Research Review: Viewing self-harm images on the internet and social media platforms: systematic review of the impact and associated psychological mechanisms.

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.

Attachment measures in middle childhood and adolescence: A systematic review of measurement properties.

BACKGROUND: Attachment theory proposes that humans develop representations of self and other in early childhood which are relatively stable across the life-course, and play a key role in psychological adaptation. However, to date, the psychometric properties of attachment measures in middle childhood and adolescence have not been evaluated in a systematic review. METHOD: A systematic review (PROSPERO ID: CRD42017057772) was conducted using COSMIN criteria. Two researchers independently searched MEDLINE, PsychINFO and Embase databases for relevant articles. RESULTS: Fifty-four studies were included in the review. The methodological quality of studies was typically fair or poor, with only a small number of studies being rated as of good or excellent quality. The measurement properties of attachment measures in this age group were frequently rated as inadequate according to COSMIN criteria. The Child Attachment Interview (CAI) has the best psychometric properties of the interview and projective measures, and the Inventory of Parent and Peer Attachment (IPPA) the best evidence of the self-report measures. Overall, the evidence for the CAI and IPPA included both positive and negative findings relating to adequacy of measurement properties. CONCLUSIONS: Attachment measures in middle childhood and adolescence currently have limited evidence for the adequacy of their psychometric properties.