Method: A retrospective review of the case notes of all 14-20 year olds who had attended the Mater Hospital A&E department between June 2001 and May 2002 with suicidal behaviour or ideation was carried out in order to establish socio-demographic information, type of suicidal or self-harming behaviour, intervention in the A&E department, and discharge plan. Active outreach attempts were made to trace, contact and interview these young peoples at least six months after the initial presentation. Quantitative measures of psychological functioning at follow-up included the General Health Questionnaire, The Beck Depression Inventory and The Scale for Suicidal Ideation. A qualitative interview covered their recall of the reasons for their deliberate self harm, their view of their current psychological functioning and personal relationships, reported repetition of deliberate self harm, and their views of what type of services would be useful for young people with suicidal ideation or behaviour.Results: A total of 89 young people aged 14-20 years (male: female ratio = 2:3) presented to the Mater A&E department between June 2001 and May 2002 with deliberate self-harm, deliberate self-poisoning and/or suicidal ideation, and accounted for 108 presentations. They showed high levels of psychosocial disadvantage. Almost half had a history of previous contact with mental health services, while the same proportion had a history of previous deliberate self-harm. Drug overdose using paracetamol was the most common method used. Psychiatric assessment was documented in 66% of cases, and documented follow up recommendations were made in 60% of cases. Two thirds of the 89 young people who formed the study population were traced. Half of those contacted agreed to be interviewed and half refused. The majority of those interviewed described themselves as functioning better psychologically than at the time of the index attendance at the A&E department The quantitative measures supported this. One third of those interviewed reported repeated deliberate self-harm since their index attendance, for which most did not seek medical intervention. Many of the young people had clear views about the importance of talking to someone when in crisis. They described a service, which was informal, accessible on a 24-hour basis, and staffed by people with experience of mental health, alcohol and drug related disorders.Conclusions: This is a particularly vulnerable group of patients from a socio-demographic and mental health perspective. Their attendance at the A&E department provides a unique opportunity for an in-depth psychosocial assessment, which should be recorded in a systematic way to assist clinical audit, facilitate strategic mental health planning and may confer some therapeutic clinical benefit to at risk young people. An easily accessible, active DSH team specifically tailored for young people in the A&E department could provide assessment and short-term follow-up. This is the approach recommended by young people in suicidal crisis, whose views need to be heard.

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