Could Media Exposure to Nonsuicidal Self-Injury Increase ED Visits for Self-Harm?

Exposure to nonsuicidal self-injury (NSSI) in the media may increase rates of self-harm among adolescents and young adults, according to results of a study published in the Journal of the American Academy of Child & Adolescent Psychiatry.

Investigators from the University of Ulsan College of Medicine in South Korea sourced data for this study from the National Emergency Department Information System (NEDIS), which obtains data from emergency department (ED) visits in South Korea. In this study, ED visits due to self-harm (N=35,928,834) between 2015 and 2018 were evaluated. Changes in self-harm incidents were compared before and after the song Barcode was broadcast in High School Rapper 2 on March 30, 2018. High School Rapper 2 was a hip-hop survival show of high school students that was popular among adolescents and young adults. The song Barcode glorified multiple parallel cut wounds made by NSSI on the artist’s right arm.

A total of 8,445,531, 9,127,979, 9,089,055, and 9,266,269 ED visits for self-harm occurred in 2015, 2016, 2017, and 2018, respectively. Overall, 92.4%-93.1% of events were accidental or unintentional.

The rates of intentional self-harm increased from 1.8% in 2015-2017 to 2.1% in 2018 (P <.001).

Compared with before the airing of Barcode, there were significant changes to the rates of self-harm ED visits among individuals aged 10 to 14 (β, 0.883; P =.001) years, 15 to 19 (β, 2.941; P <.001) years, 20 to 24 (β, 1.997; P =.002) years, and 25 to 29 (β, 1.438; P =.029) years but not among those aged 30 to 64 (β, 0.500; P =.117) years and greater than or equal to 65 (β, 0.632; P =.066) years.

Stratified by gender, the increasing trends were observed among girls (β , 1.076; P =.012) and boys (β, 0.701; P =.010) aged 10 to 14 years, girls and women aged 15 to 19 years (β, 5.158; P <.001), women (β, 2.211; P =.006) and men (β, 1.790; P =.012) aged 20 to 24 years, men aged 25 to 29 years (β, 1.508; P =.016), and men aged 30 to 64 years (β, 0.651; P =.028).

These data indicated that after media exposure to NSSI, an additional 6.1 per 100,000 girls aged 15 to 19 years and 3.2 per 100,000 girls aged 10 to 14 years per month visited the ED for self-harm compared with before Barcode.

Among only self-harm events due to cutting, increases were observed among individuals aged 10 to 14 (β, 0.318; P =.019), 15 to 19 (β, 0.924; P =.006), and 25 to 29 (β, 0.597; P =.043) years after the airing of Barcode compared with before its airing.

The results of this study must be interpreted with caution, as it remains unclear whether the broadcast of Barcode may be causal for these trends.

Study authors concluded, “Using time series analysis, we found a significant increase in ED visits due to self-harm after the song Barcode was broadcast in High School Rapper 2, which is consistent with media contagion of NSSI. We believe that the evidence is strong enough to support appropriate guidelines and careful choices regarding media exposure to NSSI, in the interest of preventing self-injurious behavior.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor