Raj Persaud, M.D. and Peter Bruggen, M.D.

Slightly Blighty

Does Social Media Drive School Students to Self-Harm?

What is more dangerous for child minds, taking some treatment or social media?

Posted Feb 04, 2019

by Dr. Raj Persaud

UK teenager Molly Russell, just 14 years old, reportedly took her own life in 2017 after viewing disturbing content—which possibly encouraged suicide or a suicidal outlook—on Instagram.

 UN Social Media
UN Social Media
Source: UN Social Media

Matt Hancock, the UK Health Minister, was subsequently reported, in the last week, as declaring that he was, "desperately concerned to ensure young people are protected."

Molly Russell’s father, according to the BBC and other outlets, said he believed Instagram "helped kill my daughter".

The headlines became; ‘Social media firms could be banned if they fail to remove harmful content, the health secretary has warned’. This for example, on the BBC News website.

The Minister for Health, said on a BBC TV interview programme on January 27th 2019, that he was "horrified" to learn of Molly Russell’s death.

Just a day or so later, the Children's Commissioner, Anne Longfield, waded in, with a widely reported open letter to tech firms, declaring: “The tragic suicide of Molly Russell and her father’s appalled response to the material she was viewing on social media before her death have again highlighted the horrific amount of disturbing content that children are accessing online…I do not think it is going too far to question whether even you, the owners (of tech companies), any longer have any control over their content”.

Suicide-encouraging sites should be regulated, and promotion of suicide over the Internet is already censored to some extent by electronic filtering. Encouraging suicide is illegal in Australia, yet remains legal in Japan, which has one of the highest suicide rates in the world.

But maybe people, particularly children, turn to the internet when in the real physical world services are difficult to access at best, or even nonexistent. Perhaps the link between social media use and suicide in children tells us something about children's perceptions about turning to mental health services supposedly designed for them and should create a call to do better in that area.

A 2015 Canadian study attempted to examine social media use and suicidal thinking in 753 middle and high school children in Ottawa. This research found that during the prior 12 months, of those who reported low use of social-networking sites such as Instagram and Facebook, only 5.5% seriously considered attempting suicide, while the proportion jumped to 24.9% for those visiting these sites for more than two hours each day.

The study, published in the academic journal, Cyberpsychology, Behavior, and Social Networking, also found that students who reported that they wanted to talk to someone about a mental health or emotional problem, but didn’t know where to turn, were also more likely to engage in heavier social networking site usage than those who were able to communicate with someone in the real world about emotional issues.

The authors, Dr. Hugues Sampasa-Kanyinga and Dr Rosamund Lewis, point out that research examining university students has found no relationship between getting depressed and heavy social media use. Those findings are in contrast to those of this study, which found such an association in high school students. This investigation found almost half (45.6%) of heavy users of social media sites had an unmet need for mental health support, but less than a fifth (16.0%) of infrequent users did.

Maybe as we get older, we get better at handling life’s trials, and perhaps we engage with social media differently. Being seen as ‘mental’ by friends means mental health issues might be particularly stigmatizing and embarrassing for younger adolescents, so they don’t seek help in the real world, and maybe as a result turn to the internet for help.

In October 2016, Jeremy Hunt confessed that children’s mental health services are the UK’s National Health Service’s biggest failing.

The British Medical Journal recently reported a survey of 1000 general practitioners (family doctors) conducted on behalf of the mental health charity Stem4, which found that almost all (99%) were apprehensive that young people in the UK risked harm while waiting for specialist mental health treatment. Most GPs (90%) also thought that mental health services for young people had deteriorated over the past two years.

Increasingly, GPs appear to be turning to prescribing antidepressants for children although the evidence that this is helpful remains to be confirmed.

In 2004 the United States Food and Drug Administration (FDA) re-analysed clinical trials and found a doubling of suicidal events for adolescents on active treatment with the newer SSRI-type antidepressants, and this led to a Black Box warning. This was as much perhaps, points out Dr. David Healy, a psychiatrist specialising in psychopharmacology, because of the background lack of efficacy of these drugs for teenage problems as for the data on suicidal events.

Healy, Professor of Psychiatry at the University of Bangor in Wales and lead author in an investigation entitled, ‘Paediatric antidepressants: Benefits and risks’, argues that in the decade since 2004, in the UK, antidepressants appear to be now among the most commonly prescribed drugs in adolescents, particularly in girls.

