Assessing the role of digital media and their relationship to psychiatric crises in adolescents
OA Version
Citation
Abstract
BACKGROUND: Digital media is used by tons of teenagers, and there is some evidence that it is playing a role in psychiatric crises, although there is very little descriptive data on it. With the increased use of social media, there is a higher chance for cyberbullying and spreading of misinformation. Social media posts can include distressing or sensationalized content, normalize suicide and spread information about suicide methods which may increase suicidal behaviors [3] and exposure to suicide cluster related social media has been associated with SI and SA during a suicide cluster [2]. Multiple studies have shown that there is an association between psychiatric issues and social media use. Youths with mental health conditions such as ADHD (attention deficit hyperactive disorder), ASD (autism spectrum disorder), and schizophrenia are especially vulnerable to problematic internet use (Ruckwongpatr et. al, 2022). We know that digital media plays a role in ED admissions and that digital and social media have mental health effects on youth. It is critical to get a better sense of the kids that are coming into the ED due to digital media complaints and whether or not devices present as an issue while they are in the ED and how that is dealt with.
OBJECTIVES: Because existing studies focus more on the association between psychiatric issues and digital media use, this study will focus on kids that are coming into the emergency room due to digital media complaints and whether or not devices present an issue while they are in the ER and how those are dealt with. Aim 1: Characterize digital media and electronic device related psychiatric crises resulting in emergency room presentation in youth aged 6-18 by: • A: Determining the incidence of digital media/electronic device related psychiatric crises.
• B: Determining relationships between digital media and electronic device related psychiatric crises and demographic variables and psychiatric diagnoses.
• C: Characterizing the frequency of specific categories of digital media and electronic related psychiatric crises.
METHODS: The study used Power Chart, an electronic medical record software, to access psychiatric consultation records from Boston Children’s Hospital in 2022. Data was collected using a spreadsheet listing medical record numbers (MRNs), accessing patient charts via Power Chart, specifically focusing on admissions related to psychiatric issues in the emergency room. The study examined gender, psychiatric history, presenting problems related to digital media use, and conflict types. Disposition, suicidal ideation, homicidal ideation, and digital media plan documentation were also analyzed. Conflict types during boarding, including behavioral dysregulation and access to restricted content, were coded. Data was analyzed using tables and graphs to understand relationships and patterns within the dataset. RESULTS: The study reviewed a total of 1,811 encounters, and analyzed data from the categories of chart-identified, patient-identified gender, race/ethnicity and age, to explore associations with digital media (DM) related conflicts. Chart-identified gender distribution showed 61% of encounters involving individuals identifying as female and 39% as male. Patient-identified gender revealed 51% encounters with someone identifying as female, 38% as male, 3.76% as transgender, and 7.2% as non-binary. For the racial/ethnic category, 37% of encounters identified as non-Hispanic white, 17% as Black, 1.16% as biracial, 1.65% as Hispanic, 4.14% as Asian, 0.17% as Native American and 39% categorized as unknown race. The majority (77%) of encounters involved youth with prior psychiatric diagnoses, including adjustment disorder (1.1%), depression (28%), anxiety (27%), trauma (7.8%), ADHD (27%), and ASD (8.7%). Of the encounters related to DM, 41.5% reported dysregulation upon separation from devices, 3% experienced interpersonal conflicts online, 28% engaged in high-risk online behaviors, and 28% encountered other forms of DM conflict. Analysis revealed disparities in DM-related conflicts by race, with 3.6% of non-Hispanic white, 7.5% of Black, 4.76% of biracial, and 5.33% of Asian encounters reporting conflicts. Transgender youth had significantly higher odds of DM-related conflicts, while non-binary identification was associated with decreased risk. Depressive disorders were significantly associated with DM conflicts, but other psychiatric diagnoses and past psychiatric history did not show significant associations. Age exhibited a statistically significant correlation with DM conflicts while adjusting for race and gender.
CONCLUSION: This study highlights the importance of researching how digital media use influences psychiatric emergency room visits among youth, given that research has shown an increase in such presentations and the role of digital media-related conflicts in exacerbating these psychiatric crises. Findings show that adolescents frequently present to the emergency room due to issues like online conflicts, emotional distress upon device separation, and engagement in risky online behaviors, particularly among those diagnosed with depression. Future research should further explore these relationships across different types of digital media use and psychiatric diagnoses, while also developing standardized assessment tools to enhance understanding of digital media-related conflicts in emergency settings and exploring demographic variations in these presentations.
Description
2024