Internet pathways in suicidality: a review of the evidence

Exploring the determinants influencing suicidal ideation and depression in gastrointestinal cancer patients

Studies have shown a heightened prevalence of depression and suicidal ideation among patients with Gastrointestinal Cancer (GIC). GIC patients are at a 1.5- to threefold increased risk of suicide and depression compared to other cancer patients. This study investigates the interplay of internet use, family burden, and emotional support on mental health (depression) and suicidal ideation among patients with GIC. The study involves 202 respondents of which 78 were undergoing GIC treatment during this study. Using structural equation modeling, our findings indicate a substantial negative correlation between mental health and suicidal ideation. Overall, suicidal ideation (median score) was noticeably lower in patient who completed their treatment with noticeable individuals with exceptionally high SI even after completing the treatment. Notably, participants who had completed their treatment demonstrated a significantly stronger correlation between emotional support and mental health compared to those who were still undergoing treatment. Age was found to moderate the mental health-suicidal ideation link significantly. Internet usage for health-related information was also inversely correlated with mental health (directly) and suicidal ideation (indirectly). We noted that the influence of emotional support on mental health was significantly higher among individuals who completed their treatment compared to those who were undergoing their GIC treatment. Family burden emerged as significant negative influences on mental health, while emotional support positively impacted mental health. The findings of this study contribute towards a deeper understanding of suicide risk factors in GIC patients, potentially shaping more effective preventive strategies.

A systematic review and meta-analysis of factors related to non-suicidal self-injury among Chinese adolescents

BACKGROUND

Over the past several decades the prevalence of adolescent non-suicidal self-injury (NSSI) has been rising steadily. Understanding the factors associated with NSSI is a critical public health concern. The current study aims to explore the critical factors related to NSSI among Chinese adolescents.

METHODS

A systematic literature search was conducted to identify the studies meeting our eligibility criteria (published until June 2022) in PubMed, Web of Science, Science Direct, Springer Link, CNKI, VIP, and Wanfang data. The meta-package of R language was used to perform a meta-analysis to compute the pooled effect (r).

RESULTS

A total of 59 studies were included in this analysis, with a sample size of 192,546. Twenty-four democratic, personal, and social factors were examined in current study. The pooled effect value (r) has revealed that 23 factors are associated with NSSI behaviors among Chinese adolescents. The factor, Internet addiction, has demonstrated the greatest association with NSSI compared to other factors.

CONCLUSION

Consistent with previous studies on adolescent NSSI, findings have demonstrated that a number of demographic, personal, and social factors significantly contribute to NSSI behaviors among Chinese adolescents. Future research on prevention and intervention for adolescent NSSI may benefit from targeting these factors.

Defining the Characteristics of an e-Health Tool for Suicide Primary Prevention in the General Population: The StopBlues Case in France

With over one million deaths per year in the world, suicide is a major public health problem that could be significantly reduced by effective prevention programs. E-health tools are of particular interest for primary prevention as they can address a broad population including people unaware of their own risk and provide information and help without the fear of stigma. Our main objective was to define the overall characteristics of an e-health tool for suicide primary prevention in the French general population by defining the characteristics of the IT features; the content of the information delivered; the best way to structure it; and how it should be relayed and by whom. The research was carried out through a literature review and a co-construction phase with stakeholders. Four types of strategies may guide the construction of e-health tools for suicide primary prevention: education and awareness, (self-)screening, accessing support, and mental health coping. They should be accessible on different devices to reach the most users, and language and content should be adapted to the target population and to the issue being addressed. Finally, the tool should be consistent with ethical and quality best practices. The e-health tool StopBlues was developed following those recommendations.

Internet addiction and residual depressive symptoms among clinically stable adolescents with major psychiatric disorders during the COVID-19 pandemic: a network analysis perspective

To assess the inter-relationships between residual depressive symptoms (RDS) and Internet addiction (IA) using network analysis among clinically stable adolescents with major psychiatric disorders during the COVID-19 pandemic. RDS and IA were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Internet Addiction Test (IAT), respectively. Central symptoms and bridge symptoms in the network model were examined. A total of 1,454 adolescents met the study criteria and were included in the analyses. The prevalence of IA was 31.2% (95% CI: 28.8%-33.6%). In the network analysis, the nodes IAT15 ("Preoccupation with the Internet"), PHQ2 ("Sad mood"), and PHQ1 ("Anhedonia") were the most central symptoms in the IA-RDS network model. Bridge symptoms included IAT10 ("Sooth disturbing about your Internet use"), PHQ9 ("Suicide ideation"), and IAT3 ("Prefer the excitement online to the time with others"). Additionally, PHQ2 ("Sad mood") was the main node linking "Anhedonia" to other IA clusters. Internet addiction was common among clinically stable adolescents with major psychiatric disorders during the COVID-19 pandemic. Core and bridge symptoms identified in this study could be prioritized as targets for the prevention and treatment of IA in this population.

TOPSIS for Analyzing the Risk Factors of Suicidal Ideation Among University Students in Malaysia

Globally, suicide is a major public health issue. Suicide is the first or second reason for death among college and university students. The suicide rate among university students is relatively high in Malaysia. Numerous risk factors exacerbate suicidal ideation. Therefore, it is critical to gain as much insight as possible into the risk factors for suicidal ideation among university students and prioritize them based on the importance level. Therefore, students with a high risk for suicide can be identified, and earlier precautions can be taken to assist the students. In this paper, 18 determinants of suicidal ideation were discovered through the systematic literature review, and these factors were then ranked according to the seriousness using the TOPSIS method. The results showed that previous suicide attempts, mental disorders, and negative life events were the most influential factors leading to suicide. In contrast, gender and the residential area had the least impact. The result enables the government, relevant stakeholders, and policymakers to develop comprehensive multisectoral strategies that can prevent suicide effectively.

Problematic Smartphone Use Mediates the Pathway from Suicidal Ideation to Positive Psychotic Experiences: a Large Cross-Sectional, Population-Based Study

The present study followed the newly hypothesized "suicidal drive for psychosis" suggesting that psychosis may be consequential to suicidal ideation (SI) and behavior and attempted to explain parts of the pathway between these variables. To this end, we aimed to test whether problematic smartphone use (PSU) has an indirect mediating effect in the cross-sectional relationship between SI and positive psychotic experiences (PEs). Lebanese community young adults (N=4158; 64.4% females; mean age 21.91±3.79) have been invited to participate to a cross-sectional, web-based study in the period from June to September 2022. After adjusting for potential confounders (i.e., the living situation, marital status, household crowding index, economic pressure, cannabis use, other drugs use, and past history of mental illness other than psychosis), we found that higher levels of suicidal ideation was significantly associated with greater PSU, which was also positively and significantly associated with more positive PEs. Finally, greater suicidal ideation was significantly and directly associated with more positive PEs. Our findings suggest that SPU may be regarded as a potential target for prevention and intervention in psychosis. Clinicians, educators, and school administrators ought to give greater attention to PSU among vulnerable young people who present with SI.

