Abstract Introduction Self-harm and suicide among young people are major public health concerns and delivering prevention and postvention support is crucial. Educational and youth organisations play a vital role in both prevention and postvention. However, evidence shows a lack of understanding of effective interventions, and limited awareness of the available guidance in this area. We reviewed current self-harm and suicide guidance available to education and youth organisations in the UK that support young people and identified gaps in this provision. Methods A systematic grey literature review was conducted between July and August 2023 using the following methods: internet searches (Google and OpenGrey), advice from experts and reference list checks. To be included, guidance had to focus on supporting children and young people aged 11–18 years and be intended for use in education or youth organisation settings in the UK. Guidance also had to include information on self-harm and/or suicide prevention or postvention and be freely and publicly available. A narrative review and content analysis of all included guidance was conducted. Gaps in existing guidance were identified from the content analysis, through consultation with young people and adult advisory group members and comparison with relevant literature. A formal quality appraisal was not undertaken due to a lack of validated frameworks to assess grey literature. Results Two hundred ninety-seven guidance resources were screened; 104 met the inclusion criteria. Regarding prevention guidance, 36 focused on self-harm, 4 on suicide and 21 covered both. By comparison, 29 covered postvention and 14 covered both prevention and postvention (8 were suicide only and six were self-harm and suicide). Notably, there was a marked imbalance in target settings, with over half of the guidance (54/104) focused on educational settings compared with only 5 resources specifically tailored to youth organisations, highlighting a substantial gap in guidance for non-education settings. Three key categories of content were identified: psychoeducation/information, recommended response and resources. Within these, 20 subcategories were identified: definitions and signposting were the most frequently included. The stakeholder-informed gap analysis revealed a lack of support for parents/carers, practical resources for professionals to use and tailored information for specific populations (e.g. neurodiverse, LGBTQIA+). Although 104 relevant guidance resources were available, it was difficult to assess the quality of the guidance as there was a lack of information on how individual guidance resources were developed and whether the content was evidence-based. Conclusion Key recommendations for future guidance include more guidance for youth organisations, more on response and support after a suicide, more tailored guidance for vulnerable groups and more guidance for how organisations can support parents and carers. Additionally, guidance should be co-produced to ensure that key topics identified as important to stakeholders are not missed.

Aims: Immersive virtual reality (VR) is increasingly being explored as a potential modality for the assessment and treatment of a range of mental health conditions, including anxiety disorders. To date, many of the VR interventions that have been developed for anxiety disorders draw upon the principles of exposure therapy, and a growing body of evidence has begun to demonstrate their efficacy. However, little is known about the ways in which the individuals for whom these interventions are designed perceive and experience them, despite the importance of understanding both patient and practitioner perspectives to enable effective intervention development and evaluation. The aim of this systematic review was to identify and synthesise the existing qualitative evidence-base in relation to exposure-based immersive VR interventions for the treatment of anxiety disorders. Methods: We systematically searched PubMed, Scopus, Medline, Embase, PsychINFO, OVID interface, MedArXiv and PsyArXiv for qualitative and mixed-methods studies reporting patient and therapist perspectives, experiences and recommendations relevant to the focus of our review. In total, 9714 abstracts were screened and 954 full-text manuscripts were retrieved, with 12 studies meeting the review inclusion criteria. The qualitative results sections of articles were coded inductively line-by-line, and the data was synthesised using thematic synthesis. Results: Twelve descriptive themes and four analytical themes were generated through the analysis. The analytical themes were: 1. Contingent experiences of anxiety (facilitators of and barriers to experiencing symptoms of anxiety during VR exposure); 2. Learning beyond exposure (the ways in which participants experienced benefits from VR exposure that extended beyond the intended mechanisms of change underpinning exposure therapy approaches); 3. “ Somewhere between being there and not being there ” (the nature of an anxiety-provoking ‘reality’ that is virtual, and how experiences of the virtual world relate to experiences of anxiety in real life); and 4. The patient, the therapist, and the Head-Mounted Device (how VR exposure-based interventions might best be positioned and delivered in the context of psychotherapy, and how VR might present both benefits and barriers for patients, therapists, and for the therapeutic relationship). Conclusion: This synthesis of the perspectives, experiences and recommendations of patients and therapists in relation to exposure-based VR interventions for anxiety disorders has a range of implications, for both practice and research. These include a number of recommendations for the design, delivery and evaluation of VR interventions for anxiety disorders, ensuring they better meet the needs of the people who use them.

