title: Self-harm and its association with internet addiction and internet exposure to suicidal thought in adolescents.
abstract: OBJECTIVE
  Self-harm (SH) is a risk factor for suicide. We aimed to determine whether internet addiction and internet exposure to confided suicidal ideation are associated with SH in adolescents.
  
  
  METHODS
  This study was a cross-sectional survey of students who self-completed a series of online questionnaires including a sociodemographic information questionnaire, questionnaire for suicidality and SH, Chen Internet Addiction Scale (CIAS), Patient Health Questionnaire (PHQ-9), multi-dimensional support scale (MDSS), Rosenberg self-esteem scale (RSES), Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), and questionnaire for substance abuse.
  
  
  RESULTS
  A total of 2479 students completed the questionnaires (response rate = 62.1%). They had a mean age of 15.44 years (range 14-19 years; standard deviation 0.61), and were mostly female (n = 1494; 60.3%). The prevalence of SH within the previous year was 10.1% (n = 250). Among the participants, 17.1% had internet addiction (n = 425) and 3.3% had been exposed to suicidal content on the internet (n = 82). In the hierarchical logistic regression analysis, internet addiction and internet exposure to suicidal thoughts were both significantly related to an increased risk of SH, after controlling for gender, family factors, exposure to suicidal thoughts in the real life, depression, alcohol/tobacco use, concurrent suicidality, and perceived social support. However, the association between internet addiction and SH weakened after adjusting for the level of self-esteem, while internet exposure to suicidal thoughts remained significantly related to an increased risk of SH (odds ratio = 1.96; 95% confidence interval: 1.06-3.64).
  
  
  CONCLUSIONS
  Online experiences are associated with SH in adolescents. Preventive strategies may include education to increase social awareness, to identify the youths most at risk, and to provide prompt help.
authors.affiliation: Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
authors.forename: Hui-Ching
authors.initials: HC
authors.lastname: Liu
authors.affiliation: Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taipei, Taiwan. Electronic address: maryliuyip@gmail.com.
authors.forename: Shen-Ing
authors.initials: SI
authors.lastname: Liu
authors.affiliation: Department of Family Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
authors.forename: Jin-Jin
authors.initials: JJ
authors.lastname: Tjung
authors.affiliation: MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.
authors.forename: Fang-Ju
authors.initials: FJ
authors.lastname: Sun
authors.affiliation: MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.
authors.forename: Hui-Chun
authors.initials: HC
authors.lastname: Huang
authors.affiliation: Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taipei, Taiwan; Department of Thanatology and Health Counseling, National Taipei University of Nursing and Health Sciences, Taiwan.
authors.forename: Chun-Kai
authors.initials: CK
authors.lastname: Fang
mesh_terms: D000293:Adolescent; D016739:Behavior, Addictive / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D020407:Internet; D016015:Logistic Models; D008297:Male; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D012944:Social Support; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D013624:Taiwan; D055815:Young Adult
keywords: adolescent; internet; self-injurious behavior; suicidal ideation; teen