The debate on whether social media has a net positive or negative effect on youth is ongoing. Therefore, we conducted a thematic analysis on 2,061 posts made by 1,038 adolescents aged 15-17 on an online peer-support platform to investigate the ways in which these teens discussed popular social media platforms in their posts and to identify differences in their experiences across platforms. Our findings revealed four main emergent themes for the ways in which social media was discussed: 1) Sharing negative experiences or outcomes of social media use (58%, n = 1,095), 2) Attempts to connect with others (45%, n = 922), 3) Highlighting the positive side of social media use (20%, n = 409), and 4) Seeking information (20%, n = 491). Overall, while sharing about negative experiences was more prominent, teens also discussed balanced perspectives of connection-seeking, positive experiences, and information support on social media that should not be discounted. Moreover, we found statistical significance for how these experiences differed across social media platforms. For instance, teens were most likely to seek romantic relationships on Snapchat and self-promote on YouTube. Meanwhile, Instagram was mentioned most frequently for body shaming, and Facebook was the most commonly discussed platform for privacy violations (mostly from parents). The key takeaway from our study is that the benefits and drawbacks of teens' social media usage can co-exist and net effects (positive or negative) can vary across different teens across various contexts. As such, we advocate for mitigating the negative experiences and outcomes of social media use as voiced by teens, to improve, rather than limit or restrict, their overall social media experience. We do this by taking an affordance perspective that aims to promote the digital well-being and online safety of youth "by design."

Background: Conversational agents (CAs; chatbots) are systems with the ability to interact with users using natural human dialogue. They are increasingly used to support interactive knowledge discovery of sensitive topics such as mental health topics. While much of the research on CAs for mental health has focused on adult populations, the insights from such research may not apply to CAs for youth. Objective: This study aimed to comprehensively evaluate the state-of-the-art research on mental health CAs for youth. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we identified 39 peer-reviewed studies specific to mental health CAs designed for youth across 4 databases, including ProQuest, Scopus, Web of Science, and PubMed. We conducted a scoping review of the literature to evaluate the characteristics of research on mental health CAs designed for youth, the design and computational considerations of mental health CAs for youth, and the evaluation outcomes reported in the research on mental health CAs for youth. Results: We found that many mental health CAs (11/39, 28%) were designed as older peers to provide therapeutic or educational content to promote youth mental well-being. All CAs were designed based on expert knowledge, with a few that incorporated inputs from youth. The technical maturity of CAs was in its infancy, focusing on building prototypes with rule-based models to deliver prewritten content, with limited safety features to respond to imminent risk. Research findings suggest that while youth appreciate the 24/7 availability of friendly or empathetic conversation on sensitive topics with CAs, they found the content provided by CAs to be limited. Finally, we found that most (35/39, 90%) of the reviewed studies did not address the ethical aspects of mental health CAs, while youth were concerned about the privacy and confidentiality of their sensitive conversation data. Conclusions: Our study highlights the need for researchers to continue to work together to align evidence-based research on mental health CAs for youth with lessons learned on how to best deliver these technologies to youth. Our review brings to light mental health CAs needing further development and evaluation. The new trend of large language model–based CAs can make such technologies more feasible. However, the privacy and safety of the systems should be prioritized. Although preliminary evidence shows positive trends in mental health CAs, long-term evaluative research with larger sample sizes and robust research designs is needed to validate their efficacy. More importantly, collaboration between youth and clinical experts is essential from the early design stages through to the final evaluation to develop safe, effective, and youth-centered mental health chatbots. Finally, best practices for risk mitigation and ethical development of CAs with and for youth are needed to promote their mental well-being.

Background: Approximately 1 in 5 American adults experience mental illness every year. Thus, mobile phone–based mental health prediction apps that use phone data and artificial intelligence techniques for mental health assessment have become increasingly important and are being rapidly developed. At the same time, multiple artificial intelligence–related technologies (eg, face recognition and search results) have recently been reported to be biased regarding age, gender, and race. This study moves this discussion to a new domain: phone-based mental health assessment algorithms. It is important to ensure that such algorithms do not contribute to gender disparities through biased predictions across gender groups. Objective: This research aimed to analyze the susceptibility of multiple commonly used machine learning approaches for gender bias in mobile mental health assessment and explore the use of an algorithmic disparate impact remover (DIR) approach to reduce bias levels while maintaining high accuracy. Methods: First, we performed preprocessing and model training using the data set (N=55) obtained from a previous study. Accuracy levels and differences in accuracy across genders were computed using 5 different machine learning models. We selected the random forest model, which yielded the highest accuracy, for a more detailed audit and computed multiple metrics that are commonly used for fairness in the machine learning literature. Finally, we applied the DIR approach to reduce bias in the mental health assessment algorithm. Results: The highest observed accuracy for the mental health assessment was 78.57%. Although this accuracy level raises optimism, the audit based on gender revealed that the performance of the algorithm was statistically significantly different between the male and female groups (eg, difference in accuracy across genders was 15.85%; P<.001). Similar trends were obtained for other fairness metrics. This disparity in performance was found to reduce significantly after the application of the DIR approach by adapting the data used for modeling (eg, the difference in accuracy across genders was 1.66%, and the reduction is statistically significant with P<.001). Conclusions: This study grounds the need for algorithmic auditing in phone-based mental health assessment algorithms and the use of gender as a protected attribute to study fairness in such settings. Such audits and remedial steps are the building blocks for the widespread adoption of fair and accurate mental health assessment algorithms in the future.

We discuss the paradigm shift from restrictive approaches toward resilience-based solutions to promote adolescents’ online safety and well-being. We describe how restrictive strategies induce a tradeoff between teens’ privacy and online safety and present empirical studies that examine resilience-based approaches.