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Original Investigation |

Googling Self-injury:  The State of Health Information Obtained Through Online Searches for Self-injury

Stephen P. Lewis, PhD1; Jasmine C. Mahdy, MA1; Natalie J. Michal, MA1; Alexis E. Arbuthnott, MA1
[+] Author Affiliations
1Department of Psychology, University of Guelph, Guelph, Ontario, Canada
JAMA Pediatr. 2014;168(5):443-449. doi:10.1001/jamapediatrics.2014.187.
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Importance  Nonsuicidal self-injury (NSSI), the deliberate destruction of one's body tissue without suicidal intent, is a significant issue for many youth. Research suggests that adolescents and emerging adults prefer the Internet as a means to retrieve NSSI resources and that important others (eg, caregivers) may also seek this information online. To our knowledge, no research to date has examined the quality of health information regarding NSSI on the Internet.

Objectives  To examine the scope and nature of web searches for NSSI websites and to evaluate the quality of health-information websites found via these online searches.

Design, Setting, and Participants  Ninety-two NSSI-related search terms were identified using the Google AdWords Keywords program. The first page of Google search results for each term was content-analyzed for website type and health-information websites were further coded for credibility, NSSI myth propagation, and quality of health information.

Main Outcomes and Measures  Frequency of NSSI web searches and indices of health information quality.

Results  Nonsuicidal self-injury–related search terms were sought more than 42 million times in the past year and health-information websites were the most common website type found (21.5%). Of these, a health and/or academic institution endorsed only 9.6%. At least one NSSI myth was propagated per website, including statements that NSSI indicates a mental disorder (49.3%), a history of abuse (40%), or the notion that primarily women self-injure (37%). The mean quality of health information score on these websites was 3.49 (SD = 1.40) of 7.

Conclusions and Relevance  Nonsuicidal self-injury–related search terms are frequently sought out worldwide and are likely to yield noncredible and low-quality information that may propagate common NSSI myths. These data suggest health professionals need to be aware of what information is online and should refer young patients and their families to reliable online resources to enhance NSSI literacy. Efforts to facilitate people's access to credible NSSI resources via the Internet are also needed.

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Figure 1.
Frequency of Website Types in Data Set

Percentage of websites per website type retrieved from the first page of Google search results (N = 962) for both duplicate and unique websites. NA indicates not applicable and SI, self-injury.

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Figure 2.
Frequency of Self-injury Myths Across Health-Information Websites

Percentage of health-information websites propagating nonsuicidal self-injury myths (n = 75). BPD indicates borderline personality disorder and NSSI, nonsuicidal self-injury.

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Figure 3.
Frequency of Health on the Internet Criteria Across Health-Information Websites

Percentage of health-information websites (n = 75) meeting relevant quality of health information criteria as suggested by the Health on the Internet Foundation.

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