Social media and Suicide

SOCIAL MEDIA AND SUICIDE RISK

An immense quantity of information on the topic of suicide is available on the Internet and via social media. Biddle et al. conducted a systematic Web search of 12 suicide-associated terms (e.g., suicide, suicide methods, how to kill yourself, and best suicide methods) to simulate the results of a typical search conducted by a person seeking information on suicide methods. They analyzed the first 10 sites listed for each search, for a total of 240 different sites. Approximately half were prosuicide Web sites and sites that provided factual information about suicide. Prosuicide sites and chat rooms that discussed general issues associated with suicide most often occurred within the first few hits of a search. We should note that this study primarily focused on prosuicide search terms and thus likely excluded many suicide prevention and support resource sites. Recupero et al. also conducted a study that examined suicide-related sites that can be found using Internet search engines. Of 373 Web site hits, 31% were suicide neutral, 29% were antisuicide, and 11% were prosuicide. The remaining sites either did not load or included “suicide” in the title but were not suicide sites (e.g., sites for movies and novels with “suicide” in their title or music bands whose names included “suicide”). Together, these studies have shown that obtaining prosuicide information on the Internet, including detailed information on suicide methods, is very easy.

The first documented use of the Internet to form a suicide pact was reported in Japan in 2000. It has now become a more common form of suicide in Japan, where the suicide rate increased from 34 suicides in 2003 to 91 suicides in 2005. South Korea now has one of the world's highest suicide rates (24.7/100 000 in 2005), and evidence exists that cybersuicide pacts may account for almost one third of suicides in that country. Currently, a dearth of published information is available regarding the number of cybersuicide pacts in the United States. The problem of cybersuicide pacts has gained international attention, however, and more research is needed to understand social media's impact on the formation of Internet-based suicide pacts.

Video-sharing Web sites have also gained in presence and popularity on the Internet, especially since the creation of YouTube in 2005. A primary concern with suicide or self-harm videos is that they may normalize and reinforce self-injurious behaviors or cause disinhibition. Lewis et al. examined the accessibility and content of the most popular YouTube videos associated with nonsuicidal self-injury, such as self-cutting, burning, and hitting oneself. In 2009, they conducted a search on the keywords “self-injury” and “self-harm” via YouTube's search option and rated and analyzed the 50 most-viewed character videos (featuring live individuals) and 50 most-viewed noncharacter videos. Their results showed that the top videos had more than 2 million viewers and more than half (58%) had no viewer restrictions, such as requiring viewers to validate that they are aged 18 years or older. Lewis et al. reported that of the videos that were retrievable during coding, 42 were neutral (neither promoted nor discouraged nonsuicidal self-injury, 26 were against self-injury, 23 provided a mixed message (both for and against self-injury), and 7 were pro–self-injury. Sixty-four percent had visual representations (such as photographs) of self-harming, specifically cutting. Lewis et al. suggested that these results represent an alarming trend that may foster communities in which nonsuicidal self-injury is encouraged and therefore increase the risk for self-injurious behavior.

In sum, evidence is growing that social media can influence prosuicide behavior. Because the Internet eliminates geographic barriers to communication between people, the emergence of prosuicide social media sites may present a new risk to vulnerable people who might otherwise not have been exposed to these potential hazards.

SOCIAL MEDIA AND SUICIDE PREVENTION

Social networking sites for suicide prevention can facilitate social connections among peers with similar experiences and increase awareness of prevention programs, crisis help lines, and other support and educational resources. For example, the National Suicide Prevention Lifeline Facebook page had more than 29 300 fans as of November 2011, and the American Foundation of Suicide Prevention Facebook page had more than 77 200 fans. Both of these Facebook pages provide links to suicide prevention Web sites and hotlines, as well as information about the warning signs of suicide. We also found 580 groups on Twitter and 385 blog profiles on  designated as suicide prevention. These social media sites allow users to interact and share relevant information, stories, and events in their local areas.

YouTube also has many videos devoted to suicide prevention, including those in the form of public service announcements. For example, the Department of Veterans Affairs produced suicide prevention public service announcements that encourage veterans and service members to seek help. We also found announcements from nonprofit organizations and universities that promote suicide prevention awareness programs at both the institutional and the national level. Other videos were created by individual users and feature support and prevention content such as memorials for loved ones who died by suicide and personal stories of getting help.

The National Suicide Prevention Lifeline's  Web site features an innovative social media platform in which suicide survivor stories are presented by animated avatars (a graphical representation of the user or the user's alter ego or character). Site users can create and design the appearance of their avatars, write a description about their personal experiences with suicide, and then record their voices or choose a computer-generated voiceover to narrate their stories. The site also provides contact information for the National Suicide Prevention Lifeline and links to other suicide prevention organizations. As of November 2011, users had shared more than 880 stories. The use of this form of social media provides an anonymous, personalized, and interactive experience geared toward suicide prevention.

Facebook has also teamed up with the United Kingdom- and Ireland-based Samaritans charity organization to launch a suicide alert reporting system so that Facebook users can report individuals who they believe are expressing suicidal thoughts or intent. Users can access a Report Suicidal Content page  through the Help Center link on their profile page. The Report Suicidal Content page is used to collect data on the content, such as the Web address (URL) of the Facebook page, the full name of the user posting the content, and the date of the posting, as well as additional information. These suicide-related alerts are purported to be given top priority by Facebook's operation staff, who then connect the person who reported the postings with the Samaritan team to help give guidance and support.

CONCLUSIONS

Public health is concerned with protecting and improving the health of entire populations, whether those populations are small communities or large nations. Social media, as we understand it today, has created virtual communities without physical borders. We have presented evidence showing that social media may pose a risk to vulnerable groups who are part of these virtual communities. We have also provided some examples of extant social media–based prevention applications and programs that follow from a public health–based approach. Framing the topic of social media and suicide from a public health perspective to address the issue and guide prevention programs makes sense.

Several significant difficulties emerge, however, when conducting research on this topic. First, conducting research with suicide rates as an outcome variable is difficult because of suicide's low base rate. Moreover, the variability in social media format, use patterns, and other influences on suicidal behavior makes it very difficult to test social media as a variable that predicts suicidal behavior. For example, an increased prevalence of other risk factors, such as alcohol use and availability of firearms among teens, might also explain the rise in suicide rates among this vulnerable group. Moreover, the causal role of social media in a person's decision to die by suicide or to acquire the means to do so may not be direct. That is, whether an at-risk person is more likely to die by suicide because he or she can obtain information about it via the Internet cannot be easily demonstrated.

Legal issues must also be considered when contemplating public health approaches to addressing some of the problems of social media and suicide. In particular are the legal complexities associated with the monitoring and filtering of content on the Internet. Although some countries are able to control Internet Web sites created within their borders, international jurisprudence makes it difficult to obtain jurisdiction over sites that originate outside the United States.  Debate has also arisen as to whether the public sector or the private sector should be responsible for restricting content on the Internet and how much restriction should be allowed. In general, the Internet is less regulated than other forms of media.