People seeking help or information online about cutting and other forms of self-injury are likely finding falsehoods and myths, according to new research from the University of Guelph.
Only about 10 per cent of websites providing information about non-suicidal self-injury (NSSI) are endorsed by health or academic institutions, according to a study published recently in JAMA Pediatrics, a journal of the American Medical Association.
It's a troubling finding, says lead author Stephen Lewis, a Guelph psychology professor. "This is a salient public health issue," he said.
People who engage in NSSI -- especially adolescents and young adults -- often turn to the Internet first when looking for help, support, or resources.
"It's a stigmatizing issue for many people and it's quite misunderstood, so going online is often more appealing to them in terms of getting information," Lewis said.
"Unfortunately, much of the information we found on the Internet is of poor quality, and some of it propagates myths about people who self-injure, which may lead to further stigmatization and isolation."
What people find online may also affect decisions to seek help, he said.
NSSI, which can include cutting, burning and bruising, affects an estimated 14 to 21 per cent of teens and young adults. Teenagers typically self-injure to deal with negative emotions, Lewis said, and the behaviour can lead to physical injuries, scarring and mental health difficulties.
Lewis and Guelph graduate students Jasmine Mahdy, Natalie Michal and Alexis Arbuthnott set out to learn how often people search online for information about NSSI and to assess the quality of available information.
They used a Google keywords program to identify 92 terms related to NSSI that receive least 1,000 hits a month. For each term, they focused on content from the first page of websites displayed in search results.
"We focused on the first page because often people don't get beyond that when doing online searches," Lewis said.
The researchers found that about 22 percent of websites were health information websites. Of these, only one in 10 was endorsed by a health or academic institution.
They also found at least one myth about NSSI on each website, such as linking self-injury to mental health or gender or calling it an attention-seeking act.
Specifically, almost half of websites said people with NSSI have mental illness; about 40 per cent said people who self-injure have a history of abuse; and 37 per cent said mostly women self-injured. All are untrue or overstatements of what is known from research, Lewis said.
The researchers found more than 42 million global searches of NSSI-related terms on the Internet in the past year.
"We were a bit surprised by the number of searches related to the topic but more surprised at how much of the information we came across was of low quality," Lewis said.
Besides exposing people who self-injure to unreliable and inaccurate information, misinformation affects people trying to help, he said.
"Parents, peers and others looking to help someone with NSSI may also be seeking information online, and what they are finding may be impacting their effectiveness as sources of support."
The study recommends getting credible sites onto the top of search pages, improving the quality of online information and educating Internet users on how to make sense of e-health information.
"The Internet potentially is a powerful vehicle to reach out to those who self-injure and offer help and recovery resources," Lewis said. "But we have to do it effectively and correctly."
Last year, he and McGill University professor Nancy Heath launched the Self-Injury Outreach and Support (SiOS) website (http://sioutreach.org/). It was the first international online initiative offering recovery support and resources for people with NSSI and for friends, families, and school and health professionals.
- Stephen P. Lewis, Jasmine C. Mahdy, Natalie J. Michal, Alexis E. Arbuthnott. Googling Self-injury. JAMA Pediatrics, 2014; DOI: 10.1001/jamapediatrics.2014.187
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