The virtual cutting edge: the internet and adolescent self-injury

An exploration of how young people and parents use online support in the context of living with cystic fibrosis

BACKGROUND

There is increasing recognition of the Internet's potential role in providing information and support for people living with long-term conditions. However, how young people and parents use online forms of self-care support in the context of living with childhood chronic illness has been under-researched.

OBJECTIVE

To explore how online peer support is used by young people and parents to support self-care in relation to cystic fibrosis (CF).

SETTING AND PARTICIPANTS

Online forum for young people and parents based on a CF charity website. A total of 279 individuals participated in the forum during the study.

DESIGN

An online ethnographical approach, involving observing, downloading and analysing discussion group postings. All postings made over a random 4-month period were included (151 discussion threads).

RESULTS

The online setting enabled a physically disconnected group to connect and create a safe space to collectively share experiences and receive support to manage and live with cystic fibrosis. Participants exchanged experientially derived advice and views on how to manage treatments, emotions, relationships, identity and support from services. While parents sought information and support on managing specific therapies/services and ways of maintaining their child's health, the information and support young people desired appeared to be more directed at how to 'fit' CF into their everyday lives.

DISCUSSION AND CONCLUSIONS

Online support groups appear to supplement professional support in relation to self-management. They enable young people and parents to share experiences, feelings and strategies for living with long-term conditions with peers and develop the expertise to empower them in interactions with health-care professionals.

Non-Suicidal Self-Injury among Adolescents in Amman, Jordan

While previous research has demonstrated cross-national differences in non-suicidal self-injury (NSSI), most studies to date have taken place in North America. The present study investigated the prevalence and characteristics of NSSI in a sample of 952 Jordanian adolescents (49.8% female) between the ages of 11-19 years. Participants completed a screening measure to assess occurrence of NSSI and its characteristics. Results indicate an overall lifetime prevalence of 22.6% (n = 215), with significantly more males (26.98%, n = 129) than females (18.14%, n = 86) reporting having engaged in NSSI at least once in their lifetime. This study provides empirical evidence that adolescent engagement in NSSI occurs at similar prevalence levels in Jordan, relative to North American samples, whereas gender comparisons of prevalence and characteristics revealed several differences.

A Virtual Mental Health Clinic for University Students: A Qualitative Study of End-User Service Needs and Priorities

BACKGROUND

Help seeking for mental health problems among university students is low, and Internet-based interventions such as virtual clinics have the potential to provide private, streamlined, and high quality care to this vulnerable group.

OBJECTIVE

The objective of this study was to conduct focus groups with university students to obtain input on potential functions and features of a university-specific virtual clinic for mental health.

METHODS

Participants were 19 undergraduate students from an Australian university between 19 and 24 years of age. Focus group discussion was structured by questions that addressed the following topics: (1) the utility and acceptability of a virtual mental health clinic for students, and (2) potential features of a virtual mental health clinic.

RESULTS

Participants viewed the concept of a virtual clinic for university students favorably, despite expressing concerns about privacy of personal information. Participants expressed a desire to connect with professionals through the virtual clinic, for the clinic to provide information tailored to issues faced by students, and for the clinic to enable peer-to-peer interaction.

CONCLUSIONS

Overall, results of the study suggest the potential for virtual clinics to play a positive role in providing students with access to mental health support.

Help-seeking behaviour and adolescent self-harm: a systematic review

OBJECTIVE

Self-harm is common in adolescence, but most young people who self-harm do not seek professional help. The aim of this literature review was to determine (a) the sources of support adolescents who self-harm access if they seek help, and (b) the barriers and facilitators to help-seeking for adolescents who self-harm.

METHOD

Using a pre-defined search strategy we searched databases for terms related to self-harm, adolescents and help-seeking. Studies were included in the review if participants were aged 11-19 years.