["Razors always speak louder": the topic of self-harm in online communities]

This study aims to understand how Brazilian online communities portray the topic of self-harm, discussing its particularities, the narratives produced, the interactions established, and the purpose of the digital space. It was based on qualitative research in the digital environment from the silent observation of Facebook online communities, which were selected considering the number of participants and their interaction. The observation followed a previous script and posts were recorded by screenshots. Publications were organized in the following categories: characterization and functioning of the community; self-directed violence (self-harm and suicide); motivations for the act; strategies to prevent the act; and loving experience. Results showed that the communities were positively guided and defended self-harm without any regulation, which guaranteed the free expression of their participants and detailed reports describing the methods and objects used, the level of efficiency, and how to hide the wounds. Although participants shared the fear of being discovered, they published images of their own scars and wounds, materializing discourses of suffering on the Internet and glamorizing the cuts, the feeling of pleasure, and the sense of belonging, since they are also identity marks. Our findings show that young people who harm themselves share their suffering experiences with other young people without the mediation of a professional, therefore, considering its possible effects on mental health is necessary.

[Asthma and suicidal behavior in adolescents: a literature review]

INTRODUCTION

Adolescence is a difficult time in life and asthma has major psychological consequences for adolescents.

OBJECTIVES

This systematic literature review focused on the association between asthma and suicidal behaviors (suicidal ideations [SI], suicide plans [SP] and suicide attempts [SA]) among adolescents in the general population.

METHOD

Research on Medline for the 1980-2021 period. Objectives This systematic literature review focused on the association between asthma and suicidal behaviors (suicidal ideations [SI], suicide plans [SP] and suicide attempts [SA]) among adolescents in the general population.

RESULTS

An overwhelming majority of the studies taken into consideration demonstrated a significant positive association between asthma and suicidal behaviors. Among the 10 studies assessing SI (with or without SP), 9 of them found a significant positive association between asthma and SI. Eight studies assessed SA; five cross-sectional studies and one prospective study demonstrated a significant positive association between asthma and SA. Only one case-control study did not find a significant positive association between asthma and SA after hospitalization for asthma. The two cross-sectional studies assessing suicidal risk taken as a whole (SI, SP and SA) demonstrated a significant positive association between asthma and at least one suicidal behavior. (OR=1.71; P<0.001). However, several studies did not include depression as an adjustment factor.

CONCLUSION

It is important that healthcare professionals assess suicide risk in adolescent suffering from asthma, the objective being to avoid SA or death from SA.

The dark side of social media: Two deaths related with chloroform intoxication

A suicide pact is an agreement between people to commit suicide together, which usually takes place at the same time, in the same place, by using the same method. Social media serve as a way of communication between people. Thus, they use such platforms to find potential suicide pact partners. Chloroform, although being regarded to as a slightly forgotten poison, is still linked to homicide and suicide cases. Death due to an acute chloroform ingestion may be a result of central nervous system depression. In this paper, we present application of headspace gas chromatographic method using a dual column/dual flame ionization detector (HS-GC-FID/FID) for the determination of chloroform in two fatal intoxication cases, as well as chloroform stability study. Analysis of biological samples revealed chloroform concentrations of 135.8, 16.1, 8.1, and 37.1 µg/ml in blood, urine, vitreous humor, and bile, respectively. Kidney, liver, and muscle specimens contained 119.5, 99.6, and 28.4 µg/g of chloroform, respectively. The results of stability studies indicate the highest decrease of chloroform in room temperature, so it is advised to store samples in a freezer. The addition of sodium fluoride is recommended as in blood samples collected to the test tubes without any preservative agent, the detection of chloroform after 91 days is almost impossible. It is important to emphasize that even old poisons can cause a lot of concerns today, as here described cases are linked to chloroform intoxication, as well as with possible danger which social media bring about nowadays.

Googling for Suicide-Content and Quality Analysis of Suicide-Related Websites: Thematic Analysis

Background

Suicide represents a public health concern, imposing a dramatic burden. Prosuicide websites are “virtual pathways” facilitating a rise in suicidal behaviors, especially among socially isolated, susceptible individuals.

Objective

The aim of this study is to characterize suicide-related webpages in the Italian language.

Methods

The first 5 most commonly used search engines in Italy (ie, Bing, Virgilio, Yahoo, Google, and Libero) were mined using the term “suicidio” (Italian for suicide). For each search, the first 100 webpages were considered. Websites resulting from each search were collected and duplicates deleted so that unique webpages could be analyzed and rated with the HONcode instrument

Results

A total of 65 webpages were included: 12.5% (8/64) were antisuicide and 6.3% (4/64) explicitly prosuicide. The majority of the included websites had a mixed or neutral attitude toward suicide (52/64, 81.2%) and had informative content and purpose (39/64, 60.9%). Most webpages targeted adolescents as an age group (38/64, 59.4%), contained a reference to other psychiatric disorders or comorbidities (42/64, 65.6%), included medical/professional supervision or guidance (45/64, 70.3%), lacked figures or pictures related to suicide (41/64, 64.1%), and did not contain any access restraint (62/64, 96.9%). The major shortcoming to this study is the small sample size of webpages analyzed and the search limited to the keyword “suicide.”

Conclusions

Specialized mental health professionals should try to improve their presence online by providing high-quality material.

Development of an online suicide prevention program involving people with lived experience: ideas and challenges

BACKGROUND

Fear of stigmatization, self-stigmatization, and insufficient information can lead to secrecy, reduced help-seeking, lower self-esteem, and lower self-efficacy among people affected by suicidality or suicide. Therefore, we developed an online suicide prevention program aiming to improve knowledge about suicidality and suicide stigma.

METHODS

Inspired by the Australian program The Ripple Effect, a German team comprising people with lived experience of suicide, researchers, and clinicians was established for developing an online suicide prevention program. Therefore, we oriented on guidelines for evidence-based health information, for reporting on suicide, and on dealing with suicidality. The lived experience team discussed and developed concept, structure, and content of the program. This manuscript presents summaries of protocols from 16 team meetings and 3 written text reviews to outline the program development process. A summative evaluation 3 years after program development began was qualitatively analyzed based on thematic analysis.

