A recurring topic in recent discussions about public health in developed countries has been concern about the mental health of young people. There is evidence going back over a decade of increase in levels of self-reported distress such as depression and anxiety and of self-harm. Explanations for these observations will naturally point to large scale social changes such as the impact of policy responses to the financial crisis and more recently to the social effects of the Covid-19 pandemic. Another recurrent concern has been about the impact of social media on young people and of the likelihood that exposure to content related to self-harm and suicide may increase risks for those who encounter it.
In the UK a major influence on this discussion has been the public campaign led by the father of teenager Molly Russell who took her own life in 2017. It emerged after her death that she had been accessing significant amounts of content about self-harm and suicide which it was felt had contributed to her death – a conclusion with which the coroner concurred at inquest. At the same time there has been a public and political debate about what form legal regulation of social media should take, a debate that has culminated in the passing into law of the UK’s Online Safety Bill (2023). Perhaps as a result of these two influences much of the tone of discussion about the influence of social media has been that it represents a toxic exposure likely to lead to lowering of mood, self-harm and perhaps suicide.
In the early years of this debate we were supervising a doctoral student whose thesis involved an analysis of images posted on social media with a tag that included self-harm. Our student’s findings suggested a more interesting, in some ways surprising and more complicated picture than was reflected in the public debate. While communication of distress was common so were stories of recovery and many of the associated comments were encouraging and supportive. The posts identified were by no means restricted to explicit discussion of self-harm and in more than half the accompanying image did not represent self-harm directly – labelled with the self-harm tag were discussions of a range other topics including the nature of gender and the female body and concerns about identity and belonging.
We decided to follow this single study with a review of the research literature to explore these issues further. The review was undertaken on behalf of the mental health charity Samaritans and explored the relation between social media use and mental health, and in particular the effect of accessing content about self-harm and suicide. We found that the nature of this content was diverse. There was content that would universally be considered harmful, such as detailed description or video streaming of methods and active, explicit encouragement to act. However, there was less evidence that much of the content in isolation could be considered obviously harmful. We found that previous research studies had indeed identified negative outcomes – the reliving of distressing personal experiences, a sense of pressure to present oneself in certain ways or to offer help to others when one was not in a position to do so, sometimes a stimulus to further, perhaps more severe, self-harm. But research also identified positive aspects of this specific social media experience – a feeling of reduced isolation and support from a community of people sharing similar experiences in a non-judgmental way, the opportunity to achieve some self understanding through a sort of “thinking out loud”, and for some people access to practical advice such as details of helping agencies or guidance on hiding scars. It was also clear that an important influence on outcomes was not just the content of social media but the way in which they were being used – such as the intensity of interaction with other posts and the amount of time spent online, and the interactions with and reactions from others to content posted
There are formidable challenges in researching this area, not least that social media are valued by many people because of their anonymity, and it is difficult to apply high quality research methods to unbiased samples. For this reason we decided that it would also be valuable to gain a wider understanding of expert opinion across this field. In other words we wanted to know if there is a consensus among experts studying the relation between social media use and mental health about what can and cannot be considered harmful and what would be the most desirable responses to this relatively new feature of the social landscape. We approached academics known for their interest in the area, and the result is the multi-author book edited by us – Social Media and Mental Health.
Our book is divided into three sections.
Section 1 involves taking stock. While the names of the most popular social media sites are familiar perhaps not enough is known about who uses social media in what ways and why, and how this exerts influence on mood and behaviour. There are ethical and legal challenges in establishing legislated regulation. If we are to move from a societal response that is based solely upon personal opinion to one that is informed by evidence then we need to understand different methods in so-called applied research and what their particular strengths and weaknesses are in allowing us to draw conclusions.
Section 2 provides a summary of the common areas of concern in this field: the effect of social media on mood; on body image and its disorders; the online gambling world, and self-harm and suicide. There is great diversity here in who accesses or posts, how they use social media and how they respond to specific content: outcomes cannot readily be attributed either to content alone or to the person alone – they are likely to arise from the interaction between content, person and context. A central issue is algorithmic pushing which increases duration and intensity of exposure. Probably the clearest evidence is in two areas, in the harmful effects of online gambling and in social media representations (and promotion) of unrealistic body types and presentations of self. In each case the social media influence can be seen as supported by and reflecting wider offline social pressures – commercial in the first example, cultural as well as commercial in the second. By contrast, social media influence on mood disorders and self-harm is less clearcut and appears harmful mainly for vulnerable people using their online time in unhealthy ways.
Section 3 summarises some important ideas and experience about the nature of social media as a resource. At the time of our own review into online resources for self-harm, we found that most sites were extremely limited in what they offered as practical help to people seeking it. What our contributors describe is their involvement in programmes of work that serve as a pointer to the next generation of online resources – developed on sound theoretical grounds and principles of practice and involving young people in determining format and content.
Social Media and Mental Health aims not just to provide a snapshot of the present state of play – destined inevitably to become outdated because of the rapidity of developments in the area. It aims also to serve as an aid in framing discussion about future responses – in education, in online intervention, and where appropriate in regulation legislated or otherwise.
Editors: Allan House , Cathy Brennan