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Firth J, Torous J, López-Gil JF, Linardon J, Milton A, Lambert J, Smith L, Jarić I, Fabian H, Vancampfort D, Onyeaka H, Schuch FB, Firth JA. From "online brains" to "online lives": understanding the individualized impacts of Internet use across psychological, cognitive and social dimensions. World Psychiatry 2024; 23:176-190. [PMID: 38727074 PMCID: PMC11083903 DOI: 10.1002/wps.21188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
In response to the mass adoption and extensive usage of Internet-enabled devices across the world, a major review published in this journal in 2019 examined the impact of Internet on human cognition, discussing the concepts and ideas behind the "online brain". Since then, the online world has become further entwined with the fabric of society, and the extent to which we use such technologies has continued to grow. Furthermore, the research evidence on the ways in which Internet usage affects the human mind has advanced considerably. In this paper, we sought to draw upon the latest data from large-scale epidemiological studies and systematic reviews, along with randomized controlled trials and qualitative research recently emerging on this topic, in order to now provide a multi-dimensional overview of the impacts of Internet usage across psychological, cognitive and societal outcomes. Within this, we detail the empirical evidence on how effects differ according to various factors such as age, gender, and usage types. We also draw from new research examining more experiential aspects of individuals' online lives, to understand how the specifics of their interactions with the Internet, and the impact on their lifestyle, determine the benefits or drawbacks of online time. Additionally, we explore how the nascent but intriguing areas of culturomics, artificial intelligence, virtual reality, and augmented reality are changing our understanding of how the Internet can interact with brain and behavior. Overall, the importance of taking an individualized and multi-dimensional approach to how the Internet affects mental health, cognition and social functioning is clear. Furthermore, we emphasize the need for guidelines, policies and initiatives around Internet usage to make full use of the evidence available from neuroscientific, behavioral and societal levels of research presented herein.
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Affiliation(s)
- Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - John Torous
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - José Francisco López-Gil
- One Health Research Group, Universidad de las Americas, Quito, Ecuador
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Alyssa Milton
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Australian Research Council, Centre of Excellence for Children and Families over the Life Course, Sydney, NSW, Australia
| | | | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ivan Jarić
- Laboratoire Ecologie, Systématique et Evolution, Université Paris-Saclay, Gif-sur-Yvette, France
- Biology Centre, Czech Academy of Sciences, České Budějovice, Czech Republic
| | - Hannah Fabian
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Center, KU Leuven, Leuven, Belgium
| | - Henry Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Health Sciences, Universidad Autônoma de Chile, Providência, Chile
| | - Josh A Firth
- Department of Biology, University of Oxford, Oxford, UK
- School of Biology, University of Leeds, Leeds, UK
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Haime Z, Kennedy L, Grace L, Cohen R, Derges J, Biddle L. The Journey of Engaging With Web-Based Self-Harm and Suicide Content: Longitudinal Qualitative Study. JMIR INFODEMIOLOGY 2024; 4:e47699. [PMID: 38546718 PMCID: PMC11009851 DOI: 10.2196/47699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/10/2023] [Accepted: 02/15/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Self-harm and suicide are major public health concerns worldwide, with attention focused on the web environment as a helpful or harmful influence. Longitudinal research on self-harm and suicide-related internet use is limited, highlighting a paucity of evidence on long-term patterns and effects of engaging with such content. OBJECTIVE This study explores the experiences of people engaging with self-harm or suicide content over a 6-month period. METHODS This study used qualitative and digital ethnographic methods longitudinally, including one-to-one interviews at 3 time points to explore individual narratives. A trajectory analysis approach involving 4 steps was used to interpret the data. RESULTS The findings from 14 participants established the web-based journey of people who engage with self-harm or suicide content. In total, 5 themes were identified: initial interactions with self-harm or suicide content, changes in what self-harm or suicide content people engage with and where, changes in experiences of self-harm or suicide behaviors associated with web-based self-harm or suicide content engagement, the disengagement-reengagement cycle, and future perspectives on web-based self-harm or suicide content engagement. Initial engagements