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A mixed-methods study of the experiences of social media platforms policies and restrictions related to self-harm content: an online cross-sectional survey and in-depth interviews

Amanda Marchant Orcid Logo, Fran Lewis, Moiz Siddiqi, Ann John Orcid Logo

Journal of Medical Internet Research

Swansea University Authors: Amanda Marchant Orcid Logo, Ann John Orcid Logo

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Abstract

Background Many features of social media platforms can influence safety in relation to self-harm/suicide related content. In 2019 platforms including Meta and Twitter (X) updated their policies regarding self-harm/suicide content. This included community guidelines, content restrictions and signpost...

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Published in: Journal of Medical Internet Research
ISSN: 1438-8871
Published: JMIR Publications
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URI: https://cronfa.swan.ac.uk/Record/cronfa71884
first_indexed 2026-05-12T16:02:02Z
last_indexed 2026-06-05T10:51:38Z
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In 2019 platforms including Meta and Twitter (X) updated their policies regarding self-harm/suicide content. This included community guidelines, content restrictions and signposting. The impact of these safety measures has yet to be fully evaluated. Aims and objectivesThe aim of this study was to better understand the perspectives of social media users of safety measures related to self-harm/suicide content including perspectives of those with a history of self-harm. MethodsThis was a cross-sectional mixed method study. Participants were recruited through convenience sampling. Quantitative data was collected using a fixed response cross-sectional survey (n= 5294 respondents aged 16-24 years, largely women/girls/non-binary). The survey consisted of questions related to experience of self-harm and suicide content, change policy in 2019, and specific safety features of platforms. Qualitative data was collected via semi-structured interviews (n=17 participants aged 16-56 years) with interview guides broadly following the topic areas of the survey. In-depth interviews were analysed using thematic analysis. Results Half of survey respondents stated that restrictions made social media feel safer. Thirty-five percent reported that this changed what they saw on social media and 9.9%(7.5-13.0; 492/4479) stated that this changed what they posted. Sixty-four percent of respondents stated that they would be &#x2018;very likely&#x2019; to click on a post marked with generic content warning, with just 15.1%[12.6-17.9] &#x2018;very likely&#x2019; to click on a post with a self-harm specific content warning. Of respondents who had content removed due to mental health or self-harm content ~90% indicated that this was harmful or very harmful to them at the time, particularly where content was removed because of visible scars (reported to be extremely harmful 58.3%[54.3-62.3; 599]; harmful 31.3%[26.3-36.7; 321]). Thematic analysis of in-depth interviews revealed 13 subthemes organised into seven overarching thematic areas. Participants described the experience of social media platforms before and after the policy changes with opinions divided on whether the current safety features were effective. Participants described the distress caused by inappropriate censoring of images e.g., where healed self-harm scars were visible. Suggestions were made for how platforms can continue to improve including age verification procedures for young people, tailored signposting and increased control over content. ConclusionsTo our knowledge this is the first study to explore the 2019 change in platform policies with respect to self-harm/suicide related content from the perspectives of those with a history of self-harm. This research adds to evidence of the risks and unintended consequences of imposing untested blanket restrictions in online settings. Full evaluation of these restrictions is essential to allow platforms to continue to improve, encouraging a safe space for supportive communities whilst mitigating potential harm.</abstract><type>Journal Article</type><journal>Journal of Medical Internet Research</journal><volume/><journalNumber/><paginationStart/><paginationEnd/><publisher>JMIR Publications</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1438-8871</issnPrint><issnElectronic/><keywords/><publishedDay>0</publishedDay><publishedMonth>0</publishedMonth><publishedYear>0</publishedYear><publishedDate>0001-01-01</publishedDate><doi/><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>External research funder(s) paid the OA fee (includes OA grants disbursed by the Library)</apcterm><funders>This work was undertaken as part of the Samaritans online excellence program and supported by the Adolescent Mental Health Data Platform (ADP) funded by the MQ Mental Health Research Charity (MQBF/3 ADP) . This work was supported by the National Centre for Suicide Prevention and Self-Harm Research (funded by Health and Care