The association of trends in charcoal-burning suicide with Google search and newspaper reporting in Taiwan: a time series analysis

The impact of media reporting of suicides on subsequent suicides in Asia: A systematic review

Introduction

This systematic review is aimed at (1) evaluating the association between media portrayals of suicides and subsequent copycat suicides or attempts among the general public in Asia, (2) understanding the factors associated with copycat suicides and (3) determining the positive impacts of the media reporting of suicides (e.g. increased help-seeking, coping).

Method

A systematic review and narrative synthesis of English and Chinese articles from 8 electronic databases (i.e. PsycINFO, MEDLINE, Embase, CINAHL, Web of Science, Ariti, China National Knowledge Infrastructure and OpenGrey) from January 2000 to May 2023 was conducted. Observational studies were included, and the data were analysed through narrative synthesis. The protocol was registered with PROSPERO (CRD42021281535).

Results

Among the 32 studies included (n=29 for evidence synthesis) in the review, there is good-quality evidence to show that copycat suicides and suicide attempts increase after media reports of a suicide, regardless of country, celebrity status, study design, type of media, mode of suicide or follow-up period. Females, younger age groups and those sharing similar characteristics as the deceased in publicised suicides (age, gender) were more susceptible to negative impact. Reporting of the mode of death of the deceased increased suicides by the same method among the public.

Conclusion

Media portrayals of suicide appear to have a negative impact on copycat suicides at the population level in Asia. Thus, in addition to tighter media control, healthcare systems, professional medical bodies and community outreach services should work collaboratively to promote early help-seeking in those with psychological distress.

The evolution of charcoal-burning suicide: A systematic scoping review

INTRODUCTION

Suicide by charcoal burning has accounted for more than 100,000 deaths. It has become an increasingly common suicide method in Hong Kong since first reported in 1998, and it has spread into South Korea, Taiwan, Japan and other countries. This systematic scoping review aimed to explore current evidence on trends, risk factors, impact of media and prevention strategies for this suicide method, and to identify research gaps.

METHODS

A search for articles published from January 1998 to June 2021 was conducted through electronic databases (MEDLINE, EMBASE, SCOPUS and PsycINFO) with the keywords (suicide*) AND (charcoal). Articles describing prevalence, trends, characteristics, risk factors and prevention strategies of charcoal burning suicide deaths were included. Non-peer-reviewed articles, non-English articles, commentaries/editorials/letters, poster abstracts, reviews, meta-analyses and studies that documented only charcoal burning suicide attempters/survivors were excluded.

RESULTS

Eighty-eight studies were identified, most from East Asia. Charcoal burning suicide rates in Hong Kong, Taiwan and Japan has passed the peak, while continuing to increase in South Korea. Risk factors are changing and not static. Media appears to play an important role in triggering and spreading information. Restricting access to charcoal, and raising public awareness have been effective in the short term in preventing charcoal burning suicide, but there is little information on their long-term effectiveness or sustainability.

DISCUSSION

More research is required to update the development and dynamic changes of charcoal burning suicide and the contributing factors. The evidence from this review may assist in detecting and intervening early for future novel suicide methods.

The association between unemployment and suicide among employed and unemployed people in Hong Kong: A time-series analysis

BACKGROUND

Unemployment is associated with suicide. However, it is unclear whether the influence of unemployment is consistent on suicide across subgroups with different employment status. This study aimed to explore the immediate and delayed association between unemployment and suicide among unemployed and employed people in Hong Kong.

METHODS

Quarterly statistics on labor force, unemployment rate and suicide count by employment status in Hong Kong (2003-2019) were obtained from the Hong Kong Census and Statistics Department and the Coroner's Court suicide reports. Separate negative binomial autoregressive regressions were used to investigate associations between unemployment and suicide among employed and unemployed people. The models controlled for linear and non-linear time trends, seasonal variations, the number of suicide cases, Consumer Price Index, and gender ratios of the labor force in the previous quarter.

