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Tang WC, Tseng HY, Lin MP, Lee YT, Wu JYW, Cheng LH, You J. Depression fully mediates the effects of problematic internet use on nonsuicidal self-injury among adolescents during the COVID-19 outbreak. J Psychiatr Res 2024; 178:236-242. [PMID: 39163662 DOI: 10.1016/j.jpsychires.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/22/2024] [Accepted: 08/05/2024] [Indexed: 08/22/2024]
Abstract
The outbreak of the coronavirus disease 2019 (COVID-19) pandemic threatened adolescents' mental health and livelihoods, which can worsen their non-suicidal self-injury (NSSI) behaviors. With the significant increase of total online time use, adolescents become more prone to problematic internet use (PIU). This study examined whether depression mediated the relationship between PIU and NSSI among adolescence during the COVID-19 outbreak. Constructed with a cross-sectional design during the COVID-19 outbreak in Taiwan, 1060 participants were drawn from junior high schools through stratified and cluster sampling, and completed a set of comprehensive surveys. The mediation model demonstrated a good fit to the data, GFI = .96, CFI = .97, NFI = .97, NNFI = .95, IFI = .97, and SRMR = .02. The overall fit of the mediational model was adequate. The path from PIU to depression, β = .41, p < .001, and the path from depression to NSSI, β = .40, p < .001, were both significant. Moreover, the effect of PIU to NSSI decreased from .23 (p < .001) to .05 (p = .099) when depression was incorporated into the analysis. Moreover, results in bootstrapping analysis displayed that the indirect effect (PIU on NSSI via depression) was statistically significant (p < .001) and the direct effect (PIU on NSSI) was statistically non-significant (p = .134). The full mediation model was confirmed. The findings of the structure equation modeling and bootstrap analysis showed that PIU significantly and positively predicted NSSI, and that depression fully mediated this relationship.
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Affiliation(s)
- Wen-Ching Tang
- Department of Educational Psychology and Counseling, National Taiwan Normal University, No.162, Sec. 1, Heping E. Rd., Da-an District, Taipei City, 106, Taiwan
| | - Hsin-Yi Tseng
- Department of Educational Psychology and Counseling, National Taiwan Normal University, No.162, Sec. 1, Heping E. Rd., Da-an District, Taipei City, 106, Taiwan
| | - Min-Pei Lin
- Department of Educational Psychology and Counseling, National Taiwan Normal University, No.162, Sec. 1, Heping E. Rd., Da-an District, Taipei City, 106, Taiwan.
| | - Yueh-Ting Lee
- Department of Counseling and Guidance, National University of Tainan, No.33, Sec. 2, Shu-Lin St., Tainan, 700, Taiwan
| | - Jo Yung-Wei Wu
- Good-Day Psychology Clinic, 5F., No. 167, Xialin Rd., South District, Tainan City, 702, Taiwan
| | - Li-Hsuan Cheng
- Department of Educational Psychology and Counseling, National Taiwan Normal University, No.162, Sec. 1, Heping E. Rd., Da-an District, Taipei City, 106, Taiwan
| | - Jianing You
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, & School of Psychology, South China Normal University, Guangzhou, 510631, PR China
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Dekel D, Marchant A, Smith T, Morgan H, Tombs S, Khanom A, Ingham K, John A. #BeSeen: understanding young people's views of the motivation and impacts of sharing self-harm imagery online and use of their social media data for research-a UK participatory arts-led qualitative study. BMJ Open 2024; 14:e076981. [PMID: 39043594 PMCID: PMC11268025 DOI: 10.1136/bmjopen-2023-076981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/26/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVES This study explored the views of young people from diverse backgrounds, with or without a history of self-harm, on the motivation and impacts of sharing self-harm imagery online and the use of their social media data for mental health research. DESIGN Thematic analysis of 27 semi-structured one-to-one interviews. SETTING Two workshops were conducted in 2021. PARTICIPANTS We recruited 27 study participants aged 16-24 (60% male). Sixteen (59%) participants were refugee and asylum seekers (RAS). RESULTS Two main themes were generated: (1) Online imagery of self-harm captured perceived motivations for sharing such images, the potential impacts on others and possible need of censorship. This theme was characterised by mixed attitudes towards motivations for sharing, with some perceiving this as attention seeking, while others thought of it as help seeking or sharing of pain. Overall, participants agreed that images of self-harm can be triggering and should include trigger warnings. (2) Data sharing for mental health and self-harm research captured views on the use of social media posts and images for research purposes, and levels of trust in public and private organisations. It outlined positive views on their data being shared for research for public benefit, but highlighted issues of consent. The two most trusted organisations to hold and conduct research were the National Health Service and Universities. Participants from the RAS group were more inclined to agree to their data being used and had higher levels of trust in government. CONCLUSION Young people care about their privacy and use of their data even when it is publicly available. Coproduction with young people of resources to support understanding and develop innovative solutions to gaining informed consent for data sharing and research for public benefit is required. Young people from excluded communities, post-immigration RAS and males should be purposively involved in future social media research.
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Affiliation(s)
- Dana Dekel
- Medical School, Swansea University, Swansea, UK
| | | | - Todd Smith
- Medical School, Swansea University, Swansea, UK
- Public Health Wales NHS Trust, Cardiff, UK
| | | | | | | | - Karen Ingham
- Medical School, Swansea University, Swansea, UK
- Independent Artist, Swansea, UK
| | - Ann John
- Medical School, Swansea University, Swansea, UK
- Public Health Wales NHS Trust, Cardiff, UK
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Susi K, Glover-Ford F, Stewart A, Knowles Bevis R, Hawton K. Research Review: Viewing self-harm images on the internet and social media platforms: systematic review of the impact and associated psychological mechanisms. J Child Psychol Psychiatry 2023. [PMID: 36940718 DOI: 10.1111/jcpp.13754] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND Viewing self-harm and suicide-related images online can precede these behaviours. We reviewed studies of potential impacts and mechanisms associated with viewing self-harm-related images on the internet and social media. METHOD CINAHL, Cochrane Library, EMBASE, HMIC, MEDLINE, PsycArticles, PsycINFO, PubMed, Scopus, Sociological Abstracts and Web of Science Core Collection databases were searched for relevant studies from inception to 22 January 2022. Inclusion criteria were English language, peer-reviewed, empirical studies with data related to impacts of viewing self-harm images or videos on the internet or social media. Quality and risk of bias were assessed using Critical Appraisal Skills Programme tools. A narrative synthesis approach was used. RESULTS Of the 15 identified studies, all found harmful effects of viewing self-harm-related images online. These included escalation of self-harm, reinforcement of engagement behaviours (e.g. commenting and sharing images), encouragement of social comparison (comparing own self-harm with others), development of a self-harm identity, social connection perpetuating or escalating self-harm, and emotional, cognitive, and physiological impacts triggering self-harm urges and acts. Nine studies found protective effects, including self-harm mitigation or reduction, promotion of self-harm recovery, encouraging social connection and help-giving, and emotional, cognitive and physiological impacts mitigating or reducing self-harm urges and acts. Causality of impact was not determined in any study. Most of the studies did not explicitly evaluate or discuss potential mechanisms. CONCLUSIONS Viewing self-harm images online may have both harmful and protective effects, but harmful effects predominated in the studies. Clinically, it is important to assess individual's access to images relating to self-harm and suicide, and the associated impacts, alongside pre-existing vulnerabilities and contextual factors. Higher quality longitudinal research with less reliance on retrospective self-report is needed, as well as studies that test potential mechanisms. We have developed a conceptual model of the impact of viewing self-harm images online to inform future research.
