Assessing Digital Risk in Psychiatric Patients: Mixed Methods Study of Psychiatry Trainees’ Experiences, Views, and Understanding
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Abstract
Background: The use of digital technology can help people access information and provide support for their mental health problems, but it can also expose them to risk, such as bullying or prosuicide websites. It may be important to consider internet-related risk behavior (digital risk) within a generic psychiatric risk assessment, but no studies have explored the practice or acceptability of this among psychiatrists. Objective: This study aimed to explore psychiatry trainees’ experiences, views, and understanding of digital risk in psychiatry. We predicted that clinician awareness would be highest among trainees who work in child and adolescent mental health services. Methods: We conducted a cross-sectional survey of psychiatry trainees attending a UK regional trainees’ conference to investigate how they routinely assess patients’ internet use and related risk of harm and their experience and confidence in assessing these risks. We conducted focus groups to further explore trainees’ understandings and experiences of digital risk assessment. Descriptive statistics and chi-squared tests were used to present the quantitative data. A thematic analysis was used to identify the key themes in the qualitative data set. Results: The cross-sectional survey was completed by 113 out of 312 psychiatry trainees (response rate 36.2%), from a range of subspecialties and experience levels. Half of the trainees (57/113, 50.4%) reported treating patients exposed to digital risk, particularly trainees subspecializing in child and adolescent psychiatry (17/22, 77% vs 40/91, 44%;P=.02). However, 67.3% (76/113) reported not feeling competent to assess digital risk. Child and adolescent psychiatrists were more likely than others to ask patients routinely about specific digital risk domains, including reckless web-based behavior (18/20, 90% vs 54/82, 66%; P=.03), prosuicide websites (20/21, 95% vs 57/81, 70%; P=.01), and online sexual behavior (17/21, 81% vs 44/81, 54%; P=.02). Although 84.1% (95/113) of the participants reported using a proforma to record general risk assessment, only 5% (5/95) of these participants prompted an assessment of internet use. Only 9.7% (11/113) of the trainees had received digital risk training, and 73.5% (83/113) reported that they would value this. Our thematic analysis of transcripts from 3 focus groups (comprising 11 trainees) identified 2 main themes: barriers to assessment and management of digital risk, and the double-edged sword of web use. Barriers reported included the novelty and complexity of the internet, a lack of confidence and guidance in addressing internet use directly, and ongoing tension between assessment and privacy. Conclusions: Although it is common for psychiatrists to encounter patients subject to digital risk, trainee psychiatrists lack competence and confidence in their assessment. Training in digital risk and the inclusion of prompts in standardized risk proformas would promote good clinical practice and prevent a potential blind spot in general risk assessment.
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While the present findings offer some confidence in regards to the quality and safety of the most commonly used apps, clinicians should still be alert to the possibility that patients are using poorer quality apps.
“As such, while the present findings offer some confidence in regards to the quality and safety of the most commonly used apps, clinicians should still be alert to (and enquiring of) the possibility that patients are using poorer quality apps (Aref-Adib et al. 2020).”
From Evaluating the quality, safety, and functionality of commonly used smartphone apps for bipolar disorder mood and sleep self-management (2022) · cites this paper as Aref-Adib et al. 2020
The Discussion (Principal Findings; page unavailable) supports asking patients about digital risks, and the Results (Double-Edged Sword; page unavailable) notes that patients use mental health apps. The paper does not assess app quality or safety, or specifically discuss patients using poorer-quality apps. The citing authors’ confidence in the most commonly used apps is framed as their own finding, not a finding attributed to this source. (LLM, conf=0.82)
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- Authors
- Aref-Adib, G., Landy, G., Eskinazi, M., Sommerlad, A., Morant, N., Johnson, S., Graham, R., Osborn, D., & Pitman, A.
- Affiliations
- University College London (GB)
- The Tavistock and Portman NHS Foundation Trust (GB)
- Corresponding author
- Pitman, Alexandra
- ORCID
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2020-07-29
- Volume
- 7
- Issue
- 7
- Pages
- e19008
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC7424482
- OpenAlex
- W3027105729
- Cited by
- 20
- References
- 24
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 3 · 2023: 1 · 2022: 5 · 2021: 1 · 2020: 1
- FWCI
- 2.68
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (ACF-2019-18-003)
- Department of Health and Social Care
- University College London
- Medical Research Council (MR/L501487/1)
- Topics
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Keywords
- digital risks, psychiatric risk assessment, psychiatric trainees, clinician competence, child and adolescent psychiatry, online sexual behavior, clinician attitudes, digital mental health services, training needs, workforce planning
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