RESULTS

After controlling for all covariates, every 1% increase in the present unemployment rate was associated with a 15% increase in the suicide rate among the employed people in the current quarter (Incidence Rate Ratio (IRR) = 1.14, 95% CI = 1.01-1.28), and a 13% decrease in the suicide rate among the unemployed in the next quarter (IRR = 0.87, 95% CI = 0.78-0.98).

LIMITATIONS

Most recent data on suicide cannot be obtained due to processing time of death investigation.

CONCLUSIONS

The influence of unemployment differed on suicide by employment status in different time periods. Employed and unemployed people have different needs in different economic conditions. Hence, it is important to provide timely, targeted and effective measures for suicide prevention to the specific group.

Perceptions towards charcoal-burning suicide and the surge of this lethal method in Taiwan

Objective

Whether sociocultural perceptions of charcoal-burning suicide have influenced its rapid increase in prevalence is unclear. We aimed to explore perceptions of Taiwan’s general population regarding charcoal-burning suicide, their personal belief in life after death, and related feelings of thoughts associated with those who attempt charcoal-burning suicide.

Methods

An online web-based survey, focussing on sociocultural attitudes towards death, as well as perceptions towards charcoal-burning suicide, and those who attempt charcoal-burning suicide, was conducted from 14 January to 14 June 2016.

Results

In total, 1343 adults completed the online survey (mean age of 33.46; 66.6% women). Notably, 90.3% of participants considered charcoal burning to be an easily accessible suicide method. Multivariable analyses revealed that among the examined factors, the perceived ‘painlessness’ of charcoal-burning suicide was associated with an over seven-fold increased risk of choosing charcoal-burning suicide (OR = 7.394; p < 0.001; 95% CI: 2.614–20.912).

Conclusion

As reflected in this study, charcoal-burning suicide is perceived as easily accessible and painless. The perceived ‘painlessness’ may be the factor that distinguishes the choice of charcoal-burning suicide from that of other suicide methods. Future efforts to target these perceptions regarding charcoal-burning suicide may be warranted in both media reporting and suicide prevention programmes.

The Werther Effect, the Papageno Effect or No Effect? A Literature Review

This paper examines the association between media reporting on suicides and the subsequent suicides. Scientific papers from two online bibliographic sources Medline (PubMed) and PsycINFO were searched. The sample included 108 research papers examining the impact of different types of media stories on suicides. The review revealed that although the media can be a double-edged sword and serve both as a risk and a protective factor, the vast majority of research suggests that the relationship between the media reporting and the actual suicide rates is causal and real. Moreover, both the quantity and the quality of media reporting may trigger additional suicides in society. Simultaneously, research suggests that especially non-fictional presentations of celebrities’ suicides in newspapers and on television news have the biggest influence on the subsequent suicides. Additionally, a strong modelling effect of media reporting on suicide is based on nationality, age, and gender. However, research shows that because a negative reporting style can be modifiable and improved, the media can also have an educative or preventive effect and can reduce the risk of contagion. Consequently, it is important to monitor the implementation of media recommendations for the reporting of suicide, and continuous education of reporters is needed.

The Werther Effect, the Papageno Effect or No Effect? A Literature Review

This paper examines the association between media reporting on suicides and the subsequent suicides. Scientific papers from two online bibliographic sources Medline (PubMed) and PsycINFO were searched. The sample included 108 research papers examining the impact of different types of media stories on suicides. The review revealed that although the media can be a double-edged sword and serve both as a risk and a protective factor, the vast majority of research suggests that the relationship between the media reporting and the actual suicide rates is causal and real. Moreover, both the quantity and the quality of media reporting may trigger additional suicides in society. Simultaneously, research suggests that especially non-fictional presentations of celebrities’ suicides in newspapers and on television news have the biggest influence on the subsequent suicides. Additionally, a strong modelling effect of media reporting on suicide is based on nationality, age, and gender. However, research shows that because a negative reporting style can be modifiable and improved, the media can also have an educative or preventive effect and can reduce the risk of contagion. Consequently, it is important to monitor the implementation of media recommendations for the reporting of suicide, and continuous education of reporters is needed.

