Exploration of Digital Health Technologies

Table 2. Content analysis of tweets resulted in the emergence of 11 themes, organized in ascending order of frequency

Theme	Description	Total # of tweets, n (%)
Understanding self-harm	Tools, research, and/or resources to better understand self-harm	1,581 (41.11)
Political	Self-harm terms used in political information, commentary, or discussions	637 (16.56)
Support	Individual support given to or received by those affected by self-harm	514 (13.36)
Calling out wrongdoings	Discouraging or pointing out the negative elements of self-harm and/or its promotion	488 (12.69)
Reasons for self-harm	Specific factors that encourage engagement in self-harm	168 (4.37)
Comparisons	Self-harm was likened to lifestyle, objects, food, and certain behaviors	153 (3.98)
Feedback on media portrayal	Reflections on portrayals of self-harm in print and digital media	133 (3.46)
Self-harm help resource	Community services and resources for those affected by self-harm	106 (2.76)
Minor themes
Self-harm terms	Single-word posts that pertain to self-harm, without a coherent sentence structure	48 (1.25)
Repercussions of self-harm	Description(s) of the negative impacts of self-harm behaviors	12 (0.31)
Accepting self-harm	Explicit promotion and/or glorification of self-harm behaviors	6 (0.16)

Return to article view

Declarations

Author contributions

EM: Conceptualization, Formal analysis, Writing—original draft, Writing—review & editing. KK and ST: Formal analysis, Writing—original draft, Writing—review & editing. WC: Conceptualization, Formal analysis, Writing—review & editing. HPS: Conceptualization, Writing—review & editing.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All initial data protocols were deemed exempt by the Colgate University Institutional Review Board (IRB) according to the Code of Federal Regulations Title 45, Part 46 (Exemption 2: Public data).

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

The datasets and code analyzed for this study will be made available via [https://github.com/WilliamCipolli/EDHT-Moghimi-et-al-2025.git].

Funding

Not applicable.

Copyright

Publisher’s note

Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

References

Suicide [Internet]. World Health Organization; c2025 [cited 2023 Nov 9]. Available from: https://www.who.int/news-room/fact-sheets/detail/suicide

Gillies D, Christou MA, Dixon AC, Featherston OJ, Rapti I, Garcia-Anguita A, et al. Prevalence and Characteristics of Self-Harm in Adolescents: Meta-Analyses of Community-Based Studies 1990–2015. Journal of the American Academy of Child & Adolescent Psychiatry. 2018;57:733–41. [DOI]

Liu RT. The epidemiology of non-suicidal self-injury: lifetime prevalence, sociodemographic and clinical correlates, and treatment use in a nationally representative sample of adults in England. Psychol Med. 2023;53:274–82. [DOI] [PubMed] [PMC]

Conner BT, Kentopp SD, O’Donnell MB, Wallace GT, Morse JL, Arkfeld PA, et al. Meaning in Life Moderates Relations between Personality and Temperament and Nonsuicidal Self-Injury in Hospitalized Adolescents. J Youth Adolesc. 2022;51:1622–35. [DOI] [PubMed]

Smith KE, Acevedo-Duran R, Lovell JL, Castillo AV, Cardenas Pacheco V. Youth Are the Experts! Youth Participatory Action Research to Address the Adolescent Mental Health Crisis. Healthcare (Basel). 2024;12:592. [DOI] [PubMed] [PMC]

Nesi J, Burke TA, Bettis AH, Kudinova AY, Thompson EC, MacPherson HA, et al. Social media use and self-injurious thoughts and behaviors: A systematic review and meta-analysis. Clin Psychol Rev. 2021;87:102038. [DOI] [PubMed] [PMC]

Kingsbury M, Reme BA, Skogen JC, Sivertsen B, Øverland S, Cantor N, et al. Differential associations between types of social media use and university students’ non-suicidal self-injury and suicidal behavior. Computers in Human Behavior. 2021;115:106614. [DOI]

Seong E, Noh G, Lee KH, Lee JS, Kim S, Seo DG, et al. Relationship of Social and Behavioral Characteristics to Suicidality in Community Adolescents With Self-Harm: Considering Contagion and Connection on Social Media. Front Psychol. 2021;12:691438. [DOI] [PubMed] [PMC]

Jarvi S, Jackson B, Swenson L, Crawford H. The Impact of Social Contagion on Non-Suicidal Self-Injury: A Review of the Literature. Arch Suicide Res. 2013;17:1–19. [DOI] [PubMed]

10.

Syed S, Kingsbury M, Bennett K, Manion I, Colman I. Adolescents’ knowledge of a peer’s non-suicidal self-injury and own non-suicidal self-injury and suicidality. Acta Psychiatr Scand. 2020;142:366–73. [DOI] [PubMed]

11.

Heath NL, Toste JR, Nedecheva T, Charlebois A. An Examination of Nonsuicidal Self-Injury Among College Students. Journal of Mental Health Counseling. 2008;30:137–56. [DOI]

12.

Alhassan MA, Pennington D. Investigating non-suicidal self-injury discussions on Twitter. International Conference on Social Media and Data Mining-ICSMDM; 2021.

13.

Silva AC, Vedana KGG, dos Santos JCP, Pillon SC, Ventura CAA, Miasso AI. Analysis of nonsuicidal self-injury posts on Twitter: A quantitative and qualitative research. Research, Society and Development. 2021;10:e40410413017. [DOI]

14.

Muehlenkamp J, Brausch A, Quigley K, Whitlock J. Interpersonal Features and Functions of Nonsuicidal Self-injury. Suicide Life Threat Behav. 2013;43:67–80. [DOI] [PubMed]

15.

