How do teens with a history of suicidal behavior and self-harm interact with social media?

Background: This study examines how engagement with depression-related social media content varies by teens who report suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI) versus those who had not experienced each behavior. Methods: Teens aged 15–17 years old (N = 93) were recruited from social media platforms from October 2016 to August 2018. Participants were asked three open-ended questions about the advantages and disadvantages of networking about depression-related content on social media. We conducted a qualitative analysis to capture themes in responses by question item. Univariate analyses were conducted to compare differences in the frequency of themes endorsed among the behavioral groups versus their counterparts. Results: Among participants (female, 73%; non-White, 45%; sexual minority, 57%), most (93%, n = 87) endorsed depressive symptoms. Sixty-five percent (n = 60) endorsed suicidal ideation within the past year, who were more likely to indicate unhelpful social interactions (p =.02) as a disadvantage of following depression content than peers who did not endorse suicidal ideation within the past year. Eighty percent (n = 74) endorsed lifetime experience of NSSI, who were more likely to indicate negative impact on relationships (p =.01) from posting depression content than peers who did not experience NSSI. Fifty-eight percent (n = 54) endorsed a lifetime suicide attempt, who were more likely to mention offering solutions (p =.03) to someone posting concerning content than peers who did not endorse a lifetime suicide attempt. Conclusions: This study provides diverse and unique perspectives on how engagement with depression-related social media varies by mental health behaviors and informs the use of social media for recruitment and outreach for teens.