Text mining to identify the nature of online questions about nonsuicidal self-harm | BMC Public Health


This study analyzed 7,893 posts from Naver Knowledge iN through topic modeling to understand online posts about NSAID. Overall, NSSI posts have steadily increased from 2009 to 2018. Additionally, we have identified 10 topics and keywords for each topic.

Recent figures have shown a dramatic increase in the number of people who self-harm in South Korea. In 2018, the number of NSSI counseling sessions at youth counseling and welfare centers more than tripled compared to 2017 [23]. Moreover, as shown in Figure 1, the data collected in this study tripled in 2018 compared to 2017. The cause of the sudden increase in the number of posts in 2018 is unclear. Naver Knowledge iN represents a general question and answer community that enables users to provide and receive information in Korea. Although its main purpose is to give and seek information, people who self-harm appear to seek information and emotional support for self-harm. People all over the world have used the internet as a means of communication, given that it provides a conducive environment for users to discuss sensitive or unexposed health topics. [24]. This finding suggests the need for consultative interventions in which people who self-harm can receive help online.

Of the 10 subjects from this study, the topic “concerns about AMNS scarring” (T5, 18.0%) had the most questions, and the number was increasing rapidly each year. Similar to the results of a previous study [25] in which many self-injurers were aware of their injuries or scars and made desperate efforts to hide their injuries from others, our study revealed many questions about the method of scar concealment. These questions included: “Does NSAID leave scars? and “How do I hide NSSI scars?” However, questions about the treatment of scars created in the past, hospitals, services that can treat scars, methods of treatment and treatment of complications have been classified in another subject called “medical advice” (T8, 7, 4%). This topic included questions regarding the hospital treatment of NSSI. Since Naver Knowledge iN represents a general Q&A community, information needs regarding NSSI, such as concerns about scars and medical advice, are the most frequently asked questions. Consistent with previous online forum content [11], the current study demonstrated that concealment of scars is common. Many people hide scars and secretly treat them privately due to social stigma [26]. However, since NSAID can induce serious safety issues by causing secondary infection or disease of injured parts, in addition to scars formed on the skin, individuals should understand the importance of proper wound treatment. and educate them on coping methods. Moreover, a previous study [27] reported that the degree of scar concealment is associated with more significant experiences of higher levels of anxiety and depressive symptoms and higher severity of NSSI cravings. The increase in publications on NSMA scarring issues means that a deeper understanding of the scar concealment practices of people engaging in NSMA is needed.

The second highest number of questions collected in this study related to “gathering information about NSSI” (T3, 14.7%). This topic described NSSI in detail and included questions about whether a specific behavior is NSSI and why one would behave that way. In particular, the term “first time” ranked first, indicating that people who have started self-harming are using the Internet for information. Therefore, efforts are needed to provide NSSI information and support over the Internet. Additionally, the accuracy of information on websites should be monitored and evaluated to protect individuals from unnecessary responses. [10].

Another topic considered was “stigma and thoughts about people who self-harm” (T10, 10.0%). People who shared their SLA experiences wanted to be accepted and verified more often than those who did not disclose SLAs [11]. People who self-injure find it difficult to disclose their condition to others for fear of stigma, but want others to understand them because they cannot avoid self-harm at the moment. Instead of condemning individuals’ self-harming behavior, we need to protect and support them in social and cultural contexts [28].

Additionally, people who did not self-injure asked questions about “how to help a friend who is self-injuring” (T6, 9.7%), signifying the importance of understanding as well as asking parties stakeholders (e.g., family, friends, partners, and colleagues) who can search for answers to NSSI questions on the Internet [9 Whitlock, Purington, and Gershkovich [29] reported that a person who witnesses NSSI or a friend’s scars might end up imitating NSSI when encountering difficult circumstances. NSSI prevention programs should be developed with consideration of the effects on adolescents who self-harm. Additionally, educating and using peers who help self-harming friends is considered beneficial [28].

We identified negative emotions such as anger (T1, 8.6%), depression (T7, 8.3%), and stress (T4, 7.9%) in online ANS posts. NSSI is a pathological response that functions as a coping mechanism to temporarily dampen intense feelings such as anxiety, depression, stress, emotional insensitivity, feelings of failure, and self-loathing. [4, 28, 30]. NSSI stabilizes intense and unbearable emotions. He seems to control the emotions when we try to find [31]. The topic of “depression” (T7) in this study included suicidal impulses. AMNS is strongly correlated with suicide attempts, and suicide is strongly linked with depression [24, 25, 28]. A meta-analysis of the prevalence of NSSI functions in community and clinical samples [30] showed that intrapersonal functions (eg, relating to emotion regulation) were most reported by people who self-injured (63–78%), while interpersonal functions (eg, expressing distress ) were less common (33–56%). Several theoretical models of the ANS focus on emotion regulation or the avoidance function of the ANS [30]. While these models may best suit people whose dominant motive leading to NSAID is to regulate difficult emotions, they may not suit someone whose primary function involves self-punishment or distress communication.

The other topic was “how to practice or stop NSAID” (T9, 7.1%). People interested in NSMA were asked if NSMA was painful and how one can self-harm without pain; thus, Internet activities can be used as a means of sharing NSSI methods. This topic also included questions about ways to stop self-harm; they feared progressing to more severe self-harm and felt no pain during the self-harm. Holey et al. [32] found that people who self-injured demonstrated greater pain tolerance and pain thresholds in laboratory tasks than noninjurious control groups, suggesting that self-harm, in particular, may be a mechanism by which individuals become insensitive to pain [8, 32]. We predict that there will be a stronger association between ANS and acquired abilities in people engaging in severe or repeated ANS. According to learned capacity which is a construct of Joiner’s interpersonal theory of suicide, once an individual achieves the learned capacity to commit suicide through desensitization or habituation to fear and pain, it is likely that an individual will be at increased risk of suicide. [7]. However, according to a study analyzing Instagram posts, only 1% of all posts conveyed information or messages about the need to help reduce ANS [24]. The Disaster and Injury Information Center provides fragmented information on ANS in Korea, but Korean websites lack information and public services related to ANS. According to Frost and Casey [33], various channels, including online support for NSSIs, are needed to help adolescents and young adults who cannot seek help through other means. Individuals use various types of online support and differ in the support they seek. A comprehensive understanding of the characteristics and scope of online activities of people who self-injure can aid in enacting self-harm interventions [11]. Postings on the Internet have the positive aspects of expressing and communicating negative emotions, but there are also negative aspects associated with sharing NSM experiences and finding ways to harm yourself. Since NSSI material in these online communities can normalize and reinforce NSSI, monitoring and intervention may be necessary to ensure that people who harm and do not harm themselves do not receive inappropriate feedback. and useless on the Internet. Mental health professionals should participate in question-and-answer communities for appropriate online interventions provided by expert panels to address the needs of those who self-harm.

NSSI caused by parental discordance and unstable family situations was categorized as “family problems” (T2, 8.3%), and the number of questions about it decreased each year. Parental emotional deprivation, a dysfunctional family, and an unstable nurturing environment during childhood are risk factors for AMNS [28]; therefore, family factors should be included when counseling people who self-injure. Whereas family support has the greatest effect on the onset, maintenance and cessation of ALC [34]investigating the relationship between a child who self-harms and his or her parents would help prevent NSAID.


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