JMIR Preprints Khasawneh et al Examining the Self-harm and Suicide Contagion Effects Related to the Portrayal of the Blue Whale Challenge on YouTube and Twitter Amro Khasawneh, Kapil Chalil Madathil, Emma Dixon, Pamela Wiśniewski, Heidi Zinzow, Rebecca Roth Submitted to: JMIR Mental Health on: August 22, 2019 Disclaimer: © The authors. All rights reserved. This is a privileged document currently under peer-review/community review. Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review purposes only. While the final peer-reviewed paper may be licensed under a CC BY license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes. https://preprints.jmir.org/preprint/15973 [unpublished, non-peer-reviewed preprint] JMIR Preprints Khasawneh et al Table of Contents Original Manuscript....................................................................................................................................................................... 4 https://preprints.jmir.org/preprint/15973 [unpublished, non-peer-reviewed preprint] JMIR Preprints Khasawneh et al Examining the Self-harm and Suicide Contagion Effects Related to the Portrayal of the Blue Whale Challenge on YouTube and Twitter Amro KhasawnehMSc, ; Kapil Chalil MadathilPhD, ; Emma DixonBSc, ; Pamela Wi?niewskiPhD, ; Heidi ZinzowPhD, ; Rebecca Roth Corresponding Author: Kapil Chalil MadathilPhD Phone: +1864-656-0856 Fax: 1 864-656-0795 Email: [email protected] Abstract Background: Research suggests that direct exposure to suicidal behavior and acts of self-harm through social media may increase suicidality through imitation and modeling, with adolescents representing a particularly vulnerable population. One example of viral self-harming behavior that could potentially be propagated through social media is the Blue Whale Challenge (BWC). Objective: We investigate how people portray BWC on social media and the potential harm this may pose to vulnerable populations. Methods: We first used a grounded approach coding 60 publicly posted YouTube videos, 1112 comments on those videos, and 150 Twitter posts that explicitly referenced BWC. We deductively coded the YouTube videos based on the Suicide Prevention Resource Center (SPRC) Messaging guidelines. Results: Overall, 83.33%, 28.33%, and 68.67% of the YouTube videos, comments, and Twitter posts were trying to raise awareness and discourage participation in BWC. Yet, about 37% of the videos violated six or more of the SPRC messaging guidelines. Conclusions: These posts might have the problematic effect of normalizing BWC through repeated exposure, modeling, and reinforcement of self-harming and suicidal behavior, especially among vulnerable adolescents. Greater efforts are needed to educate social media users and content generators on safe messaging guidelines and factors that encourage versus discourage contagion effects. (JMIR Preprints 22/08/2019:15973) DOI: https://doi.org/10.2196/preprints.15973 Preprint Settings 1) Would you like to publish your submitted manuscript as preprint? Please make my preprint PDF available to anyone at any time (recommended). Please make my preprint PDF available only to logged-in users; I understand that my title and abstract will remain visible to all users. Only make the preprint title and abstract visible. No, I do not wish to publish my submitted manuscript as a preprint. 2) If accepted for publication in a JMIR journal, would you like the PDF to be visible to the public? 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I understand that if I later pay to participate in <a href="https://jmir.zendesk.com/hc/en-us/articles/360008899632-What-is-the-PubMed-Now-ahead-of-print-option-when-I-pay-the-APF-" target="_blank">JMIR’s PubMed Now! service</a> service, my accepted manuscript PDF will automatically be made openly available. https://preprints.jmir.org/preprint/15973 [unpublished, non-peer-reviewed preprint] JMIR Preprints Khasawneh et al Original Manuscript https://preprints.jmir.org/preprint/15973 [unpublished, non-peer-reviewed preprint] JMIR Preprints Khasawneh et al Original paper Amro Khasawneh1, MS; Kapil Chalil Madathil1,2; Emma Dixon3, BS; Pamela Wiśniews!i", PhD; #eidi M$ %inzow', PhD; (ebe**a (oth' 1Clemson Uni,ersit-, Department o. /ndustrial Engineering, Clemson, SC, United States 2Clemson Uni,ersit-, 2lenn Department o. Ci,il Engineering, Clemson, SC, United States 3Uni,ersit- o. Mar-land, Colle1e Par!, Colle1e o. /nformaton Studies, Colle1e Par!, MD, United States "Uni,ersit- o. Central 4lorida, Department o. Computer S*ience, 5rlando, 46 United States 'Clemson Uni,ersit-, Department o. Ps-*holo1-, Clemson, SC United States Corresponding Author7 Kapil Chalil Madathil, PhD Assistant Pro.essor Departments o. Ci,il and /ndustrial Engineering S Palme8o Bl,d, Clemson, SC 29:3" Clemson Uni,ersit- !madath;*lemson.edu Phone: <=13> 29"?:"99 4A@: <A:"> :':?B=9' Examining the Self-harm and Suicide Contagion Efects Related to the Portrayal of Blue Whale Challenge on You u!e and "itter #bstract Background: (esear*h su11ests that dire*t exposure to sui*idal )eha,ior and a*ts o. sel.?harm thro01h so*ial media ma- increase sui*idalit- thro01h imitaton and modeling, with adolescents representng a par3*ularl- ,ulnerable populaton. 5ne example o. ,iral sel.?harming )eha,ior that *ould potentall- be propa1ated thro01h so*ial media is the Blue Whale Challenge <BWC>$ Objective: We in,es31ate how people portra- BWC on so*ial media and the potental harm this ma- pose to ,ulnerable populatons. Methods: We Crst used a 1rounded approa*h *odin1 :B publi*l- posted Do0E0)e ,ideos, 1112 *omments on those ,ideos, and 1'B Ewi8er posts that expli*itl- re.eren*ed BWC. We dedu*3,el- *oded the Do0Eube ,ideos based on the Sui*ide Pre,enton (esour*e Center <SPRC) Messa1ing 1uidelines. Results: 5,erall, A3$33F, 2A$33F, and :A$:=F o. the Do0Eube ,ideos, *omments, and Ewi8er posts were tr-ing to raise awareness and discoura1e par3*ipaton in BWC$ Det, about 3=F o. the ,ideos ,iolated six or more o. the SPRC messa1ing 1uidelines. Conclusions: Ehese posts mi1ht ha,e the problema3* eGe*t o. normali&ing BWC thro01h repeated exposure, modeling, and rein.or*ement o. sel.?harming and sui*idal beha,ior, espe*iall- among ,ulnerable adoles*ents. 2reater eGorts are needed to edu*ate so*ial media users and *ontent 1enerators on sa.e messa1ing 1uidelines and .a*tors that encoura1e ,ersus discoura1e *onta1ion eGe*ts. Keywords: So*ial media *hallenges; Blue Whale Challenge; Sel.?harm; Di1ital sel.?harm; Sui*ide; https://preprints.jmir.org/preprint/15973 [unpublished, non-peer-reviewed preprint] JMIR Preprints Khasawneh et al Mental health and wellbeing; Problema3* internet )eha,iors $ntroduction Adolescents and -oung adults are the lar1est populaton using the internet, as it has be*ome an essental instrument .or their schoolwor!, in.ormaton *olle*ton, and so*iali&ing H1I"J$ Communi*aton tools on the internet, including emails, dire*t textng, and )lo11ing ha,e be*ome .undamental in adoles*ents’ so*ial de,elopment H',6J$ More re*entl-, online so*ial networ!s, also !nown as so*ial media, su*h as 4a*eboo!, /nsta1ram, Ewi8er, and Do0Eube ha,e )e*ome more popular and *ommon staton among adolescents where the- *an de,elop publi* a**ounts or proCles to *onne*t with other indi,iduals and see their list o. *onne*tons and posts H'I=J$ While so*ial media has *reated a number o. opport0nites .or indi,iduals to 1arner so*ial support online H1,2,8I1BJ, it also has the potental to .urther mar1inali&e par3*0larl- ,ulnerable indi,iduals. (e*ent studies ha,e hi1hli1hted how so*ial media *an be used to harass, dis*riminate H11,12J, dox H13J, and so*iall- disen.ranchise those indi,iduals H1",1',1:J$ Some resear*h e,en sug1ests that so*ial media use ma- be a *ontributng .a*tor to the si1niC*ant in*rease in sui*ide rates and depressi,e s-mptoms among adoles*ents and -oung adults in the past de*ade H1,1=,1AJ$ E,idence sug1ests that sui*idal beha,ior *an )e propa1ated thro01h so*ial *onta1ion eGe*ts, whi*h model, normali&e, and rein.or*e sel.?harming )eha,ior H19I21J$ Ehese harm.ul beha,iors and so*ial *onta1ion eGe*ts ma- o**ur more .requentl- thro01h repe33,e exposure and modelling ,ia so*ial media, espe*iall- when such *ontent 1oes M,iralN H19,2B,22J$ S0*h widespread exposure to harm.ul or sug1es3,e *ontent is par3*0larl- detrimental to ,0lnerable indi,iduals, including adolescents and -oun1 adults H23,2"J$ Most o. the literature re1arding adolescent online sa.et- .o*uses on sexual or a11ressi,e )eha,iors that put -outh at risk H2'J$ Un.ortunatel-, less resear*h has examined how so*ial media *an inO0ence adolescents and -oun1 adults to enga1e in sel.?harming )eha,ior H2B,2:,2=J$ Ehus, interdisciplinar- resear*hers see! to shed li1ht on the ur1ent need to .orm a *ohesi,e resear*h a1enda around di1ital sel.?harm H2:J, online non-sui*idal sel.?inPur- H2AJ, the use o. so*ial media to discuss deliberate a*ts o. sel.?harm, and a*ts o. *-ber?sui*ide H29,3BJ$ Most o.