Background
Viewing self‐harm and suicide‐related images online can precede these behaviours. We reviewed studies of potential impacts and mechanisms associated with viewing self‐harm‐related images ...on the internet and social media.
Method
CINAHL, Cochrane Library, EMBASE, HMIC, MEDLINE, PsycArticles, PsycINFO, PubMed, Scopus, Sociological s and Web of Science Core Collection databases were searched for relevant studies from inception to 22 January 2022. Inclusion criteria were English language, peer‐reviewed, empirical studies with data related to impacts of viewing self‐harm images or videos on the internet or social media. Quality and risk of bias were assessed using Critical Appraisal Skills Programme tools. A narrative synthesis approach was used.
Results
Of the 15 identified studies, all found harmful effects of viewing self‐harm‐related images online. These included escalation of self‐harm, reinforcement of engagement behaviours (e.g. commenting and sharing images), encouragement of social comparison (comparing own self‐harm with others), development of a self‐harm identity, social connection perpetuating or escalating self‐harm, and emotional, cognitive, and physiological impacts triggering self‐harm urges and acts. Nine studies found protective effects, including self‐harm mitigation or reduction, promotion of self‐harm recovery, encouraging social connection and help‐giving, and emotional, cognitive and physiological impacts mitigating or reducing self‐harm urges and acts. Causality of impact was not determined in any study. Most of the studies did not explicitly evaluate or discuss potential mechanisms.
Conclusions
Viewing self‐harm images online may have both harmful and protective effects, but harmful effects predominated in the studies. Clinically, it is important to assess individual's access to images relating to self‐harm and suicide, and the associated impacts, alongside pre‐existing vulnerabilities and contextual factors. Higher quality longitudinal research with less reliance on retrospective self‐report is needed, as well as studies that test potential mechanisms. We have developed a conceptual model of the impact of viewing self‐harm images online to inform future research.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Background
To understand and care for men who self‐harm, it is important that healthcare professionals have understanding of how and why men self‐harm, men's experiences of self‐harm and what can be ...done to hinder or prevent self‐harm.
Aims
The aim of this study was to synthesize the existing knowledge on men who self‐harm, with a special emphasis on background, self‐harming methods, experiences and reported therapeutic interventions and/or care approaches.
Design
Scoping review of internationally published and grey literature, based on a methodological framework by Arksey and O’Malley.
Data sources
Systematic electronic database searches were conducted in CINAHL, MEDLINE (Ovid) and PsycINFO. From a total of 684 studies found, 24 studies met the inclusion criteria: full‐text, published in English, peer‐reviewed studies and grey literature including a focus on men who self‐harm, men aged between 18 and 65 years, and published between 2010 and 2019.
Results
Men's self‐harm was understood as being related to mental disorders, a means of affect regulation, a loss of self‐control, and a means of interpersonal communication. Self‐harm can be a positive or negative experience, and there is a wide variety in the methods that men use to self‐harm: sharp objects, injection, ingestion, without aids or riskful behaviour. Few studies reported on therapeutic interventions and/or care approaches for men who self‐harm.
Conclusion
Men's self‐harm should be understood as a complex, socially and culturally conditioned phenomenon and studied from a multitude of perspectives.
Impact
This scoping review concludes that self‐harm among men should be understood as a complex, socially and culturally conditioned phenomenon. To empower men and support their recovery from self‐harm, a person‐centred approach should be incorporated into research on the subject and practice.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Background
Digital self‐harm (DiSH) is a recently identified self‐harm distinct from physical self‐harm (PSH, also known as non‐suicidal self‐injury, NSSI). Although prior research has shown that ...DiSH was associated with suicidal thoughts and behaviors (STBs), it was still unclear whether DiSH has a unique association with STBs after controlling for PSH.
Method
A cross‐sectional survey was conducted on Chinese college students. The lifetime prevalence of DiSH and PSH, the functions of DiSH, recent suicide experiences (including suicide ideation, plans, and attempts), anxiety and depression were examined. A total of 5281 participants were analyzed.
Results
A total of 10.83% of participants had ever engaged in DiSH, and 1.59% of participants reported histories of both DiSH and PSH. Among participants with a history of PSH, 30.11% engaged in DiSH. Engagement in DiSH was significantly associated with suicide ideation (SI), suicide plans (SPs), and suicide attempts (SAs). More importantly, participants who engaged in both DiSH and PSH showed higher odds of SI and SPs compared to those who had only engaged in PSH. Regarding the functions of DiSH, using DiSH for self‐punishment was associated with SI and SPs, and using DiSH for sensation seeking was associated with SPs and SAs. Similar results were found for the association between DiSH and anxiety and depression.
Conclusions
Our findings suggest that DiSH has a unique association with the risks of STBs beyond PSH. Early identification and intervention for DiSH are crucial, even for individuals who already engage in PSH.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background: Self‐harm (intentional self‐poisoning and self‐injury) in children and adolescents is often repeated and is associated with increased risk of future suicide. We have investigated factors ...associated with these outcomes.
