Predicting recurrent chat contact in a psychological intervention for the youth using natural language processing.

Chat-based counseling hotlines emerged as a promising low-threshold intervention for youth mental health. However, despite the resulting availability of large text corpora, little work has investigated Natural Language Processing (NLP) applications within this setting. Therefore, this preregistered approach (OSF: XA4PN) utilizes a sample of approximately 19,000 children and young adults that received a chat consultation from a 24/7 crisis service in Germany. Around 800,000 messages were used to predict whether chatters would contact the service again, as this would allow the provision of or redirection to additional treatment. We trained an XGBoost Classifier on the words of the anonymized conversations, using repeated cross-validation and bayesian optimization for hyperparameter search. The best model was able to achieve an AUROC score of 0.68 (p < 0.01) on the previously unseen 3942 newest consultations. A shapely-based explainability approach revealed that words indicating younger age or female gender and terms related to self-harm and suicidal thoughts were associated with a higher chance of recontacting. We conclude that NLP-based predictions of recurrent contact are a promising path toward personalized care at chat hotlines.

Linguistic Variables and Gender Differences Within a Messenger-Based Psychosocial Chat Counseling Service for Children and Adolescents: Cross-Sectional Study.

BACKGROUND: Text messaging is widely used by young people for communicating and seeking mental health support through chat-based helplines. However, written communication lacks nonverbal cues, and language usage is an important source of information about a person's mental health state and is known to be a marker for psychopathology. OBJECTIVE: The aim of the study was to investigate language usage, and its gender differences and associations with the presence of psychiatric symptoms within a chat counseling service for adolescents and young adults. METHODS: For this study, the anonymized chat content of a German messenger-based psychosocial chat counseling service for children and adolescents ("krisenchat") between May 2020 and July 2021 was analyzed. In total, 661,131 messages from 6962 users were evaluated using Linguistic Inquiry and Word Count, considering the following linguistic variables: first-person singular and plural pronouns, negations, positive and negative emotion words, insight words, and causation words. Descriptive analyses were performed, and gender differences of those variables were evaluated. Finally, a binary logistic regression analysis examined the predictive value of linguistic variables on the presence of psychiatric symptoms. RESULTS: Across all analyzed chats, first-person singular pronouns were used most frequently (965,542/8,328,309, 11.6%), followed by positive emotion words (408,087/8,328,309, 4.9%), insight words (341,460/8,328,309, 4.1%), negations (316,475/8,328,309, 3.8%), negative emotion words (266,505/8,328,309, 3.2%), causation words (241,520/8,328,309, 2.9%), and first-person plural pronouns (499,698/8,328,309, 0.6%). Female users and users identifying as diverse used significantly more first-person singular pronouns and insight words than male users (both P<.001). Negations were significantly more used by female users than male users or users identifying as diverse (P=.007). Similar findings were noted for negative emotion words (P=.01). The regression model of predicting psychiatric symptoms by linguistic variables was significant and indicated that increased use of first-person singular pronouns (odds ratio [OR] 1.05), negations (OR 1.11), and negative emotion words (OR 1.15) was positively associated with the presence of psychiatric symptoms, whereas increased use of first-person plural pronouns (OR 0.39) and causation words (OR 0.90) was negatively associated with the presence of psychiatric symptoms. Suicidality, self-harm, and depression showed the most significant correlations with linguistic variables. CONCLUSIONS: This study highlights the importance of examining linguistic features in chat counseling contexts. By integrating psycholinguistic findings into counseling practice, counselors may better understand users' psychological processes and provide more targeted support. For instance, certain linguistic features, such as high use of first-person singular pronouns, negations, or negative emotion words, may indicate the presence of psychiatric symptoms, particularly among female users and users identifying as diverse. Further research is needed to provide an in-depth look into language processes within chat counseling services.

The association of socioeconomic status with the success of chat-based online counseling for children and youth: A latent change score modeling approach.