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Affiliation(s)
- Karima Susi
- Oxford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Oxford Health NHS Foundation Trust and University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
- Child and Adolescent Mental Health Services, Leicestershire Partnership NHS Trust, Leicester, UK
- Step 4 Psychological Therapies, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Francesca Glover-Ford
- Oxford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Oxford Health NHS Foundation Trust and University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Anne Stewart
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Rebecca Knowles Bevis
- Oxford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Oxford Health NHS Foundation Trust and University of Oxford, Oxford, UK
| | - Keith Hawton
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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Mavragani A, Whitlock J, Chapman J, Bhandari A, Bazarova N. Young Adults' Perceptions of 2 Publicly Available Digital Resources for Self-injury: Qualitative Study of a Peer Support App and Web-Based Factsheets. JMIR Form Res 2023; 7:e41546. [PMID: 36633896 PMCID: PMC9880808 DOI: 10.2196/41546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Digital resources have the potential to bridge the gaps in mental health services for young people who self-injure. Most research on digital resources for this population has involved observational studies of content in web-based communities or formative studies focused on the design and early evaluation of new interventions. Far less research has sought to understand young people's experiences with publicly available digital resources or to identify specific components of these resources that are perceived to be of value in their recovery. OBJECTIVE This study aimed to understand young people's experiences with 2 publicly available digital resources for self-injury-a peer support app and web-based factsheets-and to disentangle potential explanatory mechanisms associated with perceived benefits and harms. METHODS Participants were 96 individuals (aged 16-25 years) with nonsuicidal self-injury behavior in the past month, who recently completed a pilot randomized controlled trial designed to assess the efficacy of a peer support app as compared with web-based factsheets to reduce self-injury behavior. The trial showed that participants using the peer support app reported less self-injury behavior relative to those receiving the web-based factsheets over 8 weeks. In this study, we used a conventional approach to content analysis of responses to 2 open-ended questions delivered at the end of the trial with the aims of exploring participants' overall experiences with these resources and identifying the qualities of these resources that were perceived to be beneficial to or harmful for participants' recovery. RESULTS Overall, participants were more likely to report benefits than harms. Participants who used the peer support app reported more harms than those who received the web-based factsheets. In the open coding phase, clear benefits were also derived from repeated weekly surveys about self-injury. Key benefits across digital resources included enhanced self-knowledge, reduction in self-injury activity, increased outreach or informal conversations, improved attitudes toward therapy, improved mood, and feeling supported and less alone. Key challenges included worsened or unchanged self-injury activity, diminished mood, and increased barriers to outreach. The most prominent benefit derived from the web-based factsheets and weekly surveys was improved self-understanding. However, the way this manifested differed, with factsheets providing insight on why participants engage in self-injury and the function it serves them and surveys making the frequency and severity of participants' behaviors more apparent. The benefits perceived from using the peer support app were general improvements in mood and feeling less alone. CONCLUSIONS Findings contribute a nuanced understanding of young people's experiences with these digital resources and have implications for the optimization of existing platforms and the design of novel resources to support individuals who self-injure.
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Affiliation(s)
| | - Janis Whitlock
- Department of Communication, Cornell University, Ithaca, NY, United States
| | - Julia Chapman
- Department of Communication, Cornell University, Ithaca, NY, United States
| | - Aparajita Bhandari
- Department of Communication, Cornell University, Ithaca, NY, United States
| | - Natalya Bazarova
- Department of Communication, Cornell University, Ithaca, NY, United States
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Hasking P, Lewis SP, Staniland L, Mirichlis S, Hird K, Gray N, Arai M, Pemberton E, Preece D, Boyes M. Further Silencing the Voiceless: The Role of Gatekeepers in Accessing Information About Self-Injury. J Nerv Ment Dis 2023; 211:5-10. [PMID: 36596286 DOI: 10.1097/nmd.0000000000001575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
ABSTRACT Gatekeepers play a pivotal role in protecting individuals under their care and are central to keeping people safe and away from harm. In the field of nonsuicidal self-injury (NSSI), a range of gatekeepers exist, including those who protect access to vulnerable research participants, those who protect school children, those charged with making decisions about funding priorities, and those in charge of clinical care for people who self-injure. The aim of this commentary is to outline the roles these different gatekeepers have in protecting access to research participants, access to NSSI knowledge, and access to clinical care for individuals who self-injure. We provide examples in which gatekeepers may present barriers and offer solutions for how to work with gatekeepers for mutual benefit.
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Affiliation(s)
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, Ontario, Canada
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Meheli S, Banerjee D. Revisiting Social Stigma in Non-suicidal Self-injury: A Narrative Review. CONSORTIUM PSYCHIATRICUM 2022; 3:6-18. [PMID: 39044918 PMCID: PMC11262124 DOI: 10.17816/cp196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/23/2022] [Indexed: 11/08/2022] Open
Abstract
Non-suicidal self-injury (NSSI) is highly prevalent in our community. Yet, there is a significant discrepancy between the number of individuals engaging in NSSI and those who seek treatment for NSSI. This discrepancy can be due to the high social stigma associated with the behavior. The impact of NSSI stigma is significant and can impair the quality of life in the individuals engaging in NSSI, delay help-seeking, reduce access to mental health care and further fuel misinformation. Even though the symptomatology, risks, and demographics of NSSI have received attention in terms of research, there is limited literature on NSSI stigma and its consequences. With that background set, this review provides a bird's-eye view of the different levels of stigma in NSSI (public, self, and health care), associated discrimination, the various aspects of such stigmatization (NSSI-related language, physical scarring, misinformation, the media), and, finally, the collaborative clinical-outreach interventions for mitigating NSSI-associated social stigma. If NSSI is indeed recognized as a clinical disorder, future research would need to focus on these constructs of stigma and treat them with the same importance as the one given to clinical studies of intervention and symptomatology in NSSI.
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Gómez-Castillo MD, Escrivá-S V, Tolosa-Pérez MT, Navarro-Bravo B, Plateau CR, Ricarte JJ, Cuesta-Zamora C. The link between non-suicidal self-injury (NSSI), body image and activity on social networking sites among female adolescents with an eating disorder. Clin Child Psychol Psychiatry 2022; 27:730-744. [PMID: 35369739 DOI: 10.1177/13591045221081191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The link between engagement in non-suicidal self-injury (NSSI)-related activities on SNS (e.g. viewing, commenting, sharing and uploading NSSI content) with body image and NSSI behaviour remains under researched in adolescents with EDs. The main aim of the current research was to examine associations between NSSI-related activities on SNS with body image and NSSI behaviour severity among female adolescents diagnosed with an ED. A total of 52 female adolescents (mean age = 15.35 years, SD = 1.49) diagnosed with an ED completed self-report questionnaires related to NSSI behaviour, SNS usage and body image. Participants were divided into two groups: low NSSI behaviour severity (from 0 to 10 NSSI behaviours; n = 28) and high NSSI behaviour severity (more than ten NSSI behaviours; n = 24). Within the high NSSI severity group, individuals that comment and share NSSI online content significantly reported higher negative body image. A hierarchical binary logistic regression showed that the frequency of NSSI online content on SNS emerged as significant predictor of NSSI behaviour severity within last year after controlling for body image and searching for ED content on SNS. Our findings suggest that not only searching for ED content, but also being daily engaged in NSSI online activities may increase the risk of NSSI behaviour severity in female adolescents with EDs.
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Affiliation(s)
- María D Gómez-Castillo
- 16242Eating Disorders Unit of the Mental Health Services in the Hospital Complex of Albacete, Spain
| | - Verónica Escrivá-S
- 16242Eating Disorders Unit of the Mental Health Services in the Hospital Complex of Albacete, Spain
| | - María T Tolosa-Pérez
- 16242Eating Disorders Unit of the Mental Health Services in the Hospital Complex of Albacete, Spain
| | | | - Carolyn R Plateau
- Centre for Research into Eating Disorders and Behaviours, 5156Loughborough University, Loughborough, UK
| | - Jorge J Ricarte
- Psychology Department, 73073Castilla-La Mancha University, Albacete, Spain
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Kim MS, Yu J. Text mining for identifying the nature of online questions about non-suicidal self-injury. BMC Public Health 2022; 22:1041. [PMID: 35614412 PMCID: PMC9131529 DOI: 10.1186/s12889-022-13480-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The internet provides convenient access to information about non-suicidal self-injury (NSSI) owing to its accessibility and anonymity. This study aimed to explore the distribution of topics regarding NSSI posted on the internet and yearly trends in the derived topics using text mining. METHODS We searched for the keyword "non-suicidal self-injury" (Ja-Hae in Korean) in the Naver Q&A using the statistical package R. We analyzed 7893 NSSI-related questions posted between 2009 and 2018. Text mining was performed using latent Dirichlet allocation (LDA) on the dataset to determine associations between phrases and thus identify common themes in posts about NSSI. RESULTS In the LDA, we selected the following 10 most common topics: anger, family troubles, collecting information on NSSI, stress, concerns regarding NSSI scarring, ways to help a non-suicidal self-injurious friend, depression, medical advice, ways to perform or stop NSSI, and prejudices and thoughts regarding non-suicidal self-injurious people. CONCLUSIONS This study provides valuable information on the nature of NSSI questions posted online. In future research, developing websites that provide NSSI information and support or guidance on effectively communicating with NSSI is necessary.