OBJECTIVES:Many medical students with mental health problems do not seek help. However, it is unclear what medical schools can do to promote help seeking. We sought to establish the effect of medical school initiatives on help seeking for mental health problems among medical students. DESIGN:A systematic review and meta-analysis of studies published between 2013 and 2023. DATA SOURCES:MEDLINE Ovid, EMBASE Ovid, PsycINFO Ovid, Web of Science, ERIC, BEI and Education Abstracts. ELIGIBILITY CRITERIA:Studies that assess the effect of an intervention delivered by a university or healthcare organisation on medical students' attitudes towards help seeking or their help-seeking behaviour for mental health problems. DATA EXTRACTION AND SYNTHESIS:Two reviewers independently screened studies for inclusion and extracted data. Risk of bias was assessed using Cochrane Risk of Bias 2 (for randomised controlled trials (RCTs)) and Risk Of Bias In Non-randomized Studies of Interventions (for non-randomised studies). Studies were grouped according to intervention type. Meta-analysis was conducted using random-effects models. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluations. RESULTS:The evidence from the meta-analyses was of very low to low certainty. Improvements in help seeking were noted in the meta-analyses of pre-post studies investigating the effect of interventions with a lived-experience component (five studies, n=492, standardised mean difference (SMD) 0.62, 95% CI 0.33 to 0.91, p<0.001); of educational interventions (two studies, n=260, SMD 0.38, 95% CI 0.01 to 0.74, p=0.04); and of interventions to improve access to services (two studies, n=1120, OR 1.80, 95% CI 1.12 to 2.88, p=0.02). Effects on help seeking diminished over time. The meta-analysis of three pre-post studies (n=677) evaluating the effect of clinical clerkships found no benefit on personal help-seeking attitudes (SMD 0.21, 95% CI -0.08 to 0.51, p=0.16). Meta-analysis of controlled studies comparing different approaches did not find superiority of face-to-face lived-experience interventions over active control interventions. CONCLUSIONS:Overall, the evidence is of very low to low certainty, due to the serious risk of bias in the included studies, most of which used uncontrolled pre-post designs. Interventions with a lived-experience component may improve medical students' help-seeking attitudes. Standard clinical clerkships did not appear to impact personal help seeking, despite multiple previous studies suggesting they reduce stigma, suggesting barriers to help seeking extend beyond stigma and mental health literacy in this student population. Further high-quality research, particularly RCTs with long-term follow-up, is needed to firm up the evidence base in this area. PROSPERO REGISTRATION NUMBER:CRD42024319771.

Background: Mental health professionals (MHPs) are increasingly expected to address the role of digital tech-nology use in the mental health of children and young people (CYP). However, limited research captures how CYP themselves perceive their digital experiences, and how they would like these to be acknowledged and supported within mental health care. This study aims to explore CYP perspectives on their digital lives, including the impact on their mental health, and their views on how MHPs should approach conversations on the topic. It seeks to contribute to preventative approaches within services by supporting early identification of problematic online use in young people. Methods: An online survey was conducted with CYP in the UK, uring multiple-choice and opentextquestions. Content analysis was conducted collaboratively with a team of lived experience young researchers. They explored qualitative responses using systematic coding and categorisation of responses to identify themes and subthemes. The frequency of themes was then counted to highlight more common experiences and priorities. Results: Young people described both helpful and harmful impacts of online use on their mental health, influ enced by context and emotional state. They highlighted exposure to triggering content and addictive features as problematic, but valued supportive communities. Participants preferred open, non-judgemental conversations with MHPs and identified perceived gaps in professionals" understanding of their online lives. Conclusions: MHP's should approach digital experiences as integral to CYP lives and engage them in supportive, collaborative conversations, guided by GPI recommendations. Further service-level training and resources are needed to addre MHP knowledes gaps.

