BackgroundGiven the concerns about bullying via electronic communication in children and young people and its possible contribution to self-harm, we have reviewed the evidence for associations between cyberbullying involvement and self-harm or suicidal behaviors (such as suicidal ideation, suicide plans, and suicide attempts) in children and young people.ObjectiveThe aim of this study was to systematically review the current evidence examining the association between cyberbullying involvement as victim or perpetrator and self-harm and suicidal behaviors in children and young people (younger than 25 years), and where possible, to meta-analyze data on the associations.MethodsAn electronic literature search was conducted for all studies published between January 1, 1996, and February 3, 2017, across sources, including MEDLINE, Cochrane, and PsycINFO. Articles were included if the study examined any association between cyberbullying involvement and self-harm or suicidal behaviors and reported empirical data in a sample aged under 25 years. Quality of included papers was assessed and data were extracted. Meta-analyses of data were conducted.ResultsA total of 33 eligible articles from 26 independent studies were included, covering a population of 156,384 children and young people. A total of 25 articles (20 independent studies, n=115,056) identified associations (negative influences) between cybervictimization and self-harm or suicidal behaviors or between perpetrating cyberbullying and suicidal behaviors. Three additional studies, in which the cyberbullying, self-harm, or suicidal behaviors measures had been combined with other measures (such as traditional bullying and mental health problems), also showed negative influences (n=44,526). A total of 5 studies showed no significant associations (n=5646). Meta-analyses, producing odds ratios (ORs) as a summary measure of effect size (eg, ratio of the odds of cyber victims who have experienced SH vs nonvictims who have experienced SH), showed that, compared with nonvictims, those who have experienced cybervictimization were OR 2.35 (95% CI 1.65-3.34) times as likely to self-harm, OR 2.10 (95% CI 1.73-2.55) times as likely to exhibit suicidal behaviors, OR 2.57 (95% CI 1.69-3.90) times more likely to attempt suicide, and OR 2.15 (95% CI 1.70-2.71) times more likely to have suicidal thoughts. Cyberbullying perpetrators were OR 1.21 (95% CI 1.02-1.44) times more likely to exhibit suicidal behaviors and OR 1.23 (95% CI 1.10-1.37) times more likely to experience suicidal ideation than nonperpetrators.ConclusionsVictims of cyberbullying are at a greater risk than nonvictims of both self-harm and suicidal behaviors. To a lesser extent, perpetrators of cyberbullying are at risk of suicidal behaviors and suicidal ideation when compared with nonperpetrators. Policy makers and schools should prioritize the inclusion of cyberbullying involvement in programs to prevent traditional bullying. Type of cyberbullying involvement, frequency, and gender should be assessed in future studies.

BackgroundThe need for effective interventions to improve mental health and emotional well-being at a population level are gaining prominence both in the United Kingdom and globally. Advances in technology and widespread adoption of Internet capable devices have facilitated rapid development of Web-delivered psychological therapies. Interventions designed to manage a range of affective disorders by applying diverse therapeutic approaches are widely available.ObjectiveThe main aim of this review was to evaluate the evidence base of acceptance and commitment therapy (ACT) in a Web-based delivery format.MethodA systematic review of the literature and meta-analysis was conducted. Two electronic databases were searched for Web-delivered interventions utilizing ACT for the management of affective disorders or well-being. Only Randomized Controlled Trials (RCTs) were included.ResultsThe search strategy identified 59 articles. Of these, 10 articles met the inclusion criteria specified. The range of conditions and outcome measures that were identified limited the ability to draw firm conclusions about the efficacy of Web-delivered ACT-based intervention for anxiety or well-being.ConclusionsACT in a Web-based delivery format was found to be effective in the management of depression. Rates of adherence to study protocols and completion were high overall suggesting that this therapeutic approach is highly acceptable for patients and the general public.

