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. Building on research by Professor Keith Hawton’s group in the Centre for Suicide Research at the University of Oxford’s Department of Psychiatry, the University of Swansea led a study systematically reviewing evidence regarding the potential influence of the internet on self-harm/suicidal behaviour in young people.
The study, published in PLOS ONE, found that: 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.
The volume of self-harm videos shared on certain platforms and the high number of views and comments have led to suggestions of developing videos to emphasise help and recovery. The introduction of psycho-educational prevention programmes in schools concerning appropriate responses to distressed posts on social media and digital citizenship may mitigate some of the negative influences of the internet. The internet is a potential tool for outreach by health professionals. The authors identified the need for further training and encouragement of clinicians working with young people who self-harm or have mental health issues to engage in discussion about internet use. This should be a standard item during assessment. It could include asking about the role of images/videos and designing treatment plans to maximise beneficial online behaviours and reduce associated harms.
Suggestions have been made for the implementation of guidance to individuals and service providers, such as avoiding details of method and including warnings of graphic content on web pages. Stricter regulations could be modelled on the initiative in Australia, where pro-suicide sites were banned in 2006. Several major social media platforms (Tumblr, Pinterest, Instagram, Facebook) have responded to concerns and implemented policies regarding posts related to self-harm. Such content may not be searchable, is banned or brings up links to counselling and prevention resources. The potential to access groups online largely hidden from the health service, such as those for LGBT individuals or those with eating disorders for both interventions and research may improve access to care and allow representation in research that has not been possible previously.
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.
Read the full paper in PLOS ONE