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1. Welcome to the HMN webinar series! To ensure the quality of your experience, please: • Use the Audio Set up Wizard (located under Meeting) to ensure that your audio is working properly. • Check to see if your speaker is activated. When activated, the speaker icon at the top of the screen should appear green. To ask a question/make a comment at any point throughout the webinar, type using the chat room in the bottom of the screen. We’ll address your questions during the discussion portion of the webinar. Thank you! We will begin shortly!

2. Social Media Interventions for Adolescent and Young Adult Mental Health The Healthy Minds Network Webinar Series Session #7, May 2014

3. Welcome and About The Healthy Minds Network The Healthy Minds Network Research-to-practice network based at University of Michigan Public health approach to mental health among young people HMN Research-to-Practice Objectives: (1) produce knowledge (research) (2) distribute knowledge (dissemination) (3) use knowledge (practice)

4. Research-to-Practice Agenda

5. Today’s Webinar • Overview: Research focusing on ways in which social media can be used to improve adolescent and young adult mental health -Dr. Megan Moreno and Megan Pumper, University of Washington and Seattle Children’s Research Institute • Conceptual scaffolding behind the development of a social media-based intervention -Blake Wagner III, Healthy Minds Network • Walkthrough of the tinyshifts social media platform -Andrew Inscore, Healthy Minds Network • Discussion Please submit questions at any point throughout the webinar!

6. Depression and Social Media Megan Moreno, MD, MSEd, MPH & Megan Pumper

7. Our research team Our mission as the Social Media & Adolescent Health Research Team is to advance society’s understanding of the relationships between media and adolescent health towards educating adolescents, providing better care, and developing innovations in adolescent healthcare.

8. The big question • Depression is major health concern among adolescents and young adults • Many people with depression go undiagnosed or lack resources • Can social media offer new opportunities for early identification, prevention or intervention of depression?

9. Depression and Facebook

10. Studies to date using Facebook • Study 1: Epidemiology of displays • Study 2: Associations between displays and symptoms • Study 3: Peer interpretation • Study 4: Communication preferences

11. Study 1: Epidemiology of displays • Used DSM criteria for major depressive episode applied to Facebook status updates • ~25% of profiles include one or more references to symptoms • 2.5% of ppts displays met criteria for MDE for MDE

12. Study 2: Associations between displays and symptoms • Participants coded as “displayers or non-displayers” • All participants completed PHQ-9

13. Study 3: Peer interpretation • Focus groups with college students • “What do you think when you see a reference to depression on Facebook?”

14. Results “It’s like they don’t feel comfortable enough to say it in person but they really want someone to reach out to them… It’s easier to talk about it on Facebook where you’re not directly complaining to someone. And then if someone wants to help you they will.”

15. Results “If I was a close friend I would definitely say something. But I know there are people that have all these friends on Facebook and talk to them maybe once a year. If they had something in their status update I wouldn’t really think anything of it because I don’t really know them.”

16. Study 4: Communication preferences • How do college students want to be approached regarding displayed Facebook references to depression? • Interviews with college students • Coding using classical content analysis

17. Results • College students were open to being approached by friends or close peers and preferred the approach to be in person • College students were less enthusiastic about being approached by professors or advisors and suggested the approach could be initially via email • College students were wary of being approached by university officials or administrators

18. Results • For both friends and known adults, taking an inquisitive and supportive approach of asking “How are you doing? Do you want to talk about anything?” or “I saw your Facebook post and was concerned about you” was noted in several interviews.

19. Future directions • What is real-time association between display and symptoms among college students with depression? • Other social media sites? • Intervention strategies?

20. Depression and Twitter

21. Introduction • Depression is a common and pervasive behavioral health issue • Many individuals with depression go untreated • Prior studies have investigated using FB to identify individuals with depression, but Twitter is yet to be studied The purpose of this study was to examine if and how the topic of depression is being discussed on Twitter.

22. Methods • Setting: Tweets were collected from www.twitter.com during one week in the summer of 2013. • Content Selection: • Tweets were collected using the software, DiscoverText • Search terms= depressed and depression • 1000 tweets were coded for depression content • The codebook: • A pre-existing codebook was adapted • Categories of originality of tweet, format, and subject of tweet, as well as other related factors to depression • Analysis • 3 trained coders evaluated tweets • Descriptive statistics were used to examine counts within categories

23. Results • The search resulted in 297,107 tweets. • ~8% of tweets were excluded due to incomplete content • The tweets most commonly consisted of: • Unoriginal content (60.4%) • References to personal depression symptoms or experiences (49.4%) • References in first person (45.1%)

24. Results • Of the tweets that were original and referenced personal information (n=212), 128 (60.4%) tweets referenced one or more symptoms of depression. • 7.8% of these tweets described symptoms increasing in severity

25. Discussion • Depression was referenced on Twitter • Symptoms discussed in clinical visits were found on this website • Healthcare providers should be aware that Twitter is a potential outlet for discussions about depression

26. Discussion • Limitations • Lack of knowledge about excluded tweets • Search terms selected for depressed mood • Search was limited to public Twittersphere • Future research • Examining the validity of these displays • Investigating the feasibility and acceptability of reaching out to individuals via this website

27. Conclusion • We present two studies of using social media to investigate depression • Conclusions • Social media is accessible • Many people display depression on social media

28. tinyshifts: A pocketguidetoyoungadulthood Peer insighton how toflourishand managethe seeminglyunmanageable.

