Teenagers who deliberately inflict injuries on themselves, like cuts or burns, but aren't trying to kill themselves, may be spurred on by YouTube videos, according to a new study. Thousands of videos posted on the popular video-sharing site depict forms of self-harm. In what Canadian researchers think is the first study to examine the content of such videos, self-injury was defined as the deliberate destruction of one's own body tissue without the intention to commit suicide. Other studies have shown that 14% to 21% of teenagers and young adults have injured themselves deliberately at least once.

Searching the keywords "self-injury" and "self-harm," the researchers identified the 50 most popular (as determined by the number of views) self-harm videos featuring live people, some of whom were engaging in self-injury, and the 50 most popular showing only photographs and text. Cutting the arms and wrists was the most frequent method of self-injury shown in videos both with and without people, followed by burning. Fifty-eight percent of videos didn't warn viewers that the content might be upsetting or triggering.

Many videos were deemed neutral toward self-injury (42%) or discouraged it (27%). Some (23%) provided mixed messages, and some (7%) even promoted it. The videos took various tones, ranging from educational or factual (in about half) to melancholic or hopeless. Others sent hopeful messages about overcoming self-injury or urged viewers to seek help. Videos without people were more popular, and they showed more graphic examples of self-injury. Most of those posting the videos were female, as were the vast majority of viewers. "People with a history of self-harm may find some illustrations triggering, particularly those with more graphic imagery," lead author Stephen P. Lewis, assistant professor in the Department of Psychology at the University of Guelph in Ontario, Canada, told AJN.

The goal of the study was to heighten awareness of self-injury videos. Making parents and teachers aware of these videos could open the door to informed discussions. The study didn't examine how videos affect youths and young adults directly. "A key question that needs to be examined is how individuals who watch these videos actually respond to them," said Lewis, adding that his group is currently doing just that.

Lewis advises all health professionals to ask about Internet activities of youths who deliberately injure themselves. The risk of self-injury may be encouraged, normalized, or sensationalized by the types of videos examined in this study. On the other hand, YouTube videos could also offer novel ways to reach out to vulnerable youths and prevent self-injury, especially because young people tend to prefer to obtain health information online.-Carol Potera

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