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Affiliation(s)
- Myo-Sung Kim
- College of Nursing, Healthcare Sciences & Human Ecology, Dong-Eui University, Busan, South Korea
| | - Jungok Yu
- College of Nursing, Dong-A University, Busan, South Korea.
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9
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Kruzan KP, Whitlock J, Bazarova NN, Bhandari A, Chapman J. Use of a Mobile Peer Support App Among Young People With Nonsuicidal Self-injury: Small-scale Randomized Controlled Trial. JMIR Form Res 2022; 6:e26526. [PMID: 35006076 PMCID: PMC8787664 DOI: 10.2196/26526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/10/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is a widespread behavior among adolescents and young adults. Although many individuals who self-injure do not seek treatment, there is evidence for web-based help-seeking through web-based communities and mobile peer support networks. However, few studies have rigorously tested the efficacy of such platforms on outcomes relevant for NSSI recovery. OBJECTIVE The aim of this small-scale preregistered randomized controlled trial is to provide preliminary insight into the shorter- and longer-term efficacy of the use of a peer support app, TalkLife, in reducing NSSI frequency and urges and increasing readiness to change. In addition, we explore contact with informal support, interest in therapy, and attitudes toward professional help-seeking. METHODS Individuals aged 16-25 years with current (within 3 months) and chronic (>6 episodes in the past year) NSSI history were eligible to participate in this study. After baseline assessments, the intervention group was instructed to use the app actively (eg, post or comment at least three times per week) and the control group received weekly psychoeducational materials through email, for 8 weeks. Follow-up was assessed at 1 month and 2 months. Linear mixed modeling was used to evaluate condition and time point effects for the primary outcomes of NSSI frequency and urges, readiness to change, contact with informal support, interest in therapy, and attitudes toward professional help-seeking. RESULTS A total of 131 participants were included in the analysis. We evidenced a significant effect of condition on NSSI frequency such that the participants using the peer support app self-injured less over the course of the study (mean 1.30, SE 0.18) than those in the control condition (mean 1.62, SE 0.18; P=.02; η2=0.02). We also evidenced a significant condition effect of readiness to change such that the treatment participants reported greater confidence in their ability to change their NSSI behavior (mean 6.28, SE 0.41) than the control participants (mean 5.67, SE 0.41; P=.04; η2=0.02). No significant differences were observed for contact with informal support, interest in therapy, or attitudes toward professional help-seeking. CONCLUSIONS Use of the peer support app was related to reduced NSSI frequency and greater confidence in one's ability to change NSSI behavior over the course of the study period, but no effects on NSSI urges, contact with informal support, interest in therapy, or attitudes toward professional help-seeking were observed. The findings provide preliminary support for considering the use of mobile peer support apps as a supplement to NSSI intervention and point to the need for larger-scale trials. TRIAL REGISTRATION Open Science Foundation; https://osf.io/3uay9.
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Affiliation(s)
- Kaylee Payne Kruzan
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Janis Whitlock
- Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, NY, United States
| | - Natalya N Bazarova
- Department of Communication, Cornell University, Ithaca, NY, United States
| | - Aparajita Bhandari
- Department of Communication, Cornell University, Ithaca, NY, United States
| | - Julia Chapman
- Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, NY, United States
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Kruzan KP, Bazarova NN, Whitlock J. Investigating Self-injury Support Solicitations and Responses on a Mobile Peer Support Application. PROCEEDINGS OF THE ACM ON HUMAN-COMPUTER INTERACTION 2021; 5:354. [PMID: 36238758 PMCID: PMC9554950 DOI: 10.1145/3479498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Online informal support networks may provide a critical source of support for young people who self-injure. While these platforms are often intended to mitigate digital harm, there is limited understanding of how individuals use peer support venues to seek self-injury related support and the specific contingencies of supportive exchanges. The present mixed-methods study was designed to explore the types of concerns members express on a mobile peer support application and the types of responses that they receive. Specifically, our aims were to (1) understand the prevalence of peer support types exchanged and (2) surface more nuanced themes within these categories of support. We also explore the relationship between support sought through posts and received through comments. Findings have important theoretical implications for understanding support seeking and provision through a mobile peer support app, which can help guide the design and optimization of peer-driven platforms for individuals who self-injure.
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Pritchard TR, Fedchenko CA, Lewis SP. Self-Injury Is My Drug: The Functions of Describing Nonsuicidal Self-Injury as an Addiction. J Nerv Ment Dis 2021; 209:628-635. [PMID: 33958550 DOI: 10.1097/nmd.0000000000001359] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Adolescents and emerging adults who engage in nonsuicidal self-injury (NSSI) often participate in online activity regarding their self-injury. Of particular importance are the potential benefits and risks associated with online NSSI activity, including how individuals describe their NSSI experiences. One way that individuals describe these experiences is by discussing NSSI as an addiction. Accordingly, we used thematic analysis to explore why individuals may use addiction references to describe their NSSI experiences. To do this, we examined 71 posts from a popular NSSI social network. Four themes emerged: difficulty inherent in stopping, authentication, warn others, and communicate the plight of the behavior. Findings highlight a number of avenues for research as well as implications for clinicians working with clients who self-injure perceive NSSI as an addiction. Mental health professionals can leverage their understanding of clients' perceptions of NSSI to better serve this population.
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Westers NJ, Lewis SP, Whitlock J, Schatten HT, Ammerman B, Andover MS, Lloyd-Richardson EE. Media guidelines for the responsible reporting and depicting of non-suicidal self-injury. Br J Psychiatry 2021; 219:415-418. [PMID: 33161923 DOI: 10.1192/bjp.2020.191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Media coverage of non-suicidal self-injury (NSSI) ranges from providing helpful education to displaying graphic images. We offer the first research-informed, consensus-based guidelines for the responsible reporting and depicting of NSSI in the media, while also advising on ideas for dissemination and collaboration between media professionals and healthcare experts.
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Affiliation(s)
- Nicholas J Westers
- Department of Psychiatry, Children's Health Systems of Texas & University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, Ontario, Canada
| | - Janis Whitlock
- Bronfenbrenner Center for Translational Research, Cornell University, Ithica, New York, USA
| | - Heather T Schatten
- Psychosocial Research Program, Butler Hospital; and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Brooke Ammerman
- Department of Psychology, University of Notre Dame, Indiana, USA
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Marchant A, Hawton K, Burns L, Stewart A, John A. Impact of Web-Based Sharing and Viewing of Self-Harm-Related Videos and Photographs on Young People: Systematic Review. J Med Internet Res 2021; 23:e18048. [PMID: 33739289 PMCID: PMC8074996 DOI: 10.2196/18048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 10/24/2020] [Accepted: 01/17/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Given recent moves to remove or blur self-harm imagery or content on the web, it is important to understand the impact of posting, viewing, and reposting self-harm images on young people. OBJECTIVE The aim of this study is to systematically review research related to the emotional and behavioral impact on children and young people who view or share web-based self-harm-related videos or images. METHODS We searched databases (including Embase, PsychINFO, and MEDLINE) from January 1991 to February 2019. Search terms were categorized into internet use, images nonspecific and specific to the internet, and self-harm and suicide. Stepwise screening against specified criteria and data extraction were completed by two independent reviewers. Eligible articles were quality assessed, and a narrative synthesis was conducted. RESULTS A total of 19 independent studies (20 articles) were included. Of these, 4 studies focused on images, 10 (11 articles) on videos, and 5 on both. There were 4 quantitative, 9 qualitative, and 7 mixed methods articles. In total, 11 articles were rated as high quality. There has been an increase in graphic self-harm imagery over time. Potentially harmful content congregated on platforms with little moderation, anonymity, and easy search functions for images. A range of reactions and intentions were reported in relation to posting or viewing images of self-harm: from empathy, a sense of solidarity, and the use of images to give or receive help to potentially harmful ones suggesting new methods, normalization, and exacerbation of self-harm. Viewing images as an alternative to self-harm or a creative outlet were regarded in 2 studies as positive impacts. Reactions of anger, hostility, and ambivalence have been reported. There was some evidence of the role of imitation and reinforcement, driven partly by the number of comments and wound severity, but this was not supported by time series analyses. CONCLUSIONS Although the results of this review support concern related to safety and exacerbation of self-harm through viewing images of self-harm, there may be potential for positive impacts in some of those exposed. Future research should evaluate the effectiveness and potential harms of current posting restrictions, incorporate user perspectives, and develop recovery-oriented content. Clinicians assessing distressed young people should ask about internet use, including access to self-harm images, as part of their assessment.