RESULTS

Between 2018 und 2021, the lived experience team (n = 10) discussed possibilities of support in suicidal crises, attitudes towards suicide, content, and design of the online program. In a structured process, six members of the lived experience team reviewed the content. Eight persons shared their lived experience of suicide in video reports by focusing on constructive ways of dealing with suicidality or a loss by suicide, conveying hope and encouraging people to continue living. Team members recommended greater public and patient involvement from the application stage, as well as more financial and personnel resources.

CONCLUSIONS

Through contributions to discussions and text reviews, the lived experience team shaped decisions in the program development process. While involving persons with lived experiences of suicide, it is important to consider that suicidality is 1. emotionally challenging, 2. a stigmatized issue, and 3. that the aspect of safety must be a priority. A distinction must be made between the duty of care based on actual risk and inappropriate overprotection. Hereby, transparency, autonomy, and a clear structure appeared to be helpful. For further research, we recommend a structured formative review process of the development of the program. Additionally, we recommend discussing the purpose and the specific design of the evaluation with a lived experience team in advance. Trial registration German Clinical Trial RegisterDRKS00015071 on August 6, 2018.

Who seeks help online? Comparing online and offline help-seeking preferences amongst youths with suicidal ideation

BACKGROUND

Research consistently report an inverse relationship between suicide risk and help-seeking. The increasingly available internet-based support potentially offers an attractive alternative to traditional forms of assistance. The study compared the characteristics of suicidal youths in Hong Kong and their online and offline help-seeking behaviours.

METHODS

Participants (N = 1214, age-range = 15-24 years) responded to the anonymous 2018 Hong Kong Online Survey on Youth Mental Health and Internet Usage. Respondents with suicidal thoughts were classified into those who sought help online and offline, or online only ("online-help"); those who sought help offline only ("offline-help"); and those who never sought help ("no-help"). They responded to questions concerning mental health, perception towards online support, internet use, help sources, and demographic information.

RESULTS

The online-help group differed significantly from other groups, with greater suicidal ideation, distress, risk behaviours, and spent more time online for non-work-related purposes. Their perceived benefits of online support include anonymity, avoiding embarrassment, and social support. They are more likely to seek help from a combination of informal and formal sources.

LIMITATIONS

No data on whether participants sought help online or offline first, and their current treatment status is available. Our study adopted conveniences sampling, and few respondents have sought help online exclusively.

CONCLUSION

Online support offers an alternate way of engaging at-risk youths. Future clinical practice should consider online platforms as a complement, rather than a replacement, of offline platforms.

Suicide prevention in childhood and adolescence: a narrative review of current knowledge on risk and protective factors and effectiveness of interventions

INTRODUCTION

Suicide is a global mental health problem for people of all ages. While rates of suicide in children and adolescents are reported as lower than those in older populations worldwide, they represent the third leading cause of death in 15-19-year-olds. The rates are higher among boys than girls worldwide, though the death rates for girls exceed those for boys in Bangladesh, China, India, and Nepal. There has been a general decrease in adolescent suicide rates over recent decades. However, increases are reported in South East Asia as well as South America over the same time period.

METHODS

A narrative review method has been used to summarize current knowledge about risk and protective factors for suicide among children and adolescents and to discuss evidence-based strategy for suicide prevention in this age group.

RESULTS

Identified suicide risk and protective factors for children and adolescents largely overlap with those for adults. Nevertheless, developmental characteristics may strengthen the impact of some factors, such as decision-making style, coping strategies, family and peer relationships, and victimization. The implementation of evidence-based suicide preventive strategies is needed. Restricting access to lethal means, school-based awareness and skill training programs, and interventions delivered in clinical and community settings have been proven effective. The effectiveness of gatekeeper training and screening programs in reducing suicidal ideation and behavior is unproven but widely examined in selected settings.

DISCUSSION

Since most studies have been conducted in western countries, future research should assess the effectiveness of these promising strategies in different cultural contexts. The use of more rigorous study designs, the use of both short- and long-term follow-up evaluations, the larger inclusion of individuals belonging to vulnerable groups, the evaluation of online intervention, and the analysis of programs' cost-effectiveness are also required.

Social media use and self-injurious thoughts and behaviors: A systematic review and meta-analysis

Despite considerable public and scholarly debate about the role of social media in self-injurious thoughts and behaviors (SITBs), no comprehensive, quantitative synthesis of this literature has previously been undertaken. The current systematic review and meta-analysis examines associations between social media use and SITBs, including suicidal ideation, suicide plans, suicide attempts, and nonsuicidal self-injury (NSSI). A range of social media behaviors and experiences were identified, including cybervictimization and perpetration, exposure to and generation of SITB-related content, problematic use, sexting, social media importance, and frequency of use. A systematic search of PsycINFO, Medline, CINAHL, and the references of prior reviews yielded 61 eligible studies. Results largely suggested medium effect sizes for associations between specific social media constructs (cybervictimization, SITB-related social media use, problematic social media use) and SITBs. There was no association between frequency of social media use and SITBs; however, studies on this topic were limited. The majority of studies identified focused on cybervictimization, and results suggested positive associations with all SITBs, with the association between cybervictimization and suicidal ideation stronger for adolescents than adults. Overall, findings highlight the utility of examining specific social media behaviors and experiences, and point to the need for more research in this area.

Acquisition and Interpretation of Digital Information in Forensic Assessments

Despite the now ubiquitous presence of technology in everyday life, there is little written on the subject of personal digital data as it pertains to forensic mental health evaluations. Ethical concerns and limited consensus guidance on this issue have previously made it challenging to use this information in a responsible way. This Perspectives article elaborates on the different types of personal data that exist and the practical aspects of acquiring such information, including data location and legal considerations. Incorporation of personal digital information into the forensic assessment as a form of collateral information is discussed, along with the current state of the literature on technology use and its relationship to psychopathology and risk. Given the important role of technology in the life of the modern individual, deeper research into this topic will be necessary in the immediate future to establish practice standards for the safe and ethical use of digital information in both forensic and non-forensic mental health assessments.

Bovina I, V. Delibalt V, G. Dozortseva E, V. Bogdanovich N, . Rubtsova OV. Deviant online behavior in adolescent and youth circles: In search of a risk assessment model

The authors made an attempt to describe the problem of developing the concept of risk assessment of deviant online behavior of minors and young adults in social networks. The article looks into the psychological consequences of banalizing of the internet, analysis possibilities for offline and online behavior. Approaches for risk factors assessment of deviant behavior in real life are described: the qualitative (clinical), statistical (actuarial) and structured. The article systemizes the studies of risk factors, vulnerability, and deviant patterns in the context of phenomena such as aggressive, asocial, auto-aggressive, self-mutilating, suicidal, risk-taking and victim online behavior. Approaches and models of online deviant behavior are discussed; an attempt is made to build a structured model of risk assessment of deviant patterns of online behavior in the context of the cultural historical concept. On the basis of theoretical analysis, a hypothetical set of group, interindividual and intraindividual constructs is formulated, the combination of online and offline risk factors produces a model for risk assessment of deviant behavior. The article is written as part of the research project “Developing the profiling model of online behavior of minors and young adults in social networks” which was initiated by the Moscow State University of Psychology and Education.

