The internet and suicide: A double-edged tool

Internet addiction and suicidal ideation in Chinese children with migrant parents: Mediating role of anxiety and moderating role of social support

INTRODUCTION

The prevalence of internet addiction among Chinese left-behind children, coupled with its potential to exacerbate anxiety and suicidal ideation, has become a critical issue. This study seeks to address the dearth of research on the psychological underpinnings of this phenomenon, particularly the mediating role of anxiety and the moderating effect of social support across different parental migration statuses. Understanding these relationships is crucial for developing targeted interventions and informing policy decisions.

METHODS

In a cross-sectional study, we administered Young's Internet Addiction Test, alongside scales for anxiety, social support, and suicidal ideation, to 2882 middle school students in China with diverse parental migration backgrounds. Utilizing an online survey approach, we ensured broad participation and participant anonymity. Advanced statistical analyses, including regression models for mediation and moderation effects, were employed to rigorously test our hypotheses.

RESULTS

Among all participants, a significant positive correlation was observed between Internet addiction and suicidal ideation. Anxiety mediated the relationship between Internet addiction and suicidal ideation across all groups, including those with mother-only migration (Effect = 0.383, 95%CI: 0.107,0.943), father-only migration (Effect = 0.806, 95%CI: 0.487-1.230), both-parent migration(Effect = 0.289, 95%CI: 0.105-0.521), and non-left-behind children (Effect = 0.469, 95%CI: 0.342-0.630). Particularly in families where only the mother was absent, the moderating role of social support was especially prominent (B = 1.174, t = 6.446, p < 0.001 for low social support), underscoring the importance of family structure in the context of Internet addiction.

CONCLUSION

Internet addiction has both direct and indirect effects on suicidal ideation, with anxiety playing a mediating role in the indirect effects. Social support moderates and alleviates the relationship between Internet addiction and anxiety specifically in the mother-only migration group. Therefore, clarifying these relationships helps in developing and implementing effective interventions to specifically improve the mental health and living conditions of left-behind children.

Problematic Internet Usage and Self-Esteem in Chinese Undergraduate Students: The Mediation Effects of Individual Affect and Relationship Satisfaction

The aim of this cross-sectional study was to examine the mediating effects of individual affect and relationship satisfaction on the relationship between self-esteem and Problematic Internet Use (PIU). Affect was measured using the Positive and Negative Affect Schedule (PANAS), relationship satisfaction was assessed using a positive and negative semantic dimension scale, self-esteem was measured using the Rosenberg Self-Esteem Scale, and PIU was measured using the Problematic Internet Use scale with a sample of 507 Chinese university students (Mage = 20.41 years, SD = 2.49). The relationships between the variables were tested using structural equation modelling with a multiple mediation model. The results revealed that negative affect and the negative semantic dimensions of relationship satisfaction mediated the relationship between self-esteem and PIU. The implications of the results and the study’s theoretical contributions are discussed.

Changes in accessibility of suicide-related information on websites in Taiwan during 2016 and 2019

BACKGROUND/PURPOSE

To the best of our knowledge, no studies have examined longitudinal changes in the accessibility of suicide-related content on Chinese-language websites. We investigated changes between 2016 and 2019 in suicide-related materials likely to be accessed by individuals through websites in Taiwan.

METHODS

In March 2019, we searched the Taiwanese versions of Google and Yahoo! using six suicide-related terms and compared the results to a search performed in 2016. Website characteristics (e.g., pro- or anti-suicide) generated by various keywords were calculated and compared in 2016 and 2019.

RESULTS

The number of anti-suicide websites exceeded that of pro-suicide websites in 2016 and 2019. Between 2016 and 2019, the proportion of pro-suicide sites decreased slightly from 16.3% (61 out of 375 sites) to 12.3% (51 out of 417 sites) (p = 0.10). User-generated webpages constituted the primary source of pro-suicide content at both time points. Over the same period, the proportion of pro-suicide information on internet forums decreased from 59.1% to 17.8% (p < 0.001); by contrast, pro-suicide content on news websites increased significantly, from 1.9% to 11.3% (p = 0.005). Searches with the term "painless suicide" were more likely to yield pro-suicide websites and less likely to generate anti-suicide ones than searches with "suicide" in both 2016 and 2019.

CONCLUSIONS

Harmful suicide-related information circulating on websites remained easily accessible to internet users in Taiwan, particularly through user-generated and news websites. Proper site moderation and implementation of online suicide reporting guidelines are still warranted.

