A Preliminary Application of Social Cognitive Theory to Nonsuicidal Self-Injury

The Relationship between Ambivalence over Emotional Expression and Nonsuicidal Self-Injury Among Chinese Adolescents: A Longitudinal Moderated Mediation Model

BACKGROUND

Nonsuicidal self-injury (NSSI) has become a significant mental health concern for adolescents. Previous empirical studies have shown that ambivalence over emotional expression is positively associated with negative emotions and behaviors. However, little is known about the relationship between ambivalence over emotional expression and NSSI among adolescents. Therefore, this study used a longitudinal design to examine the relationship between ambivalence over emotional expression and NSSI among Chinese adolescents, and also to explore the mediating and moderating mechanisms underlying this relationship.

METHOD

A total of 1,672 students (45.8% males; Mage = 16.12 years, SD = 1.56) in a middle school in Guangzhou were tracked. The investigation was conducted twice, with an interval of 6 months.

RESULTS

Ambivalence over emotional expression was positively correlated with NSSI. After controlling for gender and baseline NSSI, anxiety symptoms fully mediated the association between ambivalence over emotional expression and NSSI. In addition, the relationship between ambivalence over emotional expression and NSSI was moderated by NSSI refusal self-efficacy.

CONCLUSIONS

These findings imply that to decrease ambivalence over emotional expression, to reduce anxiety symptoms, and to promote NSSI refusal self-efficacy may be useful for interventions and preventions of NSSI.HIGHLIGHTSTested the relationship between ambivalence over emotional expression and NSSI in adolescents.Examined a moderated-mediation model over six months.Found the mediated effect of anxiety symptoms and moderated effect of NSSI refusal self-efficacy in the relationship between ambivalence over emotional expression and NSSI.

Cognitive-emotional networks in students with and without a history of non-suicidal self-injury

BACKGROUND

Contemporary models of non-suicidal self-injury (NSSI) suggest that emotional vulnerabilities, negative self-schemas, and beliefs about NSSI work together to differentiate students who self-injure from those who do not. However, it is unclear how these mechanisms are differentially related among students with and without a history of NSSI. Considering this, we used a network analysis approach to explore how students with and without a history of NSSI vary in processing their emotional experiences in relation to their self-concepts and beliefs about NSSI.

METHOD

A sample of 480 university students (M_age = 21.18, SD = 2.43; 73.5 % female) completed self-report measures about their perceived emotional experiences (e.g., emotional reactivity, emotion regulation difficulties), self-concepts (e.g., self-esteem, self-efficacy), and NSSI.

RESULTS

A network comparison test revealed that students with a history of NSSI perceived themselves to have difficulties regulating particularly intense, unwanted negative emotions. In light of this, students with a history of NSSI expected some benefits of NSSI (e.g., emotion regulation) regardless of potential barriers (e.g., pain). Conversely, for students without a history of NSSI, expecting NSSI to have aversive outcomes was tied to expecting NSSI to have few benefits.

LIMITATIONS

The cross-sectional design limits inferences to be made about the network structures.

CONCLUSIONS

Students with and without a history of NSSI appear to differ in their cognitive processing of negative emotions and strategies used to deal with these emotions.

Trajectories of nonsuicidal self‐injury during adolescence

OBJECTIVE

Although nonsuicidal self-injury is a public health concern, there is little information on how it changes across adolescence or what contributes to stability or change. We aimed to identify trajectories of stability and change in self-injury from ages 13 to 17 years, and to identify interpersonal and intrapersonal correlates that differentiate between trajectories of stability and change.

METHOD

We used five annual waves of cohort-sequential data, targeting 7th and 8th graders attending all public schools in three municipalities in central Sweden. The data were gathered via questionnaires, using a multi-item measure of non-suicidal self-injury and assessing negative experiences at home, in school, with peers, and in romantic settings, as well as intrapersonal issues (internalizing symptoms and difficulties with emotional, and behavioral regulation). The analytic sample was 3195 adolescents (51.7% boys, 48.3% girls; ages 12-16 years at T1, M = 13.61; SD = 0.66), most of whom were born in Sweden (88.6%) to at least one parent of Swedish origin (77.4%).

