Impact of Web-Based Sharing and Viewing of Self-Harm–Related Videos and Photographs on Young People: Systematic Review

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.

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

“…Protective or positive influences associated with self-harm-related content online have also been reported, such as access to social support (Bell, 2014;Daine et al, 2013;Lewis & Seko, 2016;Marchant et al, 2017Marchant et al, , 2021Robinson et al, 2016). In the last few years, guidelines to help young people communicate safely about suicide on social media have been developed (Robinson et al, 2018).…”

“…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).…”

Typology of content warnings and trigger warnings: Systematic review

“…The use of content warnings relates to other safety-driven initiatives. A recent systematic review investigating removal or blurring of self-harm online imagery found parallel issues of potential harm and positive impacts [ 40 ], reinforcing that research in content warnings and cognate areas is complex. There is a need to move beyond the current somewhat simplistic focus on whether content warnings help or harm towards a contextualised understanding of the mechanisms by which content warnings impact on recipients with different characteristics in different sectors and when used for different purposes.…”

Etiology and risk factors for non-suicidal self-injurious behavior

“…Как и предполагалось, воздействие самоповреждений в «Instagram» во время первой волны исследования проспективно предсказывало результаты, связанные с членовредительством и суицидом, во второй волне через 1 месяц. эти результаты свидетельствуют о том, что такое воздействие может привести к заражению уязвимых пользователей и подтверждаются публикациями других исследователей [71,72].…”