Abstract
Objective
With rising rates of mental health distress amongst youth during the COVID-19 pandemic, digital resources have been identified as a valuable tools for delivering support to young people. However, many of the websites and apps developed by professionals to support the youth do not take account of the importance young people place on exercising their own agency in managing their mental health. This article investigates how young people in Aotearoa New Zealand used digital resources to manage their mental health needs during the COVID-19 pandemic.
Methods
The study gathered information from semi-structured interviews with 34 young people aged 16–22 years. The data was analysed using reflexive thematic analysis.
Results
Six themes were identified including: searching for online information about mental health; evaluating digital mental health resources; controlling mood through online activity; looking for escape in the virtual world; staying connected online; and giving and receiving support.
Conclusion
Young people's practices demonstrated their investment in their own agency, a general reluctance to engage with professional resources and recognition of the need to balance the risks and benefits of the informal strategies they preferred. Young people appeared sceptical of professionally-designed mental health resources and interventions and preferred to adapt and re-purpose the wide range of platforms and networks available in their informal digital worlds.
Introduction
Mental health professionals and researchers have identified the potential to reach young people in distress via digital resources and have focussed attention on designing web or app-based psychoeducational resources and interventions designed to support youth mental health. However, there is still much to learn about whether, and how, young people use digital resources to manage their mental health. During the COVID-19 pandemic, with young people experiencing increased stress and reduced access to other forms of support, digital strategies for dealing with mental health took on particular importance.1–3 This article explores the strategies that young people used to manage their mental health during the COVID-19 pandemic in Aotearoa New Zealand (NZ), highlighting their own agency in the ways they engaged with the wide variety of digital resources available to them.
Young people, mental health, and agency
There is widespread international concern about rising rates of mental health problems amongst youth, 4 usually defined as being between the ages of 15 and 24. 5 However, despite young people having one of the highest rates of mental health problems, estimates suggest that less than 30% of those experiencing a mental health problem will make use of professional support.6,7 Young people have long been recognised to rely on their own resources or informal peer or community support rather than engaging with a mental health professional. 8 Their reluctance to use formal mental health services has been attributed to a range of factors including practical impediments to access, concerns about negative judgement, and mental health services that are poorly designed for this age group.9–11 In this body of research, however, one of the most cited reasons given for young people's poor use of mental health services is their investment in their own autonomy and a preference for self-reliance.
Developmental theories identify the struggle to achieve autonomy as central to adolescence, 12 but it has been argued that this preoccupation now extends into early adulthood as young people spend more time in education and confront a range of economic barriers to independence. 13 While young people's quest for autonomy is often represented as a universal developmental phenomenon, it can be more usefully understood as a response to social conditions. In Western countries like NZ, young people are given mixed messages about their autonomy. While discourses associated with neoliberalism suggest that young people have considerable choice about how they live their lives, this is in marked contrast to many young people's experiences of being subject to the authority of their parents, teachers, university lecturers, and employers, as well as broader social and economic constraints that limit their choices. 14
The lack of power that young people experience in their everyday lives is echoed in their engagements with mental health services.14,15 There is a long tradition in these services of excluding people with mental health problems from decisions about their own mental health. 16 Young people are seen as a vulnerable and risky population and are particularly likely to be positioned as recipients of care rather than being recognised as active participants in managing their own mental health. 17
Resisting passive representations of people with mental health problems, some theorists have drawn attention to agency as an important ingredient in people's engagement with professional knowledge and resources.18,19 We prefer the use of the word agency rather than the narrow developmental notion of autonomy in relation to young people, as it validates the importance for all people, including young people, for being able to act on their own conscious choices. While the concept of autonomy is often treated as a personal capacity, agency recognises the way that people's ability to act is located in particular sets of power relationships. 20 There are, however, complexities in the use of agency to describe young people's behaviour. Deterministic accounts of youth often ignore agency and position young people as helpless victims of society, and their own intentions as irrelevant to mental health outcomes. 21 In contrast, humanistic notions of agency tend to overstate young people's free will and their abilities to make choices outside of social and economic constraints. 17 It is helpful perhaps to step outside of this dichotomy, and to think of young people as being able to exercise contextual agency 22 or, what has also been called, socially situated agency. 23 These concepts recognise that young people are influenced by broad social forces but are, nonetheless, actively engaged in negotiating the day-to-day situations in which they find themselves. Through their agency, young people are able to contest the operation of power as well as appropriate and use available resources in ways that match their priorities. 23 This conceptualisation of agency paves the way to explore young people as reflexive actors who actively negotiate their mental health needs.
