{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T21:00:55Z","timestamp":1790197255218,"version":"4.1.0"},"reference-count":28,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Ment Health"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Self-harm, including suicidal thoughts, self-injurious behavior, and disordered eating, is a major public health concern among adolescents and young adults. Youth increasingly encounter self-harm\u2013related content online, including websites that explicitly encourage harmful behaviors. Although exposure to such content has been linked to poorer mental health, most research is cross-sectional and has not examined longitudinal exposure trajectories. Whether persistent exposure represents a distinct digital risk pattern remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study examined longitudinal trajectories and correlates of exposure to self-harm\u2013encouraging websites over 1 year and tested whether persistent exposure was associated with subsequent suicidal ideation, self-injury, and disordered eating.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We analyzed data from 2197 US youth aged 13 to 22 years who completed waves 2 and 4 of Project Lift Up, a national longitudinal cohort study. Website exposure was categorized into 4 trajectories: none, desist (wave 2 only), new (wave 4 only), and persistent (both waves). Categories reflected reported exposure at the 2 assessment waves rather than the frequency or continuity of website use between assessments. Logistic regression models estimated associations between exposure trajectory and wave 4 suicidal ideation, self-injury, and disordered eating, restricting analyses to participants without the respective outcome at wave 2. Models were adjusted for demographics and wave 2 depression or anxiety symptoms and other mental health indicators.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Overall, 26.5% (583\/2197) reported exposure to self-harm\u2013encouraging websites at wave 2, and 18.5% (407\/2197) reported persistent exposure. Privacy concerns, embarrassment, curiosity, and lack of offline support were associated with greater odds of persistence (adjusted odds ratios [aORs] 1.84\u20103.23), whereas accidental exposure was associated with lower odds of persistence (aOR 0.28, 95% CI 0.19\u20100.41). Compared with no exposure, persistent exposure was associated with higher odds of suicidal ideation (aOR 1.88, 95% CI 1.24\u20102.86;\n P<\/jats:italic>\n =.003), self-injury (aOR 3.14, 95% CI 2.05\u20104.80;\n P<\/jats:italic>\n <.001), and disordered eating (aOR 2.46, 95% CI 1.54\u20103.93;\n P<\/jats:italic>\n <.001). Adjusted predicted probabilities showed a graded pattern, with persistent exposure associated with the highest predicted probabilities (suicidal ideation: 33.4% vs 21.3%; self-injury: 25.7% vs 10.2%; disordered eating: 11.7% vs 5.3%). New exposure was associated with increased odds of self-injury (aOR 2.32, 95% CI 1.30\u20104.15;\n P<\/jats:italic>\n =.004) but was not significantly associated with suicidal ideation or disordered eating. The desist trajectory was not significantly associated with outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Persistent exposure to self-harm\u2013encouraging websites may represent a distinct digital risk pattern associated with higher subsequent odds of suicidal ideation, self-injury, and disordered eating. Assessing patterns of repeated website exposure and youths\u2019 motivations for seeking this content\u2014not merely whether exposure occurred\u2014may improve the identification of youth at heightened risk and inform digital prevention and clinical intervention strategies.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/95200","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:59:52Z","timestamp":1790193592000},"page":"e95200-e95200","source":"Crossref","is-referenced-by-count":0,"title":["Trajectories of Persistent Exposure to Self-Harm\u2013Encouraging Websites and Subsequent Mental Health Outcomes in US Youth: Longitudinal Cohort Study"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1974-1637","authenticated-orcid":false,"given":"Kimberly J","family":"Mitchell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8221-9425","authenticated-orcid":false,"given":"Ateret","family":"Gewirtz-Meydan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9645-5055","authenticated-orcid":false,"given":"Victoria","family":"Banyard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"issue":"9","key":"R1","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1016\/S2215-0366(22)00193-6","article-title":"Prevalence of suicidal ideation and self-harm behaviours in children aged 12 years and younger: a systematic review and meta-analysis","volume":"9","author":"Geoffroy","journal-title":"Lancet Psychiatry"},{"issue":"7","key":"R2","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1007\/s00127-018-1522-1","article-title":"Increasing rates of self-harm among children, adolescents and young adults: a 10-year national registry study 2007-2016","volume":"53","author":"Griffin","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2023.10.017","article-title":"Risk and protective factors for self-harm in adolescents and young adults: an umbrella review of systematic reviews","volume":"168","author":"McEvoy","journal-title":"J Psychiatr Res"},{"issue":"7","key":"R4","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1177\/00048674231165477","article-title":"Health-related quality of life in children, adolescents and young adults with self-harm or suicidality: a systematic review","volume":"57","author":"Le","journal-title":"Aust N Z J Psychiatry"},{"issue":"3","key":"R5","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1027\/0227-5910\/a000307","article-title":"Information-seeking on the Internet","volume":"36","author":"Singaravelu","journal-title":"Crisis"},{"issue":"12","key":"R6","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.2802","article-title":"Exploring the use and effects of deliberate self-harm websites: an Internet-based study","volume":"15","author":"Harris","journal-title":"J Med Internet Res"},{"issue":"4","key":"R7","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18042186","article-title":"Psychological impact of pro-anorexia and pro-eating disorder websites on adolescent females: a systematic review","volume":"18","author":"Mento","journal-title":"Int J Environ Res Public Health"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2018.06.028","article-title":"Theoretical and empirical foundations of a novel online social networking intervention for youth suicide prevention: a conceptual review","volume":"238","author":"Bailey","journal-title":"J Affect Disord"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1080\/15374416.2020.1750019","article-title":"Adolescent peer experiences and prospective suicidal ideation: the protective role of online-only friendships","volume":"51","author":"Massing-Schaffer","journal-title":"J Clin Child Adolesc Psychol"},{"issue":"6","key":"R10","doi-asserted-by":"publisher","first-page":"2404","DOI":"10.1111\/hsc.13819","article-title":"Web-based support services to help prevent suicide in young people and students: a mixed-methods, user-informed review of characteristics and effective elements","volume":"30","author":"Cohen","journal-title":"Health Social Care Community"},{"key":"R11","doi-asserted-by":"crossref","unstructured":"Kenny B Robinson J N\u00fa\u00f1ez D . 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