Adherence to World Health Organization guideline on suicide reporting by media in Taiwan: A surveillance study from 2010 to 2018

BACKGROUND/PURPOSE

Significant associations between suicide behaviors and inappropriate suicide reports in the media have been reported. The study aimed to examine the quality of long-term suicide reports under surveillance by the Taiwan Suicide Prevention Center (TSPC).

METHODS

The TSPC conducted daily surveillance with timely feedback and interactive approaches with the media professionals. To examine the reporting trends under the surveillance, daily adherence to the 12-item World Health Organization (WHO) guidelines was analyzed for print media published between 2010 and 2018, and for online media in 2017 and 2018. The trend analysis using the Cochran-Armitage test was performed to estimate the significance of adherence changes.

RESULTS

In total, 5529 print reports and 16,445 person-event items from online media were reviewed. The number of suicide reports in print newspapers markedly decreased while it increased for online media. Surveillance of print media showed statistical significance of the improvement of reporting adherence to all guideline items except one item ("Do not publish photo or suicide notes"). Adherence rates were high (∼90%) for 6 of the 12 items over the study duration. Marked improvement was observed in three items: reporting details, giving simplistic reasons, and providing helpline resources. However, both "Highlight the alternatives to suicide" and "Work closely with health authorities to present the facts" items had the lowest adherence. Online media had similar findings and adherence profile as the print media.

CONCLUSION

The quality of suicide reports significantly improved in most WHO guideline items. Development of psychiatric-media liaisons may be beneficial for further improvement.

The evolution of the characteristics of charcoal-burning suicide in Hong Kong, 2002-2013

BACKGROUND

The use of barbecue charcoal gas for suicide led to more than 50,000 deaths in Asia since the rise of its use from 1998. Little is known whether the profile of charcoal-burning suicides changed over time.

METHODS

Hong Kong's suicide data (2002-2013) were extracted from the Coroner's files. The detailed characteristics were compared between suicide by charcoal-burning and non-charcoal-burning methods, and between charcoal-burning suicides of different periods (2002-2005 vs 2006-2009 vs 2010-2013).

RESULTS

People who died by suicide using charcoal burning (n = 2,188) were more likely to be male, aged 30-49 years, married (2002-2005 only), have debt, or live alone, and were less likely to have past or current psychiatric treatment or medical illness than non-charcoal-burning suicides (n = 9,666) across the three four-year periods. By contrast, compared to charcoal-burning suicides in 2002-2005, those in more recent periods (2006-2009 and 2010-2013) were more likely to be aged 50+, non-married, live alone (2006-2009 only), or have current psychiatric treatment or medical illness, and were less likely to be male (2006-2009 only), unemployed, or have debt.

LIMITATIONS

There could be under-reporting of certain characteristics for charcoal-burning suicides in the Coroner's files.

CONCLUSION

Charcoal-burning suicides persistently showed a distinguishable profile in Hong Kong, whilst changes in certain characteristics suggested a 'diffusion' of the method to some other groups such as older individuals. Responsible media reporting and restricting online information about new suicide methods could be potentially important prevention strategies in the early stage, whilst other strategies are needed when the methods become more commonly used.

Developing an early warning system of suicide using Google Trends and media reporting

BACKGROUND

Conventional surveillance systems for suicides typically suffer from a substantial time lag of six months to two years. This study aims to develop an early warning system of possible suicide outbreaks in Hong Kong using Google Trends and suicide-related media reporting.