Youth mental health and the digital world
Young people's high usage of the internet has drawn considerable attention from clinicians and researchers with an interest in youth mental health. 24 The research in this area reflects the contrasting views on youth agency in relation to their mental health. Many researchers and mental health clinicians have focused on concerns about the negative impact that social media and gaming have on young people's mental health.25–27 In this view, young people are often depicted as subject to the addictive power of gaming or social media, enacted through algorithms designed by nefarious commercial interests. Researchers also highlight a range of other risks including the potential to be exposed to bullying, grooming and sexualisation, social comparison, and unhelpful ideas about mental health in online social networks.28–30 While many of these concerns are valid, they might underestimate young people's ability to recognise and negotiate the risks of the digital environment in which they have grown up. 14
Ironically, even while researchers and clinicians have raised concerns about the negative impact that digital activity might have on young people's mental health, there has been a rush to exploit the potential of these new technologies to reach young people in distress. 31 Researchers have identified distinct advantages in apps and e-therapies, recognising the capacity of this new medium to overcome the barriers that prevent young people from using real-world mental health services, drawing attention to the accessibility of these resources, the potential to minimise stigma, as well as the opportunity for young people to exercise greater control over their engagement with mental health resources in the digital environment.14,32,33
There is a burgeoning body of research evaluating professionally-designed mental health apps intended for youth populations, but these might not always be in touch with young people's digital practices and preferences. Evaluations, for example, tend to focus on young people's engagement with a single platform or intervention offering mental health support. 34 However, research on young people's engagement with the internet suggests that they seldom engage with a single digital platform and rather treat the digital environment like a buffet from which they can select and curate their own resources. 35 Furthermore, the focus of research on young people's engagement with professional mental health resources often ignores their preference for informal, non-professional resources and interactions.14,36 This suggests that young people are likely to be engaging with a much broader array of resources than professionals suppose. Finally, evaluations tend to assume that young people will engage with professional mental health resources in the way that the designers intended. This has been challenged by recent research which suggests that young people de-centre professional views in their use of digital resources and focus on their own priorities in selecting and re-purposing these to meet their needs. 37 Research also indicates that young people's engagement with the wide array of resources enabled by the internet, is shaped by their own identity, their search for authentic connection, the importance of trusting relationships, as well as an investment in making their own choices. 14
Researchers have argued that it is precisely the opportunity to act outside of the influence of adults who typically assert control within their lives which makes digital activity so attractive to young people. 38 From the perspective of mental health professionals, the internet is often seen as a ‘wild West’ with potential risks to mental health. 39 (p328) However, from the perspective of young people, digital spaces allow them greater freedom to explore their mental health and to find options that they feel are a better fit for their own needs. 14 It is vital to understand more about what digital mental health resources young people are actually using and how they negotiate the potentials and risks of this unregulated terrain.
The context of COVID-19 in NZ
NZ had one of the most effective responses to COVID-19 but this entailed some of the strictest and longest lockdowns of any Western country. 40 Between 2020 and 2022, schools, universities and many places of work were intermittently forced to close and operate remotely where possible. During this period young people had much of their schooling and university study online, conducted their friendships almost completely virtually, and sometimes engaged in part-time paid work remotely too. Many young people found themselves at home for long periods of time, with only family or flatmates for company, or in school or university dormitories with a limited range of social interaction. A recent report on the impact of COVID-19 on schools in NZ suggests that this period was stressful for young people who noted fears about illness as well as the challenge of dealing with the demands of schoolwork under these conditions. 41 Other reports noted young people struggling with academic demands, financial pressures, isolation, and tense or toxic home environments during the pandemic.41–44 Young people were reported to be particularly vulnerable to the mental health effects of the pandemic, with a large NZ survey conducted in 2020 noting higher rates of distress for those between the ages of 18 and 24 than for other age groups. 45 However, while rates of distress increased, fewer people felt able to use the mental health services available, especially in Auckland where the effects of the pandemic were most pronounced. 46
Without access to professional support, many people were forced to rely on their own resources to manage the mental health impacts during this challenging period. 47 Given their familiarity with online spaces, young people reportedly turned to digital resources to help them manage their mental health. 1 While the pandemic created unusual circumstances, it also provided a unique opportunity to understand how young people might be using digital resources to help them through the challenges of this time. The current study was planned prior to the pandemic with the aim of understanding young people's digital mental health practices, but with data collection coinciding with the most significant health and social impacts of COVID-19 in NZ (between 2020 and 2022), we took the opportunity to explore how this context was shaping young people's practices. This article addresses the question of how young people used digital resources to manage their mental health during the pandemic, with a particular focus on how they enacted their agency and negotiated the challenges and opportunities in this virtual world.