BackgroundEngagement with mental health–related online content, including material relating to self-harm, suicide, and disordered eating, may influence users’ emotions and behaviours, particularly amongst vulnerable groups. However, current approaches to problematic internet use (PIU) largely rely on addiction-based constructs that may overlook these forms of engagement. We define this domain as psychologically risky problematic internet use (PR-PIU) and examine whether existing measures capture it.MethodA scoping review was conducted across databases (Scopus, PubMed, PsychInfo, and CINAHL). Studies developing or validating original PIU measures were included. Data were analysed using narrative synthesis to identify conceptual and methodological patterns across measures. Measures containing PR-PIU items were further evaluated using the COSMIN Risk of Bias checklist.Results7,475 records were screened, resulting in 85 unique PIU measures. Many (74%) conceptualised PIU through addiction-based constructs. Only four measures within the PIU measurement literature included items relevant to PR-PIU, each addressing a narrow aspect of the domain, such as exposure to self-harm or eating disorder content. COSMIN evaluation indicated variable psychometric quality and limited conceptual grounding for these measures.ConclusionExisting measures of PIU rarely capture psychologically risky forms of online engagement, highlighting an important gap in current measurement approaches. To address this, we propose a content–context–consequences (CCC) framework, which conceptualises PIU as arising from interactions between the type of content encountered, the context of engagement, and resulting outcomes. This framework provides a foundation for more precise and clinically relevant measurement of digital engagement.

Anxiety is the most common mental health problem in young people and sex/gender differences have been consistently reported, with girls and young women experiencing twice the chance of anxiety compared to boys and young men. There is a limited understanding, however, of the underlying causes of these differences. This systematic review aims to synthesise research identifying modifiable sex/gender-specific risk and protective factors for anxiety among young people aged 16–24 in high income countries. A systematic literature search was conducted on 29th February 2024 and updated on 4th July 2025 across MEDLINE (Ovid), PsycINFO (Ovid), EMBASE (Ovid), Scopus, Sociological abstracts, and Web of Science. Observational studies reporting estimates of sex/gender-specific associations between modifiable risk and protective factors and anxiety according to DSM-5 categories were included. Results were summarised using narrative synthesis. 85 studies were included. Modifiable factors were grouped into levels: individual; interpersonal relationships; local community; and wider environment and society levels. The review identified conflicting results for sex/gender differences, demonstrating the methodological limitations of the evidence base and the complexity of the modifiable risk and protective factors implicated in the explanations for sex/differences in anxiety among young people aged 16–24 years. Potential sex/gender-specific risk factors emerged; early alcohol use initiation, parental overprotection and social media may be more anxiety-inducing in females than in males. This review indicates that sex/gender differences may exist in the associations between modifiable risk and protective factors and anxiety. Future longitudinal studies are crucial to understanding how these pathways differ by sex/gender. Studies are needed which explore whether sex/gender influences the relationship between anxiety and gender discrimination, peer relationships, school/college context, the workplace and the school-to-work transition. Such evidence has the potential to guide the development of effective sex/gender-specific mental health interventions. CRD42024518279. Not applicable.

BACKGROUND:Social media is a pervasive part of young peoples' lives and may influence their mental health. Primary care is often the first point of care when seeking help for mental health problems. However, little is known about how young adults with mental health problems experience and perceive primary care support for managing social media. AIM:To explore young adults' views on help-seeking for social media use in primary care in relation to mental health problems. DESIGN & SETTING:Qualitative interview study with 28 young adults aged 18-25 with self-reported mental health problems across England. METHOD:Semi-structured interviews were analysed thematically to identify barriers and facilitators to help-seeking. Themes were organised using the Theory of Planned Behaviour - attitudes, social norms and perceived behavioural control. RESULTS:Barriers for help-seeking included attitudes that social media was a secondary issue and low expectations of meaningful support; perceived negative attitudes and limited understanding of social media by primary care clinicians, communities and families; and constrained ability to seek help due to limited consultation time and uncertainty around how to seek help. Facilitators included clinicians offering practical strategies, raising the topic non-judgmentally, receiving training to better understand young people's digital lives, longer appointment times, and clearer information about support in primary care for social media-related concerns. CONCLUSION:Young adults with mental health concerns face multiple barriers to discussing social media in primary care, shaped by attitudes and structural challenges. Addressing these through clinician training, communication, and service adaptations may enhance engagement and support.

