Social media, Smartphone use and Self-harm in Young People (3S-YP study)

Self-harm is when someone causes damage or injury to their body. Usually it is a way to relieve distressing thoughts and feelings. Often self-harm involves cutting or taking overdoses. However, it can also be any behaviour that causes injury such as burning, biting, scratching or hitting oneself.

Self-harm in young people is a major public health problem. Worldwide, it is the strongest risk factor for later suicide. More than 1 in 10 young people in the UK are thought to have self-harmed, but it could be more than double this. This is because self-harm that occurs in the community is largely hidden and does not come to the attention of clinical services.

The reasons behind self-harm are complex. The steep rise in reports of self-harm, especially amongst teenage girls in the UK has been linked to the impact of social media on mental wellbeing-although the evidence base is limited. Young people seem to be increasingly using social media to communicate distress to their peers. This is possible because they are the generation for whom smartphone ownership is the norm. Social media is ever-present in their lives, readily at hand at all times, day and night. Their smartphones are an integral part of life and a powerful social tool.

But which aspects of social media and smartphone use might increase vulnerability to self-harm? Is it excessive use, or night-time use with its impact on sleep? Young people's late-night smartphone use and waking to check social media updates is known to cause sleep disturbance. This has been linked to depressed moods and poorer self-esteem and coping ability, but might it also happen just before someone self-harms? Is an addictive pattern of use involved? Could it be that constant posting online opens young people up to receiving more negative comments or that cyberbullying itself is responsible, or a combination of factors?

We aim to study the mechanisms of social media and smartphone use that underpin self-harm in young people. We are most interested in the ways in which social media and smartphone use may change in the time leading up to a self-harm episode. We will also investigate how self-harm is related to smartphone addiction, sleep quality, depression, anxiety, loneliness and bullying over a 1 year follow-up period.

We will use data linkage between the type and content of an individual young person's social media footprint, their smartphone usage, and self-reported episodes of self-harm. We will do this for both a population-based group and a mental health patient group, who are at higher risk of self-harm. This will enable us to study a whole range of self-harm behaviours. In both groups we will be able to study community self-harm and self-harm treated in hopsitals, using hospital admission data. For the mental health patient group we will also be able to use emergency department attendance data and identify self-harm noted in the free text by clinicians.

We will develop profiles of behaviours that are linked to future self-harm episodes, and develop prediction rules for a future episode. The potential benefits of this research are to help inform the development of new interventions that might be used to ensure vulnerable young people are identified and get the help they need. This could be by harnessing the positive protective effects of social media, such as access to crisis support when someone really needs it, or empowering young people to make changes, manage their own risks and build resilience.

The design of our research questions and consideration of key ethical issues has already involved two young people expert advisory groups. Co-production will continue to be used throughout study development and in communicating the outcomes of the research, by active involvement of young people from both the groups we are studying, and representatives from YoungMinds: the UK leading charity for the wellbeing and mental health of young people.

Self-harm describes any behaviour where someone causes damage to themselves in response to distress. It is the strongest predictor of suicide, with 40-60% of people who die by suicide having self-harmed in the past.

Traditionally, researchers have mainly studied cutting or self-poisoning, rather than burning, scratching or hitting oneself. In epidemiological studies, self-harm is usually recorded from a report to health services, yet this is the 'tip of the iceberg', with most episodes not coming to medical attention. School-based and community studies have relied on individual retrospective reporting of lifetime self-harm, meaning that little is known about the specific timing or nature of non-help seeking self-harm.

There has been considerable media speculation that social media has been responsible for a steep rise in young people self-harming, especially teenage girls. However the evidence is limited to associations rather than offering insight into potential mechanisms underpinning a negative effect.

We aim to investigate these by prospectively studying 13-25 year olds from both a community and clinical cohort. Our objectives are novel: we will use retrospective social media data to identify vulnerability periods prior to self-harm; prospectively, we will assess whether these social media vulnerability profiles and smartphone use patterns in the times approaching an episode of self-harm, differ from those who do not have such an episode. If a relationship is established we shall explore mediating factors, e.g. sleep problems and bullying.

Our methodology is distinct because we are collecting user-generated social media public posts, passive smartphone usage patterns and monthly outcome data about self-harm to investigate the mechanistic links.
This grant has been designed in consultation with young people and YoungMinds, the UK leading national charity for mental health of young people. They will work closely throughout to co-produce the research.

The 3S-YP grant proposal lays the scientific groundwork for understanding the mechanisms by which social media and smartphone use may underpin self-harm in young people.

Our study findings have the potential to benefit 7 groups of beneficiaries as follows:

1. Young people/Service users/Carers/Families
If our results show strong underpinning mechanisms, this will contribute to increased understanding amongst young people and their families about aspects of social media and smartphone use that are negative. They could take evidence-based decisions to modify behaviour, e.g. limiting night-time use. Conversely if there are only weak associations, this could be reassuring especially for parent groups. The increased public awareness generated will help reduce the stigma associated with self-harm, and increase the likelihood that individuals seek help.

2. Public health/Policy makers
The recent Government green paper Transforming Children and Young People's Mental Health Provision: Department of Health/Department for Education, 2017 (consultation ended March 2018) identifies a need to ensure young people showing early signs of distress are able to access child and adolescent mental health services. Our research may help in developing indicators of those in need of formal support.

3. Educational sector
Schools have been identified as priority places where self-harm prevention should be focused, due to staff's daily encounters with young people. However The Self-Harm and Suicide in Schools GW4 project (2016) revealed that many schools are engaged in a broad, often ad hoc range of non-evidence-based practice. Because staff have to manage social media and smartphone use at school, the results of our research will help schools understand the impacts of social media on self-harm and assist them in their duty of care.

4. Third Sector
Charities such as YoungMinds, but also the NSPCC, Mind, the Samaritans and the National Self Harm Network, work directly with young people and parents. They also train professionals in mental health subjects and are asked for media comment about social media and mental health. The evidence-base this research will provide will enable them to specifically improve the support and advice they offer, the content of their training and their media contributions.

5. Social media platform developers
Although numerous studies have examined social media usage, little is understood about how young people who are vulnerable for self-harm, use social media. Findings from this project could benefit platform developers in User Interface design and Human Factors research about supportive interfaces for social media. The data collected could also inform machine learning research that leads to early interventions in self-harm cases.

6. Social scientist networks
Our study will be beneficial to 2 networks:
(1) Natcen and Sage methodology network (#NSMNSS) is for people using social media in social science research who want to explore the implications of this methodology. By developing qualitative methodology for using social media textual data to explore vulnerability profiles for a self-harm episode, our research will be of conceptual benefit to this group.
(2) The Microanalysis of Online Data (MOOD) network comprises an interdisciplinary network of academic researchers who explore ways of conducting qualitative analysis of online interactions. Our study will be beneficial as we will have results about how to apply detailed qualitative analysis to a range of social media data from young people who self-harm.

7. Employment sector
Funding for this research will enable development of capacity of an outstanding cross-disciplinary team of academic experts, working with RD, a talented midcareer PI in the field of self-harm research. Our unique academic, clinical and technical expertise will potentially allow our team to develop further competitive proposals tackling the issue of self-harm.