Assessing Digital Risk in Psychiatric Patients: Mixed Methods Study of Psychiatry Trainees' Experiences, Views, and Understanding

BACKGROUND

The use of digital technology can help people access information and provide support for their mental health problems, but it can also expose them to risk, such as bullying or prosuicide websites. It may be important to consider internet-related risk behavior (digital risk) within a generic psychiatric risk assessment, but no studies have explored the practice or acceptability of this among psychiatrists.

OBJECTIVE

This study aimed to explore psychiatry trainees' experiences, views, and understanding of digital risk in psychiatry. We predicted that clinician awareness would be highest among trainees who work in child and adolescent mental health services.

METHODS

We conducted a cross-sectional survey of psychiatry trainees attending a UK regional trainees' conference to investigate how they routinely assess patients' internet use and related risk of harm and their experience and confidence in assessing these risks. We conducted focus groups to further explore trainees' understandings and experiences of digital risk assessment. Descriptive statistics and chi-squared tests were used to present the quantitative data. A thematic analysis was used to identify the key themes in the qualitative data set.

RESULTS

The cross-sectional survey was completed by 113 out of 312 psychiatry trainees (response rate 36.2%), from a range of subspecialties and experience levels. Half of the trainees (57/113, 50.4%) reported treating patients exposed to digital risk, particularly trainees subspecializing in child and adolescent psychiatry (17/22, 77% vs 40/91, 44%;P=.02). However, 67.3% (76/113) reported not feeling competent to assess digital risk. Child and adolescent psychiatrists were more likely than others to ask patients routinely about specific digital risk domains, including reckless web-based behavior (18/20, 90% vs 54/82, 66%; P=.03), prosuicide websites (20/21, 95% vs 57/81, 70%; P=.01), and online sexual behavior (17/21, 81% vs 44/81, 54%; P=.02). Although 84.1% (95/113) of the participants reported using a proforma to record general risk assessment, only 5% (5/95) of these participants prompted an assessment of internet use. Only 9.7% (11/113) of the trainees had received digital risk training, and 73.5% (83/113) reported that they would value this. Our thematic analysis of transcripts from 3 focus groups (comprising 11 trainees) identified 2 main themes: barriers to assessment and management of digital risk, and the double-edged sword of web use. Barriers reported included the novelty and complexity of the internet, a lack of confidence and guidance in addressing internet use directly, and ongoing tension between assessment and privacy.

CONCLUSIONS

Although it is common for psychiatrists to encounter patients subject to digital risk, trainee psychiatrists lack competence and confidence in their assessment. Training in digital risk and the inclusion of prompts in standardized risk proformas would promote good clinical practice and prevent a potential blind spot in general risk assessment.

Relationships between internet use, deliberate self-harm, and happiness in adolescents: A Taiwan birth cohort pilot study

The potential risk of internet use on adolescents' self-harm is a major concern. Vulnerable adolescents who are susceptible to bullying are also susceptible to the negative influence of the internet. In this study, the pathway associations were investigated between the risk factors of deliberate self-harm, experience of being bullied, internet use, and protective factors of maternal monitoring on perceived happiness of 12- and 13-year-old adolescents in the Taiwan Birth Cohort Pilot Study dataset (n = 1,457). The Chinese Oxford Happiness Questionnaire was used to measure the adolescents' self-perceived levels of happiness, in two dimensions of social adaptation status and psychological well-being. Our results show that 354 (24.3%) of the 12-year-olds reported having been bullied, and 289 (19.8%) of the 13-year-olds reported this. Seventy-nine (5.4%) of 13-year-olds reported deliberate self-harm in the past year. Results of a structural equation model showed that those who had been bullied at age 12 years were at greater risk of deliberate self-harm at age 13 years. A negative association was found between duration of internet use and perceived level of happiness. Adolescents who spent >5 h online during days off school were at higher risk of deliberate self-harm, and perceived a lower level of happiness. Therefore, spending >5 h online during days off school could be used as an indicator in future preventive action programs to screen out those at a high risk of excessive internet use, deliberate self-harm, and psychological well-being and social adjustment issues.

Association of Internet Addiction With Nonsuicidal Self-injury Among Adolescents in China

IMPORTANCE

Both nonsuicidal self-injury (NSSI), defined as the direct, deliberate damage of one's body tissue without suicidal intent, and internet addiction among adolescents are public health concerns. However, the possible association of NSSI with internet addiction is not well understood.

OBJECTIVE

To examine the occurrence of internet addiction with NSSI and any sex differences among Chinese adolescents.

DESIGN, SETTING, AND PARTICIPANTS

A multicenter, cross-sectional, survey study was conducted from February 18 to October 15, 2015, among adolescents aged 11 to 20 years from 343 classes in 45 public high schools across 5 provinces of China. Data analysis was performed from August 1, 2018, to March 1, 2019.

EXPOSURES

Possible internet addiction and internet addiction.

MAIN OUTCOMES AND MEASURES

Less-frequent (1-4 times) NSSI and more-frequent (≥5 times) NSSI were surveyed using the Chinese version of the Functional Assessment of Self-Mutilation.

RESULTS

A total of 15 623 students (8043 male [51.5%] and 7580 female [48.5%]) aged 11 to 20 years (mean [SD] age, 15.1 [1.8] years) participated. Of these, 4670 participants (29.9%) met the criteria for possible internet addiction and 509 participants (3.3%) met the criteria for internet addiction. A total of 2667 students (17.1%) engaged in less-frequent NSSI, while 1798 students (11.5%) engaged in more-frequent NSSI in the 12 months preceding the survey. Both possible internet addiction and internet addiction were associated with less-frequent or more-frequent NSSI. The adjusted odds ratios were 1.29 (95% CI, 1.17-1.42) for possible internet addiction and 1.41 (95% CI, 1.11-1.80) for internet addiction for less-frequent NSSI; for more-frequent NSSI, the adjusted odds ratios were 1.75 (95% CI, 1.56-1.96) for possible internet addiction and 2.66 (95% CI, 2.10-3.38) for internet addiction. These associations were similarly observed among age groups of 11 to 14, 15 to 17, and 18 to 20 years. No sex disparities were found in the associations of internet addiction with NSSI, except among adolescents aged 11 to 14 years, where the odds ratios for possible internet addiction with less-frequent NSSI were higher in male adolescents (1.53; 95% CI, 1.25-1.88) than female adolescents (1.13; 95% CI, 0.90-1.47).