RESULTS

Latent growth curve modeling revealed three self-injury trajectories: a stable-low, a low-increasing, and an increasing-decreasing trajectory. Adolescents in the stable-low class reported the best overall adjustment at ages 13 and 16. Comparatively, adolescents in the other two classes reported similar levels of difficulty interpersonally and intrapersonally. Where they differed, the increase-decrease class fared worse than the low-increasing class.

CONCLUSIONS

This study suggests the need to frame self-injury as having multiple directions of development during adolescence and develop theory that aligns with differential patterns of self-injury development.

Hierarchical topological model of the factors influencing adolescents' non-suicidal self-injury behavior based on the DEMATEL-TAISM method

This study analyzed the factors influencing adolescents' non-suicidal self-injury (NSSI) behavior and their interrelationships, and established a total influencing factor model. Through a literature analysis and semi-structured interviews with 87 adolescents and 27 experts in Guangxi Province, China, 13 influencing factors were identified from six aspects: physiological factors, cognitive factors, emotional factors, social support factors, social environment, and NSSI behavior. A system of factors influencing adolescents' NSSI behavior and a model of the factors influencing the comprehensive antagonism multilevel explanatory structure were obtained using a combination of Decision-Making Trial and Evaluation Laboratory technique and Total Adversarial Interpretive Structural Model. In descending order, NSSI, emotional state, self-efficacy, and self-cognition influenced adolescents' NSSI behavior. Social environment, exercise, and recreation had a greater impact on other factors, while NSSI, emotional regulation ability, and emotional state were greatly affected by other factors. Emotion regulation ability, self-cognition, self-efficacy, family support, school support, social support, and sleep were found to be the core factors influencing NSSI behavior of adolescents. These factors could be used to directly intervene in adolescent NSSI behavior. Timely treatment of adolescents' negative emotional states is directly conducive to preventing NSSI behavior and alleviating its severity.

Relationships between Outcome Expectancies and Non-Suicidal Self-Injury: Moderating Roles of Emotion Regulation Difficulties and Self-Efficacy to Resist Self-Injury

BACKGROUND

Non-suicidal self-injury (NSSI) is the deliberate damage of one's own body tissue in the absence of suicidal intent. Research suggests that individuals engage in NSSI as a means of regulating their emotions and that NSSI is associated with emotion regulation difficulties. There is also evidence supporting the role of outcome expectancies and self-efficacy to resist NSSI. However, it is unclear how these factors work together to explain NSSI.

OBJECTIVE

To explore whether the relationships between five NSSI-specific outcome expectancies and NSSI history are moderated by emotion regulation difficulties and self-efficacy to resist NSSI.

METHOD

1002 participants (Mage = 20.51, 72.5% female, 39.7% lifetime history of NSSI) completed an online survey including measures of NSSI history, outcome expectancies, self-efficacy to resist NSSI, and emotion regulation difficulties.

RESULTS

Emotion regulation difficulties were associated with NSSI, as was expecting NSSI to regulate affect. Conversely, expectations of communication and/or pain, as well as self-efficacy to resist NSSI were negatively associated with NSSI. Expectancies also interacted with both difficulties in emotion regulation and self-efficacy to resist NSSI in predicting self-injury. For example, the association between expectations of affect regulation and self-injury was weaker when associated with greater self-efficacy to resist NSSI.

CONCLUSION

These findings provide support for considering NSSI-specific cognitions in concert with emotion regulation when understanding NSSI.HighlightsOutcome expectancies can differentiate people based on NSSI history.Emotion regulation difficulties and self-efficacy to resist NSSI moderate the relationships between outcome expectancies and NSSI history.Emotion regulation difficulties and low self-efficacy to resist NSSI work together to predict NSSI history.