RESULTS

Twenty articles met criteria for inclusion. Between a third and one half of adolescents who self-harm do not seek help for this behaviour. Of those who seek help, results showed adolescents primarily turned to friends and family for support. The Internet may be more commonly used as a tool for self-disclosure rather than asking for help. Barriers to help-seeking included fear of negative reactions from others including stigmatisation, fear of confidentiality being breached and fear of being seen as 'attention-seeking'. Few facilitators of help-seeking were identified.

CONCLUSIONS

Of the small proportion of adolescents who seek help for their self-harm, informal sources are the most likely support systems accessed. Interpersonal barriers and a lack of knowledge about where to go for help may impede help-seeking. Future research should address the lack of knowledge regarding the facilitators of help-seeking behaviour in order to improve the ability of services to engage with this vulnerable group of young people.

Exposure to websites that encourage self-harm and suicide: prevalence rates and association with actual thoughts of self-harm and thoughts of suicide in the United States

This article provides 12-month prevalence rates of youth exposure to websites which encourage self-harm or suicide and examines whether such exposure is related to thoughts of self-harm and thoughts of suicide in the past 30 days. Data were collected via telephone from a nationally representative survey of 1560 Internet-using youth, ages 10-17 residing in the United States. One percent (95% CI: 0.5%, 1.5%) of youth reported visiting a website that encouraged self-harm or suicide. Youth who visited such websites were seven times more likely to say they had thought about killing themselves; and 11 times more likely to think about hurting themselves, even after adjusting for several known risk factors for thoughts of self-harm and thoughts of suicide. Given that youth thinking about self-harm and suicide are more likely to visit these sites, they may represent an opportunity for identification of youth in need of crisis intervention.

Communal normalization in an online self-help group for adolescents with a mentally ill parent

Although implications of parental mental illness are well documented, most children of mentally ill parents are left to manage their family situation with limited information and support. We explored the role of a Norwegian online self-help group for adolescents (aged 15 to 18) with a mentally ill parent. Through in-depth interviews with 13 participants, we found that the online self-help group provided "communal normalization" by which participants, through communication in the forum, made sense of everyday experiences and emotions arising from having a mentally ill parent. We identified three main aspects of this process-recognizability, openness, and agency-all of which were important for the adolescents' efforts to obtain support, to be supportive, and to handle everyday life situations better. Communal normalization might provide resources for significantly improving the participants' life situations, and could demonstrate similar potential for users in other situations characterized by stigma, loneliness, silence, and health worries.

Suicide contagion: a systematic review of definitions and research utility

Objectives

Despite the common use of contagion to analogize the spread of suicide, there is a lack of rigorous assessment of the underlying concept or theory supporting the use of this term. The present study aims to examine the varied definitions and potential utility of the term contagion in suicide-related research.

Methods

100 initial records and 240 reference records in English were identified as relevant with our research objectives, through systematic literature screening. We then conducted narrative syntheses of various definitions and assessed their potential value for generating new research.

Results

20.3% of the 340 records used contagion as equivalent to clustering (contagion-as-cluster); 68.5% used it to refer to various, often related mechanisms underlying the clustering phenomenon (contagion-as-mechanism); and 11.2% without clear definition. Under the category of contagion-as-mechanism, four mechanisms have been proposed to explain how suicide clusters occurred: transmission (contagion-as-transmission), imitation (contagion-as-imitation), contextual influence (contagion-as-context), and affiliation (contagion-as-affiliation). Contagion-as-cluster both confounds and constrains inquiry into suicide clustering by blending proposed mechanism with the phenomenon to be studied. Contagion-as-transmission is, in essence, a double or internally redundant metaphor. Contagion-as-affiliation and contagion-as-context involve mechanisms that are common mechanisms that often occur independently of apparent contagion, or may serve as a facilitating background. When used indiscriminately, these terms may create research blind spots. Contagion-as-imitation combines perspectives from psychology, sociology, and public health research and provides the greatest heuristic utility for examining whether and how suicide and suicidal behaviors may spread among persons at both individual and population levels.

Conclusion

Clarifying the concept of “suicide contagion” is an essential step for more thoroughly investigating its mechanisms. Developing a clearer understanding of the apparent spread of suicide-promoting influences can, in turn, offer insights necessary to build the scientific foundation for prevention and intervention strategies that can be applied at both individual and community levels.