Methodology
Our research was underpinned by a social constructionist epistemology which recognises that mental health and practices to support well-being are defined differently depending on the time, context, and social group. While we recognised that there were many ‘youth cultures’ that might influence young people's digital practices differently, for this article we wanted to focus on some of the commonalities we identified across our diverse sample of young people. Our approach to the research was also influenced by a youth-empowerment orientation which prioritises the importance of hearing young people's voices in matters that concern them. 48 This position entailed a reflexive awareness of our own positioning as mental health professionals and researchers. The younger members of the research team conducted interviews to minimise the power-imbalances that commonly affect the relationship between researchers and youth participants. Their age, which was closer to that of the participants and their familiarity with the digital worlds of young people, afforded the advantages of an ‘insider’ perspective on the research topic. The senior research team included researchers who were of Māori and Pacific Island decent to ensure cultural safety for indigenous participants and interviewers were culturally matched to these participants.
Research design
The data that form the basis of this article were collected as part of a broader study on young people's digital mental health practices entitled: ‘Ka Hao te Rangatahi: Fishing with a New Net? Rethinking Responsibility for Youth Mental Health in the Digital Age’. This NZ-based study aimed to explore a diverse range of young people's experiences of using digital resources to manage their mental health, as well as the perspectives of mental health app developers and policy makers. The research was approved by the University of Auckland Human Participants Ethics Committee in 2020 for 3 years. Particular ethical considerations in this study included the mental well-being of the participants which was overseen by the two clinical psychologists on the team. The clinical psychologists provided guidance on the ethics protocols to ensure the psychological safety of participants, they trained interviewers to respond to sensitive mental health issues and were available to provide advice and a referral to a professional if a participant appeared distressed and in need of further support. All participants were provided with a list of mental health resources they could access at the conclusion of the interview. A further priority was the confidentiality of young participants who, under pandemic restrictions, were often obliged to participate in research interviews in their environments which allowed little privacy. All participants gave written informed consent for their involvement in the research. As all participants were over the age of 16, ethical guidelines did not require parent or guardian consent.
Recruitment
Purposive sampling was used in an attempt to ensure that the cultural diversity of NZ youth was well represented. Information on the research was provided to youth organisations (schools, youth groups, and university societies) in Auckland, Northland, Wellington, Nelson and Christchurch who were asked to distribute advertising material to their members via email, notice boards, or social media. The advert for participation was also circulated via social media through networks that the younger researchers on the project were part of (e.g., Facebook groups for young Pasifika or Māori people, Reddit networks for those interested in gaming). Adverts called for people between the ages of 16 and 22 years to take part in an interview to discuss how young people were using digital resources to deal with their mental health. Potential participants were asked to contact the researcher on a dedicated research phone. Those who expressed an interest in taking part in the research were emailed a participant information sheet that provided details about the researchers and the aims of the research.
Participants
There were a number of interviews with young people collected during the broader study, but for the purposes of this article we have included only the 34 interviews conducted during the period of the pandemic. Participants included 15 young women, 16 young men, and three participants who identified as non-binary. The age range of participants was 16–22 years. All participants were based in one of NZ's major cities, but some were identified as having come from rural areas to study at a city university. All participants were studying either at a school or university, and many worked part-time. Six participants were Māori, 12 had Pacific Island heritage, eight participants identified themselves as NZ European, and the remaining participants came from a variety of migrant backgrounds including India, China, Vietnam, Latin America, and South Africa. While researchers often refer to saturation- a concept associated with Grounded Theory- to justify their sample size, Malterud's notion of ‘information power’ was better suited to our study. Information power is a function of the breadth of the study aim, specificity of the sample, utilisation of an established theory, dialogue quality and analytic strategy. 49 Given the breadth of our study aim and relative nonspecificity of our intended sample, application of theory (youth empowerment), high-quality dialogue and cross-case analytic strategy, a sample size with the mid 30s was judged sufficient to yield rich data.
