Marchant Amanda, Hawton Keith, Stewart Ann, Montgomery Paul, Singaravelu Vinod, Lloyd Keith, Purdy Nicola, Daine Kate, John Ann
Medical School, Swansea University, Swansea, Wales, United Kingdom.
Centre for Suicide Research, University of Oxford, Oxford, United Kingdom.
PLoS One. 2017 Aug 16;12(8):e0181722. doi: 10.1371/journal.pone.0181722. eCollection 2017.
Research exploring internet use and self-harm is rapidly expanding amidst concerns regarding influences of on-line activities on self-harm and suicide, especially in young people. We aimed to systematically review evidence regarding the potential influence of the internet on self-harm/suicidal behaviour in young people.
We conducted a systematic review based on an electronic search for articles published between 01/01/2011 and 26/01/2015 across databases including Medline, Cochrane and PsychInfo. Articles were included if: the study examined internet use by individuals who engaged in self-harm/ suicidal behaviour, or internet use clearly related to self-harm content; reported primary empirical data; participants were aged under 25 years. New studies were combined with those identified in a previous review and subject to data extraction, quality rating and narrative synthesis.
Forty-six independent studies (51 articles) of varying quality were included. Perceived influences were: positive for 11 studies (38191 participants); negative for 18 studies (119524 participants); and mixed for 17 studies (35235 participants). In contrast to previous reviews on this topic studies focused on a wide range of internet mediums: general internet use; internet addiction; online intervention/treatment; social media; dedicated self-harm websites; forums; video/image sharing and blogs. A relationship between internet use and self-harm/suicidal behaviour was particularly associated with internet addiction, high levels of internet use, and websites with self-harm or suicide content. While there are negative aspects of internet use the potential for isolation reduction, outreach and as a source of help and therapy were also identified.
There is significant potential for harm from online behaviour (normalisation, triggering, competition, contagion) but also the potential to exploit its benefits (crisis support, reduction of social isolation, delivery of therapy, outreach). Young people appear to be increasingly using social media to communicate distress, particularly to peers. The focus should now be on how specific mediums' (social media, video/image sharing) might be used in therapy and recovery. Clinicians working with young people who self-harm or have mental health issues should engage in discussion about internet use. This should be a standard item during assessment. A protocol for this review was registered with the PROSPERO systematic review protocol registry: (http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42015019518).
鉴于人们担心网络活动对自我伤害及自杀行为的影响，尤其是对年轻人的影响，探索网络使用与自我伤害的研究正在迅速扩展。我们旨在系统回顾关于网络对年轻人自我伤害/自杀行为潜在影响的证据。
我们基于对2011年1月1日至2015年1月26日期间发表在包括Medline、Cochrane和PsychInfo等数据库中的文章进行电子检索，开展了一项系统回顾。若符合以下条件则纳入文章：该研究调查了有自我伤害/自杀行为的个体的网络使用情况，或网络使用与自我伤害内容明显相关；报告了原始实证数据；参与者年龄在25岁以下。新研究与之前回顾中识别出的研究合并，并进行数据提取、质量评级和叙述性综合分析。
纳入了46项质量各异的独立研究（51篇文章）。感知到的影响为：11项研究（38191名参与者）呈积极影响；18项研究（119524名参与者）呈消极影响；17项研究（35235名参与者）呈混合影响。与之前关于该主题的回顾不同，此次研究聚焦于广泛的网络媒介：一般网络使用、网络成瘾、在线干预/治疗、社交媒体、专门的自我伤害网站、论坛、视频/图像分享及博客。网络使用与自我伤害/自杀行为之间的关系尤其与网络成瘾、大量网络使用以及含有自我伤害或自杀内容的网站相关。虽然网络使用存在消极方面，但也发现了其在减少隔离、扩大影响范围以及作为帮助和治疗来源方面的潜力。
网络行为存在造成伤害的重大潜在风险（常态化、触发、竞争、传染），但也有利用其益处的潜力（危机支持、减少社会隔离、提供治疗、扩大影响范围）。年轻人似乎越来越多地利用社交媒体来表达痛苦，尤其是向同龄人表达。现在应关注如何在治疗和康复中利用特定媒介（社交媒体、视频/图像分享）。治疗有自我伤害行为或心理健康问题的年轻人的临床医生应就网络使用展开讨论。这应成为评估过程中的一个标准项目。本综述的方案已在PROSPERO系统综述方案注册库注册：（http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42015019518）。
