selfharm-e1433432973319Non-suicidal self-injury (NSSI), also referred to as self-injury, can be defined as the deliberate destruction of one’s own body tissue for non-suicidal reasons. Common examples of self-injury include cutting and burning, though many other methods are reported. Over the past several years, self-injury has emerged as a critical public health issue facing adolescents and emerging adults, with rates consistently ranging from 14% to 24%. Many of those who report having self-injured do so repeatedly. In addition to associating with a number of mental health difficulties (e.g., depression, anxiety), repeated self-injury has been shown to elevate suicide risk.

Over the past several years, our research team has examined the role of the Internet among youth who self-injure across a number of studies. Findings from these studies have indicated that the Internet is highly relevant to many young people who self-injure. Moreover, many youth who self-injure prefer obtaining information and resources about self-injury online (versus offline). Research from our team further suggests that those who have stake in wanting to help youth who self-injure, including caregivers and families, also use the Internet to learn more about self-injury. It is therefore important that both youth and important others (e.g., caregivers) have access to good quality information about self-injury.

In the present study, we were interested in understanding the quality of health information about self-injury that people might have access to if they used Google to search for self-injury information. To conduct our research, we used a program called Google AdWords Keywords. This program provides information about the types of search terms used (about a given topic) by Google users. This includes what search terms Google users use, how often these search terms are sought out, and what websites are in the search results for each of these terms. Upon using this program, we identified hundreds of different search terms related to self-injury. Due to the volume of individual search terms, we focused on those that received at least 1,000 searches per month. This resulted in a final list of 92 search terms. In total, these 92 terms were sought out on Google well over 42 million times in the year prior to our study (that is, over the course of 2012 and into 2013).

As a next step in our research, we were interested in understanding what kinds of websites were in the search results for all of the above search terms. To do this, we looked at just the first page of search results for each of the 92 search terms since research shows that most people mostly look at the first page of search results when conducting web searches. This resulted in the investigation of 962 websites. To do this, we adopted coding procedures used in other research examining online material about self-injury and related mental health issues.

Our findings indicated that the most common kind of websites in the search results were health information websites, which provided health information about self-injury (e.g., what it is, why it’s done, whether it can be treated). We further investigated these websites in order to determine the quality of health information they provided. To do this, we used three different approaches.

In the first approach, we wanted to know the extent to which these health information websites were endorsed by academic (e.g., a university) or health (e.g., a hospital or health agency) institutions. Our results indicated that only 9.6% of the websites received endorsements from these types of institutions. In the second approach, we examined whether the health information websites contained myths about self-injury. On average, we found that websites had at least one myth about self-injury. Across all of the websites, three myths were especially common.

In particular, we found that self-injury was often presented as a sign that someone has a mental illness. Although it is the case that many youth who engage in self-injury struggle with mental health difficulties, this does not mean that self-injury is a marker for a mental illness; indeed, many youth who self-injure do not meet diagnostic criteria for any mental illnesses.

We also found that many websites portrayed self-injury as a female behaviour. Although there is some research indicating adolescent females have higher rates of self-injury than adolescent males, several studies report no differences in the proportion of males and females who self-injure. Indeed, there are a number of males and females who engage in self-injury; it is not limited to one particular group.

Finally, we found that many websites suggested that self-injury was a sign of past abuse. Although having a history of abuse may increase the risk for self-injury, most youth who self-injure do not have a history of abuse. Taken together, the websites we studied seemed to have inaccurate information about self-injury.

As a final step in our research, we used a well-recognized set of criteria that have been developed to ensure websites providing health information have good quality (and reliable) material and information. An example of one of these criteria pertains to whether information about effective treatment was present. We were interested in determining how many criteria, out of seven, each website met. Higher scores corresponded to better quality and more credible information. Our results indicated that on average, there were about 3.5 criteria met per website; only one website met all seven criteria. This suggests that many websites do not have high quality information about self-injury.

Overall, findings from this study suggest that while information about self-injury is frequently sought out online (well over 42 million times a year), the quality of information people have access to in their search results may not always be of good quality. Poor-quality information can have a number of consequences. For youth who self-injure, the information they access about self-injury could affect their decision to seek help and discuss their self-injury experiences with others.

For example, if youth do not see much information regarding treatment options or what might help them to overcome self-injury, they may not see recovery as possible. Likewise, if youth see certain myths about self-injury when they are looking for information online, this may lead them to feel misunderstood and perhaps further stigmatized. This is concerning as many youth who self-injure already feel this way. As a result, this may affect whether they talk to others (e.g., caregivers) about self-injury as they may think others will not understand their experiences.

Another consequence of poor quality information pertains to those who want to support youth who self-injure (e.g., a young person’s family member). Specifically, if these individuals are exposed to poor quality information, it may undermine the role they can play in supporting youth who presently struggle with self-injury. Indeed, poor information may result in a limited understanding of the behavior, which may affect how they respond to young people who self-injure.

In sum, it is important that youth and others in their lives (e.g., caregivers and families) have access to good quality information about self-injury that is informed by what is known through research. To address this important need, our team has developed a website for individuals who self-injure and for those who want to support them, namely Self-injury Outreach & Support, or SiOS (www.sioutreach.org). SiOS offers research-informed and practical resources for youth who struggle with self-injury (e.g., how to cope with urges, what treatments can help), their caregivers (e.g., how to talk to teens about self-injury) and others who may want to help, including but not limited to friends, schools, and different health professionals.

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From issue: 30/03-04