Online Self-Injury Activities among Psychiatrically Hospitalized Adolescents: Prevalence, Functions, and Perceived Consequences

Friendships and peer relationships and self-harm ideation and behaviour among young people: a systematic review and narrative synthesis

Friendships and peer relationships have an important role in the experience of self-harm ideation and behaviour in young people, yet they typically remain overlooked. This systematic review and narrative synthesis explores the extant literature on this topic to identify important relationships between these constructs. We did a keyword search of peer-reviewed empirical articles relating to friendships and peer relationships and self-harm ideation and behaviour in young people (aged 11-25 years). We identified 90 articles with evidence primarily from adolescents aged 11-18 years, including mixed genders and a majority of White individuals. Findings highlight substantive relationships between the key constructs, showing that: characteristics of friends and peers, including their self-harm ideation and behaviour, relate to and predict ego self-harm ideation and behaviour; friends and peers are important sources of support; and evidence on causal mechanisms is scarce but highlights potential peer selection and influence processes. Studies of the friends and peers of young people with self-harm ideation and behaviour highlight that: friends' attitudes to self-harm and suicide influence their responses to peers with self-harm ideation and behaviour; and friends who are bereaved and friend supporters experience negative outcomes such as symptoms of depression, anxiety, PTSD, and grief, alongside difficult emotions. Despite substantial heterogeneity across samples, study designs, and definition or measurement of the primary constructs, this work presents an initial step in organising a complex literature on a crucially important topic, which can help to inform future research and evidence-based interventions.

Perceived functions and importance of digital media use and adolescent depression and suicidal ideation

INTRODUCTION

Although social media (SM) use is nearly ubiquitous among adolescents, there is a lack of clarity concerning the relationship between SM use and mental health outcomes like depression and suicidal ideation (SI), which increase during adolescence. Much of the previous literature has focused on the frequency of SM use; however, the current study examined the relationship between the perceived importance of three types of interactions and functions of SM use and depressive symptoms and suicidal ideation.

METHODS

A sample of 4057 adolescents (M age = 14.6; 47.0% girls; 69.0% Non-Hispanic/Latine White) were recruited via an online survey manager between February and March 2019. Participants completed the Adolescent Digital Technology Interactions and Importance (ADTI) Scale, which assessed the perceived importance of bridging online and offline experiences (bridging), going outside one's identity or offline experience (identity), and facilitating social connections (social). Participants also completed measures of depressive symptoms and SI and a self-report measure of SM use. A series of path analyses were conducted to examine the relationship between bridging, identity, social, and depressive symptoms and SI.

RESULTS

After accounting for covariates (gender identity, racial identity, age, and SM use), bridging was negatively associated with depressive symptoms, whereas identity was positively associated with depressive symptoms. Bridging and social connection were negatively associated with SI, whereas identity was positively associated with SI. Gender moderated these relationships; however, racial identity did not.

CONCLUSION

The results highlight the importance of understanding adolescent SM use beyond screen time in relation to depression and SI.

Positive and negative social media experiences and proximal risk for suicidal ideation in adolescents

BACKGROUND

Social media (SM) has received considerable attention as a potential risk factor for adolescent suicide. Few empirical studies, however, have examined adolescents' daily negative and positive experiences on SM and its proximal impacts on suicidal ideation (SI), particularly using intensive monitoring designs.

METHOD

Adolescents (N = 60; 14-17 years; 49% girls; 62% LGBTQ+) recruited using SM across the United States and participated in an 8-week intensive monitoring protocol. Ecological momentary assessment (three brief surveys per day) asked about negative and positive SM experiences and SI (passive and active). Multilevel modelling was used to evaluate the within-person relationships between daily SM experiences (e.g. individual fluctuations compared to a person's average) and SI, controlling for average levels of SM experiences, SM use screen time, and lifetime SI.

RESULTS

Significant within-person effects of negative and positive SM experiences were associated with days when adolescents had SI. Specifically, on days when teens endorsed more frequent negative SM experiences than usual, they were more likely to report SI. However, more positive SM experiences than usual were associated with a lower likelihood of having SI. There were no significant effects of SM use ('screen time') on SI or on the reverse associations of SI on next-day SM experiences.

CONCLUSIONS

Results indicate that SM experiences may be dynamic and modifiable risk and protective factors for SI in adolescents, whereas there is no effect of SM screen time on SI. Our results highlight that targeting negative SM experiences and augmenting the positive experiences on SM may be critical targets to improve teens' mental health and prevent suicide, rather than focusing on limiting SM screen time.

What methods are used in research of firsthand experiences with online self-harming and suicidal behavior? A scoping review

BACKGROUND

Online self-harming and suicidal behavior is a novel and rapidly increasing phenomenon warranting comprehensive mapping of used research methods.

AIM

To identify and map how knowledge on online self-harming and suicidal behavior is gathered, including how data are collected e.g. questionnaires and interviews.

METHODS

The review follows the Joanna Briggs Institute Manual for Scoping Reviews in tandem with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A keyword search of three electronic databases was conducted on two occasions, yielding 5422 records. Following duplicate removal, the records were screened based on the following inclusion criterions; (1) in English or Nordic language and published between 2011-2022, (2) presenting results for self-harming and/or suicidal behavior on social media and (3) using tools for either interview or questionnaire aiming at assessment of the experience of online self-harming and suicidal behavior from the perspective of the person who engages in the behavior. A total of 64 articles were included.

RESULTS

45 used questionnaires, 17 used interviews, and two studies mixed the two approaches. 17% of the studies had made some effort to ensure validity within the questionnaires and 15.8% gave full access to the interview guide.

CONCLUSION

Research into online self-harming and suicidal behavior is characterized by a lack of validated measurements and methodological transparency. The results emphasize a need for further development, testing, and validation of questionnaires and greater openness and reflexivity in qualitative methodology to enable cross-study comparison and advance knowledge of this complex phenomenon.

The Journey of Engaging With Web-Based Self-Harm and Suicide Content: Longitudinal Qualitative Study

BACKGROUND

Self-harm and suicide are major public health concerns worldwide, with attention focused on the web environment as a helpful or harmful influence. Longitudinal research on self-harm and suicide-related internet use is limited, highlighting a paucity of evidence on long-term patterns and effects of engaging with such content.

OBJECTIVE

This study explores the experiences of people engaging with self-harm or suicide content over a 6-month period.

METHODS

This study used qualitative and digital ethnographic methods longitudinally, including one-to-one interviews at 3 time points to explore individual narratives. A trajectory analysis approach involving 4 steps was used to interpret the data.

RESULTS

The findings from 14 participants established the web-based journey of people who engage with self-harm or suicide content. In total, 5 themes were identified: initial interactions with self-harm or suicide content, changes in what self-harm or suicide content people engage with and where, changes in experiences of self-harm or suicide behaviors associated with web-based self-harm or suicide content engagement, the disengagement-reengagement cycle, and future perspectives on web-based self-harm or suicide content engagement. Initial engagements were driven by participants seeking help, often when offline support had been unavailable. Some participants' exposure to self-harm and suicide content led to their own self-harm and suicide behaviors, with varying patterns of change over time. Notably, disengagement from web-based self-harm and suicide spaces served as a protective measure for all participants, but the pull of familiar content resulted in only brief periods of disconnection. Participants also expressed future intentions to continue returning to these self-harm and suicide web-based spaces, acknowledging the nonlinear nature of their own recovery journey and aiming to support others in the community. Within the themes identified in this study, narratives revealed that participants' behavior was shaped by cognitive flexibility and rigidity, metacognitive abilities, and digital expertise. Opportunities for behavior change arose during periods of cognitive flexibility prompted by life events, stressors, and shifts in mental health. Participants sought diverse and potentially harmful content during challenging times but moved toward recovery-oriented engagements in positive circumstances. Metacognitive and digital efficacy skills also played a pivotal role in participants' control of web-based interactions, enabling more effective management of content or platforms or sites that posed potential harms.

CONCLUSIONS

This study demonstrated the complexity of web-based interactions, with beneficial and harmful content intertwined. Participants who demonstrated metacognition and digital efficacy had better control over web-based engagements. Some attributed these skills to study processes, including taking part in reflective diaries, showing the potential of upskilling users. This study also highlighted how participants remained vulnerable by engaging with familiar web-based spaces, emphasizing the responsibility of web-based industry leaders to develop tools that empower users to enhance their web-based safety.

