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      The Power of the Web: A Systematic Review of Studies of the Influence of the Internet on Self-Harm and Suicide in Young People

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          Abstract

          Background

          There is concern that the internet is playing an increasing role in self-harm and suicide. In this study we systematically review and analyse research literature to determine whether there is evidence that the internet influences the risk of self-harm or suicide in young people.

          Methods

          An electronic literature search was conducted using the PsycINFO, MEDLINE, EMBASE, Scopus, and CINAHL databases. Articles of interest were those that included empirical data on the internet, self-harm or suicide, and young people. The articles were initially screened based on titles and abstracts, then by review of the full publications, after which those included in the review were subjected to data extraction, thematic analysis and quality rating.

          Results

          Youth who self-harm or are suicidal often make use of the internet. It is most commonly used for constructive reasons such as seeking support and coping strategies, but may exert a negative influence, normalising self-harm and potentially discouraging disclosure or professional help-seeking. The internet has created channels of communication that can be misused to ‘cyber-bully’ peers; both cyber-bullying and general internet use have been found to correlate with increased risk of self-harm, suicidal ideation, and depression. Correlations have also been found between internet exposure and violent methods of self-harm.

          Conclusions

          Internet use may exert both positive and negative effects on young people at risk of self-harm or suicide. Careful high quality research is needed to better understand how internet media may exert negative influences and should also focus on how the internet might be utilised to intervene with vulnerable young people.

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          Most cited references23

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          Bullying, cyberbullying, and suicide.

          Empirical studies and some high-profile anecdotal cases have demonstrated a link between suicidal ideation and experiences with bullying victimization or offending. The current study examines the extent to which a nontraditional form of peer aggression--cyberbullying--is also related to suicidal ideation among adolescents. In 2007, a random sample of 1,963 middle-schoolers from one of the largest school districts in the United States completed a survey of Internet use and experiences. Youth who experienced traditional bullying or cyberbullying, as either an offender or a victim, had more suicidal thoughts and were more likely to attempt suicide than those who had not experienced such forms of peer aggression. Also, victimization was more strongly related to suicidal thoughts and behaviors than offending. The findings provide further evidence that adolescent peer aggression must be taken seriously both at school and at home, and suggest that a suicide prevention and intervention component is essential within comprehensive bullying response programs implemented in schools.
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            International prevalence of adolescent non-suicidal self-injury and deliberate self-harm

            Background The behaviours of non-suicidal self-injury (NSSI) and deliberate self-harm (DSH) are prevalent among adolescents, and an increase of rates in recent years has been postulated. There is a lack of studies to support this postulation, and comparing prevalence across studies and nations is complicated due to substantial differences in the methodology and nomenclature of existing research. Methods We conducted a systematic review of current (2005 - 2011) empirical studies reporting on the prevalence of NSSI and DSH in adolescent samples across the globe. Results Fifty-two studies fulfilling the inclusion criteria were obtained for analysis. No statistically significant differences were found between NSSI (18.0% SD = 7.3) and DSH (16.1% SD = 11.6) studies. Assessment using single item questions led to lower prevalence rates than assessment with specific behaviour checklists. Mean prevalence rates have not increased in the past five years, suggesting stabilization. Conclusion NSSI and DSH have a comparable prevalence in studies with adolescents from different countries. The field would benefit from adopting a common approach to assessment to aide cross-cultural study and comparisons.
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              Deliberate self harm in adolescents: self report survey in schools in England.

              To determine the prevalence of deliberate self harm in adolescents and the factors associated with it. Cross sectional survey using anonymous self report questionnaire. 41 schools in England. 6020 pupils aged 15 and 16 years. Deliberate self harm. 398 (6.9%) participants reported an act of deliberate self harm in the previous year that met study criteria. Only 12.6% of episodes had resulted in presentation to hospital. Deliberate self harm was more common in females than it was in males (11.2% v 3.2%; odds ratio 3.9, 95% confidence interval 3.1 to 4.9). In females the factors included in a multivariate logistic regression for deliberate self harm were recent self harm by friends, self harm by family members, drug misuse, depression, anxiety, impulsivity, and low self esteem. In males the factors were suicidal behaviour in friends and family members, drug use, and low self esteem. Deliberate self harm is common in adolescents, especially females. School based mental health initiatives are needed. These could include approaches aimed at educating school pupils about mental health problems and screening for those at risk.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2013
                30 October 2013
                : 8
                : 10
                : e77555
                Affiliations
                [1 ]Centre for Evidence Based Intervention, University of Oxford, Oxford, United Kingdom
                [2 ]Centre for Suicide Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, United Kingdom
                [3 ]Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
                University of Granada, Spain
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: KH PM. Performed the experiments: KD KH VS AS SS PM. Analyzed the data: KD PM. Wrote the paper: KD KH VS AS SS PM.

                Article
                PONE-D-13-14108
                10.1371/journal.pone.0077555
                3813687
                24204868
                cd59f890-5913-43c7-b4e5-5d21ade9ab09
                Copyright @ 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 3 April 2013
                : 4 September 2013
                Page count
                Pages: 6
                Funding
                The authors have no current external funding sources for this study. KD completed the work as part of a master’s degree. KH, VS and AS are employed by Oxford Health NHS Foundation Trust. KH is an NIHR Senior Investigator. PM and SS are employed by the University of Oxford.
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