Data collection
We provided participants with the option of engaging in interviews through a variety of mediums including in-person interviews, video interviews, and digital messaging interviews. We had allowed for these different mediums in the light of previous research suggesting that while some young people were comfortable discussing the sensitive issue of mental health in-person, others, especially those who spent much of their time online, felt more able to discuss sensitive topics via text. 50 Video interviews were intended to address practical barriers to accessibility. The digital messaging option also provided greater protection for the privacy of those who did not have the option of a private space in their homes to conduct a remote video. As it transpired, under COVID-19 restrictions, the majority of our participants either chose or were obliged to conduct their interviews using video (Zoom) or instant messenger (WhatsApp). Interviews were collected intermittently between July 2020 and November 2021. At times recruitment was challenging as the impact of the pandemic was experienced by different communities.
The interviews were designed with the participation of all members of the research team, with particular attention to the suggestions of younger researchers. The interviews were piloted prior to use and revised to ensure they were youth-friendly and culturally appropriate for diverse groups of participants. The interviews covered key content areas including basic demographic information, content, websites, or apps participants used to manage their mental health, and how they used these. We also asked questions about how participants understood mental health and how their circumstances, including those related to COVID-19, affected their practices. The semi-structured format of the interviews allowed each interviewer to adopt a flexible format, allowing for the exploration of areas of interest as they emerged.
The interviews varied in length. The verbal interviews were between 30 and 90 minutes long with most of them being between 50 and 60 minutes. The instant messaging interviews tended to be about 90 minutes long, with a range between 35 and 150 minutes, although one continued for a few days as the participant struggled with an erratic internet connection.
Data analysis
Our approach to data analysis drew from Braun and Clarke's reflexive thematic analytic approach which is well-suited to identify common patterns in qualitative data.51,52 Verbal interviews were audio recorded and transcribed in full. The verbal interviews were largely transcribed by the interviewer but a small number were transcribed by a professional service and checked by the interviewer. The instant messenger interviews were automatically transcribed using WhatsApp technology. Careful reading and rereading of the data enabled us to identify codes in the data and then combine these into themes as recommended by Braun and Clarke. 51 The analysis was conducted manually, without the aid of software. We applied a reflexive approach to data analysis, in which we explored the youth perspectives present in our data in relation to our research questions and theoretical framework informed by a youth empowerment perspective and recognition of youth agency. The researcher reflexivity emphasised in Braun and Clarke's more recent work allowed us the opportunity to reflect critically on the ways in which our own positioning influenced our understanding of the data, 52 and we were able to share ideas and refine the analysis through consensual discussion. 53 We benefited from ‘insider’ insights into the worlds of young people shared by our younger team members.
Findings
The analysis generated six themes that captured the variety of ways that participants used digital resources to manage their mental health during COVID-19.
Searching for information about mental health problems: ‘I think I know myself’
Most of the participants acknowledged that they had been drawn to looking up mental health information online during the pandemic to try and make sense of their distress but, on the whole, seemed sceptical about the value of professionally designed resources and information. Many participants acknowledged that they had searched for mental health information online to see whether they might meet the criteria for a diagnosis. Despite this, the majority were clearly cautious about accepting what ‘Dr Google’ might say. As one participant put it: And, I think everyone knows that you don’t look up symptoms online and trust what you find anyway. But, sometimes I’ll be curious and look it up anyway because it might give me some idea of what's happening. I have this other app on my phone that's kind of… you enter in your symptoms and then you answer a series of questions. It asks about how often this happens, and then it kind of calculates what condition you’re dealing with. I mean, I think I know myself enough to know what kind of mental issues I deal with. I did at first use that app to test if it would come out with that result. And it did, so I was like, ‘oh wow, okay, this is cool.’ If I’m anxious and I’m not sure what to do I’ll google search remedies or healthy habits to help with my anxiety. Sometimes it works but most times it's only best for that person and they can only suggest it to others. I used to watch YouTube videos of people who did have those illnesses and try to compare and contrast their symptoms and experiences with mine. It was helpful only because I found a lot of similarities. I have watched YouTube videos before to hear about other people's experiences just to know that I wasn’t alone with what I was experiencing. I think if there were more brown people who were open to … kinda talk about mental health and their troubles… I think it would influence a lot of other… more brown people to feel comfortable to open up to people. YouTube is used to look into stuff like philosophy and individuals who share knowledge I find valuable. Granted though the videos I watch don’t touch on mental health specifically but they help me understand why someone would feel a certain way about things, and that helps me understand myself.
