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Online communities in health care are well established as technologies for facilitating interactions between patients with common conditions and communication between patients and health professionals. Less well known is how health professionals use these platforms to connect with their peers, particularly for interprofessional education or support. We present early results from our exploratory international mixed methods (survey and interview) study of health professionals' experience of engaging with online communities for interprofessional peer education. Our results show that health professionals had relatively high levels of confidence engaging with multiple platforms. They used the platforms to formally and informally share evidence-based content, engage in collegial debate and connect with international colleagues. Health professionals are keen to engage with online communities for education and are aware of how these sites' functionality can promote engagement with interdisciplinary peers.

Video gaming is a popular pastime for young males, having been shown to have both positive and negative effects on players' mental health. The aim of the current study was to ascertain the rate that male video gamers may seek mental health support for mental ill-health generally. The secondary aims were to (a) identify the most prolific barriers to seeking help; (b) determine how confident this group is to seek help; and (c) whether the variance in help-seeking efficacy be explained, in part, by age, hours gamed, self-esteem, and social capital. The survey included sections on demographic information, standardized measures of self-esteem (The Rosenberg Self-Esteem Scale), social capital (The Social Capital in Gaming Scale), help-seeking efficacy (Self-Efficacy to Seek Mental Health Care Scale), and non-standardized measures of help-seeking behavior and help-seeking barriers. The survey of 2,515 participants had a mean age of 21.37 years. The analysis identified that most participants had not sought mental health support for themselves. The most prolific barriers for this cohort to seek help were cost, confidentiality, and trust. Confidence to seek help was rated the lowest for overcoming embarrassment, understanding information, and coping with others' reactions. Help-seeking efficacy was found to be significantly predicted by age, hours spent gaming, self-esteem, and social capital. Low rates of seeking help, coupled with identifying the significant barriers of this group to seek help, may inform researchers aiming to develop targeted interventions for male youth interested in gaming and who are exhibiting mental ill-health to gain initial access, or engage more often, with mental health services when needed. Further research is recommended for investigating male gamers' insights in determining how to overcome the identified barriers for this cohort to improve mental health seeking behavior rather than avoidant behavior. From this, stigma reduction and ease of access to digital mental health services could be improved.

Digital mental health services are becoming increasingly valuable for addressing the global public health burden of mental ill-health. There is significant demand for scalable and effective web-based mental health services. Artificial intelligence (AI) has the potential to improve mental health through the deployment of chatbots. These chatbots can provide round-the-clock support and triage individuals who are reluctant to access traditional health care due to stigma. The aim of this viewpoint paper is to consider the feasibility of AI-powered platforms to support mental well-being. The Leora model is considered a model with the potential to provide mental health support. Leora is a conversational agent that uses AI to engage in conversations with users about their mental health and provide support for minimal-to-mild symptoms of anxiety and depression. The tool is designed to be accessible, personalized, and discreet, offering strategies for promoting well-being and acting as a web-based self-care coach. Across all AI-powered mental health services, there are several challenges in the ethical development and deployment of AI in mental health treatment, including trust and transparency, bias and health inequity, and the potential for negative consequences. To ensure the effective and ethical use of AI in mental health care, researchers must carefully consider these challenges and engage with key stakeholders to provide high-quality mental health support. Validation of the Leora platform through rigorous user testing will be the next step in ensuring the model is effective., (©Emma L van der Schyff, Brad Ridout, Krestina L Amon, Rowena Forsyth, Andrew J Campbell. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 19.06.2023.)

Young men's mental health is at the forefront of global public health concerns. Young males, who have a high incidence of mental health disorders, are a population that accesses services at lower rates than females and makes up the majority of videogame players. By considering the unique perspectives of digitally connected individuals on mental health service delivery, interventions may be designed to address their needs with a higher likelihood of success. This study investigated international male videogamers' perspectives on how their access to mental health services could be improved via an open-ended survey question. From a total of 2515 completed surveys, 761 responded to the qualitative question. Of these, the 71 responses that discussed access to and provision of mental healthcare services are reported in this article. Results suggest that digital mental health services were a promising way to reach this group. Anonymity and confidentiality were found to be important factors when considering online mental health services. Male videogame players identified a preference for both online and in-person services that are delivered synchronously, one-on-one with an expert practitioner, and readily available in settings that individuals find comfortable.