Applying social cognitive theory to nonsuicidal self-injury: Interactions between expectancy beliefs

ObjectiveA measure was recently developed which assesses self-efficacy to resist NSSI across differing contexts. The aim of this study was to examine how self-efficacy to resist NSSI across contexts interacts with NSSI-related outcome expectancies when differentiating NSSI history. Participant: 501 Australian college students aged 17-40 years (M = 21.21, SD = 2.36). Method: Participants completed online questionnaires. Results: Self-efficacy to resist NSSI when in contexts considered to be protective or of high risk moderated the relationships between NSSI-related outcome expectancies and recent engagement in NSSI. Participants who expected NSSI to result in communication were more likely to have recently engaged in NSSI if they held weak self-efficacy to resist NSSI in protective contexts. Expecting NSSI to result in diminished self-worth was protective against weak self-efficacy to resist NSSI. Conclusion: Results support the application of Social Cognitive Theory to NSSI and provide future avenues for exploring NSSI-specific cognitions.

Cognitive and emotional factors associated with the desire to cease non-suicidal self-injury

Background

Due to cognitive and emotional differences between individuals who have and have not stopped self‐injuring, we explored these in the context of desire to stop.

Method

Australian university students (n = 374) completed cognitive and emotional measures. Comparisons were made between those who had self‐injured in the past 12 months and those who had not, and between individuals who reported wanting to stop self‐injuring and those who did not.

Results

Approximately 20% of participants did not want to stop self‐injuring. Cognitive emotional factors (psychological distress, self‐efficacy to resist, difficulties regulating emotion, interpersonal functions, and outcome expectancies) differentiated individuals who had and had not stopped, but could not explain differences in desire to stop.

Conclusion

Factors associated with desire to stop are not the same as factors underlying behavioural cessation. Motivational approaches to changes in self‐injurious behaviour would be beneficial for clinicians and their clients.

Correlates of disclosure of non-suicidal self-injury amongst Australian university students

Purpose

Non-suicidal self-injury (NSSI) is associated with psychological disorders and suicidal thoughts and behaviours; disclosure of NSSI can serve as a catalyst for help-seeking and self-advocacy amongst people who have self-injured. This study aims to identify the socio-demographic, NSSI-related, socio-cognitive and socio-emotional correlates of NSSI disclosure. Given elevated rates of NSSI amongst university students, this study aimed to investigate these factors amongst this population.

Design/methodology/approach

Australian university students (n = 573) completed online surveys; 80.2% had previously disclosed self-injury.

Findings

NSSI disclosure was associated with having a mental illness diagnosis, intrapersonal NSSI functions, specifically marking distress and anti-dissociation, having physical scars from NSSI, greater perceived impact of NSSI, less expectation that NSSI would result in communication and greater social support from friends and significant others.

Originality/value

Expanding on previous works in the area, this study incorporated cognitions about NSSI. The ways in which individuals think about the noticeability and impact of their NSSI, and the potential to gain support, are associated with the decision to disclose self-injury. Addressing the way individuals with lived experience consolidate these considerations could facilitate their agency in whether to disclose their NSSI and highlight considerations for health-care professionals working with clients who have lived experience of NSSI.

Thoughts and beliefs about nonsuicidal self-injury: An application of social cognitive theory

According to Social Cognitive Theory, the anticipated consequences of a behavior (outcome expectancies), coupled with our belief in our ability to successfully perform the behavior (self-efficacy), determine the likelihood of engagement in a behavior. We explored whether the relationship between nonsuicidal self-injury outcome expectancies and self-injury was moderated by self-efficacy to resist nonsuicidal self-injury. Participants: Five hundred and sixteen college students aged 18-26 years (M = 20.60, SD = 1.86). Methods: Self-report measures were completed online. Results: The relationship between expecting self-injury would result in pain or emotion regulation and engaging in self-injury was moderated by a belief in the ability to resist self-injury. People who had never self-injured were more likely to believe that self-injury would cause physical pain and believe they could resist self-injury. A belief in the ability to resist self-injury countered expectations that self-injury would result in emotion regulation. Conclusion: Results may inform college-based prevention and intervention efforts.