Aims: Many people with eating disorders experience body image disturbance, and there is evidence to suggest that body image difficulties not effectively addressed through eating disorder treatment can contribute to later relapse. Virtual reality (VR) interventions designed to target body image difficulties associated with eating disorders have begun to demonstrate promising evidence of efficacy. However, little is known about the perspectives of people with eating disorders and those who care for them around such interventions. This study aims to explore stakeholders’ views of factors that could impede or support use of such interventions. Methods: Eleven young people with lived or living experience of eating disorders (PWLE), four parents/carers of people with eating disorders, and five clinicians with experience of treating eating disorders took part in semi-structured interviews or focus groups. Qualitative data was coded inductively and analysed using reflexive thematic analysis. Themes and subthemes were iteratively refined through discussions between the authors. Results: Five themes were generated. These were getting the timing right : highlighting the importance of timing within a person’s treatment journey, with suggestions for optimal timing; tailoring the intervention to the individual : all stakeholders agreed that individualisation to the person accessing treatment was critical; thoughtfully empowering agency : participants suggested that a degree of control over most aspects of the intervention would be helpful, with some key caveats; providing the right support : suggestions were made about both the necessity of support, and what this support might look like; and an overarching theme of on balance is it worth while? This overarching theme involved participants carefully weighing up the risks and benefits of using such an intervention. It included three subthemes: hope of efficacy; fear of difficulty ; and desperate belief in necessity . Conclusion: PWLE, parents and carers and clinicians shared valuable, detailed insights into how they view body image interventions in VR, the key challenging areas and suggestions for how they could be done well. They highlighted that getting these aspects right may make such an intervention on balance worthwhile. Ongoing co-production in order to optimise these components of the intervention should be utilised in the development of VR body image interventions, as they will likely make the difference as to whether people will choose to try them and whether they will be effective.

Background Self-harm and suicide among young people are pressing public health challenges in the UK. Schools and youth organisations can act as key settings to provide early intervention and support. This study explored the barriers and facilitators experienced by education and youth organisation staff as they respond to young people’s self-harm and suicidal behaviours, the support that is available to them and perceived gaps in this support. Methods We conducted 29 individual interviews and one focus group with a total of 34 professionals across schools, youth organisations, public health teams, NHS staff (e.g. educational psychologists and mental health support teams) and third-sector support services during September 2024–May 2025. Purposive sampling ensured variation in role, geography, and type of organisation. Transcripts were analysed using the Framework Method, with inductive coding refined through team discussion and matrix comparison to identify themes across stakeholders. Results Five overarching themes were identified: (1) strengthening knowledge, communication, and training; covering staff awareness, education and confidence and up-skilling and involving parents; 2) systemic gaps and barriers in provision; covering lack of early intervention strategies, resource limitations and a need for joined-up agency working; (3) role ambiguity and responsibility gaps; covering unclear role expectations across sectors, staff vulnerability, thresholds and ringfencing; (4) fear, shame, and stigma; including fear of liability, blame, reputational risk, stigmatising attitudes, myths and taboos and open dialogue and trusted relationships; and (5) social, cultural, and community considerations; covering peer support opportunities, role of community environment and inclusion/reaching marginalised groups. Conclusions This study provides qualitative insight into how self-harm and suicide risk are managed across schools, youth organisations, and external support providers. It highlights that staff often work within fragmented systems characterised by uncertainty, emotional burden, and inconsistent access to external support. Youth organisations were identified as important, accessible spaces where trusted relationships can facilitate early support and disclosure. Extending prior quantitative research, it shows how these challenges are experienced in practice across sectors. Overall, findings emphasise the need for clearer referral pathways, sustained cross-sector coordination, and strengthened staff training to enable more consistent, confident, and effective responses to young people at risk.