Evaluating digital mental health resources: ‘a foreign thing’
Participants described actively looking online for ways to cope with their mental health during the pandemic. However, while most were aware that there were a range of professionally designed online resources and apps specifically designed to help people deal with their mental health, very few participants seemed to be using these. As one participant summarised: I think there are more tools available to us. But as to whether or not we’re utilising them, I don’t think we are um, utilising them as much as the people who have developed them want us to. I don’t really like paying for apps because that's just, like, an ongoing expense and I don’t work during uni because I don’t have the time for that. I like to focus on my studies so I don’t want to, like, be paying for an app that maybe I won’t get the most use out of. I wouldn’t look online. Haven’t looked at any apps or anything. Um, I don’t know. I think there's the scary prospect of it is telling someone you don’t know about it. It might kind of help to be made by people that have issues with mental health, so it doesn’t just seem like a foreign, you know, like a foreign thing or something that you’d see at school. I don’t want to be thinking about having to go into an app every single time I do something. I imagine like, if I had a mental health app on my phone or something, I would be quite like, almost like kind of anxious about it being on there and people seeing it. A friend was like, ‘Oh I’ve got this meditation app, you should try it’. And I tried it and they do these, this is going to sound really lame…listening to someone's monotone voice talk about like you know, the scenery and breathing exercises. It does all these things. But I didn’t realise how much it kind of helps.
One participant captured the ambivalence that many of the participants seemed to feel about relying on professionally designed resources to manage their mental health, emphasising his preference for informal strategies that fitted his needs: And I think there's a lot of people out there that are similar to me… just do it yourself, DIY, you know?
Controlling mood through digital activity: ‘I can watch something funny’
Rather than relying on professional mental health resources, participants seemed to prefer repurposing their existing digital activities and platforms to consciously manipulate their mood. One young person, for example, described how they selected a very particular content because they were familiar with the effect it had on them: I can always guarantee that if I watch an episode of this show or this anime, I'll feel better walking out on it… because I was able to guarantee a form of happiness. So, it's kind of a substitute, you don't need to feel like you're alone if you just get into that sort of thing and I guess that's what really helped me, like, especially during the lockdown. Like I stay in my room a very long time. I’ve started developing quite a big anxiety, like this year. And I know that I was, and I tried to use video games as a distraction for that. When I start becoming anxious and I think of my mental health as well, ‘cause I’ve, in the past few years, you know, I’ve just been in my room alone. And it's just like, it's a bit, you know, with music it just helps me to bring it a bit up, you know, keep going forward from that situation.
Although participants often turned to digital resources to manage their mood, they also recognised a need to do this through ‘real-life’ activities. One young woman described how in the earlier COVID-19 lockdowns she had tended to spend most of her time online, but in later periods of lockdowns she realised that this did not always work for her: So like if I start seeing the signs of like me slipping back into my old bad habits, I can be like, I need to do something about this, you know I need to like get out and walk around or something just keep myself awake and alive. I realised that I wasn’t really keeping up with my [fitness routine], like, I gained weight throughout the first lockdown. But then after the second lockdown, I realised that I need to focus on my physical wellbeing, especially to help with my overall mental health. I just go for a walk, yeah. That's during exam time because I kind of just don’t wanna tune into video games at that time, yeah. ‘Cause then my brain will start thinking about stuff to do in there rather than just studying. If a game made me feel bad I wouldn't play it, I guess. I would just be like ‘Oh, I got bored of this.’
Looking for escape in the virtual world: ‘somewhere else that's different to everyday life’
Participants also chose to distract themselves from the stresses they faced over the pandemic period using a variety of digital resources. After a day of trying to keep up with digital learning and assignment schedules in the midst of COVID-19, ‘mindless’ online recreational activity provided some relief. One young man, for example, described how he used gaming as a conscious way of escaping his own expectations of himself: I was getting so stressed about my uni work that I was, like, you know what, I just need a break ‘cause I’ve been overworking myself way too much. So like, I played last night for a few hours with my friends. And, it just made all my worries go away in those few hours. I know it's like, almost like an escape from the, the reality, that they’re like you know, their everyday lives basically. A lot of people would use that as an escape you know… to an island where you don’t have to worry about money.
Some participants also spoke about using digital technology to escape the boredom of lockdowns where there was little to occupy them. One participant, for example, explained how gaming helped to fill the gap that had been previously filled by his studies and friends: So I gamed a lot more to fill in that space during lockdown…so I didn’t really have anything to do. I couldn’t work so it was just games were a good way to fill in that space. It's not going to have any impact, as in if I could spend three hours doing it and I could do brilliantly or I could spend five hours doing it and do terribly. So that's not going to impact anything else in the rest of my life. …‘cause there's no consequence essentially.