A comparison of the associations between alexithymia and both non-suicidal self-injury and risky drinking: The roles of explicit outcome expectancies and refusal self-efficacy

Both non-suicidal self-injury (NSSI) and risky drinking are positively associated with alexithymia, a personality trait characterized by difficulties appraising feelings and an externally orientated thinking style. Although researchers have studied the associations between alexithymia and both NSSI and risky drinking, the underlying factors of both associations are rarely compared. Using path analysis, we compared the mediating effects of behaviour-specific outcome expectancies and self-efficacy beliefs on the associations between alexithymia and both NSSI and risky drinking. A sample of 627 university students (76.10% female, Mage = 20.75, SD = 1.88) completed a battery of questionnaires. Alexithymia exhibited indirect effects on NSSI via affect regulation expectancies, pain expectancies, communication expectancies, and low self-efficacy to resist NSSI. Alexithymia exhibited indirect effects on risky drinking via expectations of increased confidence and negative consequences. However, the indirect effects differed depending on the valance of the emotion the individual had difficulties appraising. Our findings indicate that the underlying factors in the associations between alexithymia and both NSSI and risky drinking could differ. Where individuals who have difficulties appraising negative emotions may engage in NSSI to help regulate negative feelings, they may consume alcohol to gain more confidence in expressing their feelings. Clinical implications are discussed.

Exposure to and experience of self-harm and self-harm related content: An exploratory network analysis

Exposure to the self-harm behaviour of others plays a role in individuals' own self-harm thoughts and behaviours, but there has been little consideration of the broader range of mediums through which exposure to self-harm related content may occur. N = 477 participants completed an online study, including questions regarding lifetime history of self-harm thoughts and behaviours and the frequency with which they had been exposed to self-harm via various mediums. Gaussian Markov random field network models were estimated using graphical LASSO and extended Bayesian information criterion. Bootstrapping revealed that exposure mediums with a direct connection to self-harm thoughts and behaviours were the internet (rrp = .34, 95% CI [.26, .42]) and in-passing 'miscellaneous' exposure (rrp = .14, 95% CI [.00, .23]). However, stability of the network centrality was low (expected influence stability = 0.52). The node with the greatest increase in expected influence within the network was miscellaneous "in-passing" exposure. In-passing exposure is an understudied exposure medium. Our results may suggest new types of exposure mediums for future research. Data were cross-sectional, so temporal relationships between exposure and behaviour could not be determined. Low stability of the networks suggests that future similar studies would benefit from larger sample sizes.

Resident assistant secondary trauma and burnout associated with student nonsuicidal self-injury

Objective: To determine whether or not encountering students struggling with nonsuicidal self-injury (NSSI) put resident assistants (RAs) at greater risk of burnout or secondary traumatic stress. Participants: One hundred and fifty-five RAs at three Midwest public university campuses between March and April 2016. Methods: RAs participated in an anonymous online survey that collected demographics, information on RAs' experiences and thoughts related to their work, RAs' exposure to NSSI struggle of a resident, and measurements of compassion satisfaction, burnout, and secondary traumatic stress. Results: RAs who encountered resident NSSI demonstrated significantly higher levels of burnout and secondary traumatic stress than RAs who did not encounter resident NSSI. Conclusion: College students struggle with NSSI can significantly affect the people around them. Residence life administration and college counseling centers should provide training, support, and supervision to RAs in a way that addresses and reduces the RAs' potential distress.