METHODS

Data on 3,534 suicides from 2011 to 2015 were obtained from Hong Kong Census and Statistics Department, and the Coroner's Court. Using data from Google Trends and features extracted from media reporting on suicide news, we fitted Poisson regression models to predict the number and estimate the intensity of suicides on a weekly basis, for six subgroups, defined by gender and age. We adopted the cumulative sum (CUSUM) control chart-based method to identify outbreaks of suicide.

RESULTS

The proposed model was able to predict the number of suicides with reasonably low normalized root mean squared errors, ranging from 15.6% for young females to 24.16% for old females. The suicide intensity curves were well captured by the proposed models for young males and females, but not for other groups. The Sensitivity, Precision and F1 Score of the CUSUM-based method were 50%, 100% and 67% for young females, and 93%, 54% and 68% for young males.

LIMITATIONS

This study focused only on predicting the number of suicides in the current week, not in the future weeks. The model did not include social media, socioeconomic and climate data.

CONCLUSIONS

Our results indicate that Google Trends search terms and media reporting data may be valuable data sources for predicting possible outbreak of suicides in Hong Kong. The proposed system could support effective and targeted interventions.

Do Search Engine Helpline Notices Aid in Preventing Suicide? Analysis of Archival Data

Background

Search engines display helpline notices when people query for suicide-related information.

Objective

In this study, we aimed to examine if these notices and other information displayed in response to suicide-related queries are correlated with subsequent searches for suicide prevention rather than harmful information.

Methods

Anonymous suicide-related searches made on Bing and Google in the United States, the United Kingdom, Hong Kong, and Taiwan in a span of 10 months were extracted. Descriptive analyses and regression models were fit to the data to assess the correlation with observed behaviors.

Results

Display of helpline notices was not associated with an observed change in the likelihood of or future suicide searches (P=.42). No statistically significant differences were observed in the likelihood of people making future suicide queries (both generally and specific types of suicide queries) when comparing search engines in locations that display helpline notices versus ones that do not. Pages with higher rank, being neutral to suicide, and those shown among more antisuicide pages were more likely to be clicked on. Having more antisuicide Web pages displayed was the only factor associated with further searches for suicide prevention information (hazard=1.18, P=.002).

Conclusions

Helpline notices are not associated with harm. If they cause positive change in search behavior, it is small. This is possibly because of the variability in intent of users seeking suicide-related information. Nonetheless, helpline notice should be displayed, but more efforts should be made to improve the visibility and ranking of suicide prevention Web pages.

Suicide deaths by gas inhalation in Toronto: An observational study of emerging methods of suicide

BACKGROUND

Suicide death by gas inhalation has been the subject of global scientific interest due to a rapid increase in the use of helium and charcoal gas for suicide. These may be particularly amenable to means restriction strategies. There has been little scientific attention of this phenomenon in Canada.

METHODS

A review of coroner records was conducted for all suicide deaths in Toronto (1998-2015). Deaths were categorized as due to inhalational asphyxia by compressed gas (i.e. helium or nitrogen), charcoal burning or motor vehicle exhaust, with suicide deaths by other methods as a comparator. Demographic, clinical and suicide specific differences between decedents in these four categories were compared using chi-squared or ANOVA global test of significance with additional pairwise comparisons where appropriate. Secular trends were also examined.

RESULTS

Gas inhalational deaths accounted for 190 (4.7%) of all suicides in Toronto (n = 4062) over the study period and a higher proportion of males used compressed gas or motor vehicle exhaust gases than those who died by other methods (83.3% and 84.0% vs.69.7%, both p = 0.01). Comparing 1998-2003 to 2010-2015 there was a 1075% increase in deaths by helium (4 vs. 43 deaths) and a 533% increase in deaths by charcoal burning (3 vs. 16 deaths) although helium and charcoal burning deaths still accounted for only 4.2% of total suicides 2010-2015. Deaths by helium were more likely to be accompanied by the book "Final Exit" than those by non-inhalational methods (15% vs. 0.7%, p < 0.0001) while 13 of 14 people who died by charcoal burning whose ethnicity could be determined were Asian.

