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

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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.