Impact of social media “challenges” on poison center case volume for intentional ingestions among school-aged children: an observational study

Mental health problems among youth have escalated over the past decade, with increased rates of self-harm, including suicide attempts by ingestion. Social media use has been linked to youth mental health, including “challenges” urging youth to ingest substances for recreational and other purposes. We hypothesized that social media challenges for particular substances would temporally correspond with increased ingestions of these substances. We identified peak Google Trends search times for social media ingestion challenges involving diphenhydramine, laundry pods, nutmeg, and cinnamon, and used data from America’s Poison Centers National Poison Data System to plot reported ingestions 3 months before and after peak searches in school-aged children. There were 2,169 individuals in the analysis. Diphenhydramine was the most frequently reported ingestion for misuse/abuse and suicidal purposes (n = 266 and 1,609, respectively). For all ingestions together, 45 percent (n = 979) had a moderate health effect, and 6.35 percent (n = 137) had a major health effect. Time of peak searches corresponded with increased ingestions for each substance. We found a temporal relationship between peak Google Trends searches for ingestion challenges and ingestions of that substance reported to United States poison centers. Compared to misuse/abuse ingestions, most suicidal ingestions peaked 1–2 months later, suggesting a public health opportunity for intervention. This retrospective observational study does not establish causal effect. All data are a result of self-reporting of the exposures, which may lead to a reporting bias. Google Trends is not the only search engine and likely underestimates the true incidence of social media posts. Additional research is needed on the relationship between social media and youth mental health, particularly around “challenges” that place youths’ health at risk. There may be opportunities for intervention to decrease medical and mental health sequelae of these challenges.

过去十年来，青少年心理健康问题呈加剧态势，自残行为发生率持续攀升，其中涵盖经摄入途径实施的自杀未遂。社交媒体使用与青少年心理健康状况存在显著关联，其中不乏诱导青少年为娱乐或其他目的摄入特定物质的“挑战式活动”。本研究提出假设：针对特定物质的社交媒体挑战活动，其传播时段与该物质的摄入案例增加存在时间相关性。本研究针对涉及苯海拉明（diphenhydramine）、洗衣凝珠、肉豆蔻与肉桂的摄入类社交媒体挑战活动，确定了其谷歌趋势（Google Trends）搜索峰值时段，并借助美国毒物中心国家毒物数据系统（America’s Poison Centers National Poison Data System）的数据集，绘制学龄儿童在搜索峰值前后3个月内的报告性摄入案例变化曲线。本次分析共纳入2169名研究对象。苯海拉明是因滥用/误用及自杀意图而被摄入的最常见物质，对应报告案例数分别为266例与1609例。所有摄入案例中，45%（979例）对健康造成中度损害，6.35%（137例）造成重度健康影响。各类物质的搜索峰值时段，均与其摄入案例的增加呈现对应关系。本研究证实：摄入类社交媒体挑战的谷歌趋势搜索峰值时段，与美国毒物中心报告的对应物质摄入案例数之间存在时间关联。与滥用/误用摄入案例相比，绝大多数自杀意图摄入案例的峰值出现时间晚1至2个月，这为公共卫生干预提供了可行契机。本项回顾性观察研究并未确立因果关联。所有数据均来自暴露事件的自我报告，这可能引入报告偏倚。谷歌趋势并非唯一的搜索引擎，其可能低估了社交媒体相关帖子的真实传播规模。未来仍需开展更多针对社交媒体与青少年心理健康之间关联的研究，尤其是聚焦于威胁青少年健康的“挑战式活动”。针对此类挑战活动引发的躯体与心理健康后遗症，开展干预具备可行空间，可有效降低相关损害。