What methods are used in research of firsthand experiences with online self-harming and suicidal behavior? A scoping review

Figures & data

Figure 1. Identification of studies on online self-harming and suicidal behavior.

Figure 2. Timeline of the year of publication of the articles included in the study.

Table 1. The included studies on online self-harming and suicidal behavior and the methods they used.

1st Author Year of publication Country of 1st author	Objective	Study approach Study population Sex (% female)	Recruitment period (year)	Setting/social media platforms investigated (reported by authors)	Self-harming and/or suicidal behavior examined: Self-harming behavior (SxHB) Suicidal behavior (SB) Both
Aiba, M. (2011) Japan	To investigate several factors influencing suicidal ideation	Questionnaire 1808 participants aged 20+ 50.2	2008	“Suicide-sites” (not specified)	SB
Arendt, F. (2019) USA	To investigate the relationship between exposure to self-harm on Instagram and self-harm– and suicidality-related outcomes	Questionnaire 729 participants aged 24.15 (± 3.23) 81.6	NR	Instagram	Both
Bell, J. (2017) UK	To investigate differences between suicidal people who go online and suicidal people who do not	Questionnaire 72 participants aged 18–24 59.7	NR	NR	SB
Biddle, L. (2017) UK	To report on the purposes and methods of suicide-related use	Interview 33 participants: 13 from the community, mean age 23 53.9 20 from hospitals, mean age 31.6 60.0	2014–2016	NR	Both
Branley, D.B. (2017) UK	To investigate whether exposure to social media content predicts users’ own engagement in the offline environment and whether the relationship between exposure and risky behavior is stronger for males	Questionnaire 412 participants aged 21.20 (± 2.31) 71.0	NR	Social networking sites (e.g. Facebook, Myspace, Google+, Twitter, Tumblr, WordPress, Instagram, Pinterest, YouTube, Foursquare, Facebook Places)	SHB
Brown, R.C. (2019) Germany	To investigate experience with the expression of acute suicidal thoughts in young people	Interview 52 participants: 5 participants did not want to share sociodemographic data, 47 participants aged 16.6 (± 0.96) 87.0	2016	Instagram	SB
Brown, R.C. (2020) Germany	To assess the motivations of young people who engage in NSSI to share pictures of their wounds on Instagram and to gain insight into reactions and perceptions of comments	Interview 59 participants: 9 did not want to share sociodemographic data, 50 participants aged 16.7 (± 1.2) 72.9	2016	Instagram	SHB
Carey, J.L. (2018) USA	To investigate the use of social media in adolescents presenting for emergency care with psychiatric complaints or suicidal attempts	Questionnaire and interview 29 participants aged 17.5 75.9	NR	Facebook, Instagram, Twitter	Both
Charmaraman, L. (2021) USA	To investigate how sexual minorities in middle school use social media, who they are connected to, and for what purposes	Questionnaire 1033 participants aged 12.7 (± 1.21) 49.6	2019	Tumblr, Steam, Discord, TikTok, Snapchat, VSCO, House Party, Instagram, YouTube, Facebook, Twitter, Pinterest, Reddit, ooVoo, Zepeto, WhatsApp, Kik, Twitch	SHB
Chen, R. (2020) China	To explore how adolescents think and feel about nonfatal self-harm	Interview 22 participants aged 12–24 86.4	2018	NR	SHB
Chen, S. (2022) China	To evaluate the motives of online expression as well as their relationship to online help-seeking willingness and suicide risk	Questionnaire and interview: Questionnaire 1676 participants aged 15–19 50.4 Interview 40 participants aged 16.3 Sex not reported in sufficient detail	NR	NR	SB
Cheng, Q. (2015) China	To provide empirical answers to the question, “Are those who talk about suicide on Weibo really at greater risk of suicide?”	Questionnaire 989 participants aged 24.2 (± 4.9) 38.3	2014	Weibo	SB
Corcoran, V.P. (2020) USA	To explore how online disinhibition might relate to online NSSI communication and to disentangle both risks and benefits to those who engage in NSSI	Questionnaire 200 participants aged 21.76 (± 5.24) 65.5	NR	Reddit, LiveJournal	SHB
Coulson, N.S. (2017) UK	To explore the presence of therapeutic affordances, as reported by members of self-harm online support communities	Questionnaire 94 participants aged 23.5 94.0	NR	Facebook, unknown forums located around the world	SHB