Children and youth from lower subjective socioeconomic status (SES) backgrounds are at a heightened risk of mental disorders. Online counseling is a valuable tool to reach those less likely to seek professional help, but its success across different SES backgrounds remains unclear. This study explores the association between subjective SES and online counseling outcomes. Children and youth (N = 2139) between 10 and 24 years-of-age received chat-based online counseling and reported on SES, negative feelings before and after the chat, and perceived helpfulness of the chat via an online assessment tool. The results of a latent change score model showed a significant association between SES and negative feelings before chatting, indicating that lower SES predicted more negative feelings (r = -0.26, p < .001). Further, SES was indirectly associated with the change in negative feelings from before to after counseling, mediated by the extent of negative feelings before the chat (ß = 0.07, 95%CFI = [0.05-0.10]). Current findings extend research on online counseling programs in the context of SES. Despite higher counseling needs among low SES individuals, they do not benefit proportionally from existing online services in this sample. Future research should investigate barriers to help-seeking and implement specialized counselor training programs.

Mindful self-focus-an interaction affecting Theory of Mind?

Is thinking about oneself helpful or harmful for understanding other people? The answer might depend on how a person thinks about themself. Mindfulness is one prominent construct that seems to affect the quality and content of a person's thoughts about themselves in the world. Thus, we hypothesize that the relationship between self-focus and Theory of Mind (ToM) is moderated by mindfulness. We evaluate our hypothesis with a large cross-sectional dataset (N = 543) of native and non-native German and English speakers using OLS and MM-estimated robust multiple regression analysis. We found a small but robust self-focus × mindfulness interaction effect on ToM so that there was a significant positive relation between self-focus and ToM for more mindful individuals and no significant relation for less mindful individuals. The findings support our hypothesis that mindfulness moderates the relationship between self-focus and ToM performance. We discuss the limitations and differences between the present study and previous findings.

Who are frequent chatters? Characterization of frequent users in a 24/7 messenger-based psychological chat counseling service for children and adolescents.

Background: Online helplines have shown a high acceptance, feasibility, and usability, especially with young people. Helplines usually aim to provide one-time crisis intervention; however, there are users who frequently use such services, tying a disproportionately large proportion of service capacities. To date, there is no research on the characterization of frequent users of online helplines. Therefore, the aim of the present study is to characterize frequent chatters in a chat-based counseling context. Methods: This cross-sectional study retrospectively analyzed anonymous data of users who approached the German messenger-based psychological chat counseling service krisenchat between May 2020 and July 2021 (N = 6657), with a focus on frequent users - the "frequent chatters". Frequent chatters were defined as those who received an above average (M + 2 ∗ SD) amount of messages from counselors over a period of one week and had at least 7 days of contact with the service over the entire data collection period. Chi-square-tests and Mann-Whitney-U tests were conducted to identify differences between frequent users and the population of all users. Results: In total, n = 99 (1.5 %) users met the definition for frequent chatters and accounted for roughly a tenth (9.85 %) of all chats of the service. The mean frequent chatter was 17 years old (M = 17.29, SD = 3.56), female (n = 78, 82.1 %), and approached the service in the late afternoon (M = 5:00 pm, SD = 5:25 h). Compared to the general user population, frequent chatters reported significantly more severe concerns to counselors, of which 81.8 % included psychiatric symptoms, such as suicidality (43.4 %) and non-suicidal self-injury (41.4 %). In addition, frequent chatters were significantly more likely to contact krisenchat alongside the use of other professional help services. Further, frequent chatters wrote significantly longer and more messages during the counseling process and within a session than the general user population of krisenchat. Compared to the general user population, frequent chatters did not differ in their satisfaction with the service. Conclusion: Frequent users are known from telephone helplines and are also represented in a chat-based context. Compared to the general user population, they are more likely to report serious mental health conditions and half of them currently receive professional help, suggesting a high need for social support. In light of the increasing development of chat-based helplines, there is a need for further research on frequent chatters to develop tailored counseling strategies for their needs and to analyze options for an optimized service provision. Study registration: DRKS00026671.

