Using the internet for suicide-related purposes: Contrasting findings from young people in the community and self-harm patients admitted to hospital

Abstract

Despite accelerating interest in the impact of the internet on suicidal behaviour, empirical work has not captured detailed narratives from those who engaged in suicide-related internet use. This study explored the suicide-related online behaviour of two contrasting samples of distressed users, focusing on their purpose, methods and the main content viewed. In-depth interviews were conducted in the UK between 2014–2016 with i) young people in the community; and ii) self-harm patients presenting to hospital emergency departments. Data were analysed using methods of constant comparison. Suicide-related internet use varied according to the severity of suicidal feelings. In the young people sample, where severity was lower, use was characterised by disorganised browsing without clear purpose. A range of content was ‘stumbled upon’ including information about suicide methods. They also pursued opportunities to interact with others and explore online help. Self-harm patients were a higher severity group with a history of suicidal behaviour. Their use was purposeful and strategic, focused around ‘researching’ suicide methods to maximise effectiveness. They made specific choices about content viewed; many consulting factual content in preference to user generated accounts, while help content and communication was avoided. Findings indicate further action is necessary to improve online safety. Also, novel online help approaches are needed to engage individuals experiencing suicidal crisis. Awareness of the nature of suicide-related internet use and how this may reflect the status of an individual’s suicidal thinking could be beneficial to clinicians to promote safety and indicate risk.

Suicide and Self-Harm Related Internet Use

“…This finding was strongly reinforced in semistructured qualitative interviews also conducted with a sample of these patients as part of the wider project where the nature and outcomes of S/Sh-related Internet use were explored in depth and found to be largely negative – most purposefully seeking methods information while avoiding online help. Such insights are unavailable for the children's hospital, which makes it difficult to interpret the higher prevalence of use observed among this group ( Biddle, Derges, Goldsmith, Donovan, & Gunnell, 2017 ). It might, for example, refer to broader, more varied use as young people engage with social media, rather than increased use of the same nature as seen in adult patients.…”

Online help for people with suicidal thoughts provided by charities and healthcare organisations: a qualitative study of users’ perceptions

“…However, participants' suggestions are not without difficulty. Linking to forums and lived-experience material requires careful moderation and crafting since in some circumstances these can have detrimental effects, leading to suicide contagion or incitement [7]. A recovery story, for instance, can be either helpful or harmful to a distressed individual depending on the focus and content of its narrative [20].…”

“…Internet search studies indicate a considerable amount of suicide help material is available online [6]. While this may not always (or even commonly) be sought by distressed users [7], search algorithms, language triggers, and other devices, mean links to help pages frequently appear prominently in search results or as 'pop ups' where suicide-related terms are entered into search engines. For instance, in the UK, Samaritans (a suicide prevention charity) has collaborated with Google to ensure a box advertising their services is displayed at the top of such searches.…”

Exposure to and experience of self-harm and self-harm related content: An exploratory network analysis

“…incidental, in-passing observation of someone who participants thought may have engaged in non-suicidal self-harm. Whilst one recent qualitative study described young people who self-harm discussing "stumbling across" content and how this had negatively influenced their self-harm thoughts and behaviours (Biddle et al, 2018), to our knowledge, no other studies have assessed this type of in-passing exposure to non-suicidal self-harm alongside other more well-known exposure mediums, such as through friends or family. Intuitively, being exposed to self-harm via an important figure in one's life, such as a friend or relative, would seem as though it should have a much greater impact on individuals' own self-harm thoughts and behaviours than observing someone in passing.…”

“…Similarly, self-harm and suicide-related internet use was correlated with having engaged in self-harm with suicidal intent, however, a high number of participants also reported having accessed support and help resources online (Mars et al, 2015). Exposure to suicide-related content by "stumbling" upon content on the internet was reported by young people in a recent qualitative study (Biddle, Derges, Goldsmith, Donovan, & Gunnell, 2018), but this type of incidental exposure has mostly been overlooked in previous research.…”