Objective: The present study aimed to explore the feasibility and potential benefits of deploying virtual reality (VR) for adolescents in the ED., Methods: This multi-centre study was undertaken in paediatric and adult EDs in two university teaching hospitals. Twenty-six participants who had voluntarily attended the ED received the VR intervention. Pre- and post-measures assessing changes in state anxiety, stress and affect, and physical biomarkers were obtained., Results: The use of VR intervention was associated with significant reductions in distress (Short State Stress Questionnaire - Distress Subscale; t = 4.55, P < 0.001) and negative affect (the International Positive and Negative Affect Scale - Short Form version; t = 4.99, P < 0.001). Most participants chose 'Netflix' as their content of choice. The technology was well received by the participants with subjective reports indicating that receiving VR intervention was 'insanely cool', 'takes you away from what's actually happening' and some participants felt 'privileged to get this experience in a hospital'., Conclusions: VR technology can effectively be used in EDs to assist adolescents and young adults better manage their distress and take steps towards activating more self-control mechanisms that will in turn allow for more meaningful engagements to be established with health clinicians. This technology has broad implications for reducing distress in adolescents in a variety of clinical contexts., (© 2022 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)

There is a growing need for high-quality evidence to support the efficacy of online counseling and peer support via social networking sites (SNSs) as an intervention to reduce mental health symptoms in young people. This article presents Phase 2 of Kids Helpline (KHL) Circles, which used mixed methods to assess the acceptability, safety, user experience, and mental health benefits of a purpose-built, counselor-facilitated SNS. Young people aged 13-25 years ( n  = 552) were recruited to participate in one of six 8-week "Circles." Of those, 154 participants completed study surveys at three timepoints (baseline, midpoint, endpoint). Significant reductions in depression, anxiety, stress, and general distress symptoms were reported at the midpoint of the intervention, with further significant reductions in depression and stress symptoms by the endpoint. More than half said that their mental health improved as a direct result of KHL Circles, and most felt less mental health stigma and would be more willing to seek help for mental health issues in the future. These results contribute to increasing the evidence base for SNS interventions to reduce mental health symptoms. Adjustments are necessary for the ongoing evolution of this service to ensure it is user-centered and scientifically rigorous.

Acute and chronic psychological distress are prevalent during adolescence and can have negative impacts on adolescents in all life domains. The aim of this systematic review was to appraise the use of virtual reality (VR) interventions to manage symptoms of psychological distress symptoms among adolescents. MEDLINE, PubMed, PsycINFO, and Scopus databases were searched up to June 2020. Available citations were de-duplicated and screened by two authors using title and abstract information. A total of 301 articles were retained for full-text evaluation next to eligibility criteria. Empirical studies of all designs and comparator groups were included if these appraised the impact of an immersive VR intervention on any standardized measure indicative of psychological distress in an adolescent sample. Data were extracted into a standardized coding sheet. Results were tabulated and discussed with a narrative synthesis due to the heterogeneity between studies. A total of seven studies met inclusion criteria. There were four randomized controlled trials and three uncontrolled pilot studies on new VR interventions. Distress-related issues included: state-anxiety, venepuncture, risk taking, public speaking anxiety, social anxiety disorder, sexual victimization, and chemotherapy administration. All studies reported significant changes on outcome measures after VR treatment. Six studies reported small-to-large reductions in symptoms. The average attrition rate was 3.6 percent during the active VR treatment phase. Treatment acceptability was high in the studies that assessed user engagement factors. The VR technology can provide a safe, rapidly efficacious, and acceptable treatment modality for managing psychological distress in several key adolescent populations.

