Self-harm, defined as the “deliberate destruction or alteration of one’s body tissues without suicidal intent” (p. 2), is strongly associated with suicide in research findings. “Explicit depictions of self-harm are now easily accessible via popular content-sharing platforms such as Instagram and Youtube” (p. 2) lending itself to possible social contagion effects.
What are the connections between self-harm and suicidality in adolescents? This study reported findings from 906 Korean adolescents surveyed during their 6th-9th grade years in school. Cross-sectional data, rather than longitudinal data, was gathered and the outcomes of interest included risk of self-harm and suicidal ideation and attempts. Self-harm is a known risk factor for later suicide attempts.
The study explored connections between self-harm, suicidality, and other relevant variables (e.g., grade in school, academic performance, parents’ educational levels). Behavioral variables included frequency, severity, duration, age of onset, and forms of self-harm. Social circumstances were important as a measure of the social contagion effect. These variables included having friends who self-harm, being the victim of bullying, seeing self-harm content on social media, and posting self-harm content on social media.
Of note was the early onset of self-harm among this group of adolescents: almost 34% had begun self-harming as early as 4th grade. Forty-four percent had friends who also engaged in self-harm.
Parents’ level of education and age of onset were not significantly related to lifetime suicidality (which was measured by whether suicide had been attempted up to that point).
Predictive analyses were conducted to determine which factors predicted lifetime suicidality. The following key findings were obtained. Adolescents with at least one suicide attempt:
- Used a moderate/severe form of self-harm in the previous 12 months
- Used multiple forms of self-harm
- Engaged in self-harm for 2 or more years
- Had friends who self-harm (contagion effect)
- Were bullied at school
- Posted one’s own self-harm attempts on social media
An interesting and unexpected finding was that seeing others’ posts about self-harm on social media did not increase odds of suicidality.
What can be concluded from the results of this study? Self-harm begins in elementary school for some children, and it can progress and predispose children to later suicidal behavior. According to the authors, “the current study demonstrates that more practice with and exposure to self-harm in terms of time…and severity are associated with a great risk of suicidality in community adolescents” (p. 6). A “ramping up” effect can be seen in terms of severity of self-harm in the previous 12 months and attempted suicide.
An important consideration is the age at which these adolescents were sampled: 6th-9th grade. This limits the ability to see a connection between the variables and suicide attempts. If students were assessed in late adolescence, there may be a stronger link to suicidality.
Is social contagion evident in risk of suicide in this study? Having friends who self-harm was a significant predictor, but seeing other people’s posts about self-harm was not significant. The authors explained, “results from the present study support the idea that more active involvement, such as creating and posting content, likely occurs among those at higher risk on the spectrum of suicidality” (p. 8). Thus, posting one’s own self-harm content may be seen as a cry for help, but is not an indicator of the social contagion effect.
As with all survey data, readers should exercise caution in weighing the findings. Survey questions may not be interpreted similarly by all respondents, and the perception of anonymity could affect respondents’ honesty in answering questions.
Citation: Seong, E., Noh, G., Lee, K. H., Lee, J. S., Kim, S., Seo, D. G., … & Kim, J. W. (2021). Relationship of social and behavioral characteristics to suicidality in community adolescents with self-harm: Considering contagion and connection on social media. Frontiers in Psychology, 12, 691438.
©Jennie Dilworth, Ph.D