The Impact of a Messenger-Based Psychosocial Chat Counseling Service on Further Help-Seeking Among Children and Young Adults: Longitudinal Study.

BACKGROUND: Mental crises have high prevalences in adolescence. Early interventions appear to be highly important to diminish the risk of the deterioration, recurrence, or chronification of symptoms. In recent years, various providers have started offering live chat support in psychological crises. The messenger-based psychological counseling service krisenchat aims to support young people in crises and, if necessary, provide a recommendation for a referral to the health care system or to seek further help from a trusted adult person. OBJECTIVE: This study aimed to investigate the impact of using the counseling service of krisenchat on the further help-seeking behavior of young people, and to identify associated factors of further help-seeking. METHODS: This longitudinal study analyzed anonymous data from 247 individuals who used krisenchat between October 2021 and March 2022, and received a recommendation for further help-seeking. An online survey directly after the chat assessed the perceived helpfulness of the chat and well-being after the chat. After 4 weeks, further help-seeking, facilitators and barriers to help-seeking, and self-efficacy were assessed in an online follow-up survey. RESULTS: The most frequently recommended services or persons to seek further help from included a psychotherapist or social psychiatric service (75/225, 33.3%), a school psychologist or school social worker (52/225, 23.1%), and the user's parents (45/225, 20.0%). Of the 247 users, 120 (48.6%) indicated that they contacted the recommended service or person, and of these, 87 (72.5%) stated that they already had an appointment (or talk) with the respective service or person or that an appointment (or talk) was scheduled. The most frequently reported facilitators for further help-seeking were mental health literacy (54/120, 45.0%), improvement of self-efficacy (55/120, 45.8%), and symptom recognition (40/120, 33.3%). In users not displaying further help-seeking behavior, the most frequent barriers included stigmatization (60/127, 47.2%), lack of mental health literacy (59/127, 46.5%), need for self-reliance and autonomy (53/127, 41.7%), and negative family beliefs regarding help services (53/127, 41.7%). Subgroup comparisons indicated significantly higher levels of self-efficacy in users displaying further help-seeking behavior than in those not displaying further help-seeking behavior. Both subgroups did not differ in gender, age, recommended service or person, chat topics, perceived helpfulness, and well-being. CONCLUSIONS: The findings of this study indicate that children and young adults receiving counseling on krisenchat benefit in terms of seeking further help. Further help-seeking seems to be associated with higher levels of self-efficacy. TRIAL REGISTRATION: Deutsches Register Klinischer Studien DRKS00026671; https://tinyurl.com/4fm5xe68.

Suicidal Ideation Among Children and Young Adults in a 24/7 Messenger-Based Psychological Chat Counseling Service.

Background: Suicidality in children and young adults is a pervasive problem: approximately 40% of respondents in epidemiological surveys in German schools reported suicidal ideation, while up to 9% reported a suicide attempt in the past. While there is compelling evidence for the effectiveness of telephone-based hotline services, an increasing preference of adolescents for messenger-based counseling services can be observed. Therefore, the present study aims to investigate the utilization behavior and user satisfaction of users contacting a German messenger-based chat counseling service ("krisenchat") regarding suicidal ideation. Methods: The present cross-sectional study analyzed retrospective anonymous data on sociodemographic variables, utilization behavior, and user satisfaction of krisenchat users who used the service between May 2020 and July 2021. Chi-square-tests were used to identify associations of sociodemographic characteristics and utilization behavior with suicidal ideation. Mann-Whitney-U-tests were used to compare the user satisfaction and the recommendation-to-others-rate between suicidal and non-suicidal krisenchat-users. Results: In total, chat data of N = 11,031 users were collected. Of the n = 6,962 users included in the final analysis, n = 1,444 (20.7%) contacted krisenchat because of suicidal ideation. The average user experiencing suicidal ideation was 17 years old, female and currently not receiving other treatment. Further, suicidal ideation was significantly and positively associated with age and non-suicidal self-injury. Regarding utilization patterns, there were significant positive associations between suicidal ideation and counseling session count, mean amount of messages sent, and mean amount of words used per message by the user. User satisfaction was high, with 64.7% (n = 413) of users that answered the feedback survey and experiencing suicidal ideation rating the help they received as at least "good" and a recommendation rate of 89.6% (n = 571). Most importantly, no differences were found between users reporting suicidal ideation and those that do not regarding satisfaction and the probability of recommending the service. Conclusion: Results imply satisfaction with the counseling service among users with suicidal ideation. Nevertheless, there is a need for further research into messenger-based counseling services regarding the prevention of suicidal behavior in children, youths, and young adults. Longitudinal studies are especially needed to assess the effectiveness of messenger-based interventions. Study Registration: DRKS00026671.