Method: We used data collected in the Multicentre Study of Self‐harm in England on all self‐harm hospital presentations by individuals aged 10–18 years between 2000 and 2007, and national death information on these individuals to the end of 2010. Cox hazard proportional models were used to identify independent and multivariable predictors of repetition of self‐harm and of suicide.
Results: Repetition of self‐harm occurred in 27.3% of individuals (N = 3920) who presented between 2000 and 2005 and were followed up until 2007. Multivariate analysis showed that repetition was associated with age, self‐cutting, and previous self‐harm and psychiatric treatment. Of 51 deaths in individuals who presented between 2000 and 2007 and were followed up to 2010 (N = 5133) half (49.0%) were suicides. The method used was usually different to that used for self‐harm. Multivariate analysis showed that suicide was associated with male gender Hazard ratio (HR) = 2.4, 95% CI 1.2–4.8, self‐cutting (HR = 2.1, 95% CI 1.1–3.7) and prior psychiatric treatment at initial presentation (HR = 4.2, 95% CI 1.7–10.5). It was also associated with self‐cutting and history of psychiatric treatment at the last episode before death, and history of previous self harm.
Conclusions: Self‐cutting as a method of self‐harm in children and adolescents conveys greater risk of suicide (and repetition) than self‐poisoning although different methods are usually used for suicide. The findings underline the need for psychosocial assessment in all cases.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
•Knowledge of suicide and self-harm risk varied significantly across the studies.•Gaps exist in suicide risk knowledge in specific patient categories.•Slight improvements in knowledge observed in ...face-to-face training and education.•Long-term, routine face-to-face group training programmes are recommended.
Suicide risk screening in healthcare settings plays a significant role in suicide prevention. Healthcare staff who are poorly informed about self-harm and suicide risk are less likely to identify and subsequently screen at-risk individuals. This mixed-method systematic review aimed to appraise and synthesise evidence from studies that explored and promoted healthcare staff's knowledge and awareness of suicide and self-harm risk in healthcare settings.
Electronic databases (CINAHL, MEDLINE, APA PsycInfo, APA PsycARTICLES, Psychology and behavioural Science Collection, ERIC, and SocINDEX), the Cochrane Library, and various grey literature databases were searched for relevant studies. The level of evidence and methodological quality of the included studies were assessed.
Eighteen empirical studies were included. Levels of knowledge about suicide and self-harm risk varied significantly across the reviewed studies. Face-to-face group training and educational programmes, digital or online educational programmes, and an educational poster campaign were amongst the strategies used to promote awareness of suicide and self-harm risk, with the majority marginally succeeding in doing so.
The reviewed studies were heterogeneous in terms of design, interventions, and outcome measures which made it difficult to make comparisons. The overall level of scientific evidence was classified as being relatively low. The lack of blinding and lack of a control group were amongst the limitations for experimental studies.
Long-term, routine face-to-face group training programmes should be established to educate healthcare staff about suicide risk across all professions and in specific patient groups.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
•Methods associated with increased risk of self-harm repetition were minor and severe self-cutting, intentional drug overdoses (IDOs) involving multiple drugs including psychotropic drugs and ...self-harm by blunt object.•Minor self-cutting was the method associated with highest repetition risk.•Repetition risk was similar following IDOs of four or more drugs involving psychotropic drugs, severe self-cutting and blunt object.
Risk of self-harm repetition has consistently been shown to be higher following self-cutting compared to intentional drug overdose (IDO) and other self-harm methods. The utility of previous evidence is limited due to the large heterogeneous method categories studied. This study examined risk of hospital presented self-harm repetition according to specific characteristics of self-harm methods.
Data on consecutive self-harm presentations to hospital emergency departments (2010–2016) were obtained from the National Self-Harm Registry Ireland. Associations between self-harm method and repetition were analysed using survival analyses.
Overall, 65,690 self-harm presentations were made involving 46,661 individuals. Self-harm methods associated with increased repetition risk included minor self-cutting, severe self-cutting, multiple drug IDOs involving psychotropic drugs and self-harm by blunt object. Minor self-cutting was the method associated with highest repetition risk (adjusted hazard ratio (AHR) 1.38, 95% CI 1.31–1.45). Risk of repetition was comparable following IDOs of four or more drugs involving psychotropic drugs (AHR = 1.29, 95% CI 1.20–1.39), severe self-cutting (AHR 1.25, 95% CI 1.16–1.34) and blunt object (AHR = 1.23, 95% CI 1.07–1.42).
Information was not available on suicide or other causes of mortality.
Self-harm method and the associated risk of repetition should form a core part of biopsychosocial assessments and should inform follow-up care for self-harm patients. The observed differences in repetition associated with specific characteristics of IDO underline the importance of safety planning and monitoring prescribing for people who have engaged in IDO.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Suicidal thoughts and behaviors often emerge in a predictable sequence, with suicidal ideation (SI) preceding planning, and planning preceding actions. Few studies, however, have considered the ...timing and duration of non-suicidal self-injury (NSSI) in these transitions. Accordingly, this study examined: 1) the developmental sequencing of NSSI, SI and suicide attempts, and 2) whether age of onset or duration predict transitions from NSSI to other SITB, and from SI to NSSI.