BackgroundLived experience stories are often used on formal help sites as a support resource for individuals who self-harm. While self-harm–related internet use provides an alternative for individuals who are not yet ready or are unwilling or unable to access support offline, it has also been shown to unintentionally reinforce self-harm behavior. There are several components that might influence whether a lived experience story is perceived as helpful, unhelpful, or potentially harmful, and the evidence supporting that these encourage help-seeking in the reader is limited. ObjectiveThis study is part of a mixed methods project that aimed to investigate how variations in help-seeking messages contained within online lived experience stories are interpreted by and psychologically impact those with a history of self-harm. MethodsIndividuals with a recent history of self-harm were recruited via newsletters, social media, and websites run by the university and mental health charities to take part in an online experiment. During the experiment, participants were randomized to read stories that either mentioned (1) self-help strategies, (2) seeking help from informal and formal sources, or (3) did not mention help-seeking. Help-seeking intentions, mood, entrapment, and expectations of future self-harm were measured, and participants provided feedback on the stories. ResultsThere was limited evidence for an effect of story type on help-seeking intentions (F2, 230=4.2; P=.02; η2=0.25), and clearer evidence for an effect of story type on negative affect (F2, 230=4.02; P=.02; η2=0.10; adjustment for age, gender, and help-seeking history included). Participants in the “self-help” condition (n=83) reported lower negative affect after reading the stories compared to participants in the “no help” condition (n=80; mean difference=–3.97, 95% CI –7.72 to –0.22; P=.04) and the “informal/formal” help condition (n=75; mean difference=–3.70, 95% CI –7.55 to 0.14; P=.06). A key criticism of the stories was that they were unrelatable, but this sentiment was less prevalent among those in the “no help” condition. Key positives were that the stories included a realistic but hopeful outlook of recovery (less prevalent in the “informal/formal help” condition) and were supportive (less prevalent in the “no help” condition). ConclusionsWhile the inclusion of self-help strategies in a lived experience story reduced its impact on negative affect, the inclusion of self-help strategies or seeking help from others did not encourage help-seeking intentions. Making stories relatable, authentic, and providing multiple strategies for support might be key to encouraging help-seeking, but more research is needed.

BACKGROUND:Young people - aged 16-24 - are high users of digital technology. Online activity can be both beneficial for mental health and harmful. Appointments in general practice (GP) or primary care talking therapy provide opportunities to discuss online activity and its impact on mental health with young people. Such conversations could have preventive value by increasing awareness of problematic behaviours, identifying risk and suggest safer use strategies. However, little is known about whether such conversations are currently delivered in primary care. AIM:To explore practitioners views on discussing online activity and its role in the mental health of young people in primary care. DESIGN AND SETTING:Qualitative study with practitioners in GP and Talking Therapy Method: Semi-structured interviews with 24 practitioners, analysed using reflexive thematic analysis. RESULTS:Practitioners recognise helpful and harmful aspects to online activity, but there is variation in whether practitioners currently ask about online activity and whether they consider conversations appropriate for primary care. Several factors may shape confidence and decision making: practitioners own understanding of the online world; unable to change the impact on mental health or signpost to services; limitations in time, confidence or topic awareness. Practitioners identified a need for guidance and training to inform conversations about online activity. CONCLUSION:There is variation in whether conversations about online activity with young people are happening in primary care. The development of best-practice resources is required to ensure conversations are acceptable to young people and effective at changing problematic online activity to improve mental health.

Background: Self-harm and suicidal behaviour (SH&amp;S) among young people (YP) aged 14–21 is a major public health concern. When YP disclose SH&amp;S to adults, it is often those with whom they have ongoing trusted relationships, such as staff in schools and youth organisations. Experiences of accessing and receiving support in these settings are poorly understood. Objective: To explore the experiences of accessing and receiving support for SH&amp;S at school and youth organisations, for YP from varied backgrounds. Design: Qualitative study with a combination of interviews and focus groups. Setting and participants: 64 YP aged 14–21 across England, all with lived experience of SH&amp;S. Semi-structured topic guides covered experiences of seeking and receiving support for SH&amp;S. Framework analysis was used to generate themes. Results: YP had positive experiences where support was accessible, relatable, and flexible to fit individual needs. Education settings were widely perceived to play an important support role, and barriers to seeking help included concerns around privacy, confidentiality and lack of transparency and choice in processes. Youth organisations could be perceived as an unsuitable place to seek support. However, organisations centred on identity or lived experiences were often important for building trusted relationships whereby SH&amp;S could be disclosed. Conclusions: Creating organisational cultures that tackle SH&amp;S stigma, supported by appropriate resources and founded on positive relationships and clear communication is crucial. While YP identified key elements of existing SH&amp;S support in practice, further research could explore whether reported barriers and facilitators relate to differential effectiveness of prevention and intervention.

