Suicide is a leading cause of death among young people aged 15 to 29 years, accounting for 17.6% of deaths in high-income countries and 8.5% of deaths globally (World Health Organization, 2014b). Deaths by suicide represent the tip of an iceberg; it is estimated that non-fatal suicidal behaviour may be up to 20 times more frequent (World Health Organization, 2014a).

Despite these statistics, evidence relating to effective interventions to prevent suicide and related behaviour among young people is limited (Robinson, Hetrick, & Martin, 2011), although there is emerging evidence that school-based suicide prevention programmes are potentially helpful.

Young people are high users of social media, which includes chat rooms, blogs, video sharing sites (e.g., YouTube), social networking sites (e.g., Facebook, MySpace, Twitter, Google+) and online forums, as well as e-mail, text messaging, and video chat (Luxton, June, & Fairall, 2012).

Interventions to prevent youth suicide via social media could therefore represent a promising way forward. However, there is little evidence relating to the types of intervention that may be effective and few studies have examined the experiences of those using social media for suicide prevention activities.

Recent efforts by the Samaritans to introduce a Twitter app that could be used to alert others of potentially suicidal individuals have demonstrated that there are a number of important ethical issues to consider (The Samaritans, 2015).

A recent systematic review by Robinson et al. (2015) aimed to answer four specific research questions relating to social media and suicide prevention:

1. What format do social media sites developed specifically for the purpose of suicide prevention take?
2. What is the potential of social media in terms of its ability to ‘reach’ and identify people at risk of suicide?
3. How do people use social media sites for suicide prevention-related purposes?
4. What are the experiences of people who use social media sites for suicide-related purposes?

Methods

• The authors searched Medline, PsycInfo, CINHAL and the Cochrane Library for published studies relating to suicide (and related behaviour) and social media, with a preventative focus.
• A hand-search of references of included articles and relevant literature reviews was also conducted.
• English language articles published between 1991 and April 2014 were considered.
• No limits were placed on the study design of included articles.
• Data from the selected articles were extracted by two authors and included a range of information such as the study design, website format and participant or user characteristics.
• A narrative synthesis was conducted to analyse and synthesise the findings, given the diversity of relevant studies.

Results

The search generated 355 potentially relevant articles, following the removal of duplicates. After initial screening, 86 articles were selected for full-text review. Thirty individual studies were then selected for inclusion in the narrative synthesis and were grouped according to the research question they answered.

Format of social media sites for suicide prevention

Four studies included information on the format of social media sites for suicide prevention.

• Two examined websites that specifically targeted suicidal people and comprised email, instant chat and online forums, as well as information-based articles and lists of support organisations.
• One focused on the staff and students of a university in the United States, which reported on a static website containing emergency contact information and an online course. It also used social networking platforms such as MySpace and Facebook in order to disseminate the program.
• One targeted mental health professionals working with suicidal individuals, in which an interactive website and chat room enabled users to access professional development resources, offer and receive peer support and distribute and share information.

Ability of social media sites to identify people at risk

One study was found that specifically sought to investigate the potential of social media sites to identify people at risk of suicide, a further five included some related data.

• The key study focused on estimating the reach of potential suicide prevention initiatives among lesbian, gay and bisexual adolescents who used MySpace.
• By analysing their social networks it was found that an estimated 18,000 individuals could be reached, which was considered much higher than usual methods to detect at-risk populations.
• Other studies suggested that social media could potentially be used in the early-identification of at-risk individuals, but raised a number of ethical issues.
• Evidence was also identified highlighting the potential for monitoring suicide trends via social networking sites such as Twitter.

How people use social media sites

Fifteen studies contained information on how people use social media sites for suicide prevention-related activities.

• Eleven studies investigated the ways in which users engaged with suicide prevention forums, including one designed for those bereaved by suicide.
• Two studies focused on the way moderators of suicide forums responded to messages and two studies examined both users and moderators.
• The studies found people use suicide-related social media sites to discuss their feelings and experiences with others in a similar position, offer support, but sometimes to validate their suicidal identities instead of seeking help.
• Studies investigating the experiences of moderators found that they provided more emotional support compared to lay forum users.
• One study examined the response of forum users to a member’s suicide, which was found to be similar to offline experiences, with difficulties raised relating to the risk of contagion.