However, a number of participants who spoke about the advantages of ‘switching off’ with digital technology, also recognised the potential for this to become a ‘bad habit’. One young woman who had spoken about how ‘mindless scrolling’ through her social media accounts allowed her to disengage from pressure, explained that she recognised that this was not always helpful: I have read a lot of kind of wellbeing Instagram posts that say distraction can be helpful when you’re dealing with [a problem] when you’re in that kind of mindset. But the way I see it, distraction for me is actually unhealthy because I end up distracting myself and then it's not addressed. Too much of it is really bad for your mental health but I feel like for lots of young people that can be something that they can go do and get their mind off stuff and you know just be in their like happy place I guess.
Staying connected online: ‘it's difficult to meet them in real life’
Social connection was seen as central to participants’ mental health. As many opportunities for social interaction were disrupted or limited altogether during the pandemic, participants explained that they turned to digital connections to sustain friendships. One young man, for example, acknowledged that he had substituted social connections in-person, with social activity via gaming: …lockdown does impact it more to be [honest], I rely on gaming for the social activity. Like if I'm actually going to school and meeting new people whatever I don't feel the need to sit down and have a session of [a game] with friends. So I did definitely use it a bit over lockdown just to see what updates were, to see things like that. See how family is going over in England and things like that. So yeah I definitely used it more over lockdown than I would necessarily. I guess it was good to hear someone else's voice that isn't your parents, or your siblings…I think being cooped up inside is not something that is the most ideal for people. So, as well as voice chatting there are also, like, text channels but you can post pictures. And, we have channels where my friends just post pictures of the games like, not so for work or for news. Or like funny things or memes. And, it feels like a, yeah, it feels like a real community. It's quite nice. So that we can see what each other is doing. Like, my friends are making music or I’m just looking at some worky things on the internet. I think probably much in the same way that physical spaces do, it gives a lot of [choice]. If you curate your experience right you can sort of have a feed or a blog or a group of friends or whatever, that does see you as you are or has the same interests, and that is socially affirming. And then also you have more mainstream social media that are more mainstream society I guess, like you see your crazy aunt like, ‘vaccines are here to control us,’ and you’re like, ‘no, Aunt Linda, please stop’.
But as much as participants were able to curate and control their digital activities, some also spoke of the loss of being able to spend time in-person with their friends as they might have in the past, as one young man wistfully acknowledged: It has made me, like, more eager to see my friends in real life. I wouldn’t say I’m significantly sadder because, I guess, I’m quite used to, like, just working online anyway. But I do miss, like, seeing my friends’ faces, even if we do have some Zoom calls.
Giving and receiving support in digital networks: ‘I’ll be here for you’
Although just ‘hanging out’ online seemed a common strategy for coping with the mental health challenges of the pandemic, participants also described how online interactions offered the opportunity for valuable reciprocal support during this difficult time. As one participant put it: But, then there's also things where it's connecting you to other like-minded people that can support you when you need it and people that you can support when they need it. That's been really good. Yeah being able to feel like there are other people going through the shit that you’re going through. Something that I’ve noticed a lot this past eight, ten months is that that's definitely switched around. And I could leave my phone and I will start getting people wondering how I’m doing and saying they hadn’t heard from me, you know. So I would have things to say like, “I’ll be here for you,” or “you can talk to me about it.” That kind of thing. Yeah. “It's going to be okay.” Lines that would fit that kind of situation. I did notice recently people posting a bit more on mental health like kind of reminders, things as simple as wishing people they have a good day. And there were social media accounts I noticed people would post to take care of yourself which I thought was quite cool. Sometimes when you have a rough day at uni, or you haven’t, like, you haven’t talked to anyone all day ’cause of lockdown. Booting up a game, winning a game and just celebrating with your friends and complimenting each and saying, nice, good job, like, it feels pretty good. We are quite a close-knit group because we’ve known each other for years…Sometimes some of us just want to get it out there and have us kinda react or respond to it to show our support. I would never respond publicly. I feel like it would be a bit intrusive and some people may think I’m doing it just for show if they see I’m trying to help on a public post. I would private message them. I thought I was going on there to get better, but actually – and sometimes it becomes quite echo chamber-y, because you’re all kind of sharing all of this stuff, … And, you’re not really getting help, per se. You’re just kind of getting people reinforcing those ideas. I prefer talking to people in-person about mental health issues, especially if they’re serious. Just because then I’d be able to fully express my emotions or vice versa with whoever I’m talking to. And that way if there needs to be a hug or a cry or whatever it is we can do it together in-person. It can be hard to develop a relationship and to feel like someone genuinely cares about you if it's through a device… It's a weird thing… but like our generation is going through this process of like, kind of, rejecting technology. [It's] trying to connect us? But we’re kind of like, “Oh, you know, is it?”