were driven by participants seeking help, often when offline support had been unavailable. Some participants' exposure to self-harm and suicide content led to their own self-harm and suicide behaviors, with varying patterns of change over time. Notably, disengagement from web-based self-harm and suicide spaces served as a protective measure for all participants, but the pull of familiar content resulted in only brief periods of disconnection. Participants also expressed future intentions to continue returning to these self-harm and suicide web-based spaces, acknowledging the nonlinear nature of their own recovery journey and aiming to support others in the community. Within the themes identified in this study, narratives revealed that participants' behavior was shaped by cognitive flexibility and rigidity, metacognitive abilities, and digital expertise. Opportunities for behavior change arose during periods of cognitive flexibility prompted by life events, stressors, and shifts in mental health. Participants sought diverse and potentially harmful content during challenging times but moved toward recovery-oriented engagements in positive circumstances. Metacognitive and digital efficacy skills also played a pivotal role in participants' control of web-based interactions, enabling more effective management of content or platforms or sites that posed potential harms. CONCLUSIONS This study demonstrated the complexity of web-based interactions, with beneficial and harmful content intertwined. Participants who demonstrated metacognition and digital efficacy had better control over web-based engagements. Some attributed these skills to study processes, including taking part in reflective diaries, showing the potential of upskilling users. This study also highlighted how participants remained vulnerable by engaging with familiar web-based spaces, emphasizing the responsibility of web-based industry leaders to develop tools that empower users to enhance their web-based safety.
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Affiliation(s)
- Zoë Haime
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Laura Kennedy
- Centre for Society and Mental Health, Kings College, London, United Kingdom
- Samaritans, Surrey, United Kingdom
- Department of Health Service and Population Research, King's College London, London, United Kingdom
| | | | - Rachel Cohen
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Health and Social Services Group, Welsh Government, Cardiff, United Kingdom
| | - Jane Derges
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lucy Biddle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Susi K, Glover-Ford F, Stewart A, Knowles Bevis R, Hawton K. Research Review: Viewing self-harm images on the internet and social media platforms: systematic review of the impact and associated psychological mechanisms. J Child Psychol Psychiatry 2023. [PMID: 36940718 DOI: 10.1111/jcpp.13754] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND Viewing self-harm and suicide-related images online can precede these behaviours. We reviewed studies of potential impacts and mechanisms associated with viewing self-harm-related images on the internet and social media. METHOD CINAHL, Cochrane Library, EMBASE, HMIC, MEDLINE, PsycArticles, PsycINFO, PubMed, Scopus, Sociological Abstracts and Web of Science Core Collection databases were searched for relevant studies from inception to 22 January 2022. Inclusion criteria were English language, peer-reviewed, empirical studies with data related to impacts of viewing self-harm images or videos on the internet or social media. Quality and risk of bias were assessed using Critical Appraisal Skills Programme tools. A narrative synthesis approach was used. RESULTS Of the 15 identified studies, all found harmful effects of viewing self-harm-related images online. These included escalation of self-harm, reinforcement of engagement behaviours (e.g. commenting and sharing images), encouragement of social comparison (comparing own self-harm with others), development of a self-harm identity, social connection perpetuating or escalating self-harm, and emotional, cognitive, and physiological impacts triggering self-harm urges and acts. Nine studies found protective effects, including self-harm mitigation or reduction, promotion of self-harm recovery, encouraging social connection and help-giving, and emotional, cognitive and physiological impacts mitigating or reducing self-harm urges and acts. Causality of impact was not determined in any study. Most of the studies did not explicitly evaluate or discuss potential mechanisms. CONCLUSIONS Viewing self-harm images online may have both harmful and protective effects, but harmful effects predominated in the studies. Clinically, it is important to assess individual's access to images relating to self-harm and suicide, and the associated impacts, alongside pre-existing vulnerabilities and contextual factors. Higher quality longitudinal research with less reliance on retrospective self-report is needed, as well as studies that test potential mechanisms. We have developed a conceptual model of the impact of viewing self-harm images online to inform future research.