Dardas, L.A. (2021) Jordan	To investigate adolescents’ perceptions, beliefs, and attitudes toward suicide	Interview 92 participants aged 14–17 61.0	NR	NR	SB
Dunlop, S.M. (2011) USA	To determine whether internet sites expose young people to suicide stories that might increase suicide ideation	Questionnaire 719 participants aged 14–24 51.0	2009	YouTube, Facebook, Myspace, and similar sites	SB
Eichenberg, C. (2017) Germany	To clarify the relationship between users’ motives for participating in self-harm forums and the subjective effect on self-harming behavior	Questionnaire 309 participants aged 19.76 (± 4.64) 89.6	NR	Unspecified online forums	SHB
Ekpechu, J.O.A. (2020) Nigeria	To examine the different dimensions and instruments used in committing suicide and how they gave rise to suicidal thoughts among Nigerian university students	Interview 30 participants, no information on age or sex	2017–2019	NR	SB
Frost, M. (2016) Australia	To investigate the perspectives of young people who self-injure regarding online services	Questionnaire 1463 participants aged 18.01 (± 3.01) 87.3	2012	NR	SHB
Gansner, M. (2019) USA	To identify and characterize digital media–related admissions in a sample of psychiatrically hospitalized adolescents	Questionnaire 218 participants aged 15.6 62.0	2012–2016	NR	SHB
Gritton, J. (2017) USA	To understand American Indian and Alaska Native adolescents’ perspectives on concerning social media posts	Interview 32 participants aged 12–22 65.6	2015	Facebook, Twitter, Instagram	SB
Gürbüz, H.G.A. (2016) Turkey	To evaluate the social network site (SNS) habits of depressed adolescents and the relationship between depression and disclosure on SNSs	Questionnaire 53 adolescents with depression aged 15.29 (± 1.32) 62.3 55 adolescents without depression aged 15.23 (± 1.25) 58.2	2014	Social networking sites (e.g. Facebook, Twitter, Instagram)	SB
Harris, I.M. (2013) UK	To explore why people use self-harm forums/websites, the beliefs regarding the role of such websites, how the use of self-harm forums/websites modulates self-harm behaviors, and other ways that self-harm forums affect lives	Questionnaire 329 participants aged 23.06 (± 8.62) 91.8	2013	Forums and sites (not specified)	SHB
Harris, K.M. (2014) Australia	To explore ambiguous and undefined relationships between suicidality and specific internet use	Questionnaire 1016 participants aged 30.37 (± 10.54) 62.3	NR	Facebook, Myspace, Twitter, chat (IM), and related online activities	SB
Harris, K.M. (2017) Australia	To investigate whether a number of psychopathological and psychiatric variables predict the amount of time spent online	Questionnaire 713 participants aged 31.48 (± 13.53) 77.1	NR	NR	SB
Jacob, N. (2017) UK	To explore how young people understand and use online images of self-harm	Interview 21 participants aged 16–24 85.7	NR	Facebook	SHB
Kaukiainen, A. (2017) Australia	To determine what self-injurers believe is gained from such websites and why use is maintained	Questionnaire 199 participants: 1 did not report demographics, 198 participants aged 24.11 (± 9.89) 78.4	NR	Facebook, Beyond Blue, crazyboards.org, Instagram	SHB
Keipi, T. (2017) Finland	To investigate whether subjective well-being is associated with visiting harm-advocating websites and whether there are any cross-cultural differences in exposure to harm-advocating online content	Questionnaire 1587 participants: Finnish population of 555 aged 22.6 (± 4.21) 49.9 US population of 1032 aged 23.1 (± 4.04) 50.4	2013	Facebook, Twitter, Google+, YouTube	SHB
Khasawneh, A. (2021) USA	To investigate the effects of attitudes, perceived norms, and personal agency beliefs on adolescents’ and young adults’ willingness to participate in the Cinnamon Challenge and the ALS Ice Bucket Challenge	Questionnaire 471 participants aged 13–35 82.6	NR	NR	SHB
Kingsbury, M. (2021) Canada	To examine differential associations between types of social media use and NSSI and suicidal behaviors	Questionnaire 40065 participants aged 18–25 70.2	2018	NR	Both
Kirtley, O.J. (2021) Belgium	To investigate the relationship between exposure to self-harm and self-harm–related content and individuals’ own self-harm thoughts and behaviors	Questionnaire 477 participants aged 25.41 (± 9.46) 81.8	NR	NR	SHB
Laestadius, L.I. (2021) USA	To examine perceptions of automated alerts for NSSI posts on social media among Latinx adolescents who are at risk for NSSI	Interview 42 participants aged 13–17 57.0	2019	Snapchat, Instagram	SHB
