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This study aimed to explore how they express themselves online through images posted on social media before and after self-harm and how this expression may change across these periods, employing visual content and thematic analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A prospective cohort study, with qualitative analysis conducted using a recurrent cross-sectional approach and codebook methodology, accounting for chronological changes across time points before, during and after episodes of self-harm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Participants were recruited from a mental health NHS Trust in the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Image data during episodes of self-harm was available for 20 participants. The majority of whom were aged 18 years or older (n=15), female (n=14) and met criteria for moderate or severe anxiety and depression (n=18). The sample reflected diverse ethnic backgrounds, with six participants identifying as Asian or Mixed\/Multiple ethnic backgrounds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>None of the images investigated had direct visual presentations of self-harm. A few images referenced self-harm through the medium of text, and this was largely to normalise and promote help-seeking. Several themes were identified, including participation in activities that support well-being, love and relationships, connecting through humour, expressions of distress, and promoting mental health awareness and support. Subtle temporal changes were also observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings suggest that young people may temporarily withdraw from social media on the day of a self-harm event and rarely post graphic self-harm images around that time. This may reflect concerns about being stigmatised, but also improved platform moderation. Instead, platforms may serve as spaces for expressing self-care behaviours and connecting with others about both positive and challenging emotions, and across a range of topics including mental health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04601220\">NCT04601220<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-103456","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T13:55:14Z","timestamp":1768830914000},"page":"e103456","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Visual content and thematic analyses of images shared on social media before and after episodes of self-harm in a UK clinical youth sample"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct04601220","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9808-4956","authenticated-orcid":false,"given":"Amanda","family":"Bye","sequence":"first","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, King\u2019s College London Institute of Psychiatry Psychology & Neuroscience, London, UK"},{"name":"Department of Psychological Medicine, King\u2019s College London Institute of Psychiatry Psychology & Neuroscience, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5865-4726","authenticated-orcid":false,"given":"Kylee","family":"Trevillion","sequence":"additional","affiliation":[{"name":"Health Service and Population Research Department, King\u2019s College London Institute of Psychiatry Psychology & Neuroscience, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Wilson-Lemoine","sequence":"additional","affiliation":[{"name":"Department of Psychological Medicine, King\u2019s College London Institute of Psychiatry Psychology & Neuroscience, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9512-752X","authenticated-orcid":false,"given":"Daniel","family":"Leightley","sequence":"additional","affiliation":[{"name":"Department of Psychological Medicine, King\u2019s College London Institute of Psychiatry Psychology & Neuroscience, London, UK"},{"name":"Department of Population Health Sciences, School of Life Course & Population Sciences, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0318-8865","authenticated-orcid":false,"given":"Ben","family":"Carter","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Informatics, King\u2019s College London Institute of Psychiatry Psychology & Neuroscience, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Liakata","sequence":"additional","affiliation":[{"name":"School of Electronic Engineering & Computer Science, Queen Mary University of London, London, UK"},{"name":"The Alan Turing Institute, London, UK"},{"name":"University of Warwick, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaycee","family":"Hopper","sequence":"additional","affiliation":[{"name":"YoungMinds, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5614-8659","authenticated-orcid":false,"given":"Rina","family":"Dutta","sequence":"additional","affiliation":[{"name":"Department of Psychological Medicine, King\u2019s College London Institute of Psychiatry Psychology & Neuroscience, London, UK"},{"name":"South London and Maudsley NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"2026011905550474000_16.1.e103456.1","unstructured":"National Institute for Health and Care Excellence . 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