# Visual content and thematic analyses of images shared on social media before and after episodes of self-harm in a UK clinical youth sample

## TL;DR

This study explores how young people in the UK use social media to express themselves before and after self-harm episodes, finding that they rarely post graphic images and often focus on mental health and well-being.

## Contribution

The study provides new insights into the role of social media in the emotional expression of youth during self-harm episodes.

## Key findings

- Young people rarely post graphic self-harm images on social media around the time of self-harm events.
- Social media is used to express self-care, mental health awareness, and emotional connections.
- Subtle changes in image content were observed across time points before, during, and after self-harm episodes.

## Abstract

Little is known about how young people use social media during periods of self-harm. This study aimed to explore how they express themselves online through images posted on social media before and after self-harm and how this expression may change across these periods, employing visual content and thematic analyses.

A prospective cohort study, with qualitative analysis conducted using a recurrent cross-sectional approach and codebook methodology, accounting for chronological changes across time points before, during and after episodes of self-harm.

Participants were recruited from a mental health NHS Trust in the UK.

Image data during episodes of self-harm was available for 20 participants. The majority of whom were aged 18 years or older (n=15), female (n=14) and met criteria for moderate or severe anxiety and depression (n=18). The sample reflected diverse ethnic backgrounds, with six participants identifying as Asian or Mixed/Multiple ethnic backgrounds.

None of the images investigated had direct visual presentations of self-harm. A few images referenced self-harm through the medium of text, and this was largely to normalise and promote help-seeking. Several themes were identified, including participation in activities that support well-being, love and relationships, connecting through humour, expressions of distress, and promoting mental health awareness and support. Subtle temporal changes were also observed.

Findings suggest that young people may temporarily withdraw from social media on the day of a self-harm event and rarely post graphic self-harm images around that time. This may reflect concerns about being stigmatised, but also improved platform moderation. Instead, platforms may serve as spaces for expressing self-care behaviours and connecting with others about both positive and challenging emotions, and across a range of topics including mental health.

ClinicalTrials.gov: NCT04601220.