Start, stop, and continue: Preliminary insight into the appeal of self-injury e-communities

Nonsuicidal self-injury e-communication has gained heightened empirical and public interest. This is the first study to examine possible motives for nonsuicidal self-injury e-communication. A total of 68 nonsuicidal self-injury e-community members responded to open-ended questions concerning reasons for starting, temporarily stopping, and continuing nonsuicidal self-injury e-communication. Results from a thematic analysis indicated that being motivated to obtain support, get nonsuicidal self-injury help, help others, and better understand nonsuicidal self-injury represented motives for starting nonsuicidal self-injury e-communication. For some, negative interactions and accessing triggering material contributed to e-communication stoppage; these individuals continued e-communication to get support and help. Implications for research and e-outreach are discussed.

Family dynamics and self-injury behaviors: a correlation analysis

This study tested the relationship between family dynamics and self-injury. A total of 189 participants responded to a web-based survey collecting information related to previous self-injury behaviors and family dynamics. Participants were over 18 years old who had used self-injury (intentionally harming themselves physically to relieve painful emotions without suicidal intent), but who had not used self-injury for over a year. Results indicated that healthy family dynamics were negatively correlated and associated with higher scores of self-injury behaviors. This study offers some evidence that family dynamics influence self-injury behaviors. The implications for family therapy are discussed.

Nonsuicidal self-injury in an adolescent population in Singapore

This mixed methods study examined the phenomenon of nonsuicidal self-injury (NSSI) of adolescents in Singapore. The researchers analyzed quantitative data to understand the functions of NSSI, the relationship of parental invalidation to NSSI, and the association between academic stress and parental invalidation. In addition, the researchers employed semi-structured qualitative interviews to provide supportive qualitative data. The participants were outpatients at the Child Guidance Clinic, Singapore, between the ages of 13 to 19 years old. Researchers compared 30 participants who engage in NSSI with 30 participants who do not engage in NSSI. The emotional regulation function was the most commonly endorsed function for NSSI. Adolescents who engage in NSSI have statistically significant (p < .01) higher mean parental invalidation scores than those who do not engage in NSSI. There is also a moderate, positive correlation between the level of parental invalidation and the level of academic stress for Singaporean adolescents. The researchers discuss the implications of this study for mental health professionals.

Exploring the use and effects of deliberate self-harm websites: an Internet-based study

Background

In the United Kingdom, rates of deliberate self-harm (DSH) are rising. Alongside this, there has been an increase in the number of websites available with DSH content, and the Internet is known as a valuable resource for those who feel isolated by their condition(s). However, there is little and contradictory evidence available on the effects of using such websites. Further research is therefore required to examine the use and effects of DSH websites.

Objective

Our objectives were to explore (1) the reasons people engage in the use of self-harm forums/websites, (2) the beliefs of users of self-harm forums regarding the role of such websites, (3) how the use of self-harm forums/websites modulates self-harm behaviors, and (4) other ways that self-harm forums affect the lives of individuals who use them.

Methods

Data were collected by a questionnaire hosted on 20 websites with self-harm content. Participants were self-selected from users of these sites. Results were analyzed using descriptive statistics and simple thematic analysis.

Results

In total, 329 responses were received with 91.8% (302/329) from female site users. The majority of participants (65.6%, 187/285) visited these sites at least twice per week, and most participants used the sites to find information (78.2%, 223/285) or participate in the forums (68.4%, 195/285). Positive effects of website use such as gaining help and support, isolation reduction, and a reduction in self-harm behaviors were reported by a large number of participants. However, smaller but important numbers reported negative effects including worsened self-harm, being triggered to self-harm, and additional negative physical and psychological effects.

Conclusions

This is the first multisite study to explore DSH website use in depth. There are clear and important benefits to engaging in website use for many individuals; however, these are not experienced by all website users. Negative effects were experienced by moderate numbers following website use, and clinicians should consider the impact of a patient’s website use when consulting.

