In the US, approximately one in five adolescent and young adults have seriously thought about suicide and one in 11 have made a suicide attempt. Unfortunately, a third to half of adolescent and young adults who are experiencing suicidal and self-injurious thoughts do not seek professional help and when they do, there is a nationwide shortage of mental health professionals available to support them. When adolescent and young adults are in distress, many seek out support and validation through social media. Some content can be helpful and allow them to find a community where they feel connected, receive the support they need, or share effective coping strategies. Other content can be harmful by encouraging them to commiserate and share or promote harmful coping strategies.
TikTok is the most popular digital platform currently used by over 63% of US adolescent and young adults. Its content recommendation algorithms select and display highly personalized content to each individual user such that the more a user engages with a specific type of content, the more this content will be displayed to them. Many other social media platforms are developing similar content recommendation algorithms to increase user engagement. For adolescent and young adults who are experiencing suicidal thoughts and urges, these content recommendation algorithms can amplify their exposure to suicide-related content and increase suicide risk. The purpose of our project is to identify TikTok content and usage behaviors that increase suicide risk. These findings can inform the development of social media interventions for adolescent and young adults who are experiencing suicidal thoughts and urges.
Patient Population: Young Adults
Monitoring mood symptoms in young adults at-risk for bipolar disorder
The ages of 18-25 years are ‘peak onset’ times of major depression and bipolar disorder. These disorders have different courses and treatments, but diagnosing bipolar disorder is difficult because manic symptoms occur less often than depressive symptoms and many individuals do not recall manic symptoms. A ‘misdiagnosis lag’ of 8-10 years can contribute to prolonged periods of potentially ineffective treatments and suboptimal outcomes such as high symptom burden, relationship problems, educational attainment and occupational functioning.
This project will use remote prospective assessment and monitoring of depressive and manic symptoms in at-risk patients in-between patient visits to increase the ‘data points’ clinicians have when assessing a bipolar disorder diagnosis. This is especially important for people at risk for bipolar disorder (for example those with a family history of bipolar disorder) because manic symptoms can be provoked by first-line medication treatments for major depression. The project will use a new manic symptom measure (the Patient Mania Questionnaire-9) and a commonly used depressive symptom measure (the Patient Health Questionnaire-9) to monitor symptoms, and learn how clinicians and patients use this information clinically.
Reducing barriers to accessing mental health care using a web-based program for young adults
Most young adults with mental health (e.g., depression, anxiety) or substance use disorders do not receive treatment. Untreated mental health and substance use can be associated with impairments in social relationships, overall functioning and suicide. National data indicate that almost half of young adults with symptoms of a mental health disorder reported they needed mental health care in the past year but did not access those services. Barriers to accessing mental health care include stigma, not knowing where to go, lack of transportation and cost.
This project aims to develop a personalized web-based program for young adults to reduce self-reported barriers and increase motivation to access mental health and substance use services. Investigators will work with clinicians and young adults to develop strategies and solutions to address the identified barriers. The team will work with a community advisory board to develop program content that will be further refined through focus groups and individual interviews with young adults and clinicians. From this, the team will develop the web-based program which will serve as the first step needed to establish a larger program of research focused on reducing barriers and increasing access to mental health care to improve young adult well-being.
Housing stability for youth
The Housing Stability for Youth (H-SYNC) model was developed by the UW CoLab team in collaboration with Snohomish and Kitsap County workgroups and is intended to serve as a prevention tool for youth homelessness. Specifically, it’s designed to identify youth at risk of or currently experiencing homelessness within existing processes in juvenile court systems and refer youth and their families to appropriate prevention and housing services via a stepped-care navigation model. The court system serves as a pivotal resource for the identification of these populations in need due to the high frequency of police and court contact these populations experience. This model is being implemented in four counties in Washington State, including King, Snohomish, Kitsap, and Okanogan Counties and in collaboration with community-based organizations such as the YMCA of Greater Seattle, Cocoon House, and Kitsap Mental Health Services.
As of 2022, H-SYNC prevention program is coordinated by the Y Social Impact Center at the YMCA of Greater Seattle. H-SYNC now represents a state-wide partnership between juvenile courts and local social service providers across counties including King, Snohomish, Peirce, Spokane, Okanagan and Kitsap.
