Abstract
BackgroundResearch 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.MethodsWe 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.ResultsForty-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.ConclusionsThere 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).
Highlights
Internet use has a mixed effect on children and young people’s (CYP) well-being, with evidence of increased self-esteem and perceived social support alongside harmful effects such as increased exposure to graphic content and cyber-bullying [1]
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
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
Summary
Internet use has a mixed effect on children and young people’s (CYP) well-being, with evidence of increased self-esteem and perceived social support alongside harmful effects such as increased exposure to graphic content and cyber-bullying [1]. A recent study examining changes in online suicide-related content showed that the results of searches for self-harm have changed over time, with an increasing presence of graphic imagery [6] The role of such images has been examined in relation to self-harming behaviours [9], as well as relevant content of videos on a popular sharing website [10]. A recent study has showed that the nature of sites returned varied according to the suicide/self-harm-related search terms use and almost half contain video content Negative influences such as providing information on methods, encouraging self-harm behaviours and images considered evocative by researchers were common. We aimed to systematically review evidence regarding the potential influence of the internet on self-harm/suicidal behaviour in young people
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