Overview and aims:
Self-harm is highly prevalent among university students, but rates of help-seeking are very low and many feel unable to disclose their self-harm. Digital tools may help students who self-harm to overcome these barriers of access, providing support without needing to formally disclose self-harm before they feel ready or able to. Smartphone ownership is ubiquitous amongst students, so a smartphone app may be particularly accessible.
Research has shown that students find smartphone apps acceptable and effective for various mental health difficulties, but research is limited on evaluating apps for students who self-harm.
To explore the acceptability and helpfulness of an app for students who self-harm, this project addressed four main research questions:
- What mHealth interventions are available for individuals struggling with self-harm?
- Are apps for self-harm acceptable to university students, and how do they compare to other support for self-harm?
- Is a smartphone app acceptable and safe for students who self-harm?
- Is a self-help smartphone app helpful for improving the wellbeing of university students who self-harm, and can it be successfully implemented?
Sample:
Participants for this project were university students from one UK university with either current or previous experience of self-harm thoughts and/or behaviours. Here, self-harm was broadly defined as any intentional act of self-injury of self-poisoning irrespective of the motivation.
What did we do?
The first study in this project looked to identify if any mHealth interventions had already been developed for or evaluated with university students and, if not, if any may be appropriate for this population. In the second study, interviews explored how university students perceive and experience different interventions for self-harm and whether a smartphone app may be acceptable. Here, it was also explored how students perceive ‘recovery’ from self-harm, and what they want interventions to achieve. The third study then evaluated the safety and acceptability of a smartphone app with students attending university wellbeing services. The app was used alongside treatment as usual to ensure that participants had another source of support and were safe while using the app. Pre-post mental health and self-harm measures were used, as were follow up interviews to explore the perceived impact of the app and their experiences using it. Finally, the app was made available for download (anonymously) by anyone at the university and pre-post measures were again used to evaluate the impact. These included questionnaires assessing depression, anxiety, coping self-efficacy, coping styles, self-harm, and the experience of the app.
What did we find?
Firstly, it was found that there were no mHealth self-harm interventions that had been developed or evaluated with students. However, the app ‘BlueIce’ was identified as having the potential to be helpful and appropriate for students. In the second study, students corroborated the findings that they struggle accessing support for self-harm, and that digital tools like smartphone apps would be a welcome source of support. However, some students noted that apps may not be sufficient for everyone, reiterating the idea that they are indeed not a ‘one size fits all’ solution. Students reported that interventions should take a holistic approach to addressing self-harm, taking their wider wellbeing into account rather than focusing on reducing self-harm behaviours. Developing coping skills in particular was noted as a key outcome. Next, BlueIce evaluated alongside counselling found it to be safe and acceptable. In interviews students reported that BlueIce helped them to feel more able to cope and understand their self-harm triggers better. They also felt that it could be more broadly useful to students struggling with various mental health issues. Lastly, pre and post data in the final study identified significant reductions in symptoms of anxiety, depression, and self-harm urges. Significant increases in coping self-efficacy and in positive coping styles were also found following BlueIce use. Qualitative survey feedback indicated that BlueIce helped participants to feel more hopeful and they were more able to process their emotions in adaptive ways.
Project team:
University of Bath, UK: Bethany Cliffe, Paul Stallard
Funders/Supporters
This study was funded by the University of Bath
Publications and other outputs:
Cliffe, B., Tingley, J., Greenhalgh, I., & Stallard, P. (2021). mHealth Interventions for Self-Harm: Scoping Review. Journal of Medical Internet Research, 23(4), e25140.
Cliffe, B., & Stallard, P. (2022). University students’ experiences and perceptions of
interventions for self-harm. Journal of Youth Studies, 0(0), 1–15.
https://doi.org/10.1080/13676261.2022.2033187
Cliffe, B., Stokes, Z., & Stallard, P. (2022). The Acceptability of a Smartphone App (BlueIce)
for University Students Who Self-harm. Archives of Suicide Research, 0(0), 1–17.
https://doi.org/10.1080/13811118.2021.2022552
Contact for further details: Bethany.cliffe@bristol.ac.uk