Background: Given the high level of interest and increasing familiarity with virtual reality among adolescents, there is great potential to use virtual reality to address adolescents' unique health care delivery needs while in hospital. While there have been reviews on the use of virtual reality for specific health conditions and procedures, none to date have reviewed the full scope of virtual reality hospital interventions for adolescents who are often combined with children as a homogenous group, despite the fact that adolescents experience virtual environments different from children., Objective: The aim of this review was to systematically identify available evidence regarding the use of virtual reality interventions for adolescent patients in hospital settings to evaluate effectiveness, suitability, and safety and identify opportunities for future research., Methods: PubMed, PsycINFO, Medline, and Scopus databases were searched using keywords and phrases. Retrieved abstracts (n=1525) were double screened, yielding 276 articles for full-text screening. Of these, 8 articles met inclusion criteria. Data were extracted to a standardized coding sheet, and a narrative synthesis was performed due to the heterogeneity of the studies., Results: Four RCTs and 4 single-case reports were identified for inclusion, all of which aimed to reduce pain or anxiety. The scenarios targeted were burn pain, venipuncture, chemotherapy, preoperative anxiety, and palliative care. Three out of 4 RCTs found significant reductions in pain or anxiety outcomes measures when using virtual reality compared to standard care or other distraction techniques; however, only 1 study combined self-reported experiences of pain or anxiety with any physiological measures. Single-case reports relied primarily upon qualitative feedback, with patients reporting reduced pain or anxiety and a preference for virtual reality to no virtual reality., Conclusions: Virtual reality can provide a safe and engaging way to reduce pain and anxiety in adolescents while in hospital, particularly when virtual reality software is highly immersive and specifically designed for therapeutic purposes. As VR becomes more accessible and affordable for use in hospitals, larger and more diverse studies that capitalize on adolescents' interest in and aptitude for virtual reality, and on the full range of capabilities of this emerging technology, are needed to build on these promising results., Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020198760; https://www.crd.york.ac.uk/prospero/display&#95;record.php?ID=CRD42020198760., (©Brad Ridout, Joshua Kelson, Andrew Campbell, Kate Steinbeck. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 28.06.2021.)

Since Myanmar's transition to civilian rule in 2011, the use of smartphones has exploded. The ubiquitous use of social media, in particular Facebook, has had a well-publicized dark side as a platform for disseminating fake news and hate speech. With poor digital literacy skills, Myanmar users are susceptible to disinformation campaigns and other online dangers, particularly young people, the most prevalent users. The current study collected benchmarking data related to usage patterns and perceptions of social media among Myanmar youth living in conflict-affected areas, including internally displaced Rohingya Muslims whose voice is yet to be captured in social media research. A total of 231 participants from Rakhine and Kayah States aged 13-35 were surveyed about their use of social media and its impact on Myanmar society and their own lives. More than half of the young people sampled were heavy smartphone users, particularly Rohingya Muslims, who rely on social media for contact with society outside of their camps. Facebook was by far the most used app, however, private group chat-based platforms were also popular. A majority said that they check the accuracy of news they read on social media, however, most do so by checking other Facebook pages or asking friends or family. Overall, most young people thought that social media has both a positive impact and negative impact on their lives. This study adds to an emerging body of research into how Myanmar youth engage with social media, particularly regarding how they consume news of current events.

Workplace stress management is a growing problem that can have significant mental health and financial impact for workers and their employers. There is a growing body of evidence supporting the efficacy of Virtual Reality (VR) treatments for stress and anxiety, however no reviews of VR to date have looked specifically into the use of VR for this purpose in the workplace. This scoping review aimed to identify available evidence in this environment (i.e., workplace) and investigate whether using VR might reduce workplace stress levels. The academic databases, CINAHL, Medline, Proquest, PsychINFO, PubMed, Scopus, and Web of Science, were searched using terms focused on VR, stress or relaxation, and workplaces. Results from the articles reviewed demonstrate a wide variety of study designs and techniques, with a general indication that the interventions reduce stress. Commonalities, differences, and levels of workplace focus are examined. Areas for future studies are highlighted, and the importance of the unique contribution VR can make to stress management in the workplace is identified as a gap in the research to be filled.