The Association between Nonsuicidal Self-Injury and Perfectionism in Adolescence: The Role of Mental Disorders

Previous evidence has drawn attention to the fact that maladaptive perfectionism is a risk factor for engagement in nonsuicidal self-injury (NSSI). Until now, few studies have examined this topic, especially among community adolescents. The aim of this study was to explore the relationship between perfectionism dimensions and NSSI functions to examine the potential mediating effect of mental disorders. Altogether, 146 Hungarian community adolescents (ages 13-18 years) were involved. All participants completed the Hungarian adaptation of the Inventory of Statements about Self-Injury (ISAS), the Frost Multidimensional Perfectionism Scale (FMPS), and the Mini International Neuropsychiatric Interview Kid. To analyse the interrelationships among NSSI, perfectionism, and mental disorders, we conducted regression and network analysis. Of the 146 adolescents, 90 (61.64%, girls: 71.11%) engaged in NSSI. The Concern over Mistakes and Doubts about Action scales of the FMPS significantly and positively predicted both NSSI intrapersonal and interpersonal motivation, with comparable effect sizes, and this association was fully mediated by anxiety disorders. There was a significant direct negative relationship between the FMPS Organisation dimension and both main NSSI functions. This study draws attention to an increasing trend and the extremely high NSSI prevalence rate among community adolescents. Adolescents with perfectionistic concerns are at heightened risk for anxiety disorders, which can increase their vulnerability to NSSI engagement.

Assessing the impact of Instagram use and deliberate self-harm in adolescents: A scoping review

The use of Instagram by adolescents to access deliberate self-harm content is a growing concern among scholars, mental health professionals and families, with many adolescents (10-19-year-olds) imitating offline what they have seen online. This scoping review aims to investigate the extent to which Instagram use impacts the mental health of its adolescent users, identifying whether there is a relationship between time spent on Instagram and engagement in deliberate self-harm. The databases, PubMed, Web of Science, Google scholar, APA PsycInfo, CINAHL and child development and adolescent studies were explored, and after applying the inclusion/exclusion criteria, 15 papers were included in this review. Thematic analysis indicated that there was a relationship between time spent on Instagram and deliberate self-harm; desensitization of deliberate self-harm resulting in normalization; social contagion and that Instagram provided a sense of belonging to its users who engaged in deliberate self-harm. Implications of this research is that it is quickly outdated as new social media platforms are developed and that the reliance on self-reports does not have high validity or reliability.

Review: Digital experiences and their impact on the lives of adolescents with pre-existing anxiety, depression, eating and nonsuicidal self-injury conditions - a systematic review

BACKGROUND

Published systematic reviews provide evidence linking positive and negative digital experiences to adolescent mental health. However, these reviews focus on the general public rather than the digital experiences of adolescents with different pre-existing mental health conditions and so may be limited in their clinical relevance. We review publications relating to anxiety, depression, eating disorders and nonsuicidal self-injury to identify common and condition-specific digital experiences and how these may be implicated in the origins and maintenance of these mental health conditions.

METHODS

A systematic literature search using a combination of mental health, digital experience (including social media use), and age of the target population terms was conducted on four databases. Detailed findings from the included studies were summarised using a combination of thematic and narrative methods.

RESULTS

Five qualitative and 21 quantitative studies met the eligibility criteria for inclusion (n = 5021). Nine studies included adolescents with depression, one with eating problems, two with nonsuicidal self-injury and 14 with multiple emotional health conditions. The review identified six themes related to the target populations' digital experiences: (a) social connectivity and peer support; (b) escape and/or distraction; (c) social validation and social comparison; (d) accessing/creation of potentially harmful content; (e) cyberbullying; and (f) difficulties with self-regulation during engagement with digital media.

CONCLUSIONS

Digital practices of adolescents with pre-existing clinical vulnerabilities are complex and encompass a range of positive and negative experiences, which appear to have common elements across different clinical populations. The literature is currently too limited to identify disorder-specific practices, with too few direct or indirect comparisons between conditions.