Opportunity Based Probation
Opportunity-Based Probation (OBP) is a new juvenile probation model that expands on adolescent development research by leveraging adolescents’ drive towards independence as well as their heightened receptivity to rewards. In collaboration with their probation officers, youth create meaningful goals and incentives that reward the development of prosocial behavior. Probation officers scaffold prosocial behavior by reinforcing success and constructively addressing probation violations and problem behaviors. OBP was originally developed through a collaboration between UW CoLab and juvenile court leadership in Pierce County, Washington with funding from the Annie E. Casey Foundation and is now being implemented, refined, and tested for acceptability, implementation, and preliminary effectiveness. In 2021, a second OBP site was started in Hartford County, Connecticut and is currently undergoing co-design and implementation efforts with an eye for eventual testing and expansion statewide.
Accelerating research use in courts
Measuring the use of research evidence within organizations and systems is a rapidly growing area of study in the social sciences as researchers, policymakers, and practitioners in a variety of systems try to bridge the research-to-practice gap. With growing calls for justice systems, especially juvenile justice systems, to integrate developmental and behavioral health science within all aspects of the justice process, it is critical to develop a standardized measure of how individuals use research evidence within these systems. This will allow researchers to examine how research is used across studies, sites, and points in time, as well as to refine and compare new interventions aimed at increasing the use of research. Toward this end, the UW CoLab research team with the help of the William T. Grant Foundation, is developing and validating a measure of research use with collaborators nationwide.
Development of an interactive, web-based drinking to cope intervention and tools to assess coping skill utilization
This project will develop and test an interactive web-based intervention with text-message reminders for young adults who drink to cope with negative affect. The intervention will include interactive modules on CBT coping skills, assignments to practice the skills, text-message reminders, and weekly assessments on coping skill utilization and barriers to use. A total of 120 young adults will be randomized to the 4-week, web-based drinking to cope intervention (n=60) or an assessment only control (n=60) and complete a 1- and 3-month follow-up.
Project VERO: Development and Testing of a Personalized Normative Feedback Intervention for Young Adult Vaccine Hesitancy
Project VERO will develop and test a personalized normative feedback intervention to reduce vaccine hesitancy among young adults. Phase one entails rapid prototyping – utilizing concepts from user experience research – to refine the content and design of the brief intervention. The second phase entails an RCT enrolling unvaccinated young adults from around the US to fully test the efficacy of the intervention in terms of vaccine uptake, intentions, and attitudes towards vaccination. This project is conducted in collaboration with Drs. Jennifer Duckworth (Washington State University) and Cynthia Stappenbeck (Georgia State University).
Affective Dynamics Associated with Simultaneous Alcohol and Marijuana Use Outcomes among a High-risk Sample of Young Adults
The proposed F32 aims to conduct a secondary analysis of time-intensive daily data (MPIs: Lee/Patrick; R01AA025037) to elucidate the roles of affect and affective dynamics on simultaneous alcohol and marijuana (SAM) use outcomes among a sample of high-risk adults (N = 409). We will test whether theoretically-relevant affective dynamic processes (affective instability, negative emotion differentiation): (1) are more useful for predicting SAM use and alcohol use than mean level of affect (within- and between-subjects); (2) prospectively predict changes in SAM use and use-related problems over time; and (3) can distinguish SAM use from single substance use patterns, which has direct implications for the personalization and precision of prevention and intervention efforts.
NORTH: Developing a mobile health intervention to support treatment seeking in early psychosis
The proposed research project proposes to develop and test a mobile intervention, Normalizing Orientation to Treatment and Help-Seeking (NORTH) designed to impact knowledge and attitudes to encourage help-seeking among young adults at risk for psychosis. This project involves (1) a needs assessment to understand barriers, interests and preferences related to mHealth and in-person treatment, (2) development, refinement and usability testing of NORTH, and (3) a pilot randomized controlled trial assessing feasibility, acceptability and preliminary efficacy compared to an active control mHealth intervention providing only stress management.
