Relationship of Social and Behavioral Characteristics to Suicidality in Community Adolescents With Self-Harm: Considering Contagion and Connection on Social Media

Abstract

A close link has been established between self-harm and suicide risk in adolescents, and increasing attention is given to social media as possibly involved in this relationship. It is important to identify indicators of suicidality (i.e., suicide ideation or attempt) including aspects related to contagion in online and offline social networks and explore the role of social media in the relationship between social circumstances and suicidality in young adolescents with self-harm. This study explored characteristics of Korean adolescents with a recent history of self-harm and identified how behavioral and social features explain lifetime suicidality with emphasis on the impact of social media. Data came from a nationwide online survey among sixth- to ninth-graders with self-harm during the past 12 months (n = 906). We used χ2 tests of independence to explore potential concomitants of lifetime suicidality and employed a multivariate logistic regression model to examine the relationship between the explanatory variables and suicidality. Sensitivity analyses were performed with lifetime suicide attempt in place of lifetime suicidality. 33.9% (n = 306) and 71.2% (n = 642) reported to have started self-harm by the time they were fourth- and six-graders, respectively; 44.3% (n = 400) reported that they have friends who self-harm. Having endorsed moderate/severe forms and multiple forms of self-harm (OR 5.36, p < 0.001; OR 3.13, p < 0.001), having engaged in self-harm for two years or more (OR 2.42, p = 0.001), having friends who self-harm (OR 1.92, p = 0.013), and having been bullied at school were associated with an increased odds of lifetime suicidality (OR 2.08, p = 0.004). Notably, having posted content about one’s self-harm on social media during the past 12 months was associated with an increased odds of lifetime suicidality (OR 3.15, p < 0.001), whereas having seen related content in the same period was not. Sensitivity analyses yielded similar results with lifetime suicide attempt, supporting our findings from the logistic regression. The current study suggests that self-harm may be prevalent from early adolescence in South Korea with assortative gathering. The relationship of vulnerable adolescents’ social circumstances to suicide risk may be compounded by the role of social media. As the role of social media can be linked to both risk (i.e., contagion) and benefit (i.e., social connection and support), pre-existing vulnerabilities alongside SH and what online communication centers on should be a focus of clinical attention.

Self-harm among youth during the first 28 months of the COVID-19 pandemic in Ontario, Canada: a population-based study

“…[13][14][15][16][17]62 Although more research is needed, sex-and gender-specific stressors may be associated with the pandemic such as a differential or gendered response to less in-person contact with peers and social networks, 63 cessation of in-person mental health support services, 60 more time on social media 64,65 opportunity for social comparison [66][67][68] -and access to online communities that perpetuate self-harm contagion. [68][69][70][71] Findings from this study should be interpreted in the context of well-established sex differences in psychiatric epidemiology among youth, including the preponderance of depression, [72][73][74] higher reported prevalence of self-harm 75,76 and more suicide attempts and mental health service use among adolescent females, 77,78 all of which were trending upward before the pandemic. [79][80][81][82][83][84][85] Indeed, younger females were the largest group of new users of acute mental health services in this study, which speaks to their baseline vulnerability.…”

“… 13 – 17 , 62 Although more research is needed, sex-and gender-specific stressors may be associated with the pandemic such as a differential or gendered response to less in-person contact with peers and social networks, 63 cessation of in-person mental health support services, 60 more time on social media 64 , 65 — which may present more opportunity for social comparison 66 – 68 — and access to online communities that perpetuate self-harm contagion. 68 – 71 …”

Social contagion, violence, and suicide among adolescents

“…A survey explored the characteristics of Korean adolescents with a recent history of self-harm. This study showed that having friends who self-harm was associated with an increased likelihood of lifetime suicidality [ 29 ▪ ]. Another study showed that adolescents with a suicide attempt who sought outpatient or emergency mental healthcare were more likely to affiliate with suicidal peers compared to their matched controls [ 30 ▪ ], while another study showed that knowing a peer who had attempted suicide was associated with a transition from suicidal ideation to a planned suicide attempt [ 31 ▪ ].…”

The gender distribution and association between sociodemographic factors and self- injury: analysis from the Discharge Injury Patient Survey, South Korea

“…Previous studies on SI in South Korea have identi ed associations with female gender, lower socioeconomic status, and psychiatric conditions [20][21][22]. However, these studies often focused primarily on the adolescent population [22][23][24][25][26][27][28][29][30][31][32][33][34][35], limiting the generalizability of the ndings to all age groups. Additionally, many relied on web-based questionnaires [25,29] or small-size clinical data [30,36,37].…”