A Google Trends-based approach for monitoring NSSI

Non-suicidal self-injury (NSSI) is an intentional, direct, and socially unacceptable behavior resulting in the destruction of one’s own body tissues with no intention of dying or committing suicide, even though it is associated with a higher risk of attempted, planned, or just considered suicide. In this preliminary report, we introduce the concept of “NSSI 2.0”; that is to say, the study of the Internet usage by subjects with NSSI, and we introduce a Google Trends-based approach for monitoring NSSI, called NSSI infodemiology and infoveillance. Despite some limitations, Google Trends has already proven to be reliable for infectious diseases monitoring, and here we extend its application and potentiality in the field of suicidology. Ad hoc web portals and surveys could be designed in light of the reported results for helping people with NSSI.

The power of the web: a systematic review of studies of the influence of the internet on self-harm and suicide in young people

BACKGROUND

There is concern that the internet is playing an increasing role in self-harm and suicide. In this study we systematically review and analyse research literature to determine whether there is evidence that the internet influences the risk of self-harm or suicide in young people.

METHODS

An electronic literature search was conducted using the PsycINFO, MEDLINE, EMBASE, Scopus, and CINAHL databases. Articles of interest were those that included empirical data on the internet, self-harm or suicide, and young people. The articles were initially screened based on titles and abstracts, then by review of the full publications, after which those included in the review were subjected to data extraction, thematic analysis and quality rating.

RESULTS

Youth who self-harm or are suicidal often make use of the internet. It is most commonly used for constructive reasons such as seeking support and coping strategies, but may exert a negative influence, normalising self-harm and potentially discouraging disclosure or professional help-seeking. The internet has created channels of communication that can be misused to 'cyber-bully' peers; both cyber-bullying and general internet use have been found to correlate with increased risk of self-harm, suicidal ideation, and depression. Correlations have also been found between internet exposure and violent methods of self-harm.

CONCLUSIONS

Internet use may exert both positive and negative effects on young people at risk of self-harm or suicide. Careful high quality research is needed to better understand how internet media may exert negative influences and should also focus on how the internet might be utilised to intervene with vulnerable young people.

Direct and Indirect Peer Socialization of Adolescent Nonsuicidal Self-Injury

This study examined direct and indirect forms of peer socialization of non-suicidal self-injury (NSSI) in adolescent friendship networks. Data were collected among 348 adolescents (55% females; Mage = 15.02 years; SD = 0.53) at 4 assessment waves. Stochastic actor-based models revealed no evidence for direct socialization of NSSI: adolescents whose friends reported higher NSSI did not increase their NSSI over time. However, indirect forms of socialization were found. After controlling for direct socialization and selection effects, friends' depressive symptoms predicted changes in male and female adolescents' NSSI and friends' impulsivity predicted changes in male adolescents' NSSI. Findings highlight the importance of extending peer influence research beyond the classical "modeling" paradigm by providing evidence that peers may indirectly socialize adolescents' NSSI.

"Mauled by a Bear": narrative analysis of self-injury among adolescents in US news, 2007-2012

Self-injury among adolescents has been widely documented in the United States, Canada, Europe, and Asia; however, news coverage of self-injury has not been examined. This study analyzes 78 news accounts of self-injury among adolescents in the United States from 2007 to 2012, using critical cultural studies as a theoretical foundation and a methodology informed by Kenneth Burke's dramatism. Narrative elements within the sample are examined in relationship to one another in order to reveal implicit meanings within the news stories. Looking across the sample, I then use a framework developed by Labov and Waletzky to examine a dominant meta-narrative that downplays social causes of self-injury-notably, various forms of trauma such as childhood sexual abuse-and instead frames self-injury as a personal choice. As a result, the remedy to the problem is not constructed as redress of contemporary pressures placed upon young people, but rather, as the responsibility of adolescents to conform to the social system that causes them to hurt themselves.

