An interventional study of Trigger Warning in Suicide Prevention and Social Media Users, sponsored by Sunnybrook Health Sciences Centre. Recruiting at 1 site in Canada. Open to participants aged 14 Years to 19 Years. Per ClinicalTrials.gov, last updated 2026-11-03.
Sponsored by Sunnybrook Health Sciences Centre · Not applicable, Interventional, and Prevention
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.
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.
186 studies on the registry are indexed under Suicide Prevention; 92 are open to participants now.
This study's planned enrollment of 82 is below the median of 140 across 167 interventional studies indexed under Suicide Prevention.
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Exclusion Criteria:
In this arm, participants will view a Trigger Warning (TW: Suicide) before the suicide-related content (one male -presenting and one female-presenting).
Behavioral: Trigger Warning
In this arm participants will not view a Trigger Warning before watching the suicide-related content (one male-presenting and one female-presenting).
The intervention will be the presence of a Trigger Warning (i.e., TW: Suicide) at the start of two suicide-related videos. One video will be of a male-presenting creator, and the other of a female-presenting. Both videos are recovery centered, but neutral, therefore not overally hoepful/postive, but not negative. We hypothesize that the presence of a Trigger Warning will affect emotional and behavioral responses to the suicide-related content.
Emotional Affect
We will measure emotional affect using the International Positive and Negative Affect Schedule - Short Form (I-PANAS-SF), State Version. Participants will rate the extent to which they are presently experiencing five positive emotions (alert, inspired, determined, attentive, active) and five negative emotions (upset, hostile, ashamed, nervous, afraid).
Time frame: Administered to both study groups immediately before and immediately after viewing both videos.
State Anxiety
State Anxiety will be measured using the STAI-S. It measures trait and state anxiety. This describes a participants current but teporary emotional response to an external trigger. Definition provided by APA: "anxiety in response to a specific situation that is perceived as threatening or dangerous. State anxiety varies in intensity and fluctuates over time." Participants will rate the degree to which they currently feel: calm, tense, upset, relaxed, content, worried.
Time frame: STAI-6 is administered immediately before and after viewing both videos (administered to both groups).
Self-Reported Behavioural Avoidance Intention
It is the desire to engage in behavioural avoidance of the TikTok video. It will be measured by one single question. That single question was created for the purposes of measuring participants' intention for behavioural avoidance in this study. Participants will be asked: "If you encountered videos like the ones you just watched while scrolling on social media, how likely would you be to skip or scroll past them without watching?", with responses rated on a scale from 1 ("not at all likely") to 5 ("extremely likely").
Time frame: It will be measured post- TW and stimuli viewing, for participants in both arms.
Retrospectively rated anticipatory anxiety, defined as anxiety experienced in anticipation of viewing content, rated retrospectively
It will be measured by one single question. That single question will be asked of participants in the TW+ group: "Thinking back, how anxious did you feel immediately after seeing "Trigger warning: Suicide"?" They will rate their anxiety on a scale from 1 ("not at all") to 5 ("extremely"). For this question, TW+ participants must retrospectively rate their anxiety (i.e. think back to the anxiety they felt at the time and rate it, rather than asking for their anxiety in the moment, after the TW).
Time frame: Administered to the TW+ group after viewing both videos.
Attitudes towards/opinions about the helpfulness of TWs
Participants will complete a post-experiment questionnaire that, among some other questions, assesses perceptions on the helpfulness of trigger warnings, including their perceived helpfulness for emotionally preparing viewers, helping viewers make informed viewing decisions, allowing viewers to avoid unwanted content, and protecting individuals with a history of suicidal thoughts and/or behaviours from unexpectedly encountering distressing content.
Time frame: Administered to both groups in the post-experiment
Plan to share: Yes — De-indentified IPD information will be disseminated upon request, once results are available.
Supporting information: Statistical analysis plan
Time frame: When the manuscript is publlished we will note that IPD is available upon request. Therefore, there is no established timeframe for the aavailability of IPD.
Access criteria: Those who request access, with a valid justification as to why (e.g., re-analysis or secondary analysis).
No publications or documents are linked to this record.
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