Lavis, A. (2020) UK	To contribute to the emerging evidence base regarding opportunities, as well as risks, of the relationship between social media and adolescent mental health	Interview 10 participants aged > 18 100	2018–2019	NR	SHB
Lee, S.E. (2022) South Korea	To reduce stigma by investigating the clinical and psychosocial correlates of posting NSSI content online	Questionnaire 249 participants: 182 aged 22.19 (± 2.65) and who never posted NSSI content and 67 aged 21.93 (± 2.63) who posted NSSI content 100	2018–2019	NR	SHB
Lewis, S.P. (2016) Canada	To directly ask about experiences with NSSI e-communication to understand why people join NSSI e-communities, why some temporarily stop their involvement, and why these individuals return and continue their involvement	Questionnaire 68 participants aged 24.15 (± 8.41) 83.8	NR	E-communities (not specified)	SHB
Liu, H.C. (2017) Taiwan	To examine the relationship between self-harm in adolescents and internet exposure to confided suicidal ideation from others	Questionnaire 2479 participants aged 15.44 (± 0.61) 60.3	2008–2009	NR	Both
Liu, X. (2020) China	To propose 3 suicide-related social media use–behaviors based on social cognitive theory	Questionnaire 569 participants aged 21.94 (± 3.31) 86.3	2016	Sina Weibo	SB
Mars, B. (2015) UK	To investigate suicidal/self-harm–related internet use among young adults in the community	Questionnaire 3946 participants aged 20.9 61.1	NR	NR	Both
Mitchell, K.J. (2014) USA	To assess rates of thoughts of self-harm and thoughts of suicide, rates of youth exposure to websites encouraging self-harm and suicide, characteristics of youth who visit self-harm and suicide websites, and the relationship between visiting these websites and actual thoughts of self-harm and suicide	Questionnaire 1560 participants aged 10–17 50.3	2010–2011	NR	Both
Mok, K. (2016) Australia	To explore differences between suicidal people who go online for suicide-related reasons and suicidal people who do not go online for suicide-related reasons and to examine the factors associated with suicide-related internet use	Questionnaire 205 participants aged 20.17 (± 1.98) 76.1	2013–2014	NR	SB
Mok, K. (2016) Australia	To examine the perceived impact of suicide-related internet use and the perceived level of supportiveness or hostility of the online environment	Questionnaire 102 participants aged 20.33 (± 2.11) 73.5	2013–2014	NR	SB
Nesi, J. (2019) USA	To determine the prevalence of positive and negative social media experiences in this population and to explore differences in social media use based on diagnostic presentation	Questionnaire 433 participants aged 14.6 61.7	NR	Snapchat, text messaging, Instagram, Facebook, Twitter	Both
Nesi, J. (2021) USA	To explore patterns of online self-injury activities, the proportion of youth engaged, and the digital tools used and to classify subgroups based on the perceived functions that these activities serve for them and how they differ in multiple ways	Questionnaire 589 participants aged 14.88 (± 1.83) 55.7	NR	Snapchat, Instagram, Facebook, Twitter, YouTube, WhatsApp	Both
Nesi, J. (2022) USA	To examine the role of digital media in psychiatric hospital admissions among adolescents	Questionnaire 343 participants aged 15.2 (± 1.70) 48.7	2020–2021	NR	SB
Niederkrotenthaler, T. (2017) Austria	To assess differences between suicidal individuals who go online for suicide-related purposes and other suicidal individuals	Questionnaire 53 participants aged 22.2 (± 1.8) 52.8	2015	NR	SB
Ozawa-de Silva, C. (2020) USA	To explore whether the need to be needed and the strong desire for meaning in life are unique to suicide website visitors or are shared by Japanese college students and to explore whether they constitute two separate types of mental pain that lead to loneliness or they are interrelated	Interview 24 participants aged 20–28 79.2	2009	NR	SB
Padmanathan, P. (2018) UK	To estimate the frequency of suicidal/self-harm–related internet use among patients presenting to the emergency department who have self-harmed	Interview 2142 participants aged 8–35+ No data on sex	2013–2015	NR	Both
Patchin, J.W. (2017) USA	To examine the extent of digital self-harm among adolescents	Questionnaire 5593 participants aged 14.5 49.9	2016	NR	SHB
