The Journey of Engaging with Self-harm and Suicide Content Online: A Longitudinal Qualitative Study. (Preprint)

BACKGROUND Self-harm/suicide (SH/S) are major public health concerns globally, with attention increasingly focused on the role of the online environment as a helpful or harmful influence. Longitudinal research on the impact of SH/S-related internet use is limited, highlighting a paucity of evidence on the long-term effects of engaging with such content. OBJECTIVE This study aims to explore why people view, search for, and post SH/S content online over a longitudinal period, and the consequences of doing this. METHODS This study employed qualitative and digital ethnographic methods over a 6- month period, including interviews at three time-points to explore individual narratives of online engagement with SH/S content. A trajectory analysis approach involving four steps was used to interpret data. RESULTS Findings from 14 participants established the online journey of people who engage with SH/S content. Five themes were identified, which were influenced by cognitive flexibility: initial interactions with SH/S content, changes in where and what SH/S content people engage with, changes in experiences of SH/S behaviours associated with online SH/S content engagement, the disengagement-re-engagement cycle, and future perspectives of online SH/S content engagement. Some participants used metacognition and digital efficacy to control online engagements but were still vulnerable due to the compelling nature of the content. CONCLUSIONS Results demonstrated the complexity of online interactions, with beneficial and harmful content closely intertwined. Participants found it challenging to disengage from SH/S content, highlighting the need for interventions that prioritise upskilling users to improve their control over behaviour. Moreover, the study underscores the responsibility of online industry leaders to develop tools that enhance the safety of online spaces.