Discussion
Our study suggests that while young people used digital resources to manage their mental health during the COVID-19 pandemic, they did this in ways that carefully protected their own agency. They expressed reluctance to engage with professional mental health resources available on websites and through apps, treating these with a degree of scepticism. Other researchers have recognised that the association of apps with consumerism makes these less available and desirable for young people with limited economic resources. 54 However, the cost of apps might be only one part of young people's reluctance to engage with professionally designed mental health resources. Our analysis suggests that economic barriers might be exacerbated by a sense that professional resources represent unwanted, external impingements into their digital worlds. While the young people in this study often used terminology suggestive of a mental health agenda, they appeared to have little intention of subjecting themselves to professional judgements or recommendations, at least in their online worlds. Instead, some of their accounts suggested a concern that professional mental health resources would somehow undermine their own choice, subject them to external control, and potential stigma. These concerns have a strong similarity with the concerns that young people have about engaging with professional services in the non-virtual world.9,10
The analysis also suggested that young people might understand mental health more broadly than professionals and are open to exploring a range of resources that they feel support their physical, spiritual, and relational well-being rather than those focused exclusively on diagnosable mental health problems. Awareness of the multi-dimensional nature of wellness might be particularly important for the Māori and Pasifika youth and other similar indigenous communities who hold a more holistic understanding of mental health.55–57
Our study also highlights young people's preferences for finding their own ‘DIY (do it yourself)’ strategies for managing the challenges they struggled with during the pandemic. They found their own solutions by re-purposing existing social networks and platforms to meet their needs. They were drawn to activities such as gaming, listening to music, and scrolling through social media content to facilitate the experience of positive emotions and distract themselves from the stresses of the pandemic, including academic pressure, loneliness, feeling trapped at home, and financial challenges. Interestingly, these strategies are not dissimilar to recommendations within professional mental health protocols for distress tolerance, commonly used in Dialectical Behaviour Therapy. 58 These clinically recommended strategies include recognition of the value of taking time out from stress through distraction, and actively seeking soothing experiences, including music, as a way of managing overwhelming feelings of distress.
The importance that young people place on finding support in their own networks is also consistent with professional recommendations about social support, long recognised as an important antidote to stress and an important protective factor for young people's mental health.59,60 The findings of our study suggest that young people were acutely aware of the importance of a sense of connection and support from others during this difficult period. They actively sought opportunities to be with one another online to counteract the enforced isolation of the pandemic. They also made themselves available to receive support from others and to give this when needed. This ethos was consistent with the public health messaging on COVID-19 which emphasised kindness and mutual support. 61
Importantly, our analysis challenges the common perception that young people will be irresponsible and naive in their unregulated engagement with digital resources. 62 The young people who took part in this study seemed well aware of the risks of using digital resources to address their mental health and took steps to minimise these. Rather than just accepting information, they appeared thoughtful in their judgements about whether a particular resource would be useful to them. They were conscious of the risks of toxic or unhelpful online interactions, and cautious about the potential to get drawn into digital activities that distracted them from more direct ways of addressing their mental health.
Interestingly, while the pandemic threw the value of digital communication into relief for many adults who had not relied on this previously, for young people it seemed to make them more aware of the constraints of having to depend only on virtual connection or activity and appeared to reignite a longing for the ‘real world.’
The findings of this study have important implications for mental health professionals who are hoping to overcome the barriers to engaging young people with support by using digital resources. While it appears that digital spaces do allow young people the opportunity to exercise their agency, this does not appear to make them more inclined to engage with professionally designed digital resources. As has been found in the real world, young people still prefer to retain control over their own experiences of mental health and their choices about how to manage this. 14 While, from a professional standpoint, this might be seen as a disadvantage of digital support, this study highlights the care and thoughtfulness that young people put into negotiating their use of the wide array of digital resources available to them, and their awareness of the risks and benefits of these.