Fluctuations in Affective States and Self-Efficacy to Resist Non-Suicidal Self-Injury as Real-Time Predictors of Non-Suicidal Self-Injurious Thoughts and Behaviors

INTRODUCTION

Although research over the past decade has resulted in significantly increased knowledge about distal risk factors for non-suicidal self-injury (NSSI), little is known about short-term (proximal) factors that predict NSSI thoughts and behaviors. Drawing on contemporaneous theories of NSSI, as well as the concept of ideation-to-action, the present study clarifies (a) real-time factors that predict NSSI thoughts and (b) the extent to which theoretically important momentary factors (i.e., negative affect, positive affect, and self-efficacy to resist NSSI) predict NSSI behavior in daily life, beyond NSSI thoughts.

METHODS

Using experience sampling methodology, intensive longitudinal data was obtained from 30 young adults with frequent NSSI episodes in the last year. Participants completed assessments up to eight times per day for 12 consecutive days (signal-contingent sampling). This resulted in the collection of 2,222 assessments (median compliance = 79.2%) during which 591 NSSI thoughts and 270 NSSI behaviors were recorded. Using the dynamic structural equation modeling framework, multilevel vector autoregressive models were constructed.

RESULTS

Within the same assessment, negative affect was positively associated with NSSI thoughts, whereas positive affect and self-efficacy to resist NSSI were each negatively associated with NSSI thoughts. Across assessments, higher-than-usual negative affect and self-efficacy to resist NSSI were predictive of short-term change in NSSI thoughts. While fluctuations in both negative affect and positive affect prospectively predicted NSSI behavior, these factors became non-significant in models that controlled for the predictive effect of NSSI thoughts. In contrast, self-efficacy to resist NSSI incrementally predicted a lower probability of engaging in NSSI, above and beyond NSSI thoughts.

DISCUSSION

This study provides preliminary evidence that affective fluctuations may uniquely predict NSSI thoughts but not NSSI behaviors, and point to the role of personal belief in the ability to resist NSSI in preventing NSSI behavior. These findings illustrate the need to differentiate between the development of NSSI thoughts and the progression from NSSI thoughts to behavior, as these are likely distinct processes, with different predictors.

Does State Dissociation Mediate the Relation Between Alcohol Intoxication and Deliberate Self-Harm?

Research supports the notion that alcohol intoxication is a risk factor for deliberate self-harm (DSH). However, the underlying mechanisms for this relationship are poorly understood. We aimed to determine whether alcohol-induced dissociation mediated alcohol's effects on DSH. We used data from a dose-response study of alcohol intoxication and DSH to test the proposed model. Participants were assigned to reach target blood alcohol concentrations (BAC) ranging from 0.00% through 0.10% and then completed a behavioral measure of DSH. Dissociation was assessed using the Alcohol Dissociative Experiences Scale. BAC predicted both dissociation and DSH, but dissociation did not predict DSH. Although research on clinical populations suggests dissociation is related to DSH, our findings suggest dissociation does not mediate the effects of alcohol on self-harm.

Mental images, entrapment and affect in young adults meeting criteria of nonsuicidal self-injury disorder (NSSID) - a daily diary study

BACKGROUND

Incidents of nonsuicidal self-injury (NSSI) are often accompanied by mental images which could be perceived as distressing and/or soothing; yet existing data is derived from participants with a history of NSSI using retrospective methods. This study investigated mental images related to NSSI ("NSSI-images"), and their relationship to the proposed Nonsuicidal Self-Injury Disorder (NSSID).

METHODS

An e-mail was sent to all female students of the local University providing the link to an online screening and 201 students with a history of repetitive NSSI responded. Nineteen eligible participants meeting criteria of NSSID (mean age = 25; 32% with migrant background) further completed a baseline interview and a ten-day-diary protocol.