Old Poison, New Problem: Cyanide Fatal Intoxications Associated with Internet Shopping

Widespread access to the Internet has an increasing influence on how suicides are committed. On websites such as eBay® or Amazon.com® highly toxic substances including cyanides are available for purchase. In the last 5 years, a few fatal intoxications associated with Internet shopping and buying "suicide kits" have been reported. Epidemiology of intoxications reported by American Association of Poison Control Centers between 2000-2018 shows that about 10% of all exposures to cyanide were related to suicide attempts and intentional ingestion of this substance. In order to determine the cyanide concentration in four fatal intoxication cases associated with Internet shopping, a headspace gas chromatography with dual column/dual flame ionization detector (HS-GC-FID/FID) method was validated and applied to casework. The method was linear in range, from 1 to 50 µg/mL, with a coefficient of determination of 0.999 (R2). The limit of quantification was 1.0 µg/mL; the detection limit was 0.5 µg/mL. Intra- and inter-day validation precision and accuracy did not exceed 10% and 15%, respectively. Recovery and matrix effect values ranged from 94.8- 103.8% and -5.2─3.8%, respectively. The cyanide concentrations were determined in biological fluids (blood, urine, bile, vitreous humor, gastric content) and postmortem tissue samples (spleen, kidney, liver, brain). The headspace gas chromatographic method, which is routinely used in clinical and forensic toxicology to quantify ethanol with its congeners (methanol, acetone, isopropanol, n-propanol and n-butanol), can be also applied to determine cyanide in intoxication cases. The global problem of a high number of suicides each year, requires increasing and more restrictive control of highly toxic substances available online as well as caution monitoring of human exposure to cyanide. This old and well known poison is being increasingly used nowadays for suicidal purposes, therefore determination of cyanide in biological samples is still important in terms of clinical and forensic toxicology.

Past Year Technology-Involved Peer Harassment Victimization and Recent Depressive Symptoms and Suicide Ideation Among a National Sample of Youth

This article aims to better understand the complex role of technology in peer victimization events with recent depressive symptomatology and suicide ideation (SI). Telephone interviews were conducted with a national sample of 791 youth in the United States, aged 10 to 20 years, collected from December 2013 to March 2014. Rates of any peer harassment victimization varied by past month depressive symptomatology and SI -28% of youth with no/low depressive symptomatology reported past year peer harassment as did 43% of youth with high depressive symptomatology without SI, and 66% of youth with SI. When examining the role of technology in peer harassment, youth experiencing any mixed harassment (i.e., those incidents that occurred both in-person and through technology) were almost 4 times more likely to report past month depressive symptoms without SI (RR_adj = 3.9, 95% confidence interval [CI] = [1.5, 10.0], p ≤ .01) and 7.5 times (95% CI = [1.9, 28.9], p ≤ .01) more likely to report past month SI compared with youth who had no past year peer harassment. Given the multilayered relationships among these variables, schools, medical, and mental health professionals might screen youth who are involved in higher risk peer victimization situations, for depressive symptoms and SI to improve their access to appropriate mental health services.

Leveraging the Web and Social Media to Promote Access to Care Among Suicidal Individuals

After two decades of exponential development, the Internet has become an inseparable component of suicide prevention matters. More specifically, social media has turned out to be a privileged space for suicidal individuals to express their distress and seek support. Although this tendency carries with it specific risks and challenges, it creates unprecedented opportunities to face the challenges of help seeking and access to care. In this paper, we present the empirical, technological, and theoretical evidence supporting the implementation of a digitally augmented prevention policy that would increase its reach. Congruent to the clinical observations and theories on the help-seeking process, we argue that social media can help undertake three main functions of increasing proactivity to bring suffering Web users to care. The gateway function relates to the properties of social media interactions to leverage help-seeking barriers and enable ambivalent individuals to access the mental healthcare system. The communication outreach function aims to broadcast pro-help-seeking messages, while drawing on the functional structure of the social media network to increase its audience. The intervention outreach function consists in using machine learning algorithms to detect social media users with the highest risk of suicidal behaviors and give them a chance to overcome their dysfunctional reluctance to access help. We propose to combine these three functions into a single coherent operational model. This would involve the joint actions of a communication and intervention team on social networks, working in close collaboration with conventional mental health professionals, emergency service, and community resources.

Stepping Back From Crisis Points: The Provision and Acknowledgment of Support in an Online Suicide Discussion Forum

Suicide is a global health concern, though little is known about the social practices that might support those who are contemplating suicide. Online forums provide a unique insight into the anonymous discussion of suicide, including sociocultural norms about suicide and the delicate management of online interaction. In this article, we examine the provision and acknowledgment of support in an online discussion forum about suicide, using discursive psychology to analyze the textual interaction. The analysis illustrates how forum threads function as case studies and enable members to gain support on numerous occasions. In this way, members can gain help at crisis points as and when these occur, while still maintaining authenticity as a valid forum member. The analysis also provides additional evidence for models of suicide which highlight the fluid nature of suicidality and contributes to the preventative work on suicide by demonstrating how support can be provided at crisis points.