Record, R.A. (2019) USA	To investigate the relationship between Instagram use and intention to use the self-harm reporting feature	Questionnaire 417 participants aged 20.7 (± 3.2) 77.0	NR	Instagram	SHB
Seko, Y. (2015) Canada	To explore what drives NSSI content creation and sharing and how content creators react to others’ NSSI content	Interview 17 participants aged 19.9 82.0	2013	NR	SHB
Seong, E. (2021) South Korea	To explore characteristics of Korean adolescents with a recent history of self-harm and to identify how behavioral and social features explain lifetime suicidality with emphasis on the impact of social media	Questionnaire 906 participants aged 11–15 44.9	NR	Facebook, Instagram, Twitter, YouTube	Both
Sternudd, H.T. (2012) Sweden	To examine discourses about self-injury (SI) photos and how users are establishing the meaning of SI photos and to evaluate how activities and practices connected to SI photos are understood and articulated by users	Questionnaire 52 participants; data on age and sex available for only 70% of the group: aged 15–20 87.0	2008	NR	SHB
Sueki, H. (2014) Japan	To examine the association between suicide-related tweets and suicidal behavior to identify suicidal young people on the internet	Questionnaire 1000 participants aged 24.9 (± 2.9) 61.3	NR	Twitter	SB
Sueki, H. (2013) Japan	To examine the influence of 4 types of suicide-related internet use on users’ mental health	Questionnaire 850 participants aged 30.7 (± 5.3) 49.5	2011	NR	SB
Sueki, H. (2014) Japan	To investigate the impacts of suicide-related or mental health consultation–related internet use	Questionnaire 5495 participants aged 35.5 (± 7.8) 43.3	NR	NR	SB
Swedo, E.A. (2021) USA	To describe the prevalence of suicidal behaviors and to quantify the impact of suicide cluster–related exposures on adolescent suicidal behaviors in a community affected by an ongoing suicide cluster	Questionnaire 12448 participants, no data on age 50.3	2018	NR	SB
Teo, A.R. (2020) USA	To obtain insight into whether and how US military veterans respond to members of their social network on social media (i.e. “friends”) who are experiencing substantial emotional distress	Interview 30 participants aged 24–64 23.3	2017	Facebook	SB
Trnka, R. (2017) Czech Republic	To explore attitudes toward suicidal behavior and self-injury in emo adolescents	Interview 14 participants aged 15–19 57.1	NR	Emo web discussion forums	Both
Tseng, F.Y. (2015) Taiwan	To investigate whether self-injurious thoughts and behaviors (SITBs) are more prevalent in Taiwanese girls than boys and whether frequent use of and communication on the internet increases the risk of SITBs, especially in girls	Questionnaire 391 participants aged 12–18 54.7	NR	NR	Both
Vente, T. (2020) USA	To identify patterns in the amount of time spent on social media by adolescents who engage in high-risk behavior and the extent to which they use social media as a platform for sharing such behaviors	Questionnaire 179 participants aged 16.8 (± 2.5) 67.0	2016–2018	NR	SHB
Villani, D. (2019) Italy	To identify classes homogeneous for adolescents’ beliefs about peers’ motivations in taking part in the recent Blue Whale Challenge and to analyze the individual predictors of adolescents’ latent class membership	Questionnaire 312 participants aged 16.4 (± 1.67) No data on sex	2018	NR	Both
Weinstein, E. (2021) USA	To investigate what negative and positive experiences suicidal adolescents report related to their use of social media/smartphones and to describe their disconnection from these technologies during inpatient hospitalization and their views upon subsequent return to digital connectivity after discharge	Interview 30 participants aged 16.1 (± 1.6) 70.0	NR	Instagram, Snapchat, Facebook, Twitter, Tumblr, Twitch, VSCO, Discord, LinkedIn	SB
Yom-Tov, E. (2016) Israel	To explore the characteristics of people who participate in various pro-anorexia web communities and the differences between them	Questionnaire 761 participants, no data on age 70.3	NR	MyProAna, Tumblr, Yahoo Answers, and other pro-ana forums	Both
Zhu, L. (2016) USA	To examine the relationship between frequency of exposure to NSSI and engagement in NSSI among adolescents	Interview 90 participants aged 14.63 (± 1.35) 80.0	2013–2014	Facebook, Instagram, Twitter, Tumblr, YouTube	SHB