LIMITATIONS

Ethnicity and specific details of procurement of suicide methods were not systematically available in coroner records.

DISCUSSION

Suicide by inhalational asphyxia, particularly by compressed gases, has increased substantially over time in Toronto consistent with observations in other countries. Increased surveillance of these deaths, efforts to restrict access to these methods, and timely interventions including minimizing media reporting are all warranted.

Suicide rates and information seeking via search engines: A cross-national correlational approach

The volume of Google searches for suicide-related terms is positively associated with suicide rates, but previous studies used data from specific, restricted geographical contexts, thus, limiting the generalizability of this finding. We investigated the correlation between suicide-related search volume and suicide rates of 50 nations from five continents. We found a positive correlation between suicide rates and search volume, even after controlling for the level of industrialization. Results give credence to the global existence of a correlation. However, the reason why suicide-related search volume is higher in countries with higher suicide rates is still unclear and up to future research.

Searching for suicide-related information on Chinese websites

Growing concerns about cyber-suicide have prompted many studies on suicide information available on the web. However, very few studies have considered non-English websites. We aimed to analyze online suicide-related information accessed through Chinese-language websites. We used Taiwan's two most popular search engines (Google and Yahoo) to explore the results returned from six suicide-related search terms in March 2016. The first three pages listing the results from each search were analyzed and rated based on the attitude towards suicide (pro-suicide, anti-suicide, neutral/mixed, not a suicide site, or error). Comparisons across different search terms were also performed. In all, 375 linked webpages were included; 16.3% of the webpages were pro-suicide and 41.3% were anti-suicide. The majority of the pro-suicide sites were user-generated webpages (96.7%). Searches using the keywords 'ways to kill yourself' (31.7%) and 'painless suicide' (28.3%) generated much larger numbers of harmful webpages than the term 'suicide' (4.3%). We conclude that collaborative efforts with internet service providers and search engines to improve the ranking of anti-suicide webpages and websites and implement online suicide reporting guidelines are highly encouraged.

A Public Health Approach in Responding to the Spread of Helium Suicide in Hong Kong

Abstract. Background: The use of the helium suicide method has been increasing in popularity in Hong Kong since 2012. We have learned a valuable lesson in curbing the spread of charcoal burning (CB) suicide in the past 15 years and hope to prevent the helium suicide method from taking off in the community. Aims: To document what actions have been taken to contain the spread of the helium suicide method and review the preliminary impact of these actions. Method: We adopted a public health approach by engaging stakeholders from multiple sectors, including the police force, the fire services department, coroners, pathologists, mass media, and online media outlets. Results: A monitoring system was established by compiling data extracted from news reports, coroners' reports, and police investigations. Risk and protective factors were identified. Intervention strategies were developed to strengthen protective factors and minimize risk factors. This novel suicide method has not spread as rapidly as the CB suicide method. The preliminary outcomes suggest our actions to be effective. Limitations: The count of helium suicides in 2015 might be low. The impacts of the interventions are only estimated and require additional empirical verifications. Conclusion: The public health approach of engaging multiple partners in the early phase of a potential epidemic can be a good guide to meeting the challenges posed by any new suicide methods that emerge in the future.

Media effects on suicide methods: A case study on Hong Kong 1998-2005

Background

Previous studies have suggested that mass media’s reports of new suicide methods will increase suicides using the same method. The same pattern seems not to apply to a conventional suicide method, unless it was used by a celebrity.

Objective

1) to examine media effects on both new and non-new suicide methods during 1998 and 2005 in Hong Kong (HK), when a new method by burning charcoal (CB suicide) was spreading in the region. 2) to examine how CB competed with non-CB methods in terms of media coverage and “recruiting” suicidal persons in the socio-economic context.