Dor e Gozo: relatos de mulheres jovens sobre automutilações

Este artigo discute a prática da automutilação, destacando os relatos de mulheres jovens (entre 15 e 21 anos), atendidas em um Centro de Atenção Psicossocial (CAPS). Tais atitudes consistem em provocar, de forma consciente, feridas no próprio corpo, como cortes, arranhões, queimaduras ou perfurações, não havendo nessas ações o desejo manifesto de suicídio, embora seja comum aparecerem ideações nesse sentido nas falas das pacientes. Os relatos acerca de tal comportamento são apresentados por meio de fragmentos de falas, registrados após atendimentos psicológicos, que esboçam a descrição dos sentimentos expostos dentro do setting terapêutico. As questões suscitadas são discutidas a partir das concepções psicanalíticas a respeito do gozo e do masoquismo, com ênfase nas proposições de Freud e Lacan, focalizando a seguinte indagação: qual é a função da dor autoprovocada - e das marcas corporais autoinflingidas - na dinâmica psíquica das pacientes com histórico de automutilações?

Supportive interchanges and face-work as 'protective talk' in an online self-harm support forum

Within a context of concern about inappropriate advice-giving online, we examined how young people who self-harm behave online, and how professionals might engage with them. We use Discourse Analysis to focus on participant interactions (posts)from a forum's crisis/support rooms, and highlight the prevalence of disclaimers, hedges, questions and tags in the young people's online interactions. We use the concept of face-work as a framework to help understand interactions in the forum SharpTalk. The findings demonstrate the use of a range of mitigation devices, and suggest that the young people orientate to a 'protective' line in their supportive interactions. These findings echo Goffman's (1967) 'supportive interchanges' in that the young people's online interactions may help to preserve face, in an emotionally complex setting, whose vulnerable members also need 'protective'and sensitive support. Taking this 'line' may enable members to create a more open and trusting context for support, and to remain in a forum which they find both helpful and challenging. In light of concerns about online support, the findings provide a new perspective on online peer-support for young people who self-harm.

An evaluation of an online peer support forum for university students with depressive symptoms

BACKGROUND

Depression is the most common mental health problem among young people, particularly university students, with prevalence rates as high as 48% reported. This population however, is reluctant to seek professional help. Online interventions may be particularly appealing to students, with evidence suggesting that they use the Internet for mental health support. While there are many mental health resources on the Internet few focus specifically on the needs of young people and few have been evaluated. This research aimed to develop and pilot test an online peer support intervention for students experiencing depressive symptoms.

METHODS

A depression support Web site (www.losetheblues.ie) was designed specifically for 18-24 year old students. The study used a mixed method, involving quantitative descriptive, pre- and post-test and qualitative descriptive designs. Data were collected using the Centre for Epidemiological Studies Depression Scale (CES-D), a background questionnaire and online forum posts.

RESULTS

The sample consisted of 117 university students with self-reported depressive symptoms. Results from participants in the pre- and post-test element of the study, showed no statistical significance. The forum posts revealed that the participants' main difficulties were loneliness and perceived lack of socialization skills. The Web site provided a place for sharing, offering and receiving emotional and informational support.

CONCLUSION

Developing health care interventions in an online environment presents unique challenges to the research process, however they have the potential to provide mental health care that is accessible and affordable.

Interpersonal features and functions of nonsuicidal self-injury

Etiological models of nonsuicidal self-injury (NSSI) suggest interpersonal features may be important to understand this behavior, but social functions and correlates have not been extensively studied. This study addresses existing limitations by examining interpersonal correlates and functions of NSSI within a stratified random sample of 1,243 predominantly Caucasian college students (mean age = 21.52, SD = 4.15 years). Participants completed an anonymous online survey assessing NSSI features, perceived social support, and disclosure experiences. Approximately 15% of the students endorsed NSSI. Interpersonal reasons were endorsed proportionally more often for initiating rather than repeating the behavior. Individuals with repetitive NSSI reported significantly lower perceived social support from family members and fewer individuals to seek advice from than single-act and control participants. Fifty-nine percent had disclosed their NSSI, but rarely to mental health professionals. Conversations with others about NSSI were rated as being mostly unhelpful. These results emphasize the importance of interpersonal features and functions of NSSI, suggesting treatments should focus on strengthening interpersonal bonds alongside emotion regulation. Improving responses to disclosures of NSSI is needed to promote communication about this behavior and perceived helpfulness of such conversations.