Acceptability and feasibility of a messenger-based psychological chat counselling service for children and young adults ("krisenchat"): A cross-sectional study.

BACKGROUND: Adolescence represents a vulnerable period to experience personal crises or mental health problems. However, many concerns stay unnoticed due to the hesitance of young people to seek help and the unavailability and inaccessibility of appropriate help services. Contemporary interventions have been developed incorporating with target group specific needs and preferred modes of communication. krisenchat (German for "crisis chat") is a German low-threshold chat-based psychosocial crisis counselling service that is available around-the-clock. Despite the growing number of online support services, there is a dearth of research regarding the acceptability, usability, and feasibility. METHODS: The present cross-sectional study analyzed retrospective anonymous data on sociodemographic variables, utilization behavior, and user satisfaction of all krisenchat users between May 2020 and July 2021. Predictors of user satisfaction were identified using exploratory multiple regression analysis. Subgroup analyses were conducted using chi-square-tests to identify differences in user satisfaction. RESULTS: Data of N = 6962 users was included in the analysis. More than 50% of those reported not having contacted the professional health care system before. The mean user of krisenchat was 17 years old (M = 16.6, SD = 3.5), female (female: 83.4%, male: 14.7%, diverse: 1.8%), and first approached the service at 4 PM (M = 4:03 PM, SD = 5:44 h). More than 60% of the users contacted the service between 4 PM and 12 AM, 10% even between 12 AM and 8 AM. The most frequent chat topics were concerns regarding psychiatric symptoms (60.1%), psychosocial (34.0%) or emotional distress (30.2%). The majority of the users (64.7%) reported high levels of satisfaction and 88.3% a high likelihood (60% or more) of recommending krisenchat to others. Also, the results indicate that the number of messages and their respective length differed between users and counsellors, with users writing several, but shorter messages and counsellors replying with fewer, but longer messages. CONCLUSION: The results of the present study imply a high acceptability and feasibility of krisenchat. Overall, there is a high need for a 24/7 messenger-based chat counselling service in crises for children and young adults. Currently, there is no other online service for youth that is available after 7 PM or at weekends, which indicates the great importance of krisenchat and its function to bridge a current gap in the mental health care system. A need for further research emerges e.g., for subgroup differences regarding utilization patterns and also for further insights regarding help-seeking behavior via social media in youth. STUDY REGISTRATION: DRKS00026671.

Does Intraindividual Variability of Personality States Improve Perspective Taking? An Ecological Approach Integrating Personality and Social Cognition.

Research integrating cognitive abilities and personality has focused on the role of personality traits. We propose a theory on the role of intraindividual variability of personality states (hereafter state variability) on perspective taking, in particular, the ability to infer other peoples' mental states. First, we review the relevant research on personality psychology and social cognition. Second, we propose two complementary routes by which state variability relates to anchoring and adjustment in perspective taking. The first route, termed ego-dispersion, suggests that an increased state variability decreases egocentric bias, which reduces anchoring. The second route, termed perspective-pooling, suggests that an increased state variability facilitates efficient adjustment. We also discuss how our theory can be investigated empirically. The theory is rooted in an ecological interpretation of personality and social cognition, and flags new ways for integrating these fields of research.