29. Conceptual Scaffolding The Theory and Practice of Group Psychotherapy -Irving Yalom – Stanford 1970 • Universality • Altruism • Instillation of hope • Imparting information

30. Conceptual Scaffolding (con.’t) • 60% seek health information online • 45%-57% share health-related knowledge on social media channels Greene & Kesselheim, 2010; Lane & Twaddell, 2010; Weaver- Larisey, Reber, & Paek, 2010

31. Conceptual Scaffolding (con.’t) • 1 in 5 seek out others with similar health concerns online (Fox, 2011) • Social support is essential to health and wellbeing (Cohen & Hoberman, 1983) • “A positive relationship between having health concerns and seeking health-related social support” • Seeking health information on Facebook was linked to positive health self-efficacy(Oh at al., 2013)

32. Comments related to seeking mental health tx • “I wouldn’t like to speak about my problems. I really like to do things my own way, independently.” • “I’d prefer to talk to someone on the Internet and then maybe make my way to a counselor or a psychiatrist.” Ellis et al., 2013

33. Acceptability of mobile health-related apps • “No one has to know you’re doing it on your mobile.” • “You can access it whenever you want and it just fits into your lifestyle.” • “…I know the times I feel the lowest or most stressed are not so much sociable hours.” • “To actually go and meet someone face-to-face would probably be more difficult than going online…I can do it in the privacy of my own home, in my own time. No one is going to pass judgment; no one is going to look at me.” Schuster, Drennan, &Lings, 2013

34. Conceptual Scaffolding (con.’t) Gowen et al., 2012 Portland State University • Conducted online survey of 207 young people with psychological issues • Reported benefits of SNS -reduces social isolation -increases social engagement • Characteristics of SNS site devoted to people with similar issues: -info about how to live independently -how to manage mental health related issues -high interest in helping others

35. Introducing: tinyshifts.com

36. Potential benefits of tinyshifts • Low response cost • Anonymity/pseudonymity • Confidentiality • 24/7 access • Supplement to care • Entry point to care • Potential for prevention and early intervention • Research implications (e.g., inform intervention development)

37. Potential drawbacks of tinyshifts • Manual moderating of content • Negative contagion effect • Offensive or insensitive responses

38. tinyshifts film competition COMING THIS FALL!

39. Blake Wagner inkblots@umich.edu Andrew Inscore andrew.inscore@gmail.com Contact: healthymindsnetwork.org

40. Discussion

41. About Participating To pose a question, please submit your question using the “Chat Room” in the bottom corner of the screen. A moderator will then read your question to the group.

42. Discussion • What do you see as the long term negative effects of social media on an individuals ability for interpersonal connection? • I work closely with our counseling center and behavioral health department on campus, so learning more about how to reach students on campus via social media will be very helpful! • Any information the panelists can provide on prevalence of usage for these interventions would be wonderful. In addition, what do the panelists see as possible ethical pitfalls in utilizing these types of interventions with this population?

43. Thankyouall!

44. References • Cohen, S., & Hoberman, H.M. (1983). Positive events and social supports as buffers of life change stress. Journal of Applied Social Psychology, 13, pp. 99–125 0.1111/j.1559-1816.1983.tb02325.x • Ellis L.A., Collin P., Hurley P.J., Davenport T.A., Burns J.M., Hickie I.B. Young men's attitudes and behaviour in relation to mental health and technology: implications for the development of online mental health services. BMC Psychiatry 2013;13:119. • Fox, S. (2011). Peer-to-peer healthcare. Pew Internet & American Life. http://www.pewinternet.org/Reports/2011/P2PHealthcare.aspx. • Gorham, R., Carter, L., Nowrouzi, B., McLean, N., & Guimond, M. (2012). Social Media and Health Education: What the Early Literature Says. The Journal of Distance Education, 26, 1-10. • Gowen, K., Deschaine M., Gruttadara D., & Markey, D. (2012) Young adults with mental health conditions and social networking websites: Seeking tools to build community. Psychiatric Rehabilitation Journal 35(3), 245-50.  • Greene, J., & Kesselheim, A. (2010). Pharmaceutical marketing and the new social media. The New England Journal of Medicine, 363(22), 2087-2089. • Lane, S. & Twaddell, J.W. (2010). Should social media be used to communicate with patients? The American Journal of Maternal/Child Nursing, 35(1), 6-7. • Oh, Hyun Jung, Carolyn Lauckner, Jan Boehmer, Ryan Fewins-Bliss, and Kang Li. Computers in Human Behavior Vol. 29, No. 5. 2013 • Schuster, L., Drennan, J., & Lings, I. N. (2013). Consumer acceptance of m-wellbeing services: a social marketing perspective. European Journal of Marketing, 47, 1439-1457. • Weaver-Lariscy, R., Reber, B., & Paek, H. (2010). Examination of media channels and types as health information sources for adolescents: Comparisons for black/white, male/female, urban/rural. Journal of Broadcasting and Electronic Media, 54(1), 102-120. • Yalom, I.D., The Theory and Practice of Group Psychotherapy. New York: Basic Books, 1970.