Impact of online mental health screening tools on help-seeking, care receipt, and suicidal ideation and suicidal intent: Evidence from internet search behavior in a large U.S. cohort.
Impact of online mental health screening tools on help-seeking, care receipt, and suicidal ideation and suicidal intent: Evidence from internet search behavior in a large U.S. cohort.
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DOI：
10.1016/j.jpsychires.2020.11.010
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发表时间：
2022-01
影响因子：
4.8
通讯作者：
Barr PJ
中科院分区：
文献类型：
--
作者：
Jacobson NC;Yom-Tov E;Lekkas D;Heinz M;Liu L;Barr PJ
大多数患有精神疾病的人在发病后近十年都没有接受治疗。在线心理健康筛查反映了一种旨在缩短这种求助滞后的机制，然而，关于筛查工具在自然环境中的有效性的研究有限。我们通过必应搜索引擎对一组人进行了心理健康筛查（n=126,060）。我们评估了工具内容对后来搜索心理健康自我参考、自我诊断、寻求护理、精神活性药物、自杀意念和自杀意图的影响。网站的特点是由一对独立的评分者来评估，以确定屏幕类型和内容。这些包括是否存在暗示性诊断，关于可解释性的信息，以及转介到数字治疗，面对面治疗和危机服务。使用机器学习模型，结果表明，屏幕内容预测了随后的搜索，包括心理健康自我参考（AUC = 0.73）、心理健康自我诊断（AUC = 0.69）、心理保健寻求（AUC = 0.61）、精神活性药物（AUC = 0.55）、自杀意念（AUC = 0.58）和自杀意图（AUC = 0.60）。cox比例风险模型显示，使用现场护理转诊工具的个体随后更有可能寻找积极结束生命的方法（HR = 1.727, p = 0.007）。在线屏幕可能影响求助行为、自杀意念和自杀意图。推荐面对面治疗的网站可能会使人们面临更大的主动自杀意图的风险。需要使用大规模随机对照试验进行进一步评价。
Most people with psychiatric illnesses do not receive treatment for almost a decade after disorder onset. Online mental health screens reflect one mechanism designed to shorten this lag in help-seeking, yet there has been limited research on the effectiveness of screening tools in naturalistic settings. We examined a cohort of persons directed to a mental health screening tool via the Bing search engine (n=126,060). We evaluated the impact of tool content on later searches for mental health self-references, self-diagnosis, care seeking, psychoactive medications, suicidal ideation, and suicidal intent. Website characteristics were evaluated by pairs of independent raters to ascertain screen type and content. These included the presence/absence of a suggestive diagnosis, a message on interpretability, as well as referrals to digital treatments, in-person treatments, and crisis services. Using machine learning models, the results suggested that screen content predicted later searches with mental health self-references (AUC =0·73), mental health self-diagnosis (AUC = 0·69), mental health care seeking (AUC = 0·61), psychoactive medications (AUC = 0·55), suicidal ideation (AUC = 0·58), and suicidal intent (AUC = 0·60). Cox-proportional hazards models suggested individuals utilizing tools with in-person care referral were significantly more likely to subsequently search for methods to actively end their life (HR = 1·727, p = 0·007). Online screens may influence help-seeking behavior, suicidal ideation, and suicidal intent. Websites with referrals to in-person treatments could put persons at greater risk of active suicidal intent. Further evaluation using large-scale randomized controlled trials is needed.
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