Background Adolescence is a phase of higher vulnerability for suicidal behavior. In Germany, almost 500 adolescents and young adults aged 15-25 years commit suicide each year. Youths in rural areas are characterized by a higher likelihood of poorer mental health. In rural areas, appropriate support for adolescents and young adults in mental health crises is difficult to access. The general acceptability of digital communication in youths can make the provision of an eHealth tool a promising strategy. Objective The aim of this study was to explore the health needs regarding suicide prevention for adolescents and young adults in rural areas of Germany and Switzerland and to identify characteristics of suitable e-mental health interventions. Methods This study reports on a qualitative secondary analysis of archived data, which had been collected through formative participatory research. Using 32 semistructured interviews (individually or in groups of 2) with 13 adolescents and young adults (aged 18-25 years) and 23 experts from relevant fields, we applied a deductive-inductive methodological approach and used qualitative content analyses according to Kuckartz (2016). Results Experts as well as adolescents and young adults have reported health needs in digital suicide prevention. The health needs for rural adolescents and young adults in crises were characterized by several categories. First, the need for suicide prevention in general was highlighted. Additionally, the need for a peer concept and web-based suicide prevention were stressed. The factors influencing the acceptability of a peer-driven, web-based support were related to low-threshold access, lifelike intervention, anonymity, and trustworthiness. Conclusions The results suggest a need for suicide prevention services for adolescents and young adults in this rural setting. Peer-driven and web-based suicide prevention services may add an important element of support during crises. By establishing such a service, an improvement in mental health support and well-being could be enabled. These services should be developed with the participation of the target group, taking anonymity, trustworthiness, and low-threshold access into account.

BACKGROUND Adolescence is a phase of higher vulnerability for suicidal behavior. In Germany, almost 500 adolescents and young adults aged 15 to 25 years commit suicide each year. Youth in rural areas are characterized by a higher likelihood of poorer mental health. In rural areas, appropriate support for adolescents in mental health crises is difficult to access. The general acceptability of digital communication in youth can make the provision of an E-Health tool a promising strategy. OBJECTIVE The aim of this study is to explore the health needs regarding suicide prevention for adolescents and young adults in rural areas of Germany and Switzerland and to identify characteristics of suitable E-mental health interventions. METHODS This study reports on a qualitative secondary analysis (QSA) of archived data, which had been collected through formative participatory research. Using 32 semi-structured interviews (individually, groups of two) with n=13 adolescents and young adults (18-25 years of age) and with n=23 experts from relevant fields, we applied a deductive-inductive methodological approach and we used qualitative content analyses according to Kuckartz (2016). RESULTS Experts as well as adolescents have reported health needs in digital suicide prevention. Those health needs for rural adolescents in crises were characterized by several categories: First, the need for suicide prevention in general was highlighted. Additionally the need for a peer concept and need for online suicide prevention were stressed. The factors influencing the acceptability of a peer-driven, web-based support were related to a low-threshold access, a lifelike intervention, anonymity and trustworthiness. CONCLUSIONS The results suggest a need for suicide prevention services for adolescents in this rural setting. Peer-driven and web-based suicide prevention services for adolescents and young adults may add an important element of support during crises in this age group. These services should be developed with participation of the target group, taking anonymity, trustworthiness and low-threshold access into account.