Suicide PreventionNCT07913854
Exploring The Effect of TikTok Trigger Warnings in a Clinical Sample of Youth at Risk of Suicide
A study testing Trigger Warning in people with Suicide Prevention and Social Media Users, run by Sunnybrook Health Sciences Centre at 1 site in Canada.
Trial summary
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… Read more about this study
- Who is it for?
- Ages 14 to 19 years
- Conditions the study is for
- Suicide Prevention, Social Media Users
- What is being tested?
- Trigger Warning
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 82 participants
- Where
- 1 siteCanada
- Study dates
- 15 Nov 2026to 15 Dec 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 14 to 19 years
- All sexes
- No healthy volunteers
- Child, Adult
Who may be able to join
- 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
Who cannot join
- 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
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Canada1 site, 1 recruiting
- Recruiting
Sunnybrook Health Sciences Center
Toronto, Ontario, M4N 3M5
Zoe Shelton, B.A., 4388703910, zoejacklyn.shelton@mail.utoronto.ca
Caroline Milligan, H.BSc, 416-347-9622, caroline.milligan@sunnybrook.ca
About this study
Official title: Red Flag, Green Light: Exploring The Effect of TikTok Trigger Warnings in a Clinical Sample of Youth at Risk of Suicide
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.
Read the detailed 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.
- Conditions
- Suicide Prevention, Social Media Users
- Being tested
- Trigger Warning
- Keywords
- Create Guidelines and Best Practices, Mental Health, Youth Mental Health, Suicide, Social Media, Trigger Warnings
- Medical subject headings
- Suicide Prevention, Psychological Well-Being, Suicide
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Trigger WarningBehavioural
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.
| Study group | Role | What they receive |
|---|---|---|
| TW+: Trigger warning before suicide-related videos | Experimental | In this arm, participants will view a Trigger Warning (TW: Suicide) before the suicide-related content (one male -presenting and one female-presenting). Receives: Behavioral: Trigger Warning |
| TW-: No Trigger Warning | No intervention | In this arm participants will not view a Trigger Warning before watching the suicide-related content (one male-presenting and one female-presenting). |
What is being measured
The primary outcome is the main question the study is designed to answer.
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).
Measured: Administered to both study groups immediately before and immediately after viewing both videos.
Secondary outcomes (2)
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.
Measured: 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").
Measured: It will be measured post- TW and stimuli viewing, for participants in both arms.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 Nov 2026
- Study start15 Nov 2026 (estimated)
- Primary completion15 Aug 2027 (estimated)
- Study completion15 Dec 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Suicide PreventionStudies of the same condition, open and under way.
- More trials run by Sunnybrook Health Sciences CentreThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- 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.
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 82 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Sunnybrook Health Sciences Centre
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Rachel Mitchell, MD, MSc, Principal investigator, University of Toronto; Sunnybrook Health Sciences Center
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07913854
- Sponsor's protocol ID
- 7213
- Other IDs
- SHS-026-009
- Status last verified
- Oct 2026
- First submitted
- 27 Oct 2026
- Last updated
- 3 Nov 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: De-indentified IPD information will be disseminated upon request, once results are available.
Study at a glance
From the registry record, last updated by the sponsor on 3 Nov 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Red Flag, Green Light: Exploring The Effect of TikTok Trigger Warnings in a Clinical Sample of Youth at Risk of Suicide
- ClinicalTrials.gov ID
- NCT07913854
- Acronym / sponsor ID
- 7213
- Conditions
- Suicide Prevention, Social Media Users
- Keywords
- Create Guidelines and Best Practices, Mental Health, Youth Mental Health, Suicide, Social Media, Trigger Warnings
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 82 participants (estimated)
- Lead sponsor
- Sunnybrook Health Sciences CentreUniversity, hospital or other
- Study start
- 15 Nov 2026 (estimated)
- Primary completion
- 15 Aug 2027 (estimated)
- Study completion
- 15 Dec 2027 (estimated)
- First posted
- 3 Nov 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed 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.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 2
- Model description
- 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.
| Arm | Type | Receives |
|---|---|---|
| TW+: Trigger warning before suicide-related videos | Experimental | Behavioral: Trigger WarningIn this arm, participants will view a Trigger Warning (TW: Suicide) before the suicide-related content (one male -presenting and one female-presenting). |
| TW-: No Trigger Warning | No intervention | –In this arm participants will not view a Trigger Warning before watching the suicide-related content (one male-presenting and one female-presenting). |
Who may qualify
- Ages
- 14 to 19 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
Key inclusion criteria (3 listed)
- 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
Key exclusion criteria (3 listed)
- 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
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Trigger WarningThe 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. | Behavioural | TW+: Trigger warning before suicide-related videos |
Primary outcome
Emotional Affect
Time frame: Administered to both study groups immediately before and immediately after viewing both videos.
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).
2 secondary outcomes
State Anxiety
Time frame: STAI-6 is administered immediately before and after viewing both videos (administered to both groups).
Self-Reported Behavioural Avoidance Intention
Time frame: It will be measured post- TW and stimuli viewing, for participants in both arms.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 3 Nov 2026.
- Individual participant dataSharing planned: Yes. De-indentified IPD information will be disseminated upon request, once results are available.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Rachel Mitchell, MD, MSc principal investigator
University of Toronto; Sunnybrook Health Sciences Center
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Trigger Warning in people with Suicide Prevention and Social Media Users, run by Sunnybrook Health Sciences Centre at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 3 Nov 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Zoe Shelton, B.A. (4388703910, zoejacklyn.shelton@mail.utoronto.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Emotional Affect (time frame: Administered to both study groups immediately before and immediately after viewing both videos.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Nov 2026.