The impact of social contagion on non-suicidal self-injury: a review of the literature

In this review, we explore social contagion as an understudied risk factor for non-suicidal self-injury (NSSI) among adolescents and young adults, populations with a high prevalence of NSSI. We review empirical studies reporting data on prevalence and risk factors that, through social contagion, may influence the transmission of NSSI. Findings in this literature are consistent with social modeling/learning of NSSI increasing risk of initial engagement in NSSI among individuals with certain individual and/or psychiatric characteristics. Preliminary research suggests iatrogenic effects of social contagion of NSSI through primary prevention are not likely. Thus, social contagion factors may warrant considerable empirical attention. Intervention efforts may be enhanced, and social contagion reduced, by implementation of psychoeducation and awareness about NSSI in schools, colleges, and treatment programs.

Post-structuralism and psychological research on/through the internet

The present study has as aim to describe some procedures used for research in or through social networks, especially in Psychology. In order to do so, different ways of using the Internet as a tool or an object of investigation were analyzed, considering ethical and technical parameters in resolution 196 of the National Health Council, and in the Psychologist Code of Professional Ethics. Finally, there is a discussion on the adequacy of such procedures with post-structuralism theory, based on classic authors of this philosophical and theoretical perspective, such as Michel Foucault, Judith Butler and Tomaz Tadeu da Silva.

An investigation of the motivations driving the online representation of self-injury: a thematic analysis

The objetive of the study was to identify a) the motivations for communicating about non-suicidal self-injury (NSSI) in a publicly accessible online forum, b) The significance (if any) of the "publicness" of the behavior. Using a Thematic Analysis of 423 text-based posts from an online NSSI forum, 5 motivations for using the site were identified: confessional, marking a turning point, acting as a deterrent, dispelling myths and offering or seeking support. Motivations for using the site differ markedly from motivations for engaging in NSSI and tend to be more outwardly focused. The publicness of the site therefore seems to be significant in terms of bearing witness, providing the opportunity to confront negative stereotypes, and the ability to seek and offer support to like-minded individuals.

Responses to online photographs of non-suicidal self-injury: a thematic analysis

There is concern that graphic pictures of non-suicidal self-injury (NSSI) may detrimentally impact vulnerable viewers--namely those who may self-injure. How individuals (most who have, but some of whom have not, self-injured) respond to photographs of NSSI is currently unknown. Thematic analysis was used to assess testimony regarding NSSI imagery online. Analysis of testimony regarding NSSI photographs revealed a dichotomy. Individuals reporting positive perceptions said the photographs reduced loneliness and NSSI enactment. People reporting negative perceptions argued photographs reinforce and encourage NSSI. Experiences of being triggered by NSSI images were described by several participants. Photographs of NSSI posted online may have several risks for viewers. It is important to achieve a greater understanding of the effects of various forms of online NSSI content and to develop supportive NSSI resources on the Internet.

Self-injury among early adolescents: identifying segments protected and at risk

BACKGROUND

Self-injury has been described as a "silent school crisis," reflecting insufficient knowledge, confusion, lack of effective interventions, and the tendency for adults and youth to shy away from dealing directly with the issue. This purpose of this study was to identify distinct subgroups of youth who may be at increased risk of or reduced risk of nonsuicidal self-injury (NSSI).

METHODS

The middle-school Youth Risk Behavior Survey was administered in 8 district public middle schools in a large, southeastern county in Florida. A final sample size of 1748, representing approximately 92% of participants who self-reported attendance at 1 of the 8 middle schools (N = 1907) and 74% of the 2350 surveys originally distributed, was used in this study. Chi-squared automatic interaction detection (CHAID) was used to identify distinct segments at risk for or protected from NSSI.

