A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown

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).

Young people, the internet and mental health

“…This research has ranged from exploration of the online environment itself (e.g. Biddle et al 2016) to a systematic review of the relationship between internet use and suicidal behaviour (Marchant et al 2017). The study by Biddle et al (2016) followed on from a similar study by the same researchers (Biddle et al 2008), which involved online searches for suicide-related information to determine the type of content that is likely to be accessed by suicidal internet users.…”

“…A recent systematic review explored various aspects of the relationship between internet use and suicidal behaviour in young people (Marchant et al 2017). Examining literature published from 2011 to 2014, Marchant et al's review included 46 independent studies which reported a range of influences on suicidal behaviour.…”

Media, Technology Use, and Attitudes: Associations With Physical and Mental Well‐Being in Youth With Implications for Evidence‐Based Practice

“…Likewise, a recent review by Marchant et al. () showed that self‐harm or suicidal behavior was particularly associated with Internet addiction, high levels of Internet use, and Web sites with self‐harm or suicide content. Conversely, it was discussed that Internet use has the potential for isolation reduction and outreach, and may be a source of help and therapy.…”

Traditional and new media's influence on suicidal behavior and contagion

“…Studies exploring particular online media, such as social media, forums, or blogs, were smaller and provided lower quality evidence. Distressed online posts appear to be related to suicidal ideation and behavior in young people, but there is little evidence to suggest that social media use itself increases risk (Marchant et al, ).…”

“…Internet forums have been found to be supportive in terms of helping suicidal individuals find communities they could relate to, share their experiences with, and find mental health resources; however, there were also pro‐suicide forums that encouraged and normalized self‐harm and suicidal behaviors. Whether or not these exposures lead to suicidal behavior is still unclear and likely varies with individual circumstances (Marchant et al, ).…”