Work

Trajectories of Persistent Exposure to Self-Harm–Encouraging Websites and Subsequent Mental Health Outcomes in US Youth: Longitudinal Cohort Study

Year: 2026

Type: article

Abstract: Background Self-harm, including suicidal thoughts, self-injurious behavior, and disordered eating, is a major public health concern among adolescents and young adults. Youth increasingly encounter self-harm–related content online, including websites that explicitly encourage harmful behaviors. Although exposure to such content has been linked to poorer mental health, most research is cross-sectional and has not examined longitudinal exposure trajectories. Whether persistent exposure represents a distinct digital risk pattern remains unclear. Objective This study examined longitudinal trajectories and correlates of exposure to self-harm–encouraging websites over 1 year and tested whether persistent exposure was associated with subsequent suicidal ideation, self-injury, and disordered eating. Methods We analyzed data from 2197 US youth aged 13 to 22 years who completed waves 2 and 4 of Project Lift Up, a national longitudinal cohort study. Website exposure was categorized into 4 trajectories: none, desist (wave 2 only), new (wave 4 only), and persistent (both waves). Categories reflected reported exposure at the 2 assessment waves rather than the frequency or continuity of website use between assessments. Logistic regression models estimated associations between exposure trajectory and wave 4 suicidal ideation, self-injury, and disordered eating, restricting analyses to participants without the respective outcome at wave 2. Models were adjusted for demographics and wave 2 depression or anxiety symptoms and other mental health indicators. Results Overall, 26.5% (583/2197) reported exposure to self-harm–encouraging websites at wave 2, and 18.5% (407/2197) reported persistent exposure. Privacy concerns, embarrassment, curiosity, and lack of offline support were associated with greater odds of persistence (adjusted odds ratios [aORs] 1.84‐3.23), whereas accidental exposure was associated with lower odds of persistence (aOR 0.28, 95% CI 0.19‐0.41). Compared with no exposure, persistent exposure was associated with higher odds of suicidal ideation (aOR 1.88, 95% CI 1.24‐2.86; P =.003), self-injury (aOR 3.14, 95% CI 2.05‐4.80; P <.001), and disordered eating (aOR 2.46, 95% CI 1.54‐3.93; P <.001). Adjusted predicted probabilities showed a graded pattern, with persistent exposure associated with the highest predicted probabilities (suicidal ideation: 33.4% vs 21.3%; self-injury: 25.7% vs 10.2%; disordered eating: 11.7% vs 5.3%). New exposure was associated with increased odds of self-injury (aOR 2.32, 95% CI 1.30‐4.15; P =.004) but was not significantly associated with suicidal ideation or disordered eating. The desist trajectory was not significantly associated with outcomes. Conclusions Persistent exposure to self-harm–encouraging websites may represent a distinct digital risk pattern associated with higher subsequent odds of suicidal ideation, self-injury, and disordered eating. Assessing patterns of repeated website exposure and youths’ motivations for seeking this content—not merely whether exposure occurred—may improve the identification of youth at heightened risk and inform digital prevention and clinical intervention strategies.

Source: JMIR Mental Health

DOI: 10.2196/95200

Authors: Kimberly J Mitchell, Ateret Gewirtz-Meydan, Victoria Banyard

Institutions: University of New Hampshire, Crimes against Children Research Center, University of Haifa, Rutgers, The State University of New Jersey

Language: English

Topic: Suicide and Self-Harm Studies

Subfield: Clinical Psychology

Field: Psychology

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,750