Developing Healthy Social Media Practices: An Outpatient Caregiver-Adolescent Group Intervention

Adolescents frequently use social media to connect with peers, develop friendships, and explore their identity. However, some adolescents, particularly those with co-occurring mental health concerns or other vulnerabilities, may experience problems or dysfunction related to their social media use. Navigating online social interactions, regulating one’s own use of social media, and being aware of how content of social media may impact users are important skills that youth need to build in today’s digital age. The purpose of this paper is to describe the rationale for, and components of, a group therapy intervention (Developing Healthy Social Media Practices) for caregivers and their adolescents that seeks to (a) provide psychoeducation about the risks and benefits of social media use; (b) teach youth and their caregivers online social problem solving skills; (c) facilitate caregiver-adolescent communication about online social interactions and other online risks; and (d) promote motivation to change social media practices that youth and their caregivers identify as impacting functioning.

A Functional Approach to the Assessment of Non-Suicidal Self-Injury on YouTube

This research explores representations of non-suicidal self-injury (NSSI) on social media. The current study aims to examine the applicability of a functional model of NSSI to videos posted on YouTube by analyzing the 100 most viewed YouTube videos relating to NSSI at a point in time in 2018. Motivations for continued engagement in NSSI were examined for each content creator who posted one of the top 100 most viewed videos relating to NSSI. Categorizations of a content creator's motivation were based on Nock and Prinstein (2004) four-function model (FFM) of NSSI, in which the motivations, or functions, of NSSI are categorized by two dichotomous factors: (a) positive (i.e., involves the addition of a favorable stimulus) or negative (i.e., involves the removal of an aversive stimulus) and (b) automatic (i.e., intrapersonal) or social (i.e., interpersonal). Uploaders most endorsed automatic negative reinforcement (50%), followed by automatic positive (26%), social positive (3%), and social negative (3%). Considering the growing number of children and adolescents with near constant access to internet and social media, there may be implications for further development of safety measures for social media platforms. The results of this study may be valuable for parents, health care professionals, and educators, who should be aware of available social media content relating to NSSI and consider implementing additional media-literacy and media-safety education in school curriculums and programming for children and adolescents. Furthermore, health care professional should be aware that misconceptions of NSSI may have an impact on patients' willingness to seek treatment, or the attitude with which treatment is sought.

Global prevalence and characteristics of non-suicidal self-injury between 2010 and 2021 among a non-clinical sample of adolescents: A meta-analysis

Background

Adolescents with immature mind and unstable emotional control are high-risk groups of non-suicidal self-injury (NSSI) behavior. We meta-analyzed the global prevalence of NSSI and prevalence of NSSI characteristics in a non-clinical sample of adolescents between 2010 and 2021.

Methods

A systematic search for relevant articles published from January 1, 2010 to June 30, 2021 was performed within the scholarly database search engines of CBM, CNKI, VIP, Wanfang, PubMed, Web of Science, PsycINFO, and Embase. Eligibility criteria were as follows: provided cross-sectional data on the prevalence of NSSI; the subjects were non-clinical sample adolescents; and a clear definition of NSSI was reported. We used the following definiton of NSSI as our standard: the deliberate, self-inflicted destruction of body tissue, such as cutting, burning, and biting, without attempted suicide. The quality evaluation tool for cross-sectional studies recommended by the JBI was used. The global prevalence of NSSI was calculated based on the random-effects model by Comprehensive Meta-analysis version 3.0. Subgroup analyses were performed to compare the prevalence according to sex, living place, smoking or drinking history, and family structure.

Results

Sixty-two studies involving 264,638 adolescents were included. The aggregate prevalence of NSSI among a non-clinical sample of adolescents was similar between over a lifetime (22.0%, 95% CI 17.9-26.6) and during a 12-month period (23.2%, 95% CI 20.2-26.5). Repetitive NSSI was more common than episodic NSSI (20.3% vs. 8.3%) but the frequency of mild injury (12.6%) was similar to that of moderate injury (11.6%). Multiple-method NSSI occurred slightly more often compared than one-method NSSI (16.0% vs. 11.1%). The top three types of NSSI in adolescents were banging/hitting (12.0%, 95% CI 8.9-15.9), pinching (10.0%, 95% CI 6.7-14.8), and pulling hair (9.8%, 95% CI 8.3-11.5), and the least common type was swallowing drugs/toxic substances/chemicals (1.0%, 95% CI 0.5-2.2). Subgroup analyses showed that being female, smoking, drinking, having siblings, and belonging to a single-parent family may be linked to higher prevalence of NSSI.