Background: It has often been reported that young people are at high risk of mental health concerns, more so than at any other time in development over their life span. The situational factors that young people report as impacting their well-being are not addressed as often: specifically, family discord. Kids Helpline, a national service in Australia that provides free counseling online and by telephone to young people in distress, report that family discord and well-being issues are one of the major concerns reported by clients. In order to meet the preferences that young people seek when accessing counseling support, Kids Helpline has designed and trialed a custom-built social network platform for group counseling of young people experiencing family discord that impacts their well-being., Objective: In this exploratory study, we communicate the findings of Phase 1 of an innovative study in user and online counselor experience. This will lead to an iterative design for a world-first, purpose-built social network that will do the following: (1) increase reach and quality of service by utilizing a digital tool of preference for youth to receive peer-to-peer and counselor-to-peer support in a safe online environment and (2) provide the evidence base to document the best practice for online group counseling in a social network environment., Methods: The study utilized a participatory action research design. Young people aged 13-25 years (N=105) with mild-to-moderate depression or anxiety (not high risk) who contacted Kids Helpline were asked if they would like to trial the social networking site (SNS) for peer-to-peer and counselor-to-peer group support. Subjects were grouped into age cohorts of no more than one year above or below their reported age and assigned to groups of no more than 36 participants, in order to create a community of familiarity around age and problems experienced. Each group entered into an 8-week group counseling support program guided by counselors making regular posts and providing topic-specific content for psychoeducation and discussion. Counselors provided a weekly log of events to researchers; at 2-week intervals, subjects provided qualitative and quantitative feedback through open-ended questions and specific psychometric measures., Results: Qualitative results provided evidence of user support and benefits of the online group counseling environment. Counselors also reported benefits of the modality of therapy delivery. Psychometric scales did not report significance in changes of mood or affect. Counselors and users suggested improvements to the platform to increase user engagement., Conclusions: Phase 1 provided proof of concept for this mode of online counseling delivery. Users and counselors saw value in the model and innovation of the service. Phase 2 will address platform issues with changes to a new social network platform. Phase 2 will focus more broadly on mental health concerns raised by users and permit inclusion of a clinical population of young people experiencing depression and anxiety., Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12616000518460; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370381., (©Andrew James Campbell, Brad Ridout, Krestina Amon, Pablo Navarro, Brian Collyer, John Dalgleish. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 20.12.2019.)

Background: Over the past 2 decades, online forums for mental health support have emerged as an important tool for improving mental health and well-being. There has been important research that analyzes the content of forum posts, studies on how and why individuals engage with forums, and how extensively forums are used. However, we still lack insights into key questions on how they are experienced from the perspective of their users, especially those in rural and remote settings., Objective: The aim of our study was to investigate the dynamics, benefits, and challenges of a generalized peer-to-peer mental health online forum from a user perspective; in particular, to better explore and understand user perspectives on connection, engagement, and support offered in such forums; information and advice they gained; and what issues they encountered. We studied experiences of the forums from the perspective of both people with lived experience of mental illness and people who care for people with mental illness., Methods: To understand the experience of forum users, we devised a qualitative study utilizing semistructured interviews with 17 participants (12 women and 5 men). Data were transcribed, and a thematic analysis was undertaken., Results: The study identified 3 key themes: participants experienced considerable social and geographical isolation, which the forums helped to address; participants sought out the forums to find a social connection that was lacking in their everyday lives; and participants used the forums to both find and provide information and practical advice., Conclusions: The study suggests that online peer support provides a critical, ongoing role in providing social connection for people with a lived experience of mental ill-health and their carers, especially for those living in rural and remote areas. Forums may offer a way for individuals to develop their own understanding of recovery through reflecting on the recovery experiences and peer support shown by others and individuals enacting peer support themselves. Key to the success of this online forum was the availability of appropriate moderation, professional support, and advice., (©Jennifer Smith-Merry, Gerard Goggin, Andrew Campbell, Kirsty McKenzie, Brad Ridout, Cherry Baylosis. Originally published in JMIR Mental Health (http://mental.jmir.org), 26.03.2019.)