This qualitative study explored medical students’ decision making in relation to seeking help for mental health problems. Fourteen medical students participated in a set of three semi-structured interviews. Interviews explored students' experiences of distress and professional help-seeking for mental health problems. Data were analyzed using thematic analysis. All students experienced “stress” and seven had previously sought help. In deciding whether to seek help, students considered the meaning of difficult feelings, often attributing them to a stressful career. They considered mental health problems to be a sign of “weakness” which threatened their valued professional identity as a “strong” caregiver. Students questioned the acceptability of seeking help for mental health symptoms and believed they should know better than to seek help inappropriately. Concerns about confidentiality and career implications also led to reluctance to disclose symptoms, particularly thoughts of self harm. Busy timetables and distant clerkships imposed additional practical barriers to accessing support. The study highlights the complex interplay of individual, social, and cultural factors influencing medical students' help-seeking decisions. The findings resonate with sociological models of help-seeking, emphasizing the role of identity and perceived norms in shaping decisions. Medical educators should emphasize the importance of mental health in clinical as well as pastoral settings, and challenge unhelpful professional norms and stigma towards mental illness. Greater recognition of students' tendency to downplay suicidal thoughts may aid professionals in providing appropriate and timely support.

Youth mental health challenges are on the rise. Despite significant efforts to expand access, traditional approaches are unable to keep pace with the growing demand. While Artificial Intelligence (AI) has emerged as a promising solution to bridge the needs-provision gap, most clinicians remain unaware of the expanding range of AI tools. To support a clearer understanding of the field, this practitioner-focused commentary uses illustrative examples to explore current and future applications of AI in youth mental healthcare; address key challenges in adoption; and provide a practical framework for safe and effective integration into clinical practice. AI is becoming increasingly embedded in youth mental health care, with applications spanning early detection, diagnostic decision-making, treatment delivery, clinician training, and research acceleration. While these technologies hold significant promise, many remain insufficiently validated. For youth populations, regulatory gaps, algorithmic biases, digital inequities, and the potential for technological overdependence present distinct barriers to widespread adoption. AI is the future of youth mental health care. However, given the nascency of the field and the rapid proliferation of new tools, these technologies should be approached with thoughtful caution. To ensure safe and effective integration, clinicians are advised to use AI tools only within their area of expertise, apply them strictly within their defined therapeutic scope, and ensure alignment with legal and professional standards. Crucially, AI should serve as a complement – not a replacement – for traditional care, and may be unsuitable for youth with severe, complex, or rare clinical profiles.

Young people (YP) have long been underserved in mental health research. Co-production is part of a significant shift in youth mental health research from tokenistic involvement practices towards more genuine, meaningful collaboration with the group that the research affects: young people. This commentary reflects on learnings from a co-production process in the context of Can We Connect (CWC), a qualitative study on where YP seek mental health information online and their attitudes towards what is available. Young researchers were involved in planning, co-conducting the interviews, contributed to the data analysis and dissemination. Based on our shared experiences as a research team, we aim to provide insights into and recommendations for co-production within qualitative youth mental health research. We (n = 12, including 4 young researchers, aged 16-18) reflected on our experiences of either being, or collaborating with, a young researcher in CWC. For us, having young researchers in a research team brings (1) value to YP and (2) value to research. (3) Capitalising on differences is important, (4) having structured support for young researchers and (5) balancing levels of involvement. Open, transparent and honest communication is key to building trust, enabling young researchers to be meaningfully involved members of research teams.

Incorporating artificial intelligence (AI) into mental health applications (apps) can help to personalise support, for example through signposting topic-specific resources based on content that app users interact with. However, there is limited research exploring the acceptability of AI within digital mental health for young people. The current study explored this in the context of an online peer support platform for young people. 12 young people were interviewed online using a think aloud approach; they were aged 16–23 (M 18.64, SD 2.23). Participants identified as White (n = 7), Chinese (n = 1), Mixed Race (n = 1), Indian (n = 1), Black African (n = 1) and Bangladeshi (n = 1). 10 participants identified as women, one as non-binary and one preferred not to say. Participants were users of Tellmi, a pre-moderated mental health peer support app aimed at young people. Participants were given a link to a prototype of the Tellmi app via their web browser in which it was shown how AI could generate suggestions of pre-defined resources based on the content of fictional posts. Users were encouraged to interact with it whilst thinking aloud. Three themes were developed using reflexive thematic analysis: (1) Fear of the unknown - getting to grips with artificial intelligence; (2) AI can help save time and effort by streamlining processes; and (3) The value of human connection, which included the sub-theme: AI isn’t human and shouldn’t pretend to be.