RESULTS

Among the sample of N = 201, 83.6% reported NSSI-images. In the subsample of n = 19 diagnosed with NSSID, the frequencies of NSSI and NSSI-images were correlated; about 80% of the most significant NSSI-images were either of NSSI or of an instrument associated with NSSI (i.e., a razorblade). In the diary, 53% of the sample self-injured. NSSI-images were reported on 94% of NSSI-days, and on days with NSSI and NSSI-images, the images almost always occurred first; the images were overall perceived as twice more distressing than comforting. Images on NSSI-days were characterized by more comfort, intrusiveness and compellingness yet less vividness, and increased subsequent positive and negative affect compared to non-NSSI days. NSSI-days were further marked by increased entrapment beliefs and increased negative yet decreased positive affect at night. These results were non-significant.

LIMITATIONS

Due to non-significant results among a small sample size and a low rate of NSSI among the NSSID-group, results remain preliminary.

CONCLUSIONS

The study provides information on feasibility and methodological challenges such as intervention effects of the diary. NSSI-images may be common among individuals who engage in NSSI; they may capture ambivalent (positive and negative) appraisals of NSSI and thus play a role in NSSI and possibly a disorder such as NSSID. The preoccupation with NSSI (Criterion C of NSSID in DSM-5) may as well be imagery-based.

REGISTRATION

The study was retrospectively registered with the DRKS under the number DRKS00011854.

Common Pathways to NSSI and Suicide Ideation: The Roles of Rumination and Self-Compassion

We investigated whether rumination and self-compassion moderate and/or mediate the relationships between negative affect and both non-suicidal self-injury (NSSI) and suicide ideation. Undergraduate university students (n = 415) completed well-validated measures of negative affect, rumination, self-compassion, NSSI, and suicide ideation. Neither rumination nor self-compassion moderated associations between negative affect and NSSI and suicide ideation. However, both rumination and self-compassion mediated associations between negative affect and lifetime history of NSSI and suicide ideation. Self-compassion additionally mediated the association between negative affect and both 12-month NSSI and suicide ideation. The salience of self-compassion, particularly in predicting recent NSSI and suicide ideation, offers promise for early intervention initiatives focusing on less judgmental or self-critical means of self-relation.

Applying a cognitive-emotional model to nonsuicidal self-injury

The recently proposed cognitive-emotional model of nonsuicidal self-injury (NSSI) draws on emotion regulation models and social cognitive theory to understand the onset, maintenance, and cessation of NSSI. We tested the prediction of the model that the relationship between emotional reactivity and NSSI is moderated by specific cognitions about self-injury (i.e., self-efficacy to resist NSSI, NSSI outcome expectancies), emotion regulation, and rumination. A sample of 647 university students aged 17-25 years (M = 19.92, SD = 1.78) completed self-report measures of the constructs of interest. As expected, we found that emotional reactivity was positively related to NSSI, particularly for people who had weak self-efficacy to resist NSSI. However, emotional reactivity was negatively related to NSSI for people who were more likely to use expressive suppression to regulate emotion. Implications for the theoretical understanding of NSSI are discussed.

Self-efficacy and emotionally dysregulated behaviour: An exploratory test of the role of emotion regulatory and behaviour-specific beliefs

We examined the relationship between self-efficacy and three behaviours that can serve similar affect-regulatory functions (self-injury, risky alcohol use, disordered eating). We proposed that general self-efficacy would be indirectly related to each outcome, operating via emotion regulatory self-efficacy and behaviour-specific self-efficacy. A path analysis confirmed this proposal in a sample of 490 university students, who completed questionnaires assessing the constructs of interest. Emotion regulatory self-efficacy was a salient predictor of self-injury and disordered eating, evidencing both direct and indirect relationships. Self-efficacy to resist each of the behaviours was uniquely related to its target behaviour. We discuss these findings, outlining the implications for a theoretical understanding of emotion-regulatory behaviours, and offer suggestions for prevention and early intervention initiatives.