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Affiliation(s)
- Karima Susi
- Oxford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Oxford Health NHS Foundation Trust and University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
- Child and Adolescent Mental Health Services, Leicestershire Partnership NHS Trust, Leicester, UK
- Step 4 Psychological Therapies, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Francesca Glover-Ford
- Oxford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Oxford Health NHS Foundation Trust and University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Anne Stewart
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Rebecca Knowles Bevis
- Oxford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Oxford Health NHS Foundation Trust and University of Oxford, Oxford, UK
| | - Keith Hawton
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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Winstone L, Mars B, Ferrar J, Moran P, Penton-Voak I, Grace L, Biddle L. Investigating How People Who Self-harm Evaluate Web-Based Lived Experience Stories: Focus Group Study. JMIR Ment Health 2023; 10:e43840. [PMID: 36719729 PMCID: PMC9929729 DOI: 10.2196/43840] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The positive and negative effects of interacting with web-based content on mental health, and especially self-harm, are well documented. Lived experience stories are one such type of static web-based content, frequently published on health care or third-sector organization websites, as well as social media and blogs, as a form of support for those seeking help via the web. OBJECTIVE This study aimed to increase understanding about how people who self-harm engage with and evaluate web-based lived experience stories. METHODS Overall, 4 web-based focus groups were conducted with 13 people with recent self-harm experience (aged 16-40 years). In total, 3 example lived experience stories were read aloud to participants, who were then asked to share their reactions to the stories. Participants were also encouraged to reflect on stories previously encountered on the web. Data were analyzed thematically. RESULTS Overall, 5 themes were generated: stories of recovery from self-harm and their emotional impact, impact on self-help and help-seeking behaviors, identifying with the narrator, authenticity, and language and stereotyping. CONCLUSIONS Lived experience stories published on the web can provide a valuable form of support for those experiencing self-harm. They can be motivating and empowering for the reader, and they have the potential to distract readers from urges to self-harm. However, these effects may be moderated by age, and narratives of recovery may demoralize older readers. Our findings have implications for organizations publishing lived experience content and for community guidelines and moderators of web-based forums in which users share their stories. These include the need to consider the narrator's age and the relatability and authenticity of their journey and the need to avoid using stigmatizing language.
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Affiliation(s)
- Lizzy Winstone
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Becky Mars
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Jennifer Ferrar
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Paul Moran
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Ian Penton-Voak
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | | | - Lucy Biddle
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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Idelji-Tehrani S, Dubicka B, Graham R. The clinical implications of digital technology. Clin Child Psychol Psychiatry 2023; 28:338-353. [PMID: 36525979 PMCID: PMC9893300 DOI: 10.1177/13591045221145400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The proliferation of digital technology within the lives of children and young people (CYP) provides arguably one of the most significant clinical and ethical paradigm shifts in Child and Adolescent Psychiatry. One can argue that mental health research has taken a myopic approach to understanding the interaction between young people's technology use and their mental health. Mental health clinicians also need a better understanding of the digital lives of CYP and how technology may be supporting or harming their mental health. Within this paper, we argue that greater longitudinal research is required, particularly in vulnerable groups, and that there is an essential need for a standardised digital use assessment (DUA) tool, which assimilates CYP use of technology and their vulnerabilities/resilience to online risks. We subsequently offer a series of questions clinicians can use to explore technology use by CYP. Such an aide memoire may empower clinicians to have wider discussions around digital technology use with CYP, while also helping to develop appropriate safety and management plans.
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Affiliation(s)
- Saam Idelji-Tehrani
- Department of Child and Adolescent Psychiatry, Institute of Child Health, 11700University College London (UCL), UK
| | - Bernadka Dubicka
- Department of Child and Adolescent Psychiatry, Hull & York Medical School, 8748University of York, UK.,Department of Child and Adolescent Psychiatry, 9022Greater Manchester Mental Health Trust, UK.,Manchester Academic Health Science Centre (MAHSC), University of Manchester, UK
| | - Richard Graham
- Department of Child and Adolescent Psychiatry, Stem4, London, UK.,Keeping Well Southeast London Community, UK.,Digital Well-Being Consultant to Own it App Project
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