CONCLUSION AND RELEVANCE

Internet addiction appears to be associated with NSSI, and the findings of this study suggest that the association was similar between male adolescents and female adolescents. These data suggest that evaluation of the risk of NSSI for adolescents in association with internet addiction may help health care professionals in developing preventive interventions for NSSI.

How have excessive electronics devices and Internet uses been concerned? Implications for global research agenda from a bibliometric analysis

BACKGROUND AND AIMS

Excessive use of electronic devices has become a major global problem. However, little is known about the development and current landscape of research concerning this field. This study aimed at exploring the overall publication trend and topics of research on the overuse of electronic devices and the Internet from 1971 to 2017.

METHODS

We systematically searched the Web of Science (WoS) and Scopus databases for published articles on the excessive use of electronic devices and the Internet. Data regarding the publication volume, international collaborations, and geographical locations were analyzed by bibliometrics analysis. Latent Dirichlet Allocation (LDA) was undertaken to categorize publications into different research topics.

RESULTS

A total of 2,276 papers from the WOS and 600 papers from the Scopus were included. We found a dramatic increase in the number of scientific papers towards addiction to electronic devices and the Internet. The United State led in all publication parameters including the total number of papers and total citations. China, Korea and Taiwan were among the most prolific countries/regions. Smartphone addiction was the main concern, and the relationship between the overuse of electronic devices and the Internet and mental health issues have been highlighted. On the other hand, our study found a limited appearance of discussion on effective treatment and intervention.

DISCUSSION AND CONCLUSION

The findings of this study call for more national and international cooperation in evaluating and intervening addiction to electronic devices and the Internet to gather more knowledge about this phenomenon and evaluate the effectiveness of treatment.

Adolescents' Beliefs About Peers' Engagement in an Online Self-Harm Challenge: Exploring the Role of Individual Characteristics Through a Latent Class Analysis

In the last decade considerable attention has been devoted to the possible contribution of social media, and the Internet generally, to instigating adolescents' engagement in self-harm activities, which are considered the result of a combination of multidimensional variables, such as depression and anxiety. This study aimed to identify, using latent class analysis (LCA), classes homogeneous for adolescents' beliefs about peers' motivations in taking part in the recent Blue Whale Challenge Game, and to analyze the individual predictors (gender, mental health problems, self-harm and risk-taking behaviors, and problematic Internet use) of the adolescent's latent class membership. We performed an LCA using "perceived attraction" and "perceived constraint" as nominal indicators. Relative fit indices suggested the two class solution as the best measurement model: the first class was mostly composed of adolescents who attributed a central role to the adolescent (internal causality), while the second class mostly composed of adolescents who attributed a central role to the recruiters (external causality). In addition, we explored some individual characteristics to test whether they could predict adolescents' class membership. Results suggests that it is significantly more likely for adolescents with higher level of stress and risk-taking to attribute a central role to their peers' internal motivation, rather than to the recruiter, in deciding to take part in the online self-harm challenge game. Implications for preventive interventions are discussed.

[News coverage on suicides published in Brazilian news media channels]

This study analyzed how news coverage about suicides is published in the Brazilian electronic media and evaluated if the recommendations of the World Health Organization (WHO) were complied with in the online media. This quantitative, documentary and retrospective study investigated 89 published news items about suicide in 2017 in the Brazilian newspaper sites with the largest circulation. Descriptive statistics and tests of association were used for data analysis. The majority of news items contained neither content to be avoided nor aspects recommended by the WHO. The most frequent characteristics of the reported cases do not correspond directly to the epidemiological profile of suicidal behavior, but to media interests. Actions are needed to foster media involvement in suicide prevention, dissemination of resources and strategies to support and reduce stigma and the contagion effect.

How common are suicides using nitrous oxide?

Analysis of autopsy cases of suicide from Forensic Science South Australia files (2003–2017) where helium, nitrogen or nitrous oxide gas had been used revealed that only 2/58 (3.5%) cases utilised nitrous oxide; the remainder of cases had used helium or nitrogen. The two cases are presented here. In case 1, a 48-year-old man was found completely encased in a plastic bag with a hose connected to an opened cylinder of nitrous oxide. In case 2, a 27-year-old woman was found with a plastic bag over her head, tied around her neck, with a tube connected to a small canister of nitrous oxide. There were approximately 20 empty canisters of nitrous oxide nearby. Death in both cases was due to nitrous oxide augmentation of plastic bag asphyxia, manner suicide. The relative ease with which helium and nitrogen cylinders containing large amounts of gas can be obtained may explain the low numbers of suicides utilising nitrous oxide.

La théorie de la noyade émotive virtuelle : une théorisation ancrée sur le processus de recherche d’aide d’adolescents à risque de suicide

De plus en plus d’adolescents à risque de suicide se tournent vers les technologies de l’information et de la communication (TIC) pour chercher de l’aide. Or, à ce jour, aucune étude n’a exploré le processus de recherche d’aide par les TIC chez des adolescents à risque de suicide. Afin de pallier cette situation, une étude par théorisation ancrée a été menée afin de comprendre le processus de recherche d’aide par les TIC des adolescents ayant un risque suicidaire pour trouver des ressources concernant le suicide. La collecte de données a été effectuée à partir d’entrevues individuelles semi-structurées, d’un questionnaire sur la recherche d’aide par les TIC et d’observations d’une recherche d’aide réelle via les TIC par les adolescents de l’étude. Un n de 15 adolescents âgés de 13 à 17 ans a été atteint par saturation théorique. Les résultats ont permis l’émergence de la théorie de la noyade émotive virtuelle. Cette théorie permet d’abord de mieux comprendre le contexte initial de cette recherche d’aide, soit l’état du jeune, l’environnement social, les facteurs aggravants ainsi que le désir d’utiliser les TIC. Elle permet aussi de comprendre les différentes stratégies par les TIC utilisées par les jeunes (se distraire, s’informer, se dévoiler et aider les autres) ainsi que les conséquences engendrées (la croissance émotive, l’obtention d’aide, le soulagement temporaire, aucun changement, l’exacerbation des idées suicidaires ou le passage à l’acte). Des recommandations pour la clinique, la formation et la recherche sont ensuite émises.