His review, published with co-authors in The International Journal of Risk & Safety in Medicine estimates that there has been a 100-fold increase of antidepressant prescribing in Britain for children, while a recent CDC publication places the use of antidepressants among American adolescents potentially at 13%.

This is worrying if the UK follows where the USA leads.

Another study recently, also published in The International Journal of Risk & Safety in Medicine, reported on the forensic examination of completed suicides between 2006–2010 by adolescents in Sweden. A selective serotonin reuptake inhibitor (SSRI) antidepressant, was found in the blood of adolescent patients from 42 suicides, representing 14% of completed suicides. The authors calculate that taking an SSRI antidepressant in those between ages 10 and 19, statistically speaking appears to elevate the chances of completed suicide some 25 times. Of course association does not equal causation. There may be other explanations for this association other than simple causation. But the finding led the authors of this study to conclude: "it is crucially important that depressed youth taking SSRIs be closely monitored throughout the duration of treatment."

However, it may sometimes be that antidepressants are prescribed as a substitute for close monitoring, as close monitoring is highly labour-intensive, and issuing a prescription less so.

The Ottawa study into Canadian school students reported on earlier, found that heavy social media usage was associated with an elevated chance of suicidal thinking by 5.9 times. Again association does not imply causation. It is always possible that the causality is running in the other direction, maybe more suicidal school students tend to take to social media more. 

There is, however, a grave danger that simply blaming the internet, diverts attention away from the provision of good mental health services, which could yet save more lives than regulating the internet but won’t get a politician on TV. And good mental health services for children means more than just issuing a drug prescription, although for hard-pressed child and adolescent services, a pill is increasingly what parents seem to be offered.

One study quoted by David Healy and coauthors in his ‘Paediatric antidepressants: Benefits and risks’ paper found that in one clinical trial there were 34 suicidal events on fluoxetine (or Prozac), compared to 3 on placebo. Yet none of the academic journals which reported the study mentioned this finding.

One theory as to why prescribing antidepressants in adolescents might be possibly more risky than with adults is that, according to Professor Healy and his coauthors, ‘emotional numbness’ has been reported as a side effect. This so-called “care less syndrome” might reduce empathy for others. It is this emotion that functions as a key inhibitor to acting on suicidal impulses. It might also create a state of emptiness and lifelessness that can become unbearable to the young person.

Adolescence is a difficult time for sexual feelings. Immediate genital numbing, a side effect that occurs in close to 100% of individuals who take an SSRI, according to Professor Healy, may be a side effect that adults can more easily deal with, compared with teenagers.

SSRI's, according to Professor David Healy, also have the potential to slow growth velocity during adolescence and also cause weight gain, two aspects of body image we already know adolescents are particularly sensitive to.

No one is arguing from the data that no child anywhere cannot be helped by these drugs. Instead, the research is merely pointing out that looking after children may be a lot more complex than just prescribing a pill. We kind of knew that already for adults, yet we may have forgotten that the same principle applies to children, perhaps even more so. No one should suddenly stop any treatment but go and talk to their doctor to have their prescription reviewed and inquire as to whether additional non-pharmacological treatments can be tried.

The very basis of the operation of internet giants such as Facebook and Google is to detect our preferences and show us more of what we want, rather than what we really need. Maybe someone should devise an internet search engine that constantly sends you what you really ought to know about, but would prefer not to.

Oh wait, traditional paper press kind of tried doing that for centuries, and look what happened to them after the arrival of web search algorithms.

Since the very basis of our economy is that we ever more efficiently give people what they want, rather than what they need, we could be more searching of ourselves and the society we have created, if we are going to properly tackle child mental health.

We need to examine more deeply ourselves, and the world we are creating, and insisting our children grow into. 

References

Paediatric antidepressants: Benefits and risks David Healy, Joanna Le Noury and Jon Jureidini International Journal of Risk & Safety in Medicine 30 (2018/2019) 1–7

Suicidal risk from TADS study was higher than it first appeared Goran H ¨ ogberg, David O. Antonuccio, and David Healy International Journal of Risk & Safety in Medicine 27 (2015) 85–91

Frequent Use of Social Networking Sites Is Associated with Poor Psychological Functioning Among Children and Adolescents Hugues Sampasa-Kanying and Rosamund F. Lewis. CYBERPSYCHOLOGY, BEHAVIOR, AND SOCIAL NETWORKING Volume 18, Number 7, 2015

Lack of services puts young people at risk, say GPs. 

Seven days in medicine: 2-8 January 2019 BMJ 2019; 364. doi: https://doi.org/10.1136/bmj.l82 (Published 10 January 2019)

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