Negative online experiences and reporting rates in youth with mental health conditions

ImportanceNegative online experiences (NOE) are highly prevalent and pose significant dangers for youth with mental health and neurodevelopmental conditions. ObjectiveIdentify risk factors of NOE and reporting barriers in youths. DesignCross-sectional survey study (January to July 2023) and qualitative follow-up study (March to May 2023). SettingA community-based sample from the Child Mind Institutes Healthy Brain Network (HBN), a transdiagnostic research initiative in New York. ParticipantsA total of 1,009 youth aged 9-15 years (mean [SD] age, 11.79 [1.71] years; 585 [58.55%] male) completed a 310-item quantitative survey. The qualitative follow-up study (n=109) included four administrations of a 3-day online bulletin board. Exposure(s)Not applicable. Main Outcomes and MeasuresMain outcomes include prevalence and risk factors of NOE and reporting behaviors and barriers. Qualitative analyses provided insights into youths mental models and cognitive schemas about different NOE forms. ResultsOf the 1,129 enrolled participants, 1,009 participants completed the study (89.37%). Over one-fourth (265 [26.6%]) encountered NOE in the past year, with 182 [68.7%] reporting multiple incidents. However, only 53 [20.0%] reported the incident. Mental health symptoms (p<.01) and parenting styles (p<.001) increased the risk of NOE. Factor analyses identified three key reporting barriers: Reporting Process, Reporting Policy, and Emotional Barriers. Age, social aptitude, mental health symptoms, and parenting styles predicted the likelihood of experiencing the reporting barriers. Analyses of the qualitative follow-up study noted that youths decision-making process regarding reporting considers three areas: degree of malice, perpetrators intent, and included NOE forms. Ambiguity in these areas contributed to higher reporting uncertainty. Conclusions and RelevanceFindings highlight a gap between the prevalence of NOE and reporting rates in youths with mental health and neurodevelopmental conditions. Demographic, clinical, and parenting factors were risk factors of experiencing NOE or a reporting barrier, underscoring the need for targeted and multifaceted solutions. Potential solutions to aid in safer online spaces are proposed for policymakers, technology developers, clinicians, and educators. Key pointsO_ST_ABSQuestionC_ST_ABSWhen encountering negative online experiences (NOE), what influences reporting likelihood in youth with mental health conditions? FindingsHigh prevalence and low reporting rates of NOE were observed. Analyses identified Reporting Process, Reporting Policy, and Emotional as key reporting barriers. Parenting styles, mental health symptoms, and demographics were associated with increased likelihood of experiencing NOE or the identified barriers. The qualitative follow-up study provided insights into youths thought processes regarding NOE. MeaningOur findings document key reporting barriers in children and adolescents with mental health and neurodevelopmental conditions and potential suggestions to aid in the development of safer online spaces.