Mining social networks to improve suicide prevention: A scoping review

Attention about the risks of online social networks (SNs) has been called upon reports describing their use to express emotional distress and suicidal ideation or plans. On the Internet, cyberbullying, suicide pacts, Internet addiction, and "extreme" communities seem to increase suicidal behavior (SB). In this study, the scientific literature about SBs and SNs was narratively reviewed. Some authors focus on detecting at-risk populations through data mining, identification of risks factors, and web activity patterns. Others describe prevention practices on the Internet, such as websites, screening, and applications. Targeted interventions through SNs are also contemplated when suicidal ideation is present. Multiple predictive models should be defined, implemented, tested, and combined in order to deal with the risk of SB through an effective decision support system. This endeavor might require a reorganization of care for SNs users presenting suicidal ideation.

Nitrogen inhalation suicide pacts

Suicide pacts usually result in simultaneous deaths by mutual arrangement. While nitrogen and helium gas inhalation are being increasingly used in solitary suicide attempts, for some reason they have been rarely utilised in suicide pacts. A search of autopsy files at Forensic Science SA over a 15-year period (2003-2017) was undertaken to determine how often this method of joint suicide occurs. Only two cases were found. Case 1 comprised a 64-year-old husband and wife (who had a history of multiple sclerosis). They were found deceased in a vehicle with two empty cylinders of nitrogen gas. Case 2 comprised an 87-year-old man (who had a history of ischaemic heart disease) and his 81-year-old wife who were found deceased with plastic bags over their heads, with plastic tubes connecting the bags to opened cylinders of nitrogen. The deaths in all cases were due to nitrogen-induced asphyxiation, in the latter instance augmenting plastic-bag asphyxia. Although suicide pacts have previously usually involved carbon-monoxide toxicity or drug overdose, it is possible that dissemination of information on the use of inert gases in individual suicide attempts may alter the methods used in future.

The Darknet and suicide

CONTEXT

The Internet contains both public content ("Surface Web"), and private content ("Deep Web") sometimes hosted on exclusive networks ("Darknets") only accessible using dedicated software such as TOR (The Onion Router). This software makes it almost impossible to identify its users. Information media have reported on suicide-related aspects of Darknets, for example when poisons that can be used to kill oneself are offered for sale (Le Garff et al., 2016) when users discuss ways to kill oneself in anonymous forums (Ferrara, 2016; Franceschi-Bicchierai, 2015) and suicides that follow bullying or "doxing" (online divulgation without consent of intimate personal information) (Bartlett, 2015). Several recent studies have analyzed the nature of suicide content on the Surface Web, but to date, there have been no systematic investigations of suicidal content available on Darknets.

OBJECTIVES

The object was to document the nature and accessibility of suicide-related information available on the TOR Darknet or via the TOR software.

METHODS

We replicated the methodology used by Biddle et al. (2008, 2016) in their studies of the Surface Web, using TOR on the Darknet. We identified and chose nine search engines used on the TOR Darknet: TORCH the TOR search engine, Notevil, Ahmia, Candle, Hidden Wiki, Darknet (onion.link), Duckduckgo and Grams. Two research assistants independently coded the first 30 results of searches using the keywords, "suicide" and "suicide methods".

RESULTS

There were 476 "hits" in the search for "suicide" and "suicide method" using TOR, with fewer sites dedicated to suicide (4%), compared to the Surface Web (23.1%) (Biddle et al., 2016). Over half of the sites proposed by the TOR search engines (252, 52.9%) were outdated, inaccessible or not containing content pertinent to suicide or suicide methods. Several of the TOR search engines provided access to forums ("chat boards") where suicide was a topic (70, 14.8%). These were usually pro-suicide, are blocked or filtered by most of the Surface Web engines (e.g. Google).

DISCUSSION

Persons concerned with suicide prevention should conduct further investigations of pro-suicide forums that are accessible using TOR and their users, comparing them with the Surface Web. New strategies to prevent suicide may need to be developed for Darknets.

Types of Stressors on Nonprofessional Against-Suicide and Pro-Suicide Message Boards

Background: Little is known about presenting problems of primary posters (i.e., posters opening the thread) and their responders in nonprofessional against-suicide and pro-suicide message boards. Aims: We aimed to compare problems described in suicide message boards between different types of users (primary posters and respondents) and between against-suicide, neutral, and pro-suicide message boards. Method: In all, 1,182 archival threads with 20,499 individual postings from seven nonprofessional suicide message boards supporting an against-suicide, neutral, or pro-suicide attitude were randomly selected. Problems mentioned by primary posters and their respondents were coded with content analysis. Differences between pro-suicide, neutral, and against suicide boards, as well as correlations between primary posters and respondents, were calculated. Results: Interpersonal problems were most frequently mentioned by primary posters in against-suicide threads (40.9%) and less frequently in pro-suicide threads (11.8%; p < .001). In pro-suicide boards, the most frequent stressors were suicide method-related (e.g., how to identify a safe method: 26.2% vs. 2.5% in against-suicide boards, p < .001). Primary posters resembled respondents in terms of presenting problems in pro-suicide boards, but not in against-suicide boards. Limitations: Only self-reported problems were assessed. Conclusion: The results confirm a stronger focus on death than on life among users in pro-suicide message boards, and posters with similar problems meet in pro-suicide boards. The posters appear to clearly emphasize social strains over psychiatric problems compared with some professional settings.

Comparing Indicators of Suicidality Among Users in Different Types of Nonprofessional Suicide Message Boards

BACKGROUND

Little is known about linguistic differences between nonprofessional suicide message boards that differ in regard to their predominant attitude to suicide.

AIMS

To compare linguistic indicators potentially related to suicidality between anti-suicide, neutral, and pro-suicide message boards, and between the types of posters (primary posters, who initiate the thread, and the respective respondents).

METHOD

In all, 1,200 threads from seven German-language nonprofessional suicide message boards were analyzed using the software Linguistic Inquiry and Word Count (LIWC) with regard to wording related to suicidal fantasies, aggression, and indicators of so-called suicidal constriction. Data were analyzed with ANOVA.

RESULTS

There were fewer words related to affective, social, cognitive, and communicative processes in pro-suicide message boards than in other boards. Death-related wording and aggression as well as tentative wording appeared more prevalent in pro-suicide boards.

LIMITATIONS

Complex language structures cannot be analyzed with LIWC.

CONCLUSION

The results suggest fewer emotion words and wording related to social circumstances among primary posters and respondents in pro-suicide boards as compared with other boards, and a higher use of death- and aggression-related words. These findings might signal a higher degree of suicidality or sheer differences in matters of interest or social desirability. The differences require attention in practice and research.