Background: Anxiety conditions are debilitating and prevalent throughout the world. Acceptance and Commitment Therapy (ACT) is an effective, acceptance-based behavioral therapy for anxiety. However, there are treatment barriers (eg, financial, geographical, and attitudinal), which prevent people from accessing it. To overcome these barriers, internet-delivered ACT (iACT) interventions have been developed in recent years. These interventions use websites to deliver ACT information and skill training exercises on the Web, either as pure self-help or with therapist guidance., Objective: This systematic review aimed to examine the therapeutic impact of iACT on all anxiety conditions., Methods: The EMBASE, MEDLINE, ProQuest Central, PsycINFO, Scopus, and Web of Science databases were searched up to September 2018. The titles and abstracts of remaining records after deduplication were screened by 2 authors with a total of 36 full-text articles being retained for closer inspection next to eligibility criteria. Empirical studies of all designs, population types, and comparator groups were included if they appraised the impact of iACT treatment on any standardized measure of anxiety. Included studies were appraised on methodological quality and had their data extracted into a standardized coding sheet. Findings were then tabulated, and a narrative synthesis was performed because of the heterogeneity found between studies., Results: A total of 20 studies met inclusion criteria. There were 11 randomized controlled trials (RCTs) and 9 uncontrolled pilot studies. Participants across all studies were adults. The anxiety conditions treated were as follows: generalized anxiety disorder (GAD), social anxiety disorder (SAD), illness anxiety disorder (IAD), and general anxiety symptoms, with or without comorbid physical and mental health problems. A total of 18 studies reported significant anxiety reduction after iACT treatment. This was observed in studies that delivered iACT with (n=13) or without (n=5) therapist guidance. The average attrition rate across all included studies during the active iACT treatment phase was 19.19%. In the 13 studies that assessed treatment satisfaction, participants on average rated their iACT experience with above average to high treatment satisfaction., Conclusions: These findings indicate that iACT can be an efficacious and acceptable treatment for adults with GAD and general anxiety symptoms. More RCT studies are needed to corroborate these early iACT findings using empirical treatments in active control groups (eg, internet-delivered cognitive behavioral therapy). This would potentially validate the promising results found for SAD and IAD as well as address the full spectrum of anxiety disorders., (©Joshua Kelson, Audrey Rollin, Brad Ridout, Andrew Campbell. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 29.01.2019.)

Background: The onset of mental health problems peaks between adolescence and young adulthood; however, young people face barriers to treatment and are often reluctant to seek professional help. Many are instead seeking support and information regarding their mental health via the Web, especially via social networking sites (SNSs), and hence, there is a promising opportunity to use SNSs to deliver or integrate with youth-focused online mental health interventions. Previous reviews have evaluated the effectiveness of SNSs for specific disorders in young people; however, none of the reviews have covered the breadth of SNS-based youth mental health interventions available across all mental health issues., Objective: This review aimed to systematically identify available evidence regarding the use of SNS-based interventions to support the mental health of young people aged up to 25 years, to evaluate their effectiveness, suitability, and safety, and identify gaps and opportunities for future research., Methods: The PubMed and PsycINFO databases were searched using Medical Subject Headings terms and exploded keywords and phrases. Retrieved abstracts (n=974) were double screened, yielding 235 articles for screening at the full-text level. Of these, 9 articles met the review inclusion criteria. Given the small number of studies, and the variety of outcome measures used, a quantitative meta-analysis was not possible., Results: The 9 articles (quantitative studies, qualitative studies, and descriptions of the iterative design process) covered 5 separate interventions. Of the 5 interventions, 2 interventions used purpose-built platforms based on the moderated online social therapy (MOST) model, 2 used Facebook, and 1 evaluated a purpose-built mobile app. The 2 MOST interventions targeted specific mental health issues (depression and psychosis), whereas the others focused on improving mental health literacy, social support, and general well-being. Only 3 quantitative studies were identified, and all used a pre-post design (without a control group) to establish proof of concept. Of the outcome variables assessed, there were significant improvements in mental health knowledge and number of depressive symptoms but no improvement in anxiety or psychosis symptoms. Acceptability of and engagement with the SNS platforms were generally high, as were perceptions of usefulness and safety. Moderation by clinical experts was identified as a key component of the more successful interventions. When offered a choice, users showed a preference for mobile apps over Web-based interfaces., Conclusions: The evidence reviewed suggests young people find SNS-based interventions highly usable, engaging, and supportive. However, future studies need to address the current lack of high-quality evidence for their efficacy in reducing mental health symptoms. Given young people are already turning to SNSs to engage in knowledge seeking and peer-to-peer support, SNS-based youth mental health interventions provide an opportunity to address some of the barriers young people face in accessing qualified mental health support and information., (©Brad Ridout, Andrew Campbell. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.12.2018.)