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Affiliation(s)
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, Oxford, United Kingdom
| | - Lauren Burns
- Swansea University Medical School, Swansea, United Kingdom
| | - Anne Stewart
- Centre for Suicide Research, University Department of Psychiatry, Oxford, United Kingdom
| | - Ann John
- Swansea University Medical School, Swansea, United Kingdom
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Kruzan KP, Whitlock J, Bazarova NN. Examining the Relationship Between the Use of a Mobile Peer-Support App and Self-Injury Outcomes: Longitudinal Mixed Methods Study. JMIR Ment Health 2021; 8:e21854. [PMID: 33507154 PMCID: PMC7878111 DOI: 10.2196/21854] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/16/2020] [Accepted: 12/15/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Many individuals who self-injure seek support and information through online communities and mobile peer-support apps. Although researchers have identified risks and benefits of participation, empirical work linking participation in these web-based spaces to self-injury behaviors and thoughts is limited. OBJECTIVE This study aims to investigate the relationship between behavioral and linguistic traces on a mobile peer support app and self-injury outcomes. METHODS Natural use data and web-based surveys (N=697) assessing self-injury outcomes were collected from 268 users (aged 13-38 years; median 19; 149/268, 55.6% female) of a mobile peer-support app for 4 months. Participants were identified as having posted self-injury content using an internal classifier. Natural log data was used to predict self-injury outcomes in a series of multilevel logistic and linear regressions. RESULTS Greater engagement on a mobile peer-support app was associated with a decreased likelihood of self-injury thoughts (odds ratio [OR] 0.25, 95% CI 0.09-0.73) and fewer intentions to self-injure (b=-0.37, SE 0.09), whereas posting triggering content was associated with an increased likelihood of engaging in behaviors (OR 5.37, 95% CI 1.25-23.05) and having self-injury thoughts (OR 17.87, 95% CI 1.64-194.15). Moreover, viewing triggering content was related to both a greater ability to resist (b=1.39, SE 0.66) and a greater intention to self-injure (b=1.50, SE 0.06). CONCLUSIONS To our knowledge, this is the first study to connect naturally occurring log data to survey data assessing self-injury outcomes over time. This work provides empirical support for the relationship between participation in online forums and self-injury outcomes, and it articulates mechanisms contributing to this relationship.
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Affiliation(s)
- Kaylee Payne Kruzan
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Janis Whitlock
- Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, NY, United States
| | - Natalya N Bazarova
- Department of Communication, Cornell University, Ithaca, NY, United States
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15
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Yang X, Xin M, Liu K, Böke BN. The impact of internet use frequency on non-suicidal self injurious behavior and suicidal ideation among Chinese adolescents: an empirical study based on gender perspective. BMC Public Health 2020; 20:1727. [PMID: 33198703 PMCID: PMC7670714 DOI: 10.1186/s12889-020-09866-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We attempted to find if there were gender differences in Non-suicidal self injurious (NSSI) behaviors and Suicidal ideation among Chinese adolescents, then analyze the impact of Internet use frequency on these variables among adolescents of different genders. METHODS Based on the data from 6 high-schools and 4 universities in 4 cities in China, the gender difference in NSSI behaviors and Suicidal ideation and their related factors were analyzed in the study. RESULTS Gender differences were found during different purposes of Internet use; There was no significant gender difference in NSSI behaviors among Chinese adolescents, yet females reported significantly higher intensity of suicidal ideation compared to males; Internet use frequency could explain the prevalence of NSSI behaviors and Suicidal ideation by gender, to some categories. CONCLUSIONS There were gender differences in Internet use frequency among adolescents; Gender difference of NSSI engagement among Chinese adolescents was not statistically significant; Females had higher suicidal ideation than males; the overuse of social softwares was found to be a risk factor to both NSSI engagements and suicidal ideations for both genders; males would engage less NSSI behaviors when they spent more time on knowledge sharing softwares while might have more suicidal ideation when they spent too much time on gaming.
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Affiliation(s)
- Xueyan Yang
- Institute for Population and Development Studies, Xi'an Jiaotong University, No.28, Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Moye Xin
- Institute for Population and Development Studies, Xi'an Jiaotong University, No.28, Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Kun Liu
- Institute for Population and Development Studies, Xi'an Jiaotong University, No.28, Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Bilun Naz Böke
- Human Development, McGill University, 3700 McTavish Street, Montreal, QC, H3A1Y2, Canada
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16
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Arendt F, Markiewitz A, Scherr S. Investigating Suicide-Related Subliminal Messages on Instagram. CRISIS 2020; 42:263-269. [PMID: 33034520 DOI: 10.1027/0227-5910/a000717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Suicide is the second-leading cause of death among 15-29-year-olds and Instagram is one of the most popular and fastest-growing social media platforms among this age group. A previous study presented preliminary evidence for suicide-related "subliminal messages" on Instagram, defined as very brief presentations of suicide-related content in video posts that users have no conscious awareness of. Aim: A systematic quantitative study was pending. Method: We conducted a quantitative content analysis of 100 Instagram video posts. A frame-by-frame coding procedure allowed for an assessment of whether suicide-related content was depicted in very brief segments, even when this content could not be consciously recognized when watched at regular speed. Results: Analysis indicates that a substantial amount of suicide-related content is presented in very brief shots. We identified 67 very brief shots that appeared in 21 video posts. Of interest, 13 of these video posts presented more than one very brief suicide-related shot. Limitation: The subjective threshold of conscious awareness differs inter-individually. This complicates the operationalization of subliminal messages. Conclusion: Subliminal messages are ethically highly problematic. There is a need for a greater awareness of possible suicide-related subliminal messages on Instagram.
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Affiliation(s)
- Florian Arendt
- Department of Communication, University of Vienna, Austria
| | - Antonia Markiewitz
- Department of Communication Science and Media Research, University of Munich (LMU), Germany
| | - Sebastian Scherr
- School for Mass Communication Research, University of Leuven (KU), Belgium
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17
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Tang J, Ma Y, Lewis SP, Chen R, Clifford A, Ammerman BA, Gazimbi MM, Byrne A, Wu Y, Lu X, Chang H, Kang C, Tiemeier H, Yu Y. Association of Internet Addiction With Nonsuicidal Self-injury Among Adolescents in China. JAMA Netw Open 2020; 3:e206863. [PMID: 32496567 PMCID: PMC7273191 DOI: 10.1001/jamanetworkopen.2020.6863] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Both nonsuicidal self-injury (NSSI), defined as the direct, deliberate damage of one's body tissue without suicidal intent, and internet addiction among adolescents are public health concerns. However, the possible association of NSSI with internet addiction is not well understood. OBJECTIVE To examine the occurrence of internet addiction with NSSI and any sex differences among Chinese adolescents. DESIGN, SETTING, AND PARTICIPANTS A multicenter, cross-sectional, survey study was conducted from February 18 to October 15, 2015, among adolescents aged 11 to 20 years from 343 classes in 45 public high schools across 5 provinces of China. Data analysis was performed from August 1, 2018, to March 1, 2019. EXPOSURES Possible internet addiction and internet addiction. MAIN OUTCOMES AND MEASURES Less-frequent (1-4 times) NSSI and more-frequent (≥5 times) NSSI were surveyed using the Chinese version of the Functional Assessment of Self-Mutilation. RESULTS A total of 15 623 students (8043 male [51.5%] and 7580 female [48.5%]) aged 11 to 20 years (mean [SD] age, 15.1 [1.8] years) participated. Of these, 4670 participants (29.9%) met the criteria for possible internet addiction and 509 participants (3.3%) met the criteria for internet addiction. A total of 2667 students (17.1%) engaged in less-frequent NSSI, while 1798 students (11.5%) engaged in more-frequent NSSI in the 12 months preceding the survey. Both possible internet addiction and internet addiction were associated with less-frequent or more-frequent NSSI. The adjusted odds ratios were 1.29 (95% CI, 1.17-1.42) for possible internet addiction and 1.41 (95% CI, 1.11-1.80) for internet addiction for less-frequent NSSI; for more-frequent NSSI, the adjusted odds ratios were 1.75 (95% CI, 1.56-1.96) for possible internet addiction and 2.66 (95% CI, 2.10-3.38) for internet addiction. These associations were similarly observed among age groups of 11 to 14, 15 to 17, and 18 to 20 years. No sex disparities were found in the associations of internet addiction with NSSI, except among adolescents aged 11 to 14 years, where the odds ratios for possible internet addiction with less-frequent NSSI were higher in male adolescents (1.53; 95% CI, 1.25-1.88) than female adolescents (1.13; 95% CI, 0.90-1.47). CONCLUSION AND RELEVANCE Internet addiction appears to be associated with NSSI, and the findings of this study suggest that the association was similar between male adolescents and female adolescents. These data suggest that evaluation of the risk of NSSI for adolescents in association with internet addiction may help health care professionals in developing preventive interventions for NSSI.
