Digital Mental Health Intervention for Nonsuicidal Self-Injury in Young Adults

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PROJECT SUMMARY Nonsuicidal self-injury (NSSI) is estimated to affect 13% of young adults and is associated with considerable burden, including significant role impairment in daily life, increased risk of developing a mental health disorder, hospitalization, permanent scarring. Repeated NSSI is also associated with high lifetime risk of suicide. Timely interventions aimed at NSSI reduction could have a significant impact on improving mental health and suicide prevention. However, around 50% of young adults never disclose their NSSI to anyone, and far fewer ever seek professional help. Despite these low rates of disclosure and engagement with formal mental healthcare, young people with NSSI report interest in, and receptivity to, digital mental health interventions (DMHIs). Research has shown the effectiveness of DMHIs when applied to treat common mental health conditions, such as depression and anxiety. Given NSSI’s prevalence, the potential for the behavior to result in severe and lethal outcomes, and young adults’ openness to DMHIs, an effective and usable DMHI for NSSI could provide a unique, accessible, and scalable treatment option. We aim to design, develop, and conduct a feasibility trial for a low-intensity DMHI for young adults with repeated NSSI, which can meet the need to provide services to individuals unlikely to engage in formal treatment. Two key challenges for DMHIs are maintaining participant engagement and supporting skill implementation in critical moments of distress. Our DMHI will address challenges with engagement through the use of a highly interactive conversational agent and by evaluating the added benefit of a coach. Our DMHI will also tailor content and interactions to the user’s current state, by using ecological momentary assessment to assess NSSI risk and initiate relevant in-the-moment interventions to support users in implementing new coping strategies. The primary goals of the project are to: (1) design and develop a DMHI for young adults with repeated NSSI, in close collaboration with potential users from this population; (2) examine the feasibility of conducting a 3-arm randomized control trial of the self-guided DMHI treatment and the DMHI treatment with low-intensity coaching, compared to a wait-list control, with frequency of NSSI behaviors and urges as the primary outcomes, and suicidal ideation and depression, anxiety, and borderline personality disorder symptom severity as secondary outcomes; and (3) explore the mediational effects of psychological targets (emotional, cognitive, and behavioral regulation; self-efficacy to resist NSSI) and engagement targets (app use and subjective engagement) on NSSI frequency and urges. This program of research aims to produce a scalable DMHI for NSSI, based on validated psychological strategies.