Research Wales) and the Wolfson Centre for Young Peoples Mental Health (Grant Reference 517483)</funders><projectreference/><lastEdited>2026-06-04T12:31:40.6746788</lastEdited><Created>2026-05-12T09:18:31.1258869</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Amanda</firstname><surname>Marchant</surname><orcid>0000-0001-7013-6980</orcid><order>1</order></author><author><firstname>Fran</firstname><surname>Lewis</surname><order>2</order></author><author><firstname>Moiz</firstname><surname>Siddiqi</surname><order>3</order></author><author><firstname>Ann</firstname><surname>John</surname><orcid>0000-0002-5657-6995</orcid><order>4</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2026-06-04T12:31:40.6746788 v2 71884 2026-05-12 A mixed-methods study of the experiences of social media platforms policies and restrictions related to self-harm content: an online cross-sectional survey and in-depth interviews 0776f450dd575004ba7c69930c579cae 0000-0001-7013-6980 Amanda Marchant Amanda Marchant true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2026-05-12 MEDS Background Many features of social media platforms can influence safety in relation to self-harm/suicide related content. In 2019 platforms including Meta and Twitter (X) updated their policies regarding self-harm/suicide content. This included community guidelines, content restrictions and signposting. The impact of these safety measures has yet to be fully evaluated. Aims and objectivesThe aim of this study was to better understand the perspectives of social media users of safety measures related to self-harm/suicide content including perspectives of those with a history of self-harm. MethodsThis was a cross-sectional mixed method study. Participants were recruited through convenience sampling. Quantitative data was collected using a fixed response cross-sectional survey (n= 5294 respondents aged 16-24 years, largely women/girls/non-binary). The survey consisted of questions related to experience of self-harm and suicide content, change policy in 2019, and specific safety features of platforms. Qualitative data was collected via semi-structured interviews (n=17 participants aged 16-56 years) with interview guides broadly following the topic areas of the survey. In-depth interviews were analysed using thematic analysis. Results Half of survey respondents stated that restrictions made social media feel safer. Thirty-five percent reported that this changed what they saw on social media and 9.9%(7.5-13.0; 492/4479) stated that this changed what they posted. Sixty-four percent of respondents stated that they would be ‘very likely’ to click on a post marked with generic content warning, with just 15.1%[12.6-17.9] ‘very likely’ to click on a post with a self-harm specific content warning. Of respondents who had content removed due to mental health or self-harm content ~90% indicated that this was harmful or very harmful to them at the time, particularly where content was removed because of visible scars (reported to be extremely harmful 58.3%[54.3-62.3; 599]; harmful 31.3%[26.3-36.7; 321]). Thematic analysis of in-depth interviews revealed 13 subthemes organised into seven overarching thematic areas. Participants described the experience of social media platforms before and after the policy changes with opinions divided on whether the current safety features were effective. Participants described the distress caused by inappropriate censoring of images e.g., where healed self-harm scars were visible. Suggestions were made for how platforms can continue to improve including age verification procedures for young people, tailored signposting and increased control over content. ConclusionsTo our knowledge this is the first study to explore the 2019 change in platform policies with respect to self-harm/suicide related content from the perspectives of those with a history of self-harm. This research adds to evidence of the risks and unintended consequences of imposing untested blanket restrictions in online settings. Full evaluation of these restrictions is essential to allow platforms to continue to improve, encouraging a safe space for supportive communities whilst mitigating potential harm. Journal Article Journal of Medical Internet Research JMIR Publications 1438-8871 0 0 0 0001-01-01 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University External research funder(s) paid the OA fee (includes OA grants disbursed by the Library) This work was undertaken as part of the Samaritans online excellence program and supported by the Adolescent Mental Health Data Platform (ADP) funded by the MQ Mental Health Research Charity (MQBF/3 ADP) . This work was supported by the National Centre for Suicide Prevention and Self-Harm Research (funded by Health and Care Research Wales) and the Wolfson Centre for Young Peoples Mental Health (Grant Reference 517483) 2026-06-04T12:31:40.6746788 2026-05-12T09:18:31.1258869 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Amanda Marchant 0000-0001-7013-6980 1 Fran Lewis 2 Moiz Siddiqi 3 Ann John 0000-0002-5657-6995 4
