{
  "abstract": "Objectives Little is known about how young people use social media during periods of self-harm. This study aimed to explore how they express themselves online through images posted on social media before and after self-harm and how this expression may change across these periods, employing visual content and thematic analyses.Design A prospective cohort study, with qualitative analysis conducted using a recurrent cross-sectional approach and codebook methodology, accounting for chronological changes across time points before, during and after episodes of self-harm.Setting Participants were recruited from a mental health NHS Trust in the UK.Participants Image data during episodes of self-harm was available for 20 participants. The majority of whom were aged 18 years or older (n=15), female (n=14) and met criteria for moderate or severe anxiety and depression (n=18). The sample reflected diverse ethnic backgrounds, with six participants identifying as Asian or Mixed/Multiple ethnic backgrounds.Results None of the images investigated had direct visual presentations of self-harm. A few images referenced self-harm through the medium of text, and this was largely to normalise and promote help-seeking. Several themes were identified, including participation in activities that support well-being, love and relationships, connecting through humour, expressions of distress, and promoting mental health awareness and support. Subtle temporal changes were also observed.Conclusions Findings suggest that young people may temporarily withdraw from social media on the day of a self-harm event and rarely post graphic self-harm images around that time. This may reflect concerns about being stigmatised, but also improved platform moderation. Instead, platforms may serve as spaces for expressing self-care behaviours and connecting with others about both positive and challenging emotions, and across a range of topics including mental health.Trial registration number ClinicalTrials.gov: NCT04601220.",
  "authors": [
    {
      "affiliations": [
        "Department of Child and Adolescent Psychiatry, King’s College London Institute of Psychiatry Psychology & Neuroscience, London, UK",
        "Department of Psychological Medicine, King’s College London Institute of Psychiatry Psychology & Neuroscience, London, UK"
      ],
      "name": "Amanda Bye"
    },
    {
      "affiliations": [
        "Health Service and Population Research Department, King’s College London Institute of Psychiatry Psychology & Neuroscience, London, UK"
      ],
      "name": "Kylee Trevillion"
    },
    {
      "affiliations": [
        "Department of Psychological Medicine, King’s College London Institute of Psychiatry Psychology & Neuroscience, London, UK"
      ],
      "name": "Emma Wilson-Lemoine"
    },
    {
      "affiliations": [
        "Department of Psychological Medicine, King’s College London Institute of Psychiatry Psychology & Neuroscience, London, UK",
        "Department of Population Health Sciences, School of Life Course & Population Sciences, King’s College London, London, UK"
      ],
      "name": "Daniel Leightley"
    },
    {
      "affiliations": [
        "Department of Biostatistics and Health Informatics, King’s College London Institute of Psychiatry Psychology & Neuroscience, London, UK"
      ],
      "name": "Ben Carter"
    },
    {
      "affiliations": [
        "School of Electronic Engineering & Computer Science, Queen Mary University of London, London, UK",
        "The Alan Turing Institute, London, UK",
        "University of Warwick, Coventry, UK"
      ],
      "name": "Maria Liakata"
    },
    {
      "affiliations": [
        "YoungMinds, London, UK"
      ],
      "name": "Jaycee Hopper"
    },
    {
      "affiliations": [
        "Department of Psychological Medicine, King’s College London Institute of Psychiatry Psychology & Neuroscience, London, UK",
        "South London and Maudsley NHS Foundation Trust, London, UK"
      ],
      "name": "Rina Dutta"
    }
  ],
  "title": "Visual content and thematic analyses of images shared on social media before and after episodes of self-harm in a UK clinical youth sample",
  "uid": "816e7a75-2298-5fbe-a3c8-5151ffee0ac1"
}