Hill NTM, Robinson J, Pirkis J, Andriessen K, Krysinska K, Payne A, et al. Association of suicidal behavior with exposure to suicide and suicide attempt: A systematic review and multilevel meta-analysis. PLoS Med. 2020;17:e1003074. [DOI] [PubMed] [PMC]

16.

Online Communities of Adolescents And Young Adults Celebrating, Glorifying, and Encouraging Self-Harm and Suicide are Growing Rapidly on Twitter [Internet]. Network Contagion Research Institute; c2025 [cited 2023 Nov 17]. Available from: https://networkcontagion.us/reports/8-29-22-online-communities-of-adolescents-and-young-adults-celebrating-glorifying-and-encouraging-self-harm-and-suicide-are-growing-rapidly-on-twitter/

17.

Juwita ET, Effendi AZ, Pandin MGR. The Effect of Anonymity on Twitter towards its Users Based on Derek Parfit’s Personal Identity Theory. 2021. [DOI]

18.

Changes We’re Making to Do More to Support and Protect the Most Vulnerable People who Use Instagram [Internet]. Instagram Blog; 2019 [cited 2025 May 1]. Available from: https://about.instagram.com/blog/announcements/supporting-and-protecting-vulnerable-people-on-instagram

19.

Suicide and Self-harm policy [Internet]. X Corp.; c2025 [cited 2023 Apr 11]. Available from: https://help.twitter.com/en/rules-and-policies/glorifying-self-harm

20.

Smith H, Cipolli W. The Instagram/Facebook ban on graphic self-harm imagery: A sentiment analysis and topic modeling approach. Policy & Internet. 2022;14:170–85. [DOI]

21.

Dempsey RC, Fedorowicz SE, Wood AM. The role of perceived social norms in non-suicidal self-injury and suicidality: A systematic scoping review. PLoS One. 2023;18:e0286118. [DOI] [PubMed] [PMC]

22.

Python client for the Twitter search endpoints. GitHub, Inc.; c2025 [cited 2025 May 1]. Available from: https://github.com/twitterdev/search-tweets-python

23.

Krippendorff K. Content analysis: An introduction to its methodology. Sage Publications; 2018.

24.

Neuendorf KA. Content analysis and thematic analysis. In: Advanced Research Methods for Applied Psychology. Routledge; 2018.

25.

Jimenez-Sotomayor MR, Gomez-Moreno C, Soto-Perez-de-Celis E. Coronavirus, Ageism, and Twitter: An Evaluation of Tweets about Older Adults and COVID-19. J Am Geriatr Soc. 2020;68:1661–5. [DOI] [PubMed] [PMC]

26.

Kleinheksel AJ, Rockich-Winston N, Tawfik H, Wyatt TR. Demystifying Content Analysis. Am J Pharm Educ. 2020;84:7113. [DOI] [PubMed] [PMC]

27.

Bengtsson M. How to plan and perform a qualitative study using content analysis. NursingPlus Open. 2016;2:8–14. [DOI]

28.

Hsieh HF, Shannon SE. Three Approaches to Qualitative Content Analysis. Qual Health Res. 2005;15:1277–88. [DOI] [PubMed]

29.

Infodemic [Internet]. World Health Organization; c2025 [cited 2024 Jan 10]. Available from: https://www.who.int/health-topics/infodemic/understanding-the-infodemic-and-misinformation-in-the-fight-against-covid-19#tab=tab_1

30.

Hilton CE. Unveiling self-harm behaviour: what can social media site Twitter tell us about self-harm? A qualitative exploration. Journal of Clinical Nursing. 2017;26:1690–704. [DOI] [PubMed]

31.

Thorn P, La Sala L, Hetrick S, Rice S, Lamblin M, Robinson J. Motivations and perceived harms and benefits of online communication about self-harm: An interview study with young people. Digital Health. 2023;9:20552076231176689. [DOI] [PubMed] [PMC]

32.

Shanahan N, Brennan C, House A. Self-harm and social media: thematic analysis of images posted on three social media sites. BMJ Open. 2019;9:e027006. [DOI] [PubMed] [PMC]

33.

Corrigan PW, Powell KJ, Michaels PJ. The Effects of News Stories on the Stigma of Mental Illness. J Nerv Ment Dis. 2013;201:179–82. [DOI] [PubMed]

34.

Steeg S, Webb RT, Ibrahim S, Appleby L, Kapur N. Suicide rates and voting choice in the UK’s 2016 national Brexit referendum on European Union membership: cross-sectional ecological investigation across England’s local authority populations. BJPsych Open. 2020;6:e57. [DOI] [PubMed] [PMC]

35.

Frost DM. Hostile and harmful: Structural stigma and minority stress explain increased anxiety among migrants living in the United Kingdom after the Brexit referendum. J Consult Clin Psychol. 2020;88:75–81. [DOI] [PubMed]

36.

Picardo J, McKenzie SK, Collings S, Jenkin G. Suicide and self-harm content on Instagram: A systematic scoping review. PLoS One. 2020;15:e0238603. [DOI] [PubMed] [PMC]

37.

Atauri-Mezquida D, Nogales-González C, Martínez-Pastor E. Exploring self-harm on Twitter (X): Content moderation and its psychological effects on adolescents. Online Journal of Communication and Media Technologies. 2025;15:e202503. [DOI]

38.

Moreno MA, Ton A, Selkie E, Evans Y. Secret Society 123: Understanding the Language of Self-Harm on Instagram. J Adolesc Health. 2016;58:78–84. [DOI] [PubMed] [PMC]