title: Exploring the use and effects of deliberate self-harm websites: an Internet-based study.
abstract: BACKGROUND
  In the United Kingdom, rates of deliberate self-harm (DSH) are rising. Alongside this, there has been an increase in the number of websites available with DSH content, and the Internet is known as a valuable resource for those who feel isolated by their condition(s). However, there is little and contradictory evidence available on the effects of using such websites. Further research is therefore required to examine the use and effects of DSH websites.
  
  
  OBJECTIVE
  Our objectives were to explore (1) the reasons people engage in the use of self-harm forums/websites, (2) the beliefs of users of self-harm forums regarding the role of such websites, (3) how the use of self-harm forums/websites modulates self-harm behaviors, and (4) other ways that self-harm forums affect the lives of individuals who use them.
  
  
  METHODS
  Data were collected by a questionnaire hosted on 20 websites with self-harm content. Participants were self-selected from users of these sites. Results were analyzed using descriptive statistics and simple thematic analysis.
  
  
  RESULTS
  In total, 329 responses were received with 91.8% (302/329) from female site users. The majority of participants (65.6%, 187/285) visited these sites at least twice per week, and most participants used the sites to find information (78.2%, 223/285) or participate in the forums (68.4%, 195/285). Positive effects of website use such as gaining help and support, isolation reduction, and a reduction in self-harm behaviors were reported by a large number of participants. However, smaller but important numbers reported negative effects including worsened self-harm, being triggered to self-harm, and additional negative physical and psychological effects.
  
  
  CONCLUSIONS
  This is the first multisite study to explore DSH website use in depth. There are clear and important benefits to engaging in website use for many individuals; however, these are not experienced by all website users. Negative effects were experienced by moderate numbers following website use, and clinicians should consider the impact of a patient's website use when consulting.
authors.affiliation: Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Isobel Marion
authors.initials: IM
authors.lastname: Harris
authors.forename: Lesley Martine
authors.initials: LM
authors.lastname: Roberts
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data; D008297:Male; D016728:Self-Injurious Behavior / Q000523:psychology*; D012944:Social Support; D011795:Surveys and Questionnaires; D006113:United Kingdom; D055815:Young Adult
keywords: Internet; deliberate self-harm; self-injury; websites