Self-harm and suicidal content online, harmful or helpful? A systematic review of the recent evidence

Abstract

Purpose There are calls for greater regulation of online content related to self-harm and suicide, particularly that which is user-generated. However, the online space is a source of support and advice, including an important sharing of experiences. This study aims to explore what it is about such online content, and how people interact with it, that may confer harm or offer benefit. Design/methodology/approach The authors undertook a systematic review of the published evidence, using customised searches up to February 2021 in seven databases. The authors included empirical research on the internet or online use and self-harm or suicide content that had been indexed since 2015. The authors undertook a theoretically driven narrative synthesis. Findings From 4,493 unique records, 87 met our inclusion criteria. The literature is rapidly expanding and not all the evidence is high quality, with very few longitudinal or intervention studies so little evidence to understand possible causal links. Very little content online is classifiable as explicitly harmful or definitively helpful, with responses varying by the individual and immediate context. The authors present a framework that seeks to represent the interplay in online use between the person, the medium, the content and the outcome. Originality/value This review highlights that content should not be considered separately to the person accessing it, so online safety means thinking about all users. Blanket removal or unthinking regulation may be more harmful than helpful. A focus on safe browsing is important and tools that limit time and diversify content would support this.

Investigating How People Who Self-harm Evaluate Web-Based Lived Experience Stories: Focus Group Study

“…The positive and negative effects of interacting with web-based content on mental health, and especially on self-harm, are well documented [ 3 , 4 ]. The internet offers an important avenue for supporting people who self-harm, particularly those who are unable or reluctant to access formal, in-person support [ 5 , 6 ].…”

“…Young people experiencing suicidal feelings are also particularly likely to search for advice or peer support on the web [ 4 , 9 , 10 ]. However, web-based help seeking is also associated with risks, such as unintentional exposure to graphic or prosuicide and self-harm content and engagement with discussion forums in which self-harm is sometimes normalized and negative feelings are reinforced [ 3 , 8 , 9 , 11 ]. Therefore, it is vital that the web-based support content provided is safe, effective, and evidence-based.…”

Research Review: Viewing self‐harm images on the internet and social media platforms: systematic review of the impact and associated psychological mechanisms

“…Findings from several studies have raised concerns that self‐harm and suicidal content viewed online or on social media, particularly ‘graphic’ images or videos, may be harmful; for example, by normalising self‐harm and discouraging help‐seeking (Baker & Lewis, 2013; Bell, 2014; Brennan et al., 2022; Daine et al., 2013; Jacob, Evans, & Scourfield, 2017; Lewis, Heath, Sornberger, & Arbuthnott, 2012; Lewis & Seko, 2016; Marchant et al., 2017; Marchant, Hawton, Burns, Stewart, & John, 2021). The potential for harm is particularly concerning because self‐harm and suicide‐related internet sites are commonly accessed by young people engaging in self‐harm and are associated with both increased self‐harm and suicidal intent (Daine et al., 2013; Mars et al., 2015; Padmanathan et al., 2018).…”

Testing the Impact of the #chatsafe Intervention on Young People’s Ability to Communicate Safely About Suicide on Social Media: Protocol for a Randomized Controlled Trial

“…Social media platforms are commonly used by young people to communicate about suicide. While users rarely set out to cause harm to themselves or others, the potential for harm exists [ 18 , 19 ]. Therefore, it is essential that young people are adequately equipped to safely communicate on the internet about suicide.…”