Means restriction to prevent suicide by jumping Why is this review important? Jumping from a height is an uncommon but lethal means of suicide. While there is evidence that restricting access to means of suicide is an e ective approach for preventing suicides, the evidence for preventing suicide by jumping is not well established. This review therefore aimed to explore the impact restriction of access would have on suicide by jumping. Searching for evidence We searched several databases (the Cochrane Library, Embase, MEDLINE, PsycINFO, and Web of Science) to find studies that assessed the impact of restricting access to means of suicide by jumping. We searched the databases up until May 2019. We included studies that assessed jumping means restriction interventions delivered on their own, such as physical barriers, fencing or safety nets on bridges, or those delivered in combination with other suicide prevention interventions, such as crisis telephones and CCTV cameras. We also searched the reference lists of all included studies and relevant systematic reviews to identify additional studies and contacted authors to obtain missing information. Our main outcomes of interest were suicide, attempted suicide or self-harm and cost-e ectiveness of interventions. Key results We found 14 relevant studies. Three studies each were from Switzerland and the USA, while two studies each were from the UK, Canada, New Zealand, and Australia respectively. The majority of studies had a before-and-a er study design. Due to the observational nature of our included studies, none compared other interventions or control conditions. Jumping means restriction interventions delivered in isolation or in combination with other interventions were found to reduce the number of suicides by jumping. Data on suicide attempts were limited and no study reported self-harm. A cost-e ectiveness analysis suggested that the construction of a physical barrier on a bridge would be cost-e ective in the long term. The evidence for these assessments was of low quality because of weaknesses in study design and di erences in findings between studies, therefore requiring the need for further high-quality studies. Means restriction for the prevention of suicide by jumping (Review)

BackgroundSelf-harm is among the top five causes of acute hospital admissions and ambulance clinicians are often the first point of contact. However, the Emergency Department (ED) may not be the most appropriate place of care and little is known about the existence or nature of alternative pathways available to UK ambulance services. This survey describes the current management pathways used by ambulance services for patients who have self-harmed.MethodsA structured questionnaire was sent to all UK ambulance services by email and followed up by telephone in 2018. Three independent researchers (two clinical) coded responses which were analysed thematically.ResultsAll 13 UK ambulance services responded to the survey: nine by email and four by telephone interview. Two services reported a service-wide protocol for managing people presenting with self-harm, with referral to mental health crisis team available as an alternative to conveyance to ED, following on-scene psychosocial assessment. Four services reported local pathways for managing mental health patients which included care of patients who had self-harmed. Four services reported being in the process of developing pathways for managing mental health patients. Six services reported no service-wide nor local pathways for managing self-harm patients. No robust evaluation of new care models was reported.ConclusionPractice in ambulance services in the UK is variable, with a minority having a specific clinical pathway for managing self-harm, with an option to avoid ED. New pathways for patients who have self-harmed must be evaluated in terms of safety, clinical and cost-effectiveness.

Evidence before this studyThe adverse impact of bullying on children and young people has long been recognised. The rise of electronic communication has led to "cyberbullying". Two previous systematic reviews exploring the association between cyberbullying involvement and self-harm (SH)/suicidal behaviours included only three quantitative studies on this topic but the field has rapidly expanded. Added value of this studyWe conducted a comprehensive search of all available literature form 1 st January 1996 to 3 rd February 2017 examining the association between cyberbullying involvement and SH and suicidal behaviours in children and young people. We included studies on both victims and perpetrators of cyberbullying and assessed SH, suicidal behaviours, suicide attempts, and suicidal ideation separately. We quantified these relationships through metaanalyses. We identified 31 eligible articles across almost 30 different nations.Victims of cyberbullying are at a greater risk than non-victims of both SH and suicidal behaviours. To a lesser extent, perpetrators of cyberbullying are at risk of suicidal behaviours and suicidal ideation when compared to non-perpetrators. Implications of all the available evidenceAnti-bullying programmes in educational settings should include cyberbullying prevention alongside traditional bullying and address the needs and behaviours of both victims and perpetrators. Clinicians assessing mental health issues in children and young people should specifically and routinely ask about Internet use and cyberbullying. This research area would benefit from a clear definition of cyberbullying. Prospective longitudinal study designs should be employed to address issues of causality and direction using validated instruments to assess suicidal behaviours. More detailed analysis of the medium of cyberbullying, the interaction of cyberbullying with traditional bullying and potential protective factors is also required. 2 ABSTRACT Background