Self-harm and its association with internet addiction and internet exposure to suicidal thought in adolescents

Background/purpose: 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 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 Z 1.96; 95% confidence interval: 1.06-3.64). Conclusion: 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. Copyright (C) 2016, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http:// creativecommons. org/licenses/bync-nd/4.0/).