Leveraging the Web and Social Media to Promote Access to Care Among Suicidal Individuals

After two decades of exponential development, the Internet has become an inseparable component of suicide prevention matters. More specifically, social media has turned out to be a privileged space for suicidal individuals to express their distress and seek support. Although this tendency carries with it specific risks and challenges, it creates unprecedented opportunities to face the challenges of help seeking and access to care. In this paper, we present the empirical, technological, and theoretical evidence supporting the implementation of a digitally augmented prevention policy that would increase its reach. Congruent to the clinical observations and theories on the help-seeking process, we argue that social media can help undertake three main functions of increasing proactivity to bring suffering Web users to care. The gateway function relates to the properties of social media interactions to leverage help-seeking barriers and enable ambivalent individuals to access the mental healthcare system. The communication outreach function aims to broadcast pro-help-seeking messages, while drawing on the functional structure of the social media network to increase its audience. The intervention outreach function consists in using machine learning algorithms to detect social media users with the highest risk of suicidal behaviors and give them a chance to overcome their dysfunctional reluctance to access help. We propose to combine these three functions into a single coherent operational model. This would involve the joint actions of a communication and intervention team on social networks, working in close collaboration with conventional mental health professionals, emergency service, and community resources.

Epidemiology of Suicide and the Psychiatric Perspective

Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low- and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating- and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.

Exposure to suicide behaviour and individual risk of self-harm: Findings from a nationally representative New Zealand high school survey

PURPOSE

To examine whether there is an association between students self-reported suicide attempts and non-suicidal self-injury and exposure to suicidal behaviour among friends, family members or within school communities.

METHODS

A cross-sectional analysis of a nationally representative health and well-being survey of 8500 New Zealand high school students conducted from March through November 2012. Students' self-reported suicide attempts and repeated non-suicidal self-injury was examined in relation to student reports of self-harming behaviour among friends and family as well as data from school administrators of completed suicides within the school community.

RESULTS

Almost 1 in 20 (4.5%) students reported a suicide attempt in the last 12 months and 7.9% reported repeated non-suicidal self-injury in the last 12 months. The risk of both suicide attempts and repeated non-suicidal self-injury was highest among females, students from homes with economic deprivation and among students reporting an episode of low mood in the previous 12 months. Students exposed to suicide attempts or completed suicide among friends and/or family members were at increased risk of reporting attempted suicide and repeated non-suicidal self-injury in the last year. There was no association between completed suicide in school community and students self-reported suicide attempts or repeated non-suicidal self-injury.

CONCLUSIONS

Low mood and exposure to suicide attempts of friends and family members are associated with suicide attempts and repeated non-suicidal self-injury in New Zealand high school students. This research highlights importance of supporting adolescents with low mood and exposed to suicide of friends and family.

What Accounts for the Relationship Between Internet Use and Suicidal Ideation of Korean Older Adults? A Mediation Analysis

Objectives

This study sought to examine the relationship between Internet use and suicidal ideation in Korean older adults and the mediating roles of social relationships and depressive symptoms.

Method

A nationally representative sample of older adults aged 50 or older (N = 6,306), from four waves of the Korean Welfare Panel Study, was used in the analyses. All analyses were conducted using generalized estimation equations, and the mediation effects of social relationship satisfaction and depression in the relationship between Internet use and suicidal ideation were calculated using the product-of-coefficients approach.

Results

Internet use was linked with lower levels of suicidal ideation directly and indirectly via the protective effects of Internet use on lowering depression, which was partially mediated by the positive influence Internet use has on older adults' social relationship satisfaction.

Discussion

The results support previous theories about the relationship between social relationships, depression, and suicidal behavior and prior results about how the Internet might confer mental and social health benefits to older adults. This suggests that the Internet is an important social and health activity that contributes to lowering suicidal ideation in older adults.

A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown

Background

Research exploring internet use and self-harm is rapidly expanding amidst concerns regarding influences of on-line activities on self-harm and suicide, especially in young people. We aimed to systematically review evidence regarding the potential influence of the internet on self-harm/suicidal behaviour in young people.

Methods

We conducted a systematic review based on an electronic search for articles published between 01/01/2011 and 26/01/2015 across databases including Medline, Cochrane and PsychInfo. Articles were included if: the study examined internet use by individuals who engaged in self-harm/ suicidal behaviour, or internet use clearly related to self-harm content; reported primary empirical data; participants were aged under 25 years. New studies were combined with those identified in a previous review and subject to data extraction, quality rating and narrative synthesis.

Results

Forty-six independent studies (51 articles) of varying quality were included. Perceived influences were: positive for 11 studies (38191 participants); negative for 18 studies (119524 participants); and mixed for 17 studies (35235 participants). In contrast to previous reviews on this topic studies focused on a wide range of internet mediums: general internet use; internet addiction; online intervention/treatment; social media; dedicated self-harm websites; forums; video/image sharing and blogs. A relationship between internet use and self-harm/suicidal behaviour was particularly associated with internet addiction, high levels of internet use, and websites with self-harm or suicide content. While there are negative aspects of internet use the potential for isolation reduction, outreach and as a source of help and therapy were also identified.

Conclusions

There is significant potential for harm from online behaviour (normalisation, triggering, competition, contagion) but also the potential to exploit its benefits (crisis support, reduction of social isolation, delivery of therapy, outreach). Young people appear to be increasingly using social media to communicate distress, particularly to peers. The focus should now be on how specific mediums’ (social media, video/image sharing) might be used in therapy and recovery. Clinicians working with young people who self-harm or have mental health issues should engage in discussion about internet use. This should be a standard item during assessment.

A protocol for this review was registered with the PROSPERO systematic review protocol registry: (http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42015019518).

A Mapping Study on the Internet and Suicide

Abstract. Background: Since the mid-1990s concerns have been raised regarding the possible links between suicide and the Internet, especially among adolescents and young adults. Aims: To identify the nature and extent of the scientific publications, especially original research studies, on suicide and the Internet, and to investigate how the field has developed over time. In particular, this mapping study looks at types of publications, topic areas, focus of original research papers, and suicide-related variables of interest in publications. Method: A search of three major databases (PubMED, PsycINFO, and Sociological Abstracts) was conducted to identify papers published until the end of January 2015. Results: The study identified 237 publications on suicide and the Internet published from 1997 to the end of January 2015. These included 122 original research papers. The three most frequent topic areas covered in publications were searching for information on suicide, online interventions, and online suicide-related behaviors. The online mediums most frequently studied were online forums/message boards, search engines, intervention and information websites, and social media. Limitations: The mapping study did not include an analysis of results of research studies and did not assess their quality. Conclusion: The field is rapidly evolving, as seen in the recent increase in the number of publications. However, there are gaps in terms of the countries where research is conducted and the coverage of topics.