NR: not reported; NSSI: non-suicidal self-injury.

Table 2. The included studies on online self-harming and suicidal behavior and the questionnaires they used.

1st Author Publication year Country of 1st author	Tools used for questionnaire specifically targeting online behavior: name of tool NNT	Was the tool(s) used for questionnaire regarding online behavior validated (reported by the authors)? yes no NR	Was the tool(s) used for questionnaire regarding online behavior self-validated (reported by the authors)? yes no NR	Authors reported advantages of the tool used? yes no	Authors reported disadvantages of the tool used? yes no
Aiba, M. (2011) Japan	NNT	NR	NR	No	Yes
Akkın Gürbüz, H.G.A. (2016) Turkey	Social Network Use Questionnaire	No	Yes	No	No
Arendt, F. (2019) USA	NNT	No	NR	No	Yes
Bell, J. (2017) UK	NNT	NR	NR	No	No
Branley, D.B. (2017) UK	NNT	No	Yes	No	No
Carey, J.L. (2018) USA	NNT	NR	NR	No	No
Charmaraman, L. (2021) USA	NNT	No	No	No	Yes
Chen, S. (2022) China	NNT	No	Yes	NR	No
Cheng, Q. 2015 (China)	NNT	NR	NR	No	No
Corcoran, V.P. (2020) USA	NNT	No	Yes	No	No
Coulson, N.S. (2017) UK	NNT	NR	NR	Yes	Yes
Dunlop, S.M. (2011) USA	NNT	NR	NR	No	Yes
Eichenberg, C. (2017) Germany	NNT	NR	NR	No	Yes
Frost, M. (2016) Australia	NNT	NR	Yes	No	No
Gansner, M. (2019) USA	NNT	NR	NR	No	No
Harris, I.M. (2013) UK	NNT	NR	NR	No	Yes
Harris, K.M. (2014) Australia	NNT	NR	NR	No	No
Harris K.M. (2017) Australia	NNT	NR	NR	No	Yes
Kaukiainen, A. (2017) Australia	NNT	No	NR	Yes	No
Keipi, T. (2017) Finland	NNT	NR	NR	No	No
Khasawneh, A. (2021) USA	NNT	NR	Yes	No	No
Kingsbury, M. (2021) Canada	NNT	NR	NR	Yes	Yes
Kirtley, O.J. (2021) Belgium	NNT	NR	NR	No	Yes
Lee, S.E. (2022) South Korea	NNT	NR	NR	No	Yes
Lewis, S.P. (2016) Canada	NNT	No	No	No	Yes
Liu, H.C. (2017) Taiwan	NNT	NR	NR	No	No
Liu, X. (2020) China	NNT	Yes	Yes	No	No
Mars, B. (2015) UK	NNT	NR	NR	No	No
Mitchell, K.J. (2014) USA	NNT	NR	NR	No	Yes
Mok, K. (2016) Australia	NNT	NR	NR	No	No
Mok, K. (2016) Australia	NNT	No	No	Yes	Yes
Nesi, J. (2019) USA	Social Media Questionnaire	NR	NR	No	No
Nesi, J. (2021) USA	Online Self-Injury Questionnaire	No	Yes	No	Yes
Nesi, J. (2022) USA	NNT	NR	NR	No	No
Niederkrotenthaler, T. (2017) Austria	NNT	NR	NR	No	No
Patchin, J.W. (2017) USA	NNT	NR	NR	No	No
Record, R.A. (2019) USA	NNT	NR	NR	No	Yes
Seong, E. (2021) South Korea	NNT	NR	NR	No	No
Sternudd, H.T. (2012) Sweden	NNT	NR	NR	No	No
Sueki, H. (2014) Japan	NNT	NR	NR	No	No
Sueki, H. (2013) Japan	NNT	NR	NR	No	No
Sueki, H. (2014) Japan	NNT	NR	NR	No	No
Swedo, E.A. (2021) USA	NNT	NR	NR	No	No
Tseng, F.Y. (2015) Taiwan	NNT	NR	NR	No	Yes
Vente, T. (2020) USA	NNT	No	No	Yes	Yes
Villani, D. (2019) Italy	NNT	NR	NR	No	Yes
Yom-Tov, E. (2016) Israel	NNT	NR	NR	No	No