Conclusion

This meta-analysis found a high prevalence of NSSI in non-clinical sample of adolescents, but there are some changes in severity, methods, and reasons. Based on the current evidence, adolescents in modern society are more inclined to implement NSSI behavior by a variety of ways, which usually are repetitive, and moderate and severe injuries are gradually increasing. It is also worth noting that adolescents with siblings or in single-parent families are relatively more likely to implement NSSI behavior due to maladjustment to the new family model. Future research needs to continue to elucidate the features and risk factors of NSSI so as to intervene in a targeted way.

Limitation

The limitation of this study is that the heterogeneity among the included studies is not low, and it is mainly related to Chinese and English studies. The results of this study should be used with caution.

Systematic review registration

[www.crd.york.ac.uk/prospero/], identifier [CRD42022283217].

Digital media-related precursors to psychiatric hospitalization among youth

Digital media, including smartphones and social media, are central in youths' lives. This study aimed to examine the role of digital media in psychiatric hospital admissions among adolescents. 343 psychiatrically-hospitalized youth (Mage = 15.2; 70.3% White, 13.7% Black, 33.9% Hispanic; 48.7% female) completed self-report measures of potential digital media-related reasons for hospitalization, patterns of digital media use, and clinical symptoms (internalizing, externalizing, suicidal ideation and attempts). Digital media-related reasons for hospitalization were common, with over 40% of the sample endorsing at least one such reason; 24.8% endorsed having their phone taken away as a reason for admission. Younger adolescents and youth with addictive patterns of phone use were more likely to endorse digital media-related reasons for hospitalization, including phone restriction and negative social media experiences. In addition, youth endorsing suicide-related social media engagement (e.g., posting or messaging about suicide) as a precursor to admission reported more severe suicidal ideation and greater likelihood of a recent suicide attempt. Limitations of the study include a reliance on self-report measures and cross-sectional design. Findings highlight the need to identify youth who may be especially vulnerable to digital media experiences that contribute to risk for psychiatric hospitalization.

Associations Between Borderline Personality Disorder Symptoms and Online Self-Disclosure in Clinically Referred Youth

Communicating online via social media has proven to facilitate disclosure of intimate topics and can therefore be helpful in the development of intimate relationships. However, for youth with borderline personality disorder (BPD) symptoms, it may be more difficult to know when, what, and to whom to disclose (i.e., effective disclosure) in online contacts. The authors examine associations between BPD symptoms, online self-disclosure, and ineffective online self-disclosure (e.g., regretting sharing something online). The sample consisted of 235 clinically referred youth (66.4% female), aged 12-25 years (M = 17.82, SD = 2.96). Structural equation modeling revealed that BPD symptoms were related to higher levels of same- and cross-sex online self-disclosure as well as to more ineffective online self-disclosure. There was no moderation by sex or age. This study suggests that youth with BPD symptoms are at risk for oversharing personal information, which could affect forming and maintaining intimate relationships and increases online risks.

Social media use and self-injurious thoughts and behaviors: A systematic review and meta-analysis

Despite considerable public and scholarly debate about the role of social media in self-injurious thoughts and behaviors (SITBs), no comprehensive, quantitative synthesis of this literature has previously been undertaken. The current systematic review and meta-analysis examines associations between social media use and SITBs, including suicidal ideation, suicide plans, suicide attempts, and nonsuicidal self-injury (NSSI). A range of social media behaviors and experiences were identified, including cybervictimization and perpetration, exposure to and generation of SITB-related content, problematic use, sexting, social media importance, and frequency of use. A systematic search of PsycINFO, Medline, CINAHL, and the references of prior reviews yielded 61 eligible studies. Results largely suggested medium effect sizes for associations between specific social media constructs (cybervictimization, SITB-related social media use, problematic social media use) and SITBs. There was no association between frequency of social media use and SITBs; however, studies on this topic were limited. The majority of studies identified focused on cybervictimization, and results suggested positive associations with all SITBs, with the association between cybervictimization and suicidal ideation stronger for adolescents than adults. Overall, findings highlight the utility of examining specific social media behaviors and experiences, and point to the need for more research in this area.