Innovative Public Health Research

One example is the online communities that share self-harm experiences and, in some cases, encourage self-harm or suicide [1]. Self-harm behavior involves intentionally injuring or hurting oneself (e.g., cutting) [2]. Although self-harming behavior may indicate depression or serious mental health conditions that are associated with suicidal intentions, people do not always self-harm because they want to die by suicide [2]. It is important to understand that this behavior is not the same as a suicide attempt. While the causes of self-harm are complicated, self-harm can often be a way that some people cope with emotional or mental distress [3]. Nonetheless, these behaviors are short-term fixes and do not relieve distress in the long run. Self-harm can also lead to more serious health consequences [2].

The vast majority of teenagers – and by that I mean over 99% - do not visit websites that discuss or encourage self-harm or suicide [1]. Furthermore, popular social media sites have rules against their users promoting harmful behaviors [4]. However, enforcement of these rules can be inconsistent, allowing online communities to form around mutual interests in self-harm behavior [5]. Although less than 1% of youth have visited websites that encourage self-harm or suicide [1], followings on a particular self-harm site or social media platform can number in the thousands [5].

There are major gaps in our understanding of why youth go to sites about self-harm  and what their experiences are on these sites. Emerging research suggests, however, that these online communities can give young people a sense of shared-identity and belonging [5, 6]. Accordingly, youth who visit self-harm websites and websites that talk about suicide also use the Internet, interact with people they first met online, visit chatrooms, discuss sexual topics online, and share personal information to someone met online at significantly higher rates than youth who do not visit these types of websites [7]. Together, this research suggests that youth who visit self-harm and suicide websites are seeking connection to others. Although some behaviors that are being reinforced may be unhealthy for youth [5], the online social support that some young people find in these spaces can be important – especially if isolation or emotional distress are reasons they are engaging in self-harm [7].

Perhaps not surprisingly, research suggests that youth who have visited self-harm and suicide websites are 11 times more likely to have thought about hurting themselves, compared to youth who have not visited such websites [1]. Youth who visit such sites are also more likely to report a history of physical or sexual abuse, substance use, or delinquent behavior [1]. As such, one might view visiting self-harm and suicide websites as a cause for concern.

On the other hand, though, it could also be seen as an opportunity to have a conversation with a young person about what’s going on in their lives. Often, it can seem like teens move through an invisible online world where we only catch glimpses of what they see or do. Knowing where young people are going and with whom they spend time online can be an incredibly important way to fill some of these gaps in our knowledge and be a way to start valuable conversations with them.  Connecting youth who gravitate to potentially harmful sites to positive and supportive online social spaces can also be a very powerful opportunity to connect with like-others who are struggling to recover.

Additionally, building emotional support in offline spaces can be very beneficial: Connecting to supportive friends and family may help greatly. Getting youth involved in extracurricular activities that raise self-esteem and confidence can also be a healthy way to cope with emotional distress. If needed, counseling, both short-term and long-term, can also provide support and teach healthier coping mechanisms [1].

So, if you know someone who is going to websites about self-harm or suicide, talk to them about it. Try to understand what is going on and why they are going to these sites. Think with them about other spaces they might explore where they can find support and understanding, and offer going to these other places with them, if they find it useful. Being able to reach out and talk with others who “get it” may very well be the step for reaching youth who need help.

To learn more about self-harm and suicide and what you can do to help someone who is struggling with these experiences, visit You Matter (link is external).

You can learn more about our research at Center for Innovative Public Health Research (link is external). Find us on Google+ (link is external), Twitter (link is external), and Facebook (link is external).

Acknowledgments: Thanks to Dr. Kimberly Mitchell and Emilie Chen for their contributions to this blog.

Teaser image courtesy of Garrett Gill (link is external) (CC BY 2.0 (link is external)).

References:

[1] Mitchell KJ, Wells M, Priebe G, Ybarra ML. Exposure to websites that encourage self-harm and suicide: prevalence rates and association with actual thoughts of self-harm and thoughts of suicide in the United States. Journal of Adolescence. 2014;37(8):1335-1344.

[2] Mayo Clinic Staff. Self-injury/cutting. 2012; http://www.mayoclinic.org/diseases-conditions/self-injury/basics/definition/con-20025897 (link is external).

[3] ‘Direct link’ between self-harming and the internet. BBC News. 2015. http://www.bbc.com/news/uk-wales-31878391 (link is external)

[4] Tumblr Staff. A New Policy Against Self-Harm Blogs. 2012. http://staff.tumblr.com/post/18132624829/self-harm-blogs. (link is external)

[5] Vine S. My chilling journey into the self-harm websites that drove a much loved daughter to suicide. Telegraph. 2014. http://www.telegraph.co.uk/news/health/11025101/Self-harming-among-children-surges-to-unprecedented-levels.html (link is external)

[6] Baker D, Fortune S. Understanding Self-Harm and Suicide Websites. Crisis.29(3):118-122.