RESULTS

CHAID analyses suggested large groups of youth at risk for (and not at risk) having ever tried self-injury including suicidal tendencies, substance use, low belief in life possibilities, and exposure to peer self-injury. Protective factors identified included having low to zero levels of suicidal tendencies, high belief in life possibilities, lack of substance use, and not being a victim of bullying.

CONCLUSION

Engaging adolescents in prevention programs at early stage can reduce the chances of suicidal behavior as well as physical injury. Schools should take the lead in advocating for the development of evidence-based interventions that are capable of addressing factors that contribute to self-injury at multiple levels of youth's environments.

[How do adolescents view non-suicidal self-injury? Differences between affected and non-affected adolescents in a school sample]

Despite the growing number of epidemiologic studies about the prevalence of non-suicidal self-injury (NSSI), little knowledge exists regarding the way adolescents view NSSI, whether differences in the attitudes towards NSSI between affected and non-affected adolescents exist and whether the acquaintance with adolescents engaging in NSSI influence one's attitudes towards self-injury? In an epidemiological study of non-suicidal self-injury, we assessed the attitudes of 447 ninth grade students (age 15 years SD = 0.7, 52% male) NSSI using a self-constructed questionnaire with three factors. Sixty one (13.6%) pupils reported that they had intentionally injured themselves once in their life time. 43% (n = 179) indicated that they discuss the topic with others, though over half of these pupils 54% (n = 98) stated feeling burdened by discussions with friends affected by NSSI. Comparisons between affected and non-affected adolescents revealed that adolescents who had never exhibited NSSI tend to believe that NSSI is mostly interpersonally motivated. Moreover, the adolescents affected by NSSI assessed the emotional reaction as more appropriate than non-affected adolescents. This should be considered in the design and refinement of inpatient treatment concepts. Our results suggest focusing on intrapersonal motives in psychotherapeutic sessions and reducing interpersonal motives for self-injurious behaviour through the establishment of clear and transparent milieu therapeutic structural conditions.

Non-suicidal self-injury, youth, and the Internet: What mental health professionals need to know

Non-suicidal self-injury (NSSI) content and related e-communication have proliferated on the Internet in recent years. Research indicates that many youth who self-injure go online to connect with others who self-injure and view others' NSSI experiences and share their own through text and videos platforms. Although there are benefits to this behaviour in terms of receiving peer support, these activities can introduce these young people to risks, such as NSSI reinforcement through the sharing of stories and strategies, as well as, risks for triggering of NSSI urges. Due to the nature of these risks mental health professionals need to know about these risks and how to effectively assess adolescents' online activity in order to adequately monitor the effects of the purported benefits and risks associated with NSSI content. This article offers research informed clinical guidelines for the assessment, intervention, and monitoring of online NSSI activities. To help bridge the gap between youth culture and mental health culture, these essentials include descriptions of Community, Social Networking, and Video/Photo Sharing websites and the terms associated with these websites. Assessment of these behaviours can be facilitated by a basic Functional Assessment approach that is further informed using specific recommended online questions tailored to NSSI online and an assessment of the frequency, duration, and time of day of the online activities. Intervention in this area should initially assess readiness for change and use motivational interviewing to encourage substitution of healthier online activities for the activities that may currently foster harm.

Social media and suicide: a public health perspective

There is increasing evidence that the Internet and social media can influence suicide-related behavior. Important questions are whether this influence poses a significant risk to the public and how public health approaches might be used to address the issue. To address these questions, we provide an overview of ways that social media can influence suicidal behavior, both negatively and positively, and we evaluate the evidence of the risk. We also discuss the legal complexities of this important topic and propose future directions for research and prevention programs based on a public health perspective.

What are young adults saying about mental health? An analysis of Internet blogs

BACKGROUND

Despite the high prevalence of mental health concerns, few young adults access treatment. While much research has focused on understanding the barriers to service access, few studies have explored unbiased accounts of the experiences of young adults with mental health concerns. It is through hearing these experiences and gaining an in-depth understanding of what is being said by young adults that improvements can be made to interventions focused on increasing access to care.