Methods

A self- and mutual- exciting process model was fitted to the data, adjusting for divorce rate, unemployment rate, and property price index. Breaking the whole period into onset, peak, and post-peak stages, the model was fitted again to examine the differences.

Results

Comparable copycat effects were found on both CB and non-CB suicide news. The only cross-method media effects were found in the onset stage when non-CB suicide news showed suppressing effect on CB suicides. CB suicides reported a significant self-excitation effect. A higher divorce rate and lower property price index were associated with significantly more suicides incidences and more suicide news.

Conclusions

The emerging of CB suicide method did not substitute media coverage of non-CB suicide in HK. Media effects in this case were not limited to new suicide method or celebrity suicide. The effects were further fueled by adverse socio-economic conditions.

Global trends in suicide epidemiology

PURPOSE OF REVIEW

Suicide is a major cause of mortality accounting for nearly 1 million deaths globally per year. Suicide occurs throughout the lifespan; therefore, large epidemiological samples are needed to identify patterns in suicide death. This review examines emerging evidence relating to risk and protective factors as well as preventive measures for suicide.

RECENT FINDINGS

The global financial crisis, natural disasters, air pollution and second-hand smoke have all been associated with increased suicide rates. At an individual level, past self-harm, parental loss or separation and younger age relative to classmates all confer risk. There is mixed evidence for religious affiliation and lithium levels in drinking water as protective factors. Means restriction strategies including barriers at suicide hotspots, firearms restrictions and limiting access to both pesticides and charcoal have all prevented suicide. Other interventions with recent evidence include improvements in mental health systems, selective serotonin reuptake inhibitor (SSRI) and lithium treatment in youth and mental health awareness in schools.

SUMMARY

The evidence for risk/protective factors for suicide continues to grow and, more importantly, numerous prevention efforts continue to demonstrate positive outcomes. Public policy experts should attend to the environmental and social determinants of health when devising suicide prevention programs, and the evidence-based prevention strategies identified here should be implemented more broadly.

Spatial and temporal evolution of the epidemic of charcoal-burning suicide in Japan

PURPOSE

An epidemic of carbon monoxide poisoning suicide by burning charcoal occurred in Hong Kong and Taiwan. An epidemic also emerged in Japan from February 2003 and resulted in an increase of 10-20 % in overall suicide rates in younger adults (aged <45 years) in the mid-2000s. We investigated the spatial and temporal evolution of the epidemic to assess its impact on the epidemiology of suicide in Japan.

METHODS

Mortality data were obtained from the official vital statistics of Japan. Smoothed standardized mortality ratios of charcoal-burning and non-charcoal-burning suicide were estimated for the period 2003-2013 using Bayesian hierarchical models. Joinpoint regression analysis was performed to analyze secular trends in suicide rates by gender, method used and geographic location between 1999 and 2013.

RESULTS

Suicide by burning charcoal rose sharply in the mid-2000s and was not accompanied by a simultaneous decline in alternative methods. The epidemic of charcoal-burning suicide in Japan showed a pronounced spatial pattern, being concentrated in rural prefectures particularly among males. For men but not women, the epidemic contributed to the widening of urban-rural disparities in suicide rates (higher rates in rural areas).

CONCLUSIONS

Our results differ from previous research in other Asian countries (e.g., Taiwan), where the epidemic of charcoal-burning suicide emerged more prominently in urban areas. In Japan, the introduction and diffusion of charcoal burning contributed to a real excess in suicide rates, as well as a widening of the urban/rural disparity in suicide.

Newspaper reporting and the emergence of charcoal burning suicide in Taiwan: A mixed methods approach

BACKGROUND

It has been suggested that extensive media reporting of charcoal burning suicide was a key factor in the rapid spread of this novel method in many East Asian countries. But very few empirical studies have explored the relationship between media reporting and the emergence of this new method of suicide.

AIMS

We investigated the changing pattern of media reporting of charcoal burning suicides in Taiwan during 1998-2002 when this method of suicide increased most rapidly, assessing whether the characteristics of media reporting were associated with the changing incidence of suicide using this method.

