Overview
Rates of suicide among Canadian youth have risen steadily over the past two decades, alongside rapid growth in social media use-especially TikTok. Our research shows that TikTok contains substantial suicide-related content that may pose risks to vulnerable young people by provoking distress or encouraging copycat behaviour. Many creators add trigger warnings (TWs) to flag upsetting material, yet their impact is unclear. Although research shows mixed effects of TWs among people with trauma histories, no studies have examined TWs in the context of suicide-related content. Our recent findings indicate that TWs are associated with reduced engagement suicide-related videos on TikTok-contrary to our hypothesis that they might increase engagement. Although we can only speculate, reduced engagement may reflect youth avoiding TW-labelled content, or other unknown factors. This study will examine how a clinical population of youth at risk of suicide emotionally and behaviourally respond to TWs on self-harm and suicide-related content. Findings will provide key evidence to inform public health recommendations aimed at protecting youth from harmful content online.
Description
7: Department of Psychiatry, Sunnybrook Health Science Centre, Toronto, Canada 8: National Council for Suicide Prevention, Minneapolis, Minnesota, USA Background: Suicide is the second leading cause of death among Canadian youth under 24. Social media, particularly TikTok, is widely used by Canadian youth, where suicide-related content is highly prevalent. Harmful content that glamorizes or normalizes suicide is especially concerning given its potential to contribute to social contagion-the spread of behaviours, emotions, and attitudes through social networks.
Trigger warnings (TWs), which alert viewers to potentially distressing material, are one strategy intended to mitigate the negative effects of exposure to suicide-related content. However, evidence regarding their effects on emotional responses and behavioural avoidance remains mixed. To date, no research has examined TWs specifically in relation to suicide-related social media content or among clinical populations at elevated risk for suicide. This study aims to examine the impact of TWs on affect and state anxiety among youth viewing suicide-related TikTok content.
Methods: Youth aged 14-19 years with a lifetime history of suicidal thoughts and/or behaviours, including passive suicidal ideation within the past 6 months, will be recruited (N = 82). Exclusion criteria include suicidal intent, planning, or behaviour within the past 6 months, as well as active psychosis or mania. Participants will be randomized 1:1 to view two expert-vetted, recovery-oriented TikTok videos featuring one male-appearing and one female-appearing protagonist, with the video order counterbalanced. Participants will view the videos either with (TW+) or without (TW-) a 6-second trigger warning.
Affect and state anxiety will be assessed immediately before and after viewing the TikTok videos using standardized measures (β = 0.80, α = .05, f = 0.20). Post-experiment questionnaires will also assess participants' perceptions of the utility of trigger warnings. Among participants in the TW+ condition, questionnaires will also assess intention to avoid the warned-about content and retrospectively rated anticipatory anxiety following exposure to the trigger warning.
Changes in affect and state anxiety will be analyzed using linear mixed-effects models examining the interaction between trigger warning condition and time (TW presence × time). Post-experiment outcomes will be analyzed using ANCOVAs, adjusting for relevant confounders. Outcomes will also be examined by sex and gender to identify patterns suggestive of potential sex- and gender-related differences.
Results: Preliminary results are expected to be available by the time of the symposium. We hypothesize that trigger warnings (TWs) presented before suicide-related TikTok videos will alter viewers' emotional responses compared with viewing the same videos without TWs.
Discussion: This study will provide novel evidence on how trigger warnings influence emotional and behavioural responses to suicide-related content among youth at elevated risk for suicide. The results may inform evidence-based recommendations for social media platforms and public health strategies aimed at promoting safer online environments for youth. They may also help guide clinical approaches to assessing and addressing the influence of social media on suicide risk and broader mental health outcomes.
Eligibility
Inclusion Criteria:
- Lifetime or recent suicidal thoughts as measured on the Columbia Suicide Severity Rating Scale (C-SSRS)20 screening version. Defined as answering "YES" Question 2 on the C-SSRS with a lifetime and/or past month time-framing ("In your entire life, have you ever had any thoughts of killing yourself?" and/or "In the past month, have you had any thoughts of killing yourself?")
- Self-identified consumer of short-form content on social media (e.g. Instagram reels, TikTok, YouTube Shorts) in the last year.
- English comprehension
Exclusion Criteria:
- Suicidal ideation with any intent or plan in the last 6 months. Defined as answering "YES" on any one C-SSRS Question 3 to 5 with a past 6-months timeframe. Note: Suicidal ideation in the absence of intent or planning is not an exclusion criterion
- Suicidal behaviour in the last 6 months. Defined as answering "YES" to C-SSRS Question 6 ("In your entire life, have you ever done anything, started to do anything, or prepared to do anything to end your life?") AND a 6-months follow up questions ("Was this within the past 6 months?"). Note: Lifetime suicidal behaviour (i.e. answering yes to only Question 6) is not an exclusion criterion
- In active psychosis or mania, as indicated by patient's medical records