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Affiliation(s)
- Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, P. R. China
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Ying Ma
- Department of Child Healthcare, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, P. R. China
| | - Stephen P. Lewis
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Angela Clifford
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | | | - Marufu Martin Gazimbi
- Global Development Institute, ALB, University of Manchester, Manchester, United Kingdom
| | - Adrian Byrne
- School of Medicine, Queen’s Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Yu Wu
- Shenzhen Center for Disease Control and Prevention, Nanshan District, Shenzhen, P. R. China
| | - Xinchuan Lu
- Department of Child and Adolescent Psychiatry, Suzhou Guangji Hospital, Suzhou, P. R. China
| | - Hongjuan Chang
- Department of Maternal and Child Healthcare, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hankou District, Wuhan, P. R. China
| | - Chun Kang
- Department of Maternal and Child Healthcare, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hankou District, Wuhan, P. R. China
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Centre–Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Yizhen Yu
- Department of Maternal and Child Healthcare, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hankou District, Wuhan, P. R. China
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Fulcher JA, Dunbar S, Orlando E, Woodruff SJ, Santarossa S. #selfharn on Instagram: understanding online communities surrounding non-suicidal self-injury through conversations and common properties among authors. Digit Health 2020; 6:2055207620922389. [PMID: 32426154 PMCID: PMC7218342 DOI: 10.1177/2055207620922389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 04/06/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives #selfharm has been blocked by Instagram, but manoeuvring hashtags (e.g. #selfharn) are beginning to appear in order for secret non-suicidal self-injury (NSSI) communities to communicate. The purpose of this study was to (a) determine the nature of the #selfharn conversation on Instagram, (b) analyze common properties of the visual content (i.e. images and videos; n = 93) tagged with #selfharn, and (c) discover what kind of environment the authors (n = 50) of #selfharn were creating. Methods A multi-method approach was utilized for this study. Netlytic was used to generate a text and content analysis to examine the authors’ captions and comments (n = 8772) associated with #selfharn (collected over a seven-day period). Results After removing #selfharn from the dataset, the text analysis revealed that #depression (n = 3081) and #suicide (n = 2270) were the most commonly used terms associated with #selfharn. Overall, 52% (n = 4386) of the popular words/phrases related with #selfharn posts were categorized as ‘bad feelings’. Through manual coding, it was determined that the majority of #selfharn visual content (n = 92; 99%) did not generate an advisory warning but did contain a wound (n = 70; 75%). The #selfharn author analysis suggests that most were women (n = 18; 36%) with a dark-coloured profile aesthetic (n = 37; 74%) determined by an overwhelming amount of grey, black, blue, red, or purple colours. Conclusion According to the text and content analyses, #selfharn on Instagram may be contributing negatively to an online community of mental-health issues. More resources should be provided by Instagram to those who are involved in the NSSI Instagram community.
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Affiliation(s)
- Jory A Fulcher
- Faculty of Human Kinetics, University of Windsor, Canada
| | - Sarah Dunbar
- Faculty of Human Kinetics, University of Windsor, Canada
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19
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Hetrick SE, Subasinghe A, Anglin K, Hart L, Morgan A, Robinson J. Understanding the Needs of Young People Who Engage in Self-Harm: A Qualitative Investigation. Front Psychol 2020; 10:2916. [PMID: 31998182 PMCID: PMC6968776 DOI: 10.3389/fpsyg.2019.02916] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 12/10/2019] [Indexed: 11/27/2022] Open
Abstract
Self-harm is common and associated with adverse outcomes. Research about the risk factors for self-harm has informed the field with regard to clinical interventions that should be delivered for young people who engage in self-harm. Missing is an in-depth understanding of what the triggers of an urge to self-harm might be, including in young people being treated with a clinical intervention. Therefore, there is little knowledge about what techniques young people find helpful to deal with urges to self-harm when they occur. This qualitative study engaged seven young people with lived experience of self-harm in semi-structured interviews about the immediate triggers of the urge to self-harm, and helpful strategies to manage this urge. Thematic analysis using a general inductive approach revealed distressing emotions and a sense of isolation as key themes, with other triggers associated with their induction. Highlighted was the wide range of situations and emotions that can be triggering, such that a further key theme was the idiosyncratic nature of the self-help strategies young people found helpful. Interventions that are developed to support young people who self-harm must address this complexity and findings highlight the need for young people to maintain some autonomy and control while being supported to connect with others for support. This research adds to the literature on self-help strategies to support young people in moments when they are experiencing distressing emotions, feel isolated, and have an urge to self-harm providing important insight to the prevention and intervention for self-harm among young people.
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Affiliation(s)
- Sarah E Hetrick
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Aruni Subasinghe
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Kate Anglin
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Laura Hart
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia.,Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Amy Morgan
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia.,Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jo Robinson
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
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20
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Brown RC, Fischer T, Goldwich DA, Plener PL. "I just finally wanted to belong somewhere"-Qualitative Analysis of Experiences With Posting Pictures of Self-Injury on Instagram. Front Psychiatry 2020; 11:274. [PMID: 32372983 PMCID: PMC7186324 DOI: 10.3389/fpsyt.2020.00274] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/20/2020] [Indexed: 11/18/2022] Open
Abstract
Non-suicidal self-injury (NSSI) is a common phenomenon among adolescents, but is often not disclosed due to fear of stigmatization. Social media is frequently used to publish photos of NSSI and share experiences with NSSI. Objectives of this study were to find out more about the motivation for publishing NSSI content and to investigate the effect that sharing this content on social media has on young people. In the current study, we interviewed N=59 participants (mean age = 16.7 years [SD = 1.2 years]; 72.9% female), who had all posted NSSI content within the past month on the social media platform Instagram. Semi-structured interviews were conducted via the Instagram messaging app. Interviews were analyzed qualitatively, assisted by the Software Atlas.ti 7. Participants were asked about their motivation for and their experiences with posting NSSI content online. Motivations for posting pictures online were mainly social (connecting, disclosure, communicating), while self-focused reasons like documenting NSSI or recovery were also mentioned. All participants reported having received positive reactions (being offered help, connecting, receiving empathy), as well as negative comments (harassment, being misunderstood) to their own NSSI content by other Instagram users. Participants' reactions to other users' NSSI content on Instagram was often identification with the content or being triggered, but also wanting to offer help or sometimes even being deterred from NSSI. None of the participants mentioned successful referral to professional help through their online NSSI activity. One target for future interventions could therefore be social media, or other online platforms, where adolescents might be more easily reached. Mental health practitioners should be aware of their clients' online activity and encourage reflection upon positive and negative effects of viewing or sharing NSSI content online.