704 first-year students from a mid-sized Canadian university (Sample 1) and 2095 adults from an online research volunteer panel (Sample 2) completed the Self-Injurious Thoughts and Behaviors Interview self-report, which assessed the presence, age of onset, and recency of SITB.
NSSI and SI typically onset before age 15, while suicide planning and attempt usually began after age 15. Transition from NSSI to SI was likeliest in the first year after NSSI onset. Transition from NSSI to suicide attempt was likeliest in the second and third year after NSSI onset in Sample 1, and up to four years after NSSI onset in Sample 2. Early (before age 13) and late (after age 16) onsets of NSSI predicted higher odds of transitioning from NSSI to SI or attempt. Transition from SI to NSSI was likeliest in the first two years after SI onset and when SI began before age 13.
The first year after NSSI or SI onset are critical for transitions to other SITB. Targeted prevention and monitoring should be considered for people who recently initiated NSSI.
•NSSI and suicidal ideation (SI) typically begin within 1–2 years of each other•Transition from NSSI to SI was likeliest in the first year after NSSI onset•Transition risk from NSSI to attempt persisted for 3+ years after NSSI onset•NSSI onset before age 13 or after 16 predicted transitioning to SI or attempt•Onset of SI before age 13 predicted transition to NSSI
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
War profoundly impacts people’s lives, causing death, displacement, and psychological trauma, but research investigating suicidality of adolescents in this context has been limited. We compared ...suicidality or self-harm behavior among adolescents in regions that were, and were not, affected by Russia’s initial invasion of Ukraine in 2014.
This cross-sectional study comprised 2,752 school students aged 11 to 17 years from the war-affected Donetsk region and non-war Kirovograd region. Data collection occurred in 2016 and 2017 using self-report tools to assess suicidality or self-harm behavior; psychopathology including posttraumatic stress disorder (PTSD), depression, and anxiety; and war trauma exposure.
Adolescent girls in the war-affected region reported more suicide attempts (9.5% vs 5.1%; adjusted odds ratio aOR 1.8, 95% CI 1.2-2.8), suicidal ideation (39.3% vs 19.6%; aOR 2.6, 95% CI 2.01-3.3), or self-harm behavior (19.6% vs 13.1%; aOR 1.6, 95% CI 1.2-2.1), and boys reported more suicidal ideation (17.0% vs 9.8%; aOR 1.7, 95% CI 1.2-2.4). Boys and girls with PTSD, depression, or anxiety showed increased risks for any suicidality or self-harm. A dose-effect relation was observed between war trauma exposure and suicidality or self-harm. The association was strongest for adolescents who had experienced 5 or more different war trauma exposures (aOR 3.2, 95% CI 2.2-4.8).
War trauma exposure and psychopathology were strongly associated with suicidality or self-harm behavior, with a greater impact in girls than boys. The high prevalence of suicidality found in this study emphasizes the need for intervention on a large scale for adolescents living in war situations.
Since the 1990s, suicide in recession-plagued Japan has soared, and rates of depression have both increased and received greater public attention. In a nation that has traditionally been ...uncomfortable addressing mental illness, what factors have allowed for the rising medicalization of depression and suicide? Investigating these profound changes from historical, clinical, and sociolegal perspectives, Depression in Japan explores how depression has become a national disease and entered the Japanese lexicon, how psychiatry has responded to the nation's ailing social order, and how, in a remarkable transformation, psychiatry has overcome the longstanding resistance to its intrusion in Japanese life.
Background
The COVID‐19 pandemic is the most serious global public health crisis since the 1918 influenza pandemic. This study is the first to assess its mental health impact across the lifespan in ...the United States in adolescents, adults, and health care workers.
Methods
We recruited 4909 participants through an online survey advertising on Facebook and Instagram to assess exposure to COVID‐19 and psychiatric symptoms from April 27 to July 13. We also recruited through the University of Pittsburgh, University of Pittsburgh Medical Center, and other health care systems around Pittsburgh. The primary outcomes were clinically significant depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms, suicidal ideation or behavior, and grief reactions since COVID‐19.
Results
Adolescents were significantly more likely to report moderate to severe symptoms of depression (55% vs. 29%; χ2 = 122, df = 1; p < .001), anxiety (48% vs. 29%; χ2 = 73; df = 1; p < .001), PTSD (45% vs. 33%; χ2 = 12; df = 1; p < .001), suicidal ideation or behavior (38% vs. 16%; χ2 = 117; df = 1; p < .001), and sleep problems (69% vs. 57%; χ2 = 26; df = 1; p < .001) compared to adults. The rates of intense grief reactions among those who lost someone to COVID‐19 was 55%. Loneliness was the most common predictor across outcomes and higher number of hours spent on social media and exposure to media about COVID‐19 predicted depression symptoms and suicidal ideation or behavior in adolescents.
Conclusions
The COVID‐19 pandemic is associated with increased rates of clinically significant psychiatric symptoms. Loneliness could put individuals at increased risk for the onset of psychiatric disorders.
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DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
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