METHODS

A mixed method approach, combining quantitative and qualitative analysis of newspaper content during 1998-2002 was used. We compared differences in reporting characteristics before and after the rapid increase in charcoal burning suicide. Point-biserial and Pearson correlation coefficients were calculated to quantify the associations between the media item content and changes in suicide rates.

RESULTS

During the period when charcoal burning suicide increased rapidly, the number of reports per suicide was considerably higher than during the early stage (0.31 vs. 0.10). Detailed reporting of this new method was associated with a post-reporting increase in suicides using the method. Qualitative analysis of news items revealed that the content of reports of suicide by charcoal burning changed gradually; in the early stages of the epidemic (1999-2000) there was convergence in the terminology used to report charcoal burning deaths, later reports gave detailed descriptions of the setting in which the death occurred (2001) and finally the method was glamourized and widely publicized (2001-2002).

LIMITATIONS

Our analysis was restricted to newspaper reports and did not include TV or the Internet.

CONCLUSIONS

Newspaper reporting was associated with the evolution and establishment of charcoal burning suicide. Working with media and close monitoring of changes in the incidence of suicide using a new method might help prevent a suicide epidemic such as charcoal burning suicide seen in Taiwan.

Information Accessibility of the Charcoal Burning Suicide Method in Mainland China

Background

There has been a marked rise in suicide by charcoal burning (CB) in some East Asian countries but little is known about its incidence in mainland China. We examined media-reported CB suicides and the availability of online information about the method in mainland China.

Methods

We extracted and analyzed data for i) the characteristics and trends of fatal and nonfatal CB suicides reported by mainland Chinese newspapers (1998–2014); ii) trends and geographic variations in online searches using keywords relating to CB suicide (2011–2014); and iii) the content of Internet search results.

Results

109 CB suicide attempts (89 fatal and 20 nonfatal) were reported by newspapers in 13 out of the 31 provinces or provincial-level-municipalities in mainland China. There were increasing trends in the incidence of reported CB suicides and in online searches using CB-related keywords. The province-level search intensities were correlated with CB suicide rates (Spearman’s correlation coefficient = 0.43 [95% confidence interval: 0.08–0.68]). Two-thirds of the web links retrieved using the search engine contained detailed information about the CB suicide method, of which 15% showed pro-suicide attitudes, and the majority (86%) did not encourage people to seek help.

Limitations

The incidence of CB suicide was based on newspaper reports and likely to be underestimated.

Conclusions

Mental health and suicide prevention professionals in mainland China should be alert to the increased use of this highly lethal suicide method. Better surveillance and intervention strategies need to be developed and implemented.

Suicide Communication on Social Media and Its Psychological Mechanisms: An Examination of Chinese Microblog Users

BACKGROUND

This study aims to examine the characteristics of people who talk about suicide on Chinese microblogs (referred to as Weibo suicide communication (WSC)), and the psychological antecedents of such behaviors.

METHODS

An online survey was conducted on Weibo users. Differences in psychological and social demographic characteristics between those who exhibited WSC and those who did not were examined. Three theoretical models were proposed to explain the psychological mechanisms of WSC and their fitness was examined by Structural Equation Modeling (SEM).

RESULTS

12.03% of our respondents exhibited WSC in the past 12 months. The WSC group was significantly younger and less educated, preferred using blogs and online forums for expressing themselves, and reported significantly greater suicide ideation, negative affectivity, and vulnerable personality compared to non-WSC users. SEM examinations found that Weibo users with higher negative affectivity or/and suicidal ideation, who were also using blogs and forums more, exhibited a significantly higher possibility of WSC.

CONCLUSION

Weibo users who are at greater suicide risk are more likely to talk about suicide on Weibo. WSC is a sign of negative affectivity or suicide ideation, and should be responded to with emotional support and suicide prevention services.