BackgroundSocial networking site (SNS) users may experience mental health difficulties themselves or engage with mental health–related content on these platforms. While SNSs use moderation systems and user tools to limit harmful content availability, concerns persist regarding the implementation and effectiveness of these methods. ObjectiveThis study aimed to use an ethnographic walkthrough method to critically evaluate 4 SNSs—Instagram, TikTok, Tumblr, and Tellmi. MethodsWalkthrough methods were used to identify and analyze mental health content moderation and safety and well-being resources of SNS platforms. We completed systematic checklists for each of the SNS platforms and then used thematic analysis to interpret the data. ResultsFindings highlighted both successes and challenges in balancing user safety and content moderation across platforms. While varied mental health resources were available on platforms, several issues emerged, including redundancy of information, broken links, and a lack of non–US-centric resources. In addition, despite the presence of several self-moderation tool options, there was insufficient evidence of user education and testing around these features, potentially limiting their effectiveness. Platforms also faced difficulties addressing harmful mental health content due to unclear language around what was allowed or disallowed. This was especially evident in the management of mental health–related terminology, where the emergence of “algospeak,” where users adopt alternative codewords or phrases to avoid having content removed or banned by moderation systems, highlighted how users easily bypass platform censorship. Furthermore, platforms did not detail support for reporters or reportees of mental health–related content, leaving users susceptible. ConclusionsOur study resulted in the production of preliminary recommendations for platforms regarding potential mental health content moderation and well-being procedures and tools. We also emphasized the need for more inclusive user-centered design, feedback, and research to improve SNS safety and moderation features.

Despite the growing role of content moderation online, particularly in mental health spaces, there is limited research into the effectiveness of platform practices and a lack of user-driven evidence for regulatory guidance. This study aimed to explore user accounts of moderation related to self-harm and suicide (SH/S) content online, including their experiences of being moderated and perspectives on moderation practices. Additionally, where participants were also moderators, their experiences of moderating SH/S content were explored. 14 participants were interviewed at baseline, n = 8 at 3-months and n = 7 at 6-months. They also completed daily diaries of online use between interviews. Thematic analysis was used to explore perspectives. Three key themes were identified: ‘content reporting behaviour’, exploring factors influencing decisions to report content; ‘perceptions of having content blocked’, exploring experiences and speculative accounts of SH/S content moderation; and ‘content moderation and moderators’, examining participant views on moderation approaches and their experiences of moderating. This study revealed challenges in moderating SH/S content online, and highlighted inadequacies with current procedures. Participants struggled to self-moderate online SH/S spaces, showing the need for proactive platform-level strategies. Additionally, whilst the lived experience of moderators was valued, associated risks emphasised the need for supportive measures. Policymakers and industry leaders should prioritise transparent and consistent moderation practices.

Objective Self-harm and suicide-related online use can bring harms and benefits for users. Research suggests a need to improve user metacognition around online engagement to manage these conflicting effects, but behavioural interventions to achieve this are lacking. We aimed to analyse data from a 6-month longitudinal qualitative study, in which participants journalled about their self-harm and suicide-related online use as part of the study. Methods Participants were interviewed at three timepoints (n = 9 participants, 25 interviews) and completed a daily reflective diary between interviews. Experiences of diary use were explored qualitatively during interviews and in free-text diary entries. Results All participants derived benefits from journalling about their engagements with self-harm and suicide-related online content, such as increased insight about the nature and impact of their online use. Some in turn reported positive behaviour changes. However, daily completion was burdensome and some participants reported potential costs, including increased attention to self-harm content. Conclusions Journalling about online activity should be explored as potential individual-level intervention to tackle harmful online use and reduce linked mental health morbidity, both within and outside of clinical setting. Co-designed research with lived-experience users and practitioners will be essential for maximising safety and likely success.