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Affiliation(s)
- Rebecca C Brown
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | | | | | - Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany.,Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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Polskaya N, Yakubovskaya D. The Impact of Social Media Platforms on Self-Injurious Behavior in Adolescents. КОНСУЛЬТАТИВНАЯ ПСИХОЛОГИЯ И ПСИХОТЕРАПИЯ 2019. [DOI: 10.17759/cpp.2019270310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The paper provides a review of studies on non-suicidal self-injury (NSSI) in online social networking. Content characteristics of online self-injury narrative are examined by focusing on such categories as hashtags, images, and comments. Negative and positive aspects of social networks’ impact on the risk of self-injury in adolescent are summarized. The presence of NSSI content online and the ability to communicate on issues relating to self-injury can either improve psychological well-being of the users by increasing their mood and self-acceptance, giving means to receive support from others and get information on mental health resources, or increase the person’s susceptibility to self-injuries by initiating their interest in this subject and reinforcing, and encouraging repeated self-harm. Therefore, mental health professionals are facing a global challenge: to create supportive and helpful online content, which implies the development of a new methodology, including language and terminology, that could integrate existing online discourse on self-injury and transform it from within.
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23
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Trnka R, Kuška M, Balcar K, Tavel P. Understanding death, suicide and self-injury among adherents of the emo youth subculture: A qualitative study. DEATH STUDIES 2018; 42:337-345. [PMID: 28590823 DOI: 10.1080/07481187.2017.1340066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Emo youth subculture bases its subcultural identification mostly on symbols of death, dying, suicide, and other kinds of morbid content. The main goal of the present study was to explore attitudes toward suicidal behavior and self-injury in emo adolescents. Semistructured in-depth qualitative interviews were conducted with 14 emo adherents, accompanied by the analysis of emo Web discussion forums. Participants reported attitudes including high acceptance for suicidal behavior and self-injury. The identification with the emo youth subculture is considered to be a factor strengthening vulnerability towards risky behaviors.
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Affiliation(s)
- Radek Trnka
- a Science and Research Department , Prague College of Psychosocial Studies , Prague , Czech Republic
- b Social Health Institute - OUSHI, Palacký University , Olomouc , Czech Republic
| | - Martin Kuška
- a Science and Research Department , Prague College of Psychosocial Studies , Prague , Czech Republic
- b Social Health Institute - OUSHI, Palacký University , Olomouc , Czech Republic
| | - Karel Balcar
- a Science and Research Department , Prague College of Psychosocial Studies , Prague , Czech Republic
| | - Peter Tavel
- b Social Health Institute - OUSHI, Palacký University , Olomouc , Czech Republic
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Arendt F. Suicide on Instagram - Content Analysis of a German Suicide-Related Hashtag. CRISIS 2018; 40:36-41. [PMID: 29932019 DOI: 10.1027/0227-5910/a000529] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide is the second leading cause of death among 15-29-year-olds globally. Unfortunately, the suicide-related content on Instagram, a popular social media platform for youth, has not received the scholarly attention it deserves. METHOD The present study provides a content analysis of posts tagged as #selbstmord, a German suicide-related hashtag. These posts were created between July 5 and July 11, 2017. RESULTS Approximately half of all posts included words or visuals related to suicide. Cutting was by far the most prominent method. Although sadness was the dominant emotion, self-hate and loneliness also appeared regularly. Importantly, inconsistency - a gap between one's inner mental state (e.g., sadness) and one's overtly expressed behavior (e.g., smiling) - was also a recurring theme. Conversely, help-seeking, death wishes, and professional awareness-intervention material were very rare. An explorative analysis revealed that some videos relied on very fast cutting techniques. We provide tentative evidence that users may be exposed to purposefully inserted suicide-related subliminal messages (i.e., exposure to content without the user's conscious awareness). LIMITATIONS We only investigated the content of posts on one German hashtag, and the sample size was rather small. CONCLUSION Suicide prevention organizations may consider posting more awareness-intervention materials. Future research should investigate suicide-related subliminal messages in social media video posts. Although tentative, this finding should raise a warning flag for suicide prevention scholars.
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Affiliation(s)
- Florian Arendt
- 1 Department of Communication Science and Media Research, University of Munich (LMU), Germany
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Abstract
BACKGROUND Social media presents an important means for social interaction, especially among adolescents, with Instagram being the most popular platform in this age-group. Pictures and communication about non-suicidal self-injury (NSSI) can frequently be found on the internet. METHODS During 4 weeks in April 2016, n = 2826 (from n = 1154 accounts) pictures which directly depicted wounds on Instagram were investigated. Those pictures, associated comments, and user accounts were independently rated for content. Associations between characteristics of pictures and comments as well as weekly and daily trends of posting behavior were analyzed. RESULTS Most commonly, pictures depicted wounds caused by cutting on arms or legs and were rated as mild or moderate injuries. Pictures with increasing wound grades and those depicting multiple methods of NSSI generated elevated amounts of comments. While most comments were neutral or empathic with some offering help, few comments were hostile. Pictures were mainly posted in the evening hours, with a small peak in the early morning. While there was a slight peak of pictures being posted on Sundays, postings were rather evenly spread across the week. CONCLUSIONS Pictures of NSSI are frequently posted on Instagram. Social reinforcement might play a role in the posting of more severe NSSI pictures. Social media platforms need to take appropriate measures for preventing online social contagion.
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Affiliation(s)
- R C Brown
- Department for Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Ulm,Germany
| | - T Fischer
- Freelancing data journalist,Berlin,Germany
| | | | - F Keller
- Department for Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Ulm,Germany
| | - R Young
- MRC Social and Public Health Sciences Unit,University of Glasgow,Glasgow,Scotland
| | - P L Plener
- Department for Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Ulm,Germany
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McEvoy PM, Hayes S, Hasking PA, Rees CS. Thoughts, images, and appraisals associated with acting and not acting on the urge to self-injure. J Behav Ther Exp Psychiatry 2017; 57:163-171. [PMID: 28601695 DOI: 10.1016/j.jbtep.2017.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/05/2017] [Accepted: 05/31/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The aim of this study was to examine the frequency, content, and appraisals of thoughts and images occurring during urges to engage in non-suicidal self-injury (NSSI). METHOD Undergraduates (N = 154) with a history of NSSI completed an online survey of their thoughts, images, and appraisals when they acted on urges to engage in NSSI as well as when they resisted urges to self-injure. RESULTS Most (>90%) participants reported experiencing both thoughts and images during urges to engage in NSSI. During urges that resulted in self-injury, self-critical and hopeless thoughts were most distressing, and thoughts about relief from emotional distress were most comforting. Images of the anticipated injury were most common. During urges that did not result in self-injury themes of the futility of NSSI, positive self-talk, and the impact on others were most common. Images were most frequently of the negative impact on self and others, and the anticipated injury. Appraisals encouraging NSSI occurred when individuals did and did not act on their urges, but concurrent strong discouraging appraisals appeared to be protective on occasions when urges did not result in self-injury. LIMITATIONS Retrospective self-report was used to assess cognitive content. Generalisability of findings to non-student samples needs to be assessed. CONCLUSIONS Findings from this study may inform comprehensive assessment of thoughts and images associated with urges to engage in NSSI. NSSI interventions may need to promote thoughts, imagery and appraisals that discourage NSSI whilst simultaneously modifying cognitions that encourage NSSI.
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Affiliation(s)
- Peter M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia.
| | - Sarra Hayes
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Penelope A Hasking
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Clare S Rees
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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Campaioli G, Sale E, Simonelli A, Pomini V. The Dual Value of the Web: Risks and Benefits of the Use of the Internet in Disorders with A Self-Destructive Component in Adolescents and Young Adults. CONTEMPORARY FAMILY THERAPY 2017. [DOI: 10.1007/s10591-017-9443-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Much debate surrounds the potential effects of self-harm forum use. Arguments in favor highlight factors such as providing access to a supportive community. However critical voice highlighting potential dangers such as forums serving as a platform to promote self-harm, clearly dominate the debate. Using an online questionnaire, the goal of the current study was to examine sociodemographic characteristics, the psychopathology of forum users, motives for participating, and subjective effects of self-harm forum use. A total of 309 self-harm forum users participated in this study. 3 heterogeneous user types with differing motives for visiting the forum and different usage effects were identified. The results question the assumptions that self-harm forums are a source of harm and point to their predominantly constructive and preventive functions.