NNT: no named tool; NR: not reported.

Table 3. The included studies on online self-harming and suicidal behavior that used interviews.

1st Author Publication year Country of 1st author	Type of interview (reported by the authors): structured semi-structured focus group NR	Place of interview (reported by the authors): face-to-face online by telephone NR	Trained interviewers (reported by the authors)? yes no NR	Interview guide available in text or appendix? yes no partially	Scientific method of analysis (reported by the authors)	Authors reported advantages of the tool used? yes no	Authors reported disadvantages of the tool used? yes no
Biddle, L. (2017) UK	Semi-structured	Face-to-face, except 1, which was by telephone	Yes	Yes	Constant comparison	No	No
Brown, R.C. (2019) Germany	Semi-structured	Online	Yes	No	Qualitative text analysis	No	No
Brown, R.C. (2020) Germany	Semi-structured	Online	Yes	No	Qualitative content analysis	No	No
Carey, J.L. (2018) USA	Semi-structured	NR	NR	No	Coded analysis	No	No
Chen, R. (2020) China	Semi-structured	Face-to-face	Yes	No	Interpretative qualitative analysis	No	No
Chen, S. (2022) China	Semi-structured and focus group	NR	NR	Partially	Inductive thematic analysis	No	No
Dardas, L.A. (2021) Jordan	Focus group	Face-to-face	NR	No	Deductive thematic analysis	No	No
Ekpechu, J.O.A. (2020) Nigeria	Focus group	Face-to-face	NR	No	NR	No	No
Gritton, J. (2017) USA	Focus group	Face-to-face	Yes	Yes	Constant comparative method	Yes	Yes
Jacob, N. (2017) UK	Semi-structured	Face-to-face	NR	No	Thematic analysis	No	No
Laestadius, L.I. (2021) USA	Semi-structured	Face-to-face	NR	Partially	Framework analysis	No	No
Lavis, A. (2020) UK	Semi-structured	Online	NR	No	Iterative thematic analysis	No	No
Ozawa-de Silva, C. (2020) USA	Semi-structured	Face-to-face	NR	No	Comparative method	No	No
Padmanathan, P. (2018) UK	Structured	Face-to-face	Yes	No	NR	Yes	Yes
Seko, Y. (2015) Canada	Semi-structured	Online	NR	Partially	Thematic content analysis	No	No
Teo, A.R. (2020) USA	Semi-structured	23 face-to-face, 7 by telephone	NR	Partially	Double coding	No	No
Trnka, R. (2017) Czech Republic	Semi-structured	Face-to-face	NR	Partially	Inductive content analysis	No	No
Weinstein, E. (2021) USA	Semi-structured	Face-to-face	NR	Yes	Thematic analysis	No	No
Zhu, L. (2016) USA	Structured	Face-to-face	NR	Partially	Statistics	No	Yes

NR: not reported.

Data availability statement

All data generated or analyzed during this study are included in this published article and its supplementary information files.