title A mixed-methods study of the experiences of social media platforms policies and restrictions related to self-harm content: an online cross-sectional survey and in-depth interviews
spellingShingle A mixed-methods study of the experiences of social media platforms policies and restrictions related to self-harm content: an online cross-sectional survey and in-depth interviews
Amanda Marchant
Ann John
title_short A mixed-methods study of the experiences of social media platforms policies and restrictions related to self-harm content: an online cross-sectional survey and in-depth interviews
title_full A mixed-methods study of the experiences of social media platforms policies and restrictions related to self-harm content: an online cross-sectional survey and in-depth interviews
title_fullStr A mixed-methods study of the experiences of social media platforms policies and restrictions related to self-harm content: an online cross-sectional survey and in-depth interviews
title_full_unstemmed A mixed-methods study of the experiences of social media platforms policies and restrictions related to self-harm content: an online cross-sectional survey and in-depth interviews
title_sort A mixed-methods study of the experiences of social media platforms policies and restrictions related to self-harm content: an online cross-sectional survey and in-depth interviews
author_id_str_mv 0776f450dd575004ba7c69930c579cae
ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv 0776f450dd575004ba7c69930c579cae_***_Amanda Marchant
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Amanda Marchant
Ann John
author2 Amanda Marchant
Fran Lewis
Moiz Siddiqi
Ann John
format Journal article
container_title Journal of Medical Internet Research
institution Swansea University
issn 1438-8871
publisher JMIR Publications
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
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description Background Many features of social media platforms can influence safety in relation to self-harm/suicide related content. In 2019 platforms including Meta and Twitter (X) updated their policies regarding self-harm/suicide content. This included community guidelines, content restrictions and signposting. The impact of these safety measures has yet to be fully evaluated. Aims and objectivesThe aim of this study was to better understand the perspectives of social media users of safety measures related to self-harm/suicide content including perspectives of those with a history of self-harm. MethodsThis was a cross-sectional mixed method study. Participants were recruited through convenience sampling. Quantitative data was collected using a fixed response cross-sectional survey (n= 5294 respondents aged 16-24 years, largely women/girls/non-binary). The survey consisted of questions related to experience of self-harm and suicide content, change policy in 2019, and specific safety features of platforms. Qualitative data was collected via semi-structured interviews (n=17 participants aged 16-56 years) with interview guides broadly following the topic areas of the survey. In-depth interviews were analysed using thematic analysis. Results Half of survey respondents stated that restrictions made social media feel safer. Thirty-five percent reported that this changed what they saw on social media and 9.9%(7.5-13.0; 492/4479) stated that this changed what they posted. Sixty-four percent of respondents stated that they would be ‘very likely’ to click on a post marked with generic content warning, with just 15.1%[12.6-17.9] ‘very likely’ to click on a post with a self-harm specific content warning. Of respondents who had content removed due to mental health or self-harm content ~90% indicated that this was harmful or very harmful to them at the time, particularly where content was removed because of visible scars (reported to be extremely harmful 58.3%[54.3-62.3; 599]; harmful 31.3%[26.3-36.7; 321]). Thematic analysis of in-depth interviews revealed 13 subthemes organised into seven overarching thematic areas. Participants described the experience of social media platforms before and after the policy changes with opinions divided on whether the current safety features were effective. Participants described the distress caused by inappropriate censoring of images e.g., where healed self-harm scars were visible. Suggestions were made for how platforms can continue to improve including age verification procedures for young people, tailored signposting and increased control over content. ConclusionsTo our knowledge this is the first study to explore the 2019 change in platform policies with respect to self-harm/suicide related content from the perspectives of those with a history of self-harm. This research adds to evidence of the risks and unintended consequences of imposing untested blanket restrictions in online settings. Full evaluation of these restrictions is essential to allow platforms to continue to improve, encouraging a safe space for supportive communities whilst mitigating potential harm.
published_date 0001-01-01T06:39:19Z
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