Table 2.

Summary of included studies examining the perspectives of individuals on the impact of sharing and viewing web-based images or videos of self-harm.

Category (Author, year, country, quality score)	User perspectives
	Aims and objectives	Participants or sample	Results
Jacob, 2017 [9], United Kingdom, high.	To explore how young people understand and use web-based images of self-harm using semistructured interviews	21 individuals aged 16-24 years, living in Wales, United Kingdom, with a previous history of self-harm. Mean age for self-harm commencement was 13 years. A total of 16 participants sought professional help, 8 presented to emergency departments for their injuries; 86% (18/21) were female.	Some individuals cited the internet as a catalyst in the development of self-harm, where individuals were searching for advice and support and self-harm had “just come up” in the search with instructions and images. The majority engaged with web-based spaces to support and further develop a pre-existing set of self-harming practices and reported the role of the internet in normalizing self-harm. Image rather than text-based interactions were the primary reason cited for using the internet for self-harm–related purposes. Images were said to invoke a physical reaction and inspire behavioral enactment. Participants reported viewing self-harm images as part of a ritualistic practice.
Seko, 2015 [38], multiple countries, high.	To conduct qualitative analysis of web-based interviews with individuals who produce self-harm content. To understand why content creators create and share self-harm–themed content and what needs are met by doing so	Creators of self-harm creative content, n=17; 82% (14/17) female	Thematic analysis of participants’ narratives identified 2 prominent motives: self-oriented motivation (to express self and creativity, to reflect on self-harm experience, and to mitigate self-destructive urges) and social motivation (to support similar others, to seek out peers, and to raise social awareness). Participants also reported a double-edged impact of self-harm content both as a trigger and a deterrent to self-harm.
Sternudd, 2012 [39], multiple countries, moderate.	To examine discourses about self-injury photos from a user’s perspective using web-based questionnaires	Users of self-injury forum: n=52; 87% (45/52) female	Informants reported that viewing or sharing images had alleviating rather than triggering effects with production of images often about memory and proof. Publishing them was seen as a way of sharing experiences with others and to give or receive help. Self-injury photos were described as a resource of a self-harm community culture. Informants often emphasized that the outcome of viewing these photos varies due to individual and situational differences.