ArticleBMJ paediatrics open2026
Absence of digital intervention: exploring the motivations behind self-harm adolescents' avoidance of psychological support techniques.
Article in BMJ paediatrics open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFrom the perspective of behavioural psychology and adolescent psychopathology, non-suicidal self-harm (NSSI) among adolescents is a multidetermined behaviour shaped by biological, psychological and social factors. Digital mental health interventions are vital for adolescent self-harm support, yet their acceptance among self-harming adolescents is low with significant avoidance tendencies. Existing research focuses on technical attributes of these tools but rarely explores the psychological motivations and contextual factors driving avoidance in this group, and few studies interpret such avoidance behaviour under a unified biopsychosocial framework.
methodsA grounded theory approach was adopted, complying with the COREQ criteria. Semi-structured interviews were conducted with 21 emotionally stable adolescents aged 12-18 years who had engaged in NSSI in the past year, recruited from a tertiary hospital emergency department. Data were analysed via open, axial and selective coding with ethical approval obtained.
resultsGuided by the biopsychosocial behavioural framework, this study identified that adolescents' avoidance of digital psychological interventions is a comprehensive outcome of interactions among biological traits, psychological mechanisms and social contextual factors. Three core psychological pathways driving avoidance were extracted: emotional avoidance, trust deficit and feelings of ineffectiveness and frustration. Physiological stress responses linked to shame and anxiety (biological dimension) amplified these psychological barriers, while situational social factors moderated the entire behavioural process.
conclusionsAdolescents' avoidance of digital interventions is a layered, dynamic, multidetermined behavioural phenomenon embedded in the Chinese cultural context, which can be systematically interpreted via the biopsychosocial behavioural framework covering biological traits, individual psychology, interpersonal and ecological social factors. Future digital tools require trauma-informed, context-adaptive design to reduce emotional triggers, enhance user control, strengthen privacy protection and rebuild trust, thereby improving acceptability and effectiveness.
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