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Jacob N, Evans R, Scourfield J. The influence of online images on self-harm: A qualitative study of young people aged 16-24. J Adolesc 2017; 60:140-147. [PMID: 28881214 PMCID: PMC5614108 DOI: 10.1016/j.adolescence.2017.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 08/04/2017] [Accepted: 08/06/2017] [Indexed: 11/19/2022]
Abstract
To date, research on the role of the Internet in self-harm has focused on young people's interaction via the medium of text, with limited consideration of the effect of images. This qualitative study explores how young people understand and use online images of self-harm. Semi-structured interviews were conducted with a community sample of 21 individuals aged 16–24 living in Wales, UK, with a previous history of self-harm. Interviewees reported the role of the Internet in normalising young people's self-harm. Images rather than textual interactions are the primary reason cited for using the Internet for self-harm purposes. Images invoke a physical reaction and inspire behavioural enactment, with Tumblr, which permits the sharing of images by anonymous individuals, being the preferred platform. Viewing online images serves a vital role in many young people's self-harm, as part of ritualistic practice. Online prevention and intervention need to attend to the importance of images.
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Affiliation(s)
- Nina Jacob
- The Centre for Trials Research, Cardif University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
| | - Rhiannon Evans
- DECIPHER, Cardiff School of Social Sciences, The Glamorgan Building, King Edward VII Avenue, Cardiff CF10 3WT, UK
| | - Jonathan Scourfield
- Cardiff School of Social Sciences, Cardiff University, The Glamorgan Building, King Edward VII Avenue, Cardiff CF10 3WT, UK.
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Hasking PA, Di Simplicio M, McEvoy PM, Rees CS. Emotional cascade theory and non-suicidal self-injury: the importance of imagery and positive affect. Cogn Emot 2017; 32:941-952. [PMID: 28838289 PMCID: PMC6050645 DOI: 10.1080/02699931.2017.1368456] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Grounded in Emotional Cascade Theory, we explored whether rumination and multisensory imagery-based cognitions moderated the relationships between affect and both odds of non-suicidal self-injury (NSSI), and frequency of the behaviour. A sample of 393 university students completed self-report questionnaires assessing the constructs of interest. Contrary to expectations, rumination did not emerge as a significant moderator of the affect-NSSI relationship. However, the relationship between affect and frequency of NSSI was moderated by the use of imagery. Further, the relationship between negative affect and NSSI was moderated by positive affect, underscoring the need to consider both negative and positive affect in models of NSSI. Most youth who self-injured reported thinking in images while the urge to self-injure was strong, with 53% thinking in images at least half the time. Future work is needed to explore how positive and negative affect work in concert to govern NSSI, and how imagery might either exacerbate or reduce risk of NSSI.
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Affiliation(s)
- Penelope A Hasking
- a School of Psychology & Speech Pathology , Curtin University , Perth , Australia
| | | | - Peter M McEvoy
- a School of Psychology & Speech Pathology , Curtin University , Perth , Australia.,c Centre for Clinical Interventions , Perth , Australia
| | - Clare S Rees
- a School of Psychology & Speech Pathology , Curtin University , Perth , Australia
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Marchant A, Hawton K, Stewart A, Montgomery P, Singaravelu V, Lloyd K, Purdy N, Daine K, John A. A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown. PLoS One 2017; 12:e0181722. [PMID: 28813437 PMCID: PMC5558917 DOI: 10.1371/journal.pone.0181722] [Citation(s) in RCA: 191] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/06/2017] [Indexed: 11/18/2022] Open
Abstract
Background Research exploring internet use and self-harm is rapidly expanding amidst concerns regarding influences of on-line activities on self-harm and suicide, especially in young people. We aimed to systematically review evidence regarding the potential influence of the internet on self-harm/suicidal behaviour in young people. Methods We conducted a systematic review based on an electronic search for articles published between 01/01/2011 and 26/01/2015 across databases including Medline, Cochrane and PsychInfo. Articles were included if: the study examined internet use by individuals who engaged in self-harm/ suicidal behaviour, or internet use clearly related to self-harm content; reported primary empirical data; participants were aged under 25 years. New studies were combined with those identified in a previous review and subject to data extraction, quality rating and narrative synthesis. Results Forty-six independent studies (51 articles) of varying quality were included. Perceived influences were: positive for 11 studies (38191 participants); negative for 18 studies (119524 participants); and mixed for 17 studies (35235 participants). In contrast to previous reviews on this topic studies focused on a wide range of internet mediums: general internet use; internet addiction; online intervention/treatment; social media; dedicated self-harm websites; forums; video/image sharing and blogs. A relationship between internet use and self-harm/suicidal behaviour was particularly associated with internet addiction, high levels of internet use, and websites with self-harm or suicide content. While there are negative aspects of internet use the potential for isolation reduction, outreach and as a source of help and therapy were also identified. Conclusions There is significant potential for harm from online behaviour (normalisation, triggering, competition, contagion) but also the potential to exploit its benefits (crisis support, reduction of social isolation, delivery of therapy, outreach). Young people appear to be increasingly using social media to communicate distress, particularly to peers. The focus should now be on how specific mediums’ (social media, video/image sharing) might be used in therapy and recovery. Clinicians working with young people who self-harm or have mental health issues should engage in discussion about internet use. This should be a standard item during assessment. A protocol for this review was registered with the PROSPERO systematic review protocol registry: (http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42015019518).
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Affiliation(s)
- Amanda Marchant
- Medical School, Swansea University, Swansea, Wales, United Kingdom
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, United Kingdom
| | - Ann Stewart
- Oxford Central Child and Adolescent Mental Health Services, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Paul Montgomery
- Centre for Evidence Based Intervention, University of Oxford, Oxford, United Kingdom
| | | | - Keith Lloyd
- Medical School, Swansea University, Swansea, Wales, United Kingdom
| | - Nicola Purdy
- Medical School, Swansea University, Swansea, Wales, United Kingdom
| | - Kate Daine
- Centre for Evidence Based Intervention, University of Oxford, Oxford, United Kingdom
| | - Ann John
- Medical School, Swansea University, Swansea, Wales, United Kingdom
- * E-mail:
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Jarvi SM, Swenson LP, Batejan KL. Motivation for and use of social networking sites: Comparisons among college students with and without histories of non-suicidal self-injury. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2017; 65:306-312. [PMID: 28362222 DOI: 10.1080/07448481.2017.1312410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This research examines potential differences in social network use and motivation for social network use by non-suicidal self-injury (NSSI) status. PARTICIPANTS 367 (73% women; Mage = 20.60) college students were recruited in November-December 2011. METHODS A random sample of 2,500 students was accessed through a university registrar to recruit students interested in an online survey assessing NSSI and various health-related behaviors. RESULTS Social network use and motivations for social networks did not differ by NSSI status. CONCLUSIONS Results suggest that it is not patterns of use or motivation to use social networks that could lead to concern about online behavior (i.e., behavior increasing risk of future NSSI) among those with NSSI history. Rather, future preventive and intervention efforts should address the NSSI-related content that is available online, since this is unregulated, often explicit, and commonly includes "pro-NSSI" content that may be problematic and increase risk among vulnerable individuals.
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Affiliation(s)
| | - Lance P Swenson
- a Department of Psychology , Suffolk University , Boston , MA , USA
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Hasking PA, Heath NL, Kaess M, Lewis SP, Plener PL, Walsh BW, Whitlock J, Wilson MS. Position paper for guiding response to non-suicidal self-injury in schools. SCHOOL PSYCHOLOGY INTERNATIONAL 2016. [DOI: 10.1177/0143034316678656] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Around the world, school staff are increasingly expressing concern about nonsuicidal self-injury (NSSI) and how best to address this behavior in the school setting. However, there is a notable lack of informed guidance for schools, and clear inconsistencies in the practices school staff adopt. In this position paper we draw on our collective research and clinical expertise to provide best-practice guidelines for addressing NSSI in school settings. We outline the importance of a school protocol, and the key features all school protocols should contain. We also focus on how schools can minimize contagion of NSSI within their school environment. We believe these guidelines will be an important starting point for schools interested in developing an evidence-based approach to addressing NSSI.