Experiences of people using social media sites

Five studies examined the experiences of individuals who used social media sites for suicide prevention purposes, via interview or survey.

• Three studies focused on vulnerable individuals and two on individuals bereaved by suicide.
• One study revealed that 70% of 290 users of online forums found them to be useful and supportive.
• Some studies reported use of online forums may be related to decreased suicidal ideation, but attributing this to the forum use is difficult. Others suggested that those engaging with suicide related sites were less likely to seek help and that some users displayed a mistrust of psychiatric services, with suicide sometimes portrayed as a legitimate solution to problems.
• Studies on the users of online support forums for people bereaved by suicide revealed that users were more likely to have experienced a negative reaction from family and friends and that they had greater levels of depression, grief and suicidal ideation compared to those who used face-to-face support groups.

Strengths and limitations

The key strengths of this study included its comprehensive search strategy. However, it was limited to English-language articles and therefore there is a chance that important papers may not have been identified. Similarly, the grey literature was not searched.

The narrative synthesis was detailed, but was ultimately restricted by the studies included which varied considerably in design, quality and focus.

Conclusions

The systematic review identified a set of 30 studies relating to social media and suicide prevention related activities. Heterogeneity of studies made overall conclusions about the efficacy of social media activities rather difficult. Most studies were descriptive accounts or cross-sectional in nature and often focused on specific websites, therefore limiting the generalisability of findings.

However, potential benefits of social media sites were identified, including the possibility for reaching a large number of potentially ‘hard-to-reach’ individuals and reports that individuals found the supportive environment of suicide-related forums helpful. The study also raised a number of important issues including confidentiality, the risk of contagion and normalisation of suicide-related behaviour, as well as the difficulty of assessing the risk of suicide online, all of which should not be underestimated.

Further high quality studies are required to fully elucidate the efficacy and safety of social media interventions for suicide prevention. Given the issues raised recently surrounding the introduction of the Samaritans ‘Radar’ app, research is also needed regarding the acceptability of social media interventions among the general public and those particularly at risk.

If you need help and support now, please call the Samaritans on 08457 90 90 90.

If you need help

If you need help and support now and you live in the UK or the Republic of Ireland, please call the Samaritans on 116 123.

If you live elsewhere, we recommend finding a local Crisis Centre on the IASP website.

We also highly recommend that you visit the Connecting with People: Staying Safe resource.

Links

Primary paper

Robinson, J., et al. (2015). Social media and suicide prevention: a systematic review. Early Intervention in Psychiatry: DOI: 10.1111/eip.12229 [PubMed abstract]

Other references

Luxton, D. D., June, J. D., & Fairall, J. M. (2012). Social Media and Suicide: A Public Health Perspective. American Journal of Public Health, 102(S2), S195-S200. doi: 10.2105/AJPH.2011.300608

Robinson, J., Hetrick, S. E., & Martin, C. (2011). Preventing Suicide in Young People: Systematic Review. Australian and New Zealand Journal of Psychiatry, 45(1), 3-26. doi: 10.3109/00048674.2010.511147 [PubMed abstract]

The Samaritans. (2015). Samaritans Radar.   Retrieved 13/07/2015, from http://www.samaritans.org/how-we-can-help-you/supporting-someone-online/samaritans-radar

World Health Organization. (2014a). Preventing suicide: A global imperative.   Retrieved 19/02/2015, from http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/

World Health Organization. (2014b). Suicide a leading cause of death among young adults in high-income countries.   Retrieved 12/07/2015, from http://www.euro.who.int/en/health-topics/noncommunicable-diseases/mental-health/news/news/2014/09/suicide-a-leading-cause-of-death-among-young-adults-in-high-income-countries

Twin Design / Shutterstock.com