Stepping Back From Crisis Points: The Provision and Acknowledgment of Support in an Online Suicide Discussion Forum

Suicide is a global health concern, though little is known about the social practices that might support those who are contemplating suicide. Online forums provide a unique insight into the anonymous discussion of suicide, including sociocultural norms about suicide and the delicate management of online interaction. In this article, we examine the provision and acknowledgment of support in an online discussion forum about suicide, using discursive psychology to analyze the textual interaction. The analysis illustrates how forum threads function as case studies and enable members to gain support on numerous occasions. In this way, members can gain help at crisis points as and when these occur, while still maintaining authenticity as a valid forum member. The analysis also provides additional evidence for models of suicide which highlight the fluid nature of suicidality and contributes to the preventative work on suicide by demonstrating how support can be provided at crisis points.

Suicide and Suicide Attempts in Adolescents

Suicide is the second leading cause of death for adolescents 15 to 19 years old. This report updates the previous statement of the American Academy of Pediatrics and is intended to assist pediatricians, in collaboration with other child and adolescent health care professionals, in the identification and management of the adolescent at risk for suicide. Suicide risk can only be reduced, not eliminated, and risk factors provide no more than guidance. Nonetheless, care for suicidal adolescents may be improved with the pediatrician's knowledge, skill, and comfort with the topic, as well as ready access to appropriate community resources and mental health professionals.

The perceived impact of suicide-related internet use: A survey of young Australians who have gone online for suicide-related reasons

The aim of the present study was to examine the perceived impact of suicide-related Internet use, particularly of websites with potentially harmful attitudes towards suicide (encouraging suicide or discouraging help-seeking) or potentially helpful attitudes towards suicide (discouraging suicide or encouraging help-seeking), the online availability of suicide methods and online suicide communities The present study used a cross-sectional, anonymous online survey. Participants were 102 Australian citizens and permanent residents recruited from various, non-mental health-related websites, aged 18–24 years, who had gone online for suicide-related reasons within the past 12 months. Overall, there was a significant decrease in participants’ retrospective ratings of their suicidal thoughts and behaviours from before they first went online for suicide-related reasons to the time of the survey. However, characteristics of websites did not significantly predict users’ suicidal thoughts and behaviours. Participants reported both positive and negative online experiences, even for similar forms of suicide-related Internet use (e.g. reading information on suicide methods). The findings suggest that suicide-related Internet use is complex and its impact cannot necessarily be strictly attributed to specific types of websites or online content. The Internet may pose a risk to some vulnerable individuals but may also provide helpful, valuable support to others. Mental health professionals should therefore be aware of these potential risks and direct more efforts towards online suicide prevention.

Who Goes Online for Suicide-Related Reasons?

BACKGROUND

Although people who use the Internet for suicide-related reasons have been found to report significantly higher levels of suicidal ideation, little is known about the characteristics of these users.

AIMS

To examine the differences between suicidal people who use the Internet for suicide-related reasons and those who do not.

METHOD

Participants were 205 Australian citizens and permanent residents aged 18-24 years who had felt suicidal within the past year. Participants were recruited online through non-mental health-related websites and asked to complete an anonymous online survey.

RESULTS

In univariate analyses, suicide-related users reported significantly higher levels of social anxiety and lifetime and past year suicidal ideation than non-suicide-related users, as well as a higher likelihood of future suicide and overall higher risk for suicide. There were no differences on depressive symptoms and perceived social support. Both groups were unlikely to anticipate seeking help from any source and generally perceived similar barriers to offline help-seeking. Multivariate analyses showed that past year suicidal ideation and likelihood of future suicide significantly predicted suicide-related Internet use.

CONCLUSIONS

Individuals may choose to go online for alternative methods of coping when their suicidal feelings become more severe, demonstrating the need for more online suicide prevention efforts.

Suicide and the Internet: Changes in the accessibility of suicide-related information between 2007 and 2014

BACKGROUND

Following the ongoing concerns about cyber-suicide, we investigate changes between 2007 and 2014 in material likely to be accessed by suicidal individuals searching for methods of suicide.

METHODS

12 search terms relating to suicide methods were applied to four search engines and the top ten hits from each were categorised and analysed for content. The frequency of each category of site across all searches, using particular search terms and engines, was counted.

RESULTS

Key changes: growth of blogs and discussion forums (from 3% of hits, 2007 to 18.5% of hits, 2014); increase in hits linking to general information sites - especially factual sites that detail and evaluate suicide methods (from 9%, 2007 to 21.7%, 2014). Hits for dedicated suicide sites increased (from 19% to 23%), while formal help sites were less visible (from 13% to 6.5%). Overall, 54% of hits contained information about new high-lethality methods.

LIMITATIONS

We did not search for help sites so cannot assess the balance of suicide promoting versus preventing sites available online. Social media was beyond the scope of this study.

CONCLUSIONS

Working with ISPs and search engines would help optimise support sites. Better site moderation and implementation of suicide reporting guidelines should be encouraged.

Risk Factors of Internet Addiction among Internet Users: An Online Questionnaire Survey

BACKGROUNDS

Internet addiction (IA) has become a major public health issue worldwide and is closely linked to psychiatric disorders and suicide. The present study aimed to investigate the prevalence of IA and its associated psychosocial and psychopathological determinants among internet users across different age groups.

METHODS

The study was a cross-sectional survey initiated by the Taiwan Suicide Prevention Center. The participants were recruited from the general public who responded to the online questionnaire. They completed a series of self-reported measures, including Chen Internet Addiction Scale-revised (CIAS-R), Five-item Brief Symptom Rating Scale (BSRS-5), Maudsley Personality Inventory (MPI), and questions about suicide and internet use habits.

RESULTS

We enrolled 1100 respondents with a preponderance of female subjects (85.8%). Based on an optimal cutoff for CIAS-R (67/68), the prevalence rate of IA was 10.6%. People with higher scores of CIAS-R were characterized as: male, single, students, high neuroticism, life impairment due to internet use, time for internet use, online gaming, presence of psychiatric morbidity, recent suicide ideation and past suicide attempts. Multiple regression on IA showed that age, gender, neuroticism, life impairment, internet use time, and BSRS-5 score accounted for 31% of variance for CIAS-R score. Further, logistic regression showed that neuroticism, life impairment and internet use time were three main predictors for IA. Compared to those without IA, the internet addicts had higher rates of psychiatric morbidity (65.0%), suicide ideation in a week (47.0%), lifetime suicide attempts (23.1%), and suicide attempt in a year (5.1%).

CONCLUSION

Neurotic personality traits, psychopathology, time for internet use and its subsequent life impairment were important predictors for IA. Individuals with IA may have higher rates of psychiatric morbidity and suicide risks. The findings provide important information for further investigation and prevention of IA.