13 Reasons Why: Perceptions and Correlates of Media Influence in Psychiatrically Hospitalized Adolescents.

OBJECTIVE: The Netflix series 13 Reasons Why (13RW) has sparked controversy due to graphic depictions of youth suicide, bullying, and sexual assault. However, further research is needed examining experiences of the show among youth with psychiatric illness. This exploratory, mixed-methods study examines adolescents' perceptions of 13RW and associations among viewership, suicide-related media influence processes, and self-injurious thoughts and behaviors (SITBs). METHOD: Participants were 242 adolescents hospitalized in a psychiatric inpatient facility; 60.7% female, 30.2% male, 9.1% other genders; ages 11 to 18; and 74.3% White, 7.5% Black, and 21.8% Hispanic. Participants completed measures of series viewership, media message processing, and SITBs. Participants who watched completed open-ended questions regarding beliefs and opinions about the series. RESULTS: In all, 50.4% of participants watched 13RW, with girls (63.3%) more likely to have watched than boys (26.0%). More than half (55.9%) of youth expressed negative reactions to the show, while approximately one-third (33.8%) expressed positive reactions. Having watched the series was associated with greater likelihood of past-year non-suicidal self-injury (NSSI), but not with suicidal ideation or past-year suicide attempts. Youth's interpretation of media messages in 13RW, including greater identification with and perceived likeability of the main character, were associated with suicidal ideation and past-year NSSI. CONCLUSIONS: Findings suggest high rates of 13RW viewership among psychiatrically hospitalized youth, particularly girls, and provide insight into factors that may affect youths' vulnerability to suicide-related media effects.

Social media use and self-injurious thoughts and behaviors: A systematic review and meta-analysis.

Despite considerable public and scholarly debate about the role of social media in self-injurious thoughts and behaviors (SITBs), no comprehensive, quantitative synthesis of this literature has previously been undertaken. The current systematic review and meta-analysis examines associations between social media use and SITBs, including suicidal ideation, suicide plans, suicide attempts, and nonsuicidal self-injury (NSSI). A range of social media behaviors and experiences were identified, including cybervictimization and perpetration, exposure to and generation of SITB-related content, problematic use, sexting, social media importance, and frequency of use. A systematic search of PsycINFO, Medline, CINAHL, and the references of prior reviews yielded 61 eligible studies. Results largely suggested medium effect sizes for associations between specific social media constructs (cybervictimization, SITB-related social media use, problematic social media use) and SITBs. There was no association between frequency of social media use and SITBs; however, studies on this topic were limited. The majority of studies identified focused on cybervictimization, and results suggested positive associations with all SITBs, with the association between cybervictimization and suicidal ideation stronger for adolescents than adults. Overall, findings highlight the utility of examining specific social media behaviors and experiences, and point to the need for more research in this area.

A Process Evaluation of a Substance Use Brief Intervention for Adolescents in a Psychiatric Inpatient Program.

The present study represents a two-phase process evaluation of the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) on an adolescent psychiatric inpatient unit. The first phase analyzed uptake efforts using chart review data, which revealed that 158 (16.8%) of 942 hospitalized patients (Mean age = 15.81, SD = 1.24) were eligible to receive the brief intervention; however, only 30 (19%) adolescents received the intervention, 15 (9.5%) declined treatment, and 113 (71.5%) were never offered. The second phase involved directed content analyses of clinical staff and providers' perceived facilitators and barriers to the implementation. Qualitative findings revealed that providers and staff accepted and agreed with the use of the brief substance use intervention, though perceived time constraints, competing demands, and insufficient staffing interfered with implementation across disciplines. Barriers included patients' length of stay and competing treatment priorities. Several recommendations emerged including, utilization of non-clinical staff, a clear administration protocol, and the use of computer-based interventions. Findings from the present study shed light on the need to consider alternate or more streamlined substance use treatments such as computerized approaches and focus on ways in which protocol can be modified to fit the needs within an acute, short-term setting.