OBJECTIVE

To move beyond past research by using an innovative qualitative research method of analyzing the blogs of young adults (18-25 years of age) with mental health concerns to understand their experiences.

METHODS

We used an enhanced Internet search vehicle, DEVONagent, to extract Internet blogs using primary keywords related to mental health. Blogs (N = 8) were selected based on age of authors (18-25 years), gender, relevance to mental health, and recency of the entries. Blogs excerpts were analyzed using a combination of grounded theory and consensual qualitative research methods.

RESULTS

Two core categories emerged from the qualitative analysis of the bloggers accounts: I am powerless (intrapersonal) and I am utterly alone (interpersonal). Overall, the young adult bloggers expressed significant feelings of powerlessness as a result of their mental health concerns and simultaneously felt a profound sense of loneliness, alienation, and lack of connection with others.

CONCLUSIONS

The present study suggests that one reason young adults do not seek care might be that they view the mental health system negatively and feel disconnected from these services. To decrease young adults' sense of powerlessness and isolation, efforts should focus on creating and developing resources and services that allow young adults to feel connected and empowered. Through an understanding of the experiences of young adults with mental health problems, and their experiences of and attitudes toward receiving care, we provide some recommendations for improving receptivity and knowledge of mental health care services.

Wie psychisch belastet fühlen sich Jugendliche mit selbstverletzendem Verhalten?

In den letzten Jahren wurden zahlreiche Prävalenzstudien zum selbstverletzenden Verhalten bei Heranwachsenden in unterschiedlichen Ländern veröffentlicht. Aus der Schweiz liegen jedoch keine belastbaren Zahlen vor. Kritisch ist bei der Vielzahl der Studien anzumerken, dass sich diese oft auf ein „einfaches“ Feststellen der Prävalenz beschränken und kaum Hinweise für eine effektive Frühintervention geben. Im Rahmen einer epidemiologischen Fragebogenuntersuchung im Kanton Basel-Stadt wurden 447 Schüler (M = 14.95 Jahre, SD = 0.74, 52 % männlich) untersucht. Neben der Erfassung der Form und Art der Selbstverletzung wurde auch die psychische Belastung der Schüler erfasst. Es sollte überprüft werden, wie viele Selbstverletzer sich im Screening für psychische Störungen (SPS-J) als psychisch belastet beschreiben. 61 (13.6 %) Jugendliche gaben an, sich bereits mindestens einmal selbstverletzt zu haben. 29 (6.4 %) haben sich im letzten Monat selbst verletzt, 4 davon häufiger als viermal. Die Ergebnisse bestätigten die hohen Prävalenzraten für selbstverletzendes Verhalten. Interessant ist, dass Selbstverletzer im Schnitt zwar wesentlich höhere Werte im SPS-J erzielten, sich aber bei weitem nicht alle als psychisch auffällig beschrieben (18 von 61 selbstverletzenden Jugendlichen erzielten unauffällige Werte). Für eine effektivere Identifikation sollten daher Fragen zum selbstverletzenden Verhalten in psychopathologische Screeningfragebögen integriert werden, um diese Symptomatik adäquat abbilden zu können. Die Ergebnisse und die hohen Prävalenzen legen nahe, dass verschiedene Subgruppen von Selbstverletzern existieren, die passgenaue Hilfen für ihre Symptomatik benötigen.

Seeking validation in unlikely places: the nature of online questions about non-suicidal self-injury

Recent research points to the salience of the Internet as a means to seek information about non-suicidal self-injury (NSSI) but no research has explored what is asked about NSSI online. The current study examined the nature of NSSI questions asked on Yahoo! Answers. One hundred and eight questions were analyzed using a content analysis. The most frequently asked questions pertained to seeking validation for NSSI experiences (30.56%); however, the responses provided were sometimes quite invalidating. Other common questions included those related to general NSSI information (17.59%), scar concealment (11.11%), and NSSI-related media (11.11%). Efforts are needed to provide NSSI resources and support online but websites may need to be monitored to safeguard against unhelpful responses.