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Affiliation(s)
| | | | - Michael Kaess
- Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
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Zhu L, Westers NJ, Horton SE, King JD, Diederich A, Stewart SM, Kennard BD. Frequency of Exposure to and Engagement in Nonsuicidal Self-Injury Among Inpatient Adolescents. Arch Suicide Res 2016; 20:580-90. [PMID: 26983456 DOI: 10.1080/13811118.2016.1162240] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined the relationship between frequency of exposure to non-suicidal self-injury (NSSI) and engagement in NSSI among adolescents. Ninety inpatient adolescents with a history of NSSI, ages 12 to 17, completed a structured interview. The majority of participants had learned about NSSI prior to initiating the behavior themselves. More frequent exposure to specific methods of NSSI was associated with greater frequency of using those same methods. Greater exposure to NSSI in the media and seeking out NSSI content were related to greater frequency of engagement in NSSI. Clinicians may help those who self-injure to become more knowledgeable and educated consumers of media to prevent NSSI behavior and contagion.
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Lewis SP, Seko Y. A Double-Edged Sword: A Review of Benefits and Risks of Online Nonsuicidal Self-Injury Activities. J Clin Psychol 2015; 72:249-62. [PMID: 26613372 DOI: 10.1002/jclp.22242] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This review aimed to synthesize current evidence on the perceived benefits and risks of online activity pertinent to nonsuicidal self-injury (NSSI). METHOD A systematic literature search was conducted to identify peer-reviewed articles, which yielded a total of 27 articles published between 2005 and 2015. Following this, a thematic analysis was employed to identify perceived benefits and risks of online NSSI activity. RESULTS Our thematic analysis identified 4 potential benefits (mitigation of social isolation, recovery encouragement, emotional self-disclosure, curbing NSSI urges) and 3 potential risks (NSSI reinforcement, triggering NSSI urges, stigmatization of NSSI) associated with online NSSI activities. CONCLUSION Given the double-edged effect of online NSSI activities, clinicians may benefit from incorporating clients' online NSSI activity in the context of NSSI assessment and treatment. Future research ought to directly examine the link between online NSSI activity and NSSI behavior to better understand the nature of these benefits and risks.
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Lewis SP, Mehrabkhani S. Every scar tells a story: Insight into people’s self-injury scar experiences. COUNSELLING PSYCHOLOGY QUARTERLY 2015. [DOI: 10.1080/09515070.2015.1088431] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mars B, Heron J, Biddle L, Donovan JL, Holley R, Piper M, Potokar J, Wyllie C, Gunnell D. Exposure to, and searching for, information about suicide and self-harm on the Internet: Prevalence and predictors in a population based cohort of young adults. J Affect Disord 2015; 185:239-45. [PMID: 26150198 PMCID: PMC4550475 DOI: 10.1016/j.jad.2015.06.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND There is concern over the potential impact of the Internet on self-harm and suicidal behaviour, particularly in young people. However, little is known about the prevalence and patterns of suicide/self-harm related Internet use in the general population. METHODS Cross sectional study of 3946 of the 8525 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) who were sent a self-report questionnaire including questions on suicide/self-harm related Internet use and self-harm history at age 21 years. RESULTS Suicide/self-harm related Internet use was reported by 22.5% (886/3946) of participants; 11.9% (470/3946) had come across sites/chatrooms discussing self-harm or suicide, 8.2% (323/3946) had searched for information about self-harm, 7.5% (296/3946) had searched for information about suicide and 9.1% (357/3946) had used the Internet to discuss self-harm or suicidal feelings. Suicide/self-harm related Internet use was particularly prevalent amongst those who had harmed with suicidal intent (70%, 174/248), and was strongly associated with the presence of suicidal thoughts, suicidal plans, and history of self-harm. Sites offering help, advice, or support were accessed by a larger proportion of the sample (8.2%, 323/3946) than sites offering information on how to hurt or kill yourself (3.1%, 123/3946). Most individuals (81%) who had accessed these potentially harmful sites had also accessed help sites. LIMITATIONS (i) There were differences between questionnaire responders and non-responders which could lead to selection bias and (ii) the data were cross-sectional, and we cannot conclude that associations are causal. CONCLUSIONS Suicide/self-harm related Internet use is common amongst young adults, particularly amongst those with suicidal thoughts and behaviour. Both harmful and helpful sites were accessed, highlighting that the Internet presents potential risks but also offers opportunities for suicide prevention.
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Affiliation(s)
- Becky Mars
- School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol BS8 2BN, United Kingdom.
| | - Jon Heron
- School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol BS8 2BN, United Kingdom
| | - Lucy Biddle
- School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol BS8 2BN, United Kingdom
| | - Jenny L. Donovan
- School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol BS8 2BN, United Kingdom
| | | | - Martyn Piper
- PAPYRUS Prevention of Young Suicide, United Kingdom
| | - John Potokar
- School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol BS8 2BN, United Kingdom
| | | | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol BS8 2BN, United Kingdom
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Seko Y, Kidd SA, Wiljer D, McKenzie KJ. On the Creative Edge: Exploring Motivations for Creating Non-Suicidal Self-Injury Content Online. QUALITATIVE HEALTH RESEARCH 2015; 25:1334-1346. [PMID: 25662942 DOI: 10.1177/1049732315570134] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The last decade has witnessed an exponential growth in user-generated online content featuring Non-Suicidal Self-Injury (NSSI), including photography, digital video, poems, blogging, and drawings. Although the increasing visibility of NSSI content has evoked public concern over potential health risks, little research has investigated why people are drawn to create and publish such content. This article reports the findings from a qualitative analysis of online interviews with 17 individuals who produce NSSI content. A thematic analysis of participants' narratives identified two prominent motives: self-oriented motivation (to express self and creativity, to reflect on NSSI experience, to mitigate self-destructive urges) and social motivation (to support similar others, to seek out peers, to raise social awareness). Participants also reported a double-edged impact of NSSI content both as a trigger and a deterrent to NSSI.
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Affiliation(s)
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada Univeristy of Toronto, Ontario, Canada
| | - David Wiljer
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada Univeristy of Toronto, Ontario, Canada
| | - Kwame J McKenzie
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada Univeristy of Toronto, Ontario, Canada
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Research with adolescents who engage in non-suicidal self-injury: ethical considerations and challenges. Child Adolesc Psychiatry Ment Health 2015; 9:37. [PMID: 26417391 PMCID: PMC4584461 DOI: 10.1186/s13034-015-0071-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 07/14/2015] [Indexed: 11/22/2022] Open
Abstract
Non-suicidal self-injury (NSSI) has emerged as a significant psychiatric issue among youth. In addition to its high prevalence rates, NSSI is associated with a number of psychiatric issues and confers risk for varying degrees of physical injury. It is also a risk factor for attempted suicide. Thus, youth who engage in NSSI represent a vulnerable and high-risk population and researchers are likely to encounter a variety of ethical challenges when conducting NSSI research. Accordingly, it is critical that researchers be familiar with the major ethical issues involved in NSSI research and how to effectively account for and address them. This is important both prior to obtaining clearance from their Institutional Review Boards and when carrying out their research. To date, there is no consolidated resource to delineate the ethical challenges inherent to NSSI research and how these can be effectively navigated throughout the research process. The goals of this paper are to review international best practices in NSSI research across the various contexts within which it is studied, to offer guidelines for managing these issues, to identify areas in which variation in approaches prohibits decisive recommendations, and to generate questions in need of further consideration among scholars in this field.
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Lewis SP, Michal NJ. Start, stop, and continue: Preliminary insight into the appeal of self-injury e-communities. J Health Psychol 2014; 21:250-60. [PMID: 24707032 DOI: 10.1177/1359105314527140] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Lewis SP, Heath NL, Michal NJ, Duggan JM. Non-suicidal self-injury, youth, and the Internet: What mental health professionals need to know. Child Adolesc Psychiatry Ment Health 2012; 6:13. [PMID: 22463379 PMCID: PMC3464157 DOI: 10.1186/1753-2000-6-13] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/07/2012] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Stephen P Lewis
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada.
| | - Nancy L Heath
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC H3A 1Y2, Canada
| | - Natalie J Michal
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Jamie M Duggan
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC H3A 1Y2, Canada
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