Background: The melanoma incidence and mortality rates in rural and remote communities are exponentially higher than in urban areas. Digital health could be used to close the urban/rural gap for melanoma and improve access to posttreatment and support care services., Objective: The aim of this review was to understand how digital health is currently used for melanoma posttreatment care and determine the benefits for Australian rural and remote areas., Methods: A systematic search of PubMed, Medline, PsycINFO, and Scopus was conducted in March 2018. Findings were clustered per type of intervention and related direct outcomes., Results: Five studies met the inclusion criteria, but none investigated the benefits of digital health for melanoma posttreatment care in rural and remote areas of Australia. Some empirical studies demonstrated consumers' acceptance of digital intervention for posttreatment care. The findings did not take into consideration individual, psychological, and socioeconomic factors, even though studies show their significant impacts on melanoma quality of aftercare., Conclusions: Digital interventions may be used as an adjunct service by clinicians during melanoma posttreatment care, especially in regions that are less-resourced by practitioners and health infrastructure, such as rural and remote Australia. Technology could be used to reduce the disparity in melanoma incidence, mortality rates, and accessibility to posttreatment care management between urban and rural/remote populations., (©Audrey Rollin, Brad Ridout, Andrew Campbell. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 24.09.2018.)

Introduction and Aims: University students usually overestimate peer alcohol use, resulting in them 'drinking up' to perceived norms. Social norms theory suggests correcting these inflated perceptions can reduce alcohol consumption. Recent findings by the current authors show portraying oneself as 'a drinker' is considered by many students to be a socially desirable component of their Facebook identity, perpetuating an online culture that normalises binge drinking. However, social networking sites have yet to be utilised in social norms interventions., Design and Methods: Actual and perceived descriptive and injunctive drinking norms were collected from 244 university students. Ninety-five students screened positive for hazardous drinking and were randomly allocated to a control group or intervention group that received social norms feedback via personalised Facebook private messages over three sessions., Results: At 1 month post-intervention, the quantity and frequency of alcohol consumed by intervention group during the previous month had significantly reduced compared with baseline and controls. Reductions were maintained 3 months post-intervention. Intervention group perceived drinking norms were significantly more accurate post-intervention., Discussion and Conclusions: This is the first study to test the feasibility of using Facebook to deliver social norms interventions. Correcting misperceptions of peer drinking norms resulted in clinically significant reductions in alcohol use. Facebook has many advantages over traditional social norms delivery, providing an innovative method for tackling problem drinking at university. These results have implications for the use of Facebook to deliver positive messages about safe alcohol use to students, which may counter the negative messages regarding alcohol normally seen on Facebook., (© 2014 Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: Alcohol is a key component of identity exploration for many young people, yet few studies have investigated identity construction in relation to problematic drinking. Increases in youth alcohol consumption have coincided with expanding use of communications technologies, particularly social networking sites (SNS), which have altered traditional conditions of identity construction. It has been found young people often engage with alcohol in the SNS environment by portraying themselves as binge drinkers. The current study applied an innovative approach to identity construction (the photographic essay) to provide insight into the portrayal of ‘alcohol-identity’ on Facebook., Design and Methods: One hundred and fifty-eight university students completed a range of alcohol measures before providing access for researchers to view their Facebook profiles to operationalise their alcohol-identity according to autophotographic methodology., Results: Participants utilised a variety of photographic and textual material to present alcohol as a component of their identity on Facebook, with over half having selected an alcohol-related profile image. Alcohol-identity predicted alcohol consumption and problematic alcohol-related behaviours as measured by questionnaires used to reliably identify alcohol-related problems in university students. Almost 60% reported potentially problematic alcohol use according to the Alcohol Use Disorders Identification Test., Discussion and Conclusions: Findings suggest that portraying oneself as a drinker is considered by many young people to be a socially desirable component of identity in the SNS environment, perpetuating an online culture that normalises binge drinking. Ready-made Facebook photo essays provide an alternate method of accessing problematic alcohol use, supplementing self-report measures.