Youth mental health support and education via peer moderated online discussion boards: A pilot study Derek Richards (1), Thomas Richardson (2), Eoin Pluinceid (2) (1) Student Counselling Service, Trinity College, Dublin. (2) Peer Support Network, Trinity College, Dublin.

Introduction Student mental health - Students have a particular vulnerability to mental ill health due to: - Age (Rana et al., 1999) - Academic stress (Tyrell, 1992) - Financial difficulties (Roberts & Zelenyanszki, 2002) - High levels of drug and alcohol use (Ramstedt & Hope, 2005) - Poor coping mechanisms (Hope et al., 2005) Students have high levels of depression (USI, 2003); link between depression and suicide well-established (Williams & Whitfield, 2001). Age group of 20-30 have highest suicide rate in Ireland (Callahan & Chambers, 2004); majority of students within this age range Reluctance to seek help (Hope et al., 2005) Preference for peer support (83%) outweighs preference for talking to a counsellor (6%) or medical professional (7%) - Peer Support Network in TCD only 16 face-to-face referrals a year (Rashleigh, 2006)

Introduction Internet and mental health Those who are reluctant to use face-to-face services, in particular men, are more likely to use the internet for such services (Begley, 2004; Kracen, 2003) Advantages of transferring peer support online outweigh disadvantages (White & Dorman, 2001) - Benefits of online support include: - Anonymity (Kummervold et al., 2002) - Disinhibition (Joinson, 1998) - 24 hour access (Finfgeld, 2000) Student’s highest users of internet and ICT in Ireland (Demuenter, 2006) Students use internet to seek help and support (Escoffey, 2005) This study used the unique approach of using discussion boards solely moderated by peers - Our hypothesis was that such an approach has potential as a supportive and educational intervention for student mental health

Design & Method Website established with electronic discussion boards Users had to register in case of emergency and to obtain demographic data - 3 main forums: -Stress and the college student - Academic anxiety - Depression and apathy These relate to three highest reasons for referral to TCD SCS (TCD SCS, 2005) 7 volunteers from PSN assigned to moderate discussion boards Additional qualitative analysis made on posts from depression and apathy board for its overall popularity - Categories from Salem et al. (1998) used to code posts, double-blind inter-rater coding used achieving Cohen’s kappa of 0.88.

Results Use of boards Over 10-week period 389 students registered, 25 actively posted ‘Depression and apathy’ board had 37 posts and 2686 page views - 53% of user posts were made outside of weekday 9-5 hours Disinhibition - High levels of disclosure (87%) - 9% of users made a direct reference to having suicidal thoughts: “ constant suicidal thoughts….won’t go away” - 45% of users had some indirect reference to suicidal thoughts: “I just don’t feel happy any longer, sometimes I wish it could be over with” “Every thought is tainted with the seeming inevitability of it all being meaningless” “I was just diagnosed with clinical depression” “I am on antidepressants”

Development of a supportive and empathic community 62% of posts contain social support Reciprocity of support: 37% of users made multiple posts 84% posts contain help-seeking and disclosure - Ease of online use: ‘I tried talking to a counsellor but I felt I couldn’t be completely honest’ ‘It’s nice to be able to communicate anonymously with other students’ Learning ‘Local Knowledge’ Of Mental Health Issues And Services Available 30% posts contain knowledge creation and sharing Experiential knowledge common in user posts, second-hand professional in moderators Requests for feedback in 20% both user and moderator posts - Local knowledge: ‘at the student health centre there is a psychiatric service available’

Therapeutic Benefits Of Reading And Writing 87% user posts contain disclosure Some posts contain solely disclosure “Its good to read other people opinions and feel that you’re not alone”

Role of the Peer Supporter

Conclusion This study aimed to assess the potential for online peer-moderated discussion boards Higher use than face-to-face peer support Gateway to additional services 24-hour availability Evidence of supportive and empathic community Meeting need in those with depression and suicidal ideation Disinhibition: high levels of disclosure Peer-support transferred online effectively -Online context reduces stigma and encourages help-seeking