This article on "digital self-harm" caught my eye because I hadn't really considered this aspect of cyberbullying. It's a very preliminary study based on an online survey, but it does highlight what could be an important aspect of social media and adolescent health.
Source: Patchin JW, Hinduja S. Digital self-harm among adolescents. J Adolesc Health.2017 Dec;61(6):761–766; doi:10.1016/j.jadohealth.2017.06.012. See AAP Grand Rounds commentary by Dr. Charlene Wong (subscription required).
The survey was administered online over a 3-month period in 2016, targeted at a "nationally representative" sample of close to 40,000 12- to 17-year-old students. Unfortunately, the response rate to the survey was only 15%; more on that later.
The authors didn't provide a link or appendix to the full survey but did mention it required an average of 23 minutes to complete, pretty long in the survey world. They do mention some of the questions, and aside from the demographics 2 specifically addressed the topic of digital self-harm: "In my lifetime, I have anonymously posted something online about myself that was mean," and "In my lifetime, I have anonymously cyberbullied myself online." The survey included a subsequent open-ended question asking about their motivation for engaging in such behavior.
Of the adolescents completing the survey, around 5 - 6% answered in the affirmative to at least 1 of the questions. Motivations included seeking attention, trying to be funny, self-hate, and just looking for a reaction. Using multivariate analysis with the numerous demographic factors, participating in offline self-harm, depressive symptoms, drug use, engaging in cyberbullying, and being non-heterosexual were independently associated with digital self-harm.
A 15% response rate is very poor, limiting any firm conclusions from the study. This response rate isn't particularly surprising; this is an adolescent population that may not be strongly inclined to spend over 20 minutes completing the questionnaires. I probably would have ignored the request myself! Because survey data rely on self-reporting, it is more likely that responses can be inaccurate. Furthermore, significant sampling bias can occur with low response rates; respondents may be a significantly different group of individuals than nonrespondents.
It's important to pilot or validate surveys before distribution, to try to eliminate questions that could contain confusing wording or asking for information in a leading manner. The authors of this study didn't mention piloting the survey, which drops this study down a notch in quality in my view.
So, what do we do with this information? I don't think we can confidently conclude anything about rates, motivations, or associated factors with digital self-harm. However, just knowing that this form of self-harm exists can help clinicians work with troubled adolescents. Dr. Wong in her commentary mentions the AAP's Family Media Use Plan. I hadn't looked at it previously, so I decided to check it out. Scrolling down, it does have a planning section for "Digital Citizenship" that includes 1 choice for "Not being rude or bullying anyone else." However, there is no mention of self-bullying, probably because it's a fairly new concept. Clinicians could use this section as a trigger to ask about digital self-harm, and it's possible to enter a customized choice in the Plan that would cover this particular issue. Think about it next time you discuss media use with your adolescent (and younger) patients.