Reflective journaling on suicide and self-harm related online use: An intervention approach for reducing online harm and mental health impact

Objective: Self-harm and suicide-related online use can bring harms and benefits for users. Research suggests a need to improve user metacognition around online engagement to manage these conflicting effects, but behavioural interventions to achieve this are lacking. We aimed to analyse data from a 6-month longitudinal qualitative study, in which participants journalled about their self-harm and suicide-related online use as part of the study. Methods: Participants were interviewed at three timepoints (n = 9 participants, 25 interviews) and completed a daily reflective diary between interviews. Experiences of diary use were explored qualitatively during interviews and in free-text diary entries. Results: All participants derived benefits from journalling about their engagements with self-harm and suiciderelated online content, such as increased insight about the nature and impact of their online use. Some in turn reported positive behaviour changes. However, daily completion was burdensome and some participants reported potential costs, including increased attention to self-harm content. Conclusions: Journalling about online activity should be explored as potential individual-level intervention to tackle harmful online use and reduce linked mental health morbidity, both within and outside of clinical setting. Co-designed research with lived-experience users and practitioners will be essential for maximising safety and likely success.