Of this fraction of youth who have experienced online meanness, most do not find it to be particularly upsetting.[2] Certainly, however, some exchanges are more upsetting than others, and there is an important minority of youth who are really distressed by the experience. Because some victims who are upset by the online harassment may not speak out about their feelings[3], it is important that we try to recognize when someone might be having a hard time. As adults, knowing what to look out for can help us reach struggling youth and get them the help and support they need.

Based upon studies on online harassment, youth are more likely to feel distress if, as part of the online harassment:

More than one harasser or bully is involved. Multiple harassers can leave victims feeling more vulnerable and less able to defend themselves.[4] The presence of bystanders who neither directly participate in the online harassment nor stand up to protect the victim can also have a negative impact.[5]

The harasser attempts to contact the victim offline. Many online harassers also know their victims offline.[6] Whether this is true or not for a particular victim, situations when the harasser tries to contact the victim through the telephone, face-to-face, or by sending items to him/her can increase the likelihood that the victim will feel upset.[7]

The harasser is more “powerful” than the victim. Power can be lots of things, including having more friends, being more popular, being physically stronger, or something else that makes one person ‘above’ the other. Many studies have found that being harassed by someone who has more power can increase the likelihood of distress.[8]

The harassment happens repeatedly. Repeated harassment—along with power imbalance between the victim and harasser—can be a sign that the victim might not just be getting harassed, but also bullied.[8] Bullying is a more intense form of harassment and, as such, can have a greater impact on the victim. This might include depression and anxiety, losing sleep, and lower grades at school.[3]

Youth who experience more than one of the above are even more likely to be upset.[8]

As adults, we want to protect our kids. It can be hard to think about our kids being harassed or bullied online. Online experiences might be even more stressful for us to think about than in-person ones because we might feel like we have less control over what happens online. However, just like other in-person places (think about the mall, parties on the weekend, etc.), a conversation with kids about where they go and who they spend time with online can help you get a better sense of what they are experiencing. Sometimes, just starting the conversation can be really helpful for both of you.

In addition to talking with kids about their technology use, there are some concrete things that anyone can do if they are being harassed. If your child shares that she’s being victimized, here are some potential ways to deal with the harassment that you can think about together [3, 9]:

Log off, and avoid reading hurtful comments. Do not respond to the person, as this can encourage them to continue their behavior. Block the person from email, instant messengers, social networking sites, chat rooms, and other online channels. Change your passwords to online accounts. Consider changing your usernames and email address if the harasser or bully keeps trying to contact you through them. Contact tech support or the webmaster to delete any fake accounts created to impersonate you. Talk to someone you trust! This might be a friend, a parent, teacher, or school counselor. Victimization does not need to be faced alone. Many states are increasing the penalty for online harassment, which can help in prosecuting bullies if legal action is needed to make them stop. Remember too, that experiencing online meanness does not happen to everyone: Five in six youth have not been targeted. Instead of thinking about online harassment as something that is bound to happen, think about it as something that you can help your child manage if it does.

Each person and each situation is different. What may work for one person may not work for another. What is important is that your child feels not only supported by you, but also empowered to address the situation with a solution that you choose together.

Learn more about our research at Center for Innovative Public Health Research.

Find us on Google+, Twitter, and Facebook.

Acknowledgments:

This article is based on “What features make online harassment incidents upsetting to youth?” as part of the Third Youth Internet Safety Survey. conducted by the Crimes against Children Research Center at University of New Hampshire. This 2010 cross-sectional telephone survey examined 1,560 youth, aged 10-17, who had reported using the Internet.

Thank you to Emilie Chen for her contributions to this blog.

References:

[1] Lenhart A, Madden M, Smith A, Purcell K, Zickuhr K, Rainie L. Teens, kindness and cruelty on social network sites. 2011; Available at: http://www.pewinternet.org/2011/11/09/teens-kindness-and-cruelty-on-social-network-sites/

[2] Mitchell KJ, Ybarra ML, Jones LM, Espelage D. What features make online harassment incidents upsetting to youth? J Sch Violence. 2014. [published online ahead of print]

[3] American Osteopathic Association. “Cyber-Bullying and its Effect on our Youth.” Available at: http://www.osteopathic.org/osteopathic-health/about-your-health/health-conditions-library/general-health/Pages/cyber-bullying.aspx

[4] Salmivalli C. Bullying and the peer group: A review. Aggress Violent Behav. 2010;15(2):112-120.

[5] Salmivalli C, Voeten M. Connections between attitudes, group norms, and behavior in bullying situations. Int J Behav Dev. 2004; 28(3):246-258.

[6] Jones LM, Mitchell KJ, Finkelhor D. Online harassment in context: Trends from three youth Internet safety surveys (2000, 2005, 2010). Psychology of Violence. 2013;3(1):53-69.

[7] Ybarra ML, Mitchell KJ, Wolak J, Finkelhor D. Examining characteristics and associated distress related to harassment: Findings from the Second Youth Internet Safety Survey. Pediatrics. 2006; 118:1169-1177.

[8] Ybarra M, Espelage D, Mitchell KJ. Differentiating youth who are bullied from other victims of peer-aggression: the importance of differential power and repetition. J Adolesc Health. 2014; 55(2):293-300.