Using a Modified Theory of Planned Behavior to Examine Adolescents' Workplace Safety and Health Knowledge, Perceptions, and Behavioral Intention: A Structural Equation Modeling Approach

Work, a defining feature of adolescence in the United States, has many benefits. Work also has risks, as adolescents experience a higher rate of serious job-related injuries compared to adults. Talking Safety, a free curriculum from the National Institute for Occupational Safety and Health, is one tool educators may adopt to provide teens with essential workplace safety and health education. Adolescents (N = 2503; female, 50.1%; Hispanic, 50.0%) in a large urban school district received Talking Safety from their eighth-grade science teachers. This study used a modified theory of planned behavior (which included a knowledge construct), to examine students' pre- and post-intervention scores on workplace safety and health knowledge, attitude, self-efficacy, and behavioral intention to enact job safety skills. The results from confirmatory factor analyses indicate three unique dimensions reflecting the theory, with a separate knowledge factor. Reliability estimates are ω ≥ .83. The findings from the structural equation models demonstrate that all paths, except pre- to posttest behavioral intention, are statistically significant. Self-efficacy is the largest contributor to the total effect of these associations. As hypothesized, knowledge has indirect effects on behavioral intention. Hispanic students scored lower at posttest on all but the behavioral intention measure, possibly suggesting the need for tailored materials to reach some teens. Overall the findings support the use of a modified theory of planned behavior to evaluate the effectiveness of a foundational workplace safety and health curriculum. This study may inform future efforts to ensure that safe and healthy work becomes integral to the adolescent experience.

Social exposure and emotion dysregulation: Main effects in relation to nonsuicidal self-injury

We examined the relation of interpersonal and media exposure to nonsuicidal self-injury (NSSI) among 340 university students in the southeastern United States (73.5% female, M age = 19.38 years, SD = 1.15). We also assessed interactions and main effects of each exposure and emotion dysregulation in relation to NSSI, testing the social learning hypothesis of NSSI. Most participants endorsed medium to high levels of exposure to NSSI via media sources. More than one-third of participants were somewhat or very familiar with someone who engaged in NSSI. Almost half reported occasional or frequent conversations about NSSI. Both exposure forms were significantly related to NSSI history. However, hurdle regression analyses revealed that interpersonal exposure and emotion dysregulation, but not media exposure, were significantly associated with NSSI history and frequency. We did not find evidence for an emotion dysregulation-by-interpersonal-exposure interaction. We discuss implications for theoretical models of NSSI, limitations, and future directions.

Examining the scope and patterns of deliberate self-injurious cutting content in popular social media

BACKGROUND

Social networking services (SNS) have rapidly become a central platform for adolescents' social interactions and media consumption patterns. The present study examined a representative sample of publicly accessible content related to deliberate self-injurious cutting across three SNS platforms: Twitter, Tumblr, and Instagram.

METHODS

Data collection simulated searches for publicly available deliberate self-injury content on Twitter, Tumblr, and Instagram. Over a six-month period at randomly generated time points, data were obtained by searching "#cutting" on each SNS platform and collecting the first 10 posts generated. Independent evaluators coded posts for presence of the following: (a) graphic content, (b) negative self-evaluations, (c) references to mental health terms, (d) discouragement of deliberate self-injury, and (e) recovery-oriented resources. Differences across platforms were examined.

RESULTS

Data collection yielded a sample of 1,155 public posts (770 of which were related to mental health). Roughly 60% of sampled posts depicted graphic content, almost half included negative self-evaluations, only 9.5% discouraged self-injury, and <1% included formal recovery resources. Instagram posts displayed the greatest proportion of graphic content and negative self-evaluations, whereas Twitter exhibited the smallest proportion of each.

CONCLUSIONS

Findings characterize the graphic nature of online SNS deliberate self-injury content and the relative absence of SNS-posted resources for populations seeking out deliberate self-injurious cutting content. Mental health professionals must recognize the rapidly changing landscape of adolescent media consumption, influences, and social interaction as they may pertain to self-harm patterns.