Recognition that young people are active agents in seeking, selecting, and using digital resources is an important step in understanding how best their mental health can be supported through this medium. Their concern to protect their own agency does not negate the value of professional knowledge on mental health, but it does suggest a different role for professionals if they want to facilitate young people's finding meaningful support online. Rather than positioning youth as recipients of psychoeducation websites and intervention apps, professionals might work together with young people to develop guidelines for the use of the informal resources they already use and to increase the safety of their interactions with these. Instead of designing professional interventions that might be seldom used, professionals would do better to develop young people's capacity to engage with their digital world in ways that are supportive of their mental health and minimise the risks of this environment. This could, for example, include helping young people become more proficient in evaluating the quality of mental health information available on the internet, choosing what material they engage with, carefully curating their online feeds, or monitoring the time they spend on social media. Strategies could also include building young people's skills to engage supportively with their online social networks. There are already some good examples of how this kind of approach can be implemented. For instance, #chatsafe worked with young people to develop guidelines for the discussion of suicide in their social media networks. 63 Working closely with young people, it might be possible to match mental health support better to the digital priorities and practices of this population.
Limitations
While the sample captures a diverse range of NZ youth perspectives, the constraints of this article did not allow for an in-depth analysis of differences within the group. This is particularly relevant for the Māori and Pasifika youth who have higher rates of mental health problems arising due to the impact of colonisation and ongoing systemic racism. 64 There has also not been an opportunity to explore gender differences, particularly recognising that young men and women might use digital resources differently and the LGBTQ+ community might have particular mental health needs as a result of the discrimination they face. 65 The specificity of experience within these important groups of young people will be addressed in future articles. Finally, it needs to be acknowledged that while all the data was collected during the two years in which the COVID-19 pandemic was most evident in NZ, there were periods in which both the virus and association restrictions varied in intensity and these effects were also not uniformly felt around the country. The data have largely not been reported with reference to this changing context, except where participants specifically mentioned this.
Conclusions
This study highlights young people's agency in using digital resources for managing their mental health and their preference for using a wide variety of informal resources rather than relying on professional expertise. While professionals are concerned about young people engaging with mental health in unregulated digital spaces, young people's informal strategies for managing their mental health were often consistent with professional recommendations and the analysis suggested that they actively negotiated and tried to avoid some of the risks of the online environment. There is potential to use digital resources to reach young people in distress, but this needs to be done together with young people and in ways that fit with their own practices, including a respectful recognition of their agency.
Supplemental Material
sj-docx-1-dhj-10.1177_20552076241260116 - Supplemental material for Digital mental health strategies used by young people in Aotearoa New Zealand during the COVID-19 pandemic: ‘Just do it yourself, DIY’
Supplemental material, sj-docx-1-dhj-10.1177_20552076241260116 for Digital mental health strategies used by young people in Aotearoa New Zealand during the COVID-19 pandemic: ‘Just do it yourself, DIY’ by Kerry Gibson, Susanna Trnka, Monique Jonas, Pikihuia Pomare, Shauney Thompson, Jemaima Tiatia-Siau, KDee Aimiti Ma'ia'i, Miriama Aoake, Thibaut Bouttier-Esprit, Imogen Spray and Sanchita Vyas in DIGITAL HEALTH
Supplemental Material
sj-docx-2-dhj-10.1177_20552076241260116 - Supplemental material for Digital mental health strategies used by young people in Aotearoa New Zealand during the COVID-19 pandemic: ‘Just do it yourself, DIY’
Supplemental material, sj-docx-2-dhj-10.1177_20552076241260116 for Digital mental health strategies used by young people in Aotearoa New Zealand during the COVID-19 pandemic: ‘Just do it yourself, DIY’ by Kerry Gibson, Susanna Trnka, Monique Jonas, Pikihuia Pomare, Shauney Thompson, Jemaima Tiatia-Siau, KDee Aimiti Ma'ia'i, Miriama Aoake, Thibaut Bouttier-Esprit, Imogen Spray and Sanchita Vyas in DIGITAL HEALTH
Footnotes
Acknowledgements
The authors would like to acknowledge the Marsden Fund – The Royal Society of New Zealand for funding this research. They also acknowledge the young people who participated in this study.
Contributorship
KG, ST, MJ, PP, and JT conceived the study, conducted a literature search, prepared the application for ethics approval, oversaw data collection, and contributed to analytic discussions. ST, KA, MA, TB, IS, and SV collected the data and contributed to analytic discussions. KG conducted the analysis and wrote the manuscript. All authors reviewed drafts of the article, and provided feedback and approved the final manuscript. KG is the guarantor for the article.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Ethical approval
Ethical approval was granted for this study by the University of Auckland Human Participants Ethics Committee on 14 May 2020 (reference number 024545).
Funding
The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This research was funded by a grant from the Marsden Fund – Royal Society of New Zealand. Grant number 19-UOA-056.
Supplemental material
Supplemental material for this article is available online.
References
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