Analysis of Internet Suicide Pacts Reported by the Media in Mainland China

BACKGROUND

In mainland China, frequent Internet suicide pacts in recent years have raised strong concerns from several social sectors and the influence of social networks on suicide is constantly growing.

AIMS

To identify the epidemiological characteristics of media-reported Internet suicide pacts in mainland China.

METHOD

Our study comprised 62 Internet suicide pacts involving 159 victims in mainland China before June 1, 2015. Kendall's randomness test, a trend test, and a circular distribution test were applied to identify the rising or concentrated trends in the time of occurrence of Internet suicide pacts.

RESULTS

The overall male-to-female ratio was 2.3:1. Suicide victims were mainly people in their 20s to 30s (84.1%). In all, 87.1% suicide victims completed suicide in sealed hotels or rental housing, and charcoal-burning suicide accounted for 80.6% of cases.

CONCLUSION

People who complete suicide as part of an Internet suicide pact are more likely to be males, aged 20-30 years. Charcoal-burning suicide in sealed hotels or rental housing was the commonest way of dying.

A Systematic Assessment of Smartphone Tools for Suicide Prevention

Background

Suicide is a leading cause of death globally, and there has been a rapid growth in the use of new technologies such as mobile health applications (apps) to help identify and support those at risk. However, it is not known whether these apps are evidence-based, or indeed contain potentially harmful content. This review examines the concordance of features in publicly available apps with current scientific evidence of effective suicide prevention strategies.

Methods

Apps referring to suicide or deliberate self-harm (DSH) were identified on the Android and iOS app stores. Systematic review methodology was employed to screen and review app content. App features were labelled using a coding scheme that reflected the broad range of evidence-based medical and population-based suicide prevention interventions. Best-practice for suicide prevention was based upon a World Health Organization report and supplemented by other reviews of the literature.

Results

One hundred and twenty-three apps referring to suicide were identified and downloaded for full review, 49 of which were found to contain at least one interactive suicide prevention feature. Most apps focused on obtaining support from friends and family (n = 27) and safety planning (n = 14). Of the different suicide prevention strategies contained within the apps, the strongest evidence in the literature was found for facilitating access to crisis support (n = 13). All reviewed apps contained at least one strategy that was broadly consistent with the evidence base or best-practice guidelines. Apps tended to focus on a single suicide prevention strategy (mean = 1.1), although safety plan apps provided the opportunity to provide a greater number of techniques (mean = 3.9). Potentially harmful content, such as listing lethal access to means or encouraging risky behaviour in a crisis, was also identified.

Discussion

Many suicide prevention apps are available, some of which provide elements of best practice, but none that provide comprehensive evidence-based support. Apps with potentially harmful content were also identified. Despite the number of apps available, and their varied purposes, there is a clear need to develop useful, pragmatic, and multifaceted mobile resources for this population. Clinicians should be wary in recommending apps, especially as potentially harmful content can be presented as helpful. Currently safety plan apps are the most comprehensive and evidence-informed, for example, “Safety Net” and “MoodTools—Depression Aid”.

Suicide and the Internet: Changes in the accessibility of suicide-related information between 2007 and 2014

BACKGROUND

Following the ongoing concerns about cyber-suicide, we investigate changes between 2007 and 2014 in material likely to be accessed by suicidal individuals searching for methods of suicide.

METHODS

12 search terms relating to suicide methods were applied to four search engines and the top ten hits from each were categorised and analysed for content. The frequency of each category of site across all searches, using particular search terms and engines, was counted.

RESULTS

Key changes: growth of blogs and discussion forums (from 3% of hits, 2007 to 18.5% of hits, 2014); increase in hits linking to general information sites - especially factual sites that detail and evaluate suicide methods (from 9%, 2007 to 21.7%, 2014). Hits for dedicated suicide sites increased (from 19% to 23%), while formal help sites were less visible (from 13% to 6.5%). Overall, 54% of hits contained information about new high-lethality methods.

LIMITATIONS

We did not search for help sites so cannot assess the balance of suicide promoting versus preventing sites available online. Social media was beyond the scope of this study.

CONCLUSIONS

Working with ISPs and search engines would help optimise support sites. Better site moderation and implementation of suicide reporting guidelines should be encouraged.

Does Social Belonging to Primary Groups Protect Young People From the Effects of Pro-Suicide Sites?

BACKGROUND

The Internet has facilitated the existence of extreme and pathological communities that share information about ways to complete suicide or to deliberately harm or hurt oneself. This material is user-generated and easily accessible.

AIMS

The present study analyzed the buffering effect of social belonging to a primary group in the situation of pro-suicide site exposure.

METHOD

Cross-national data were collected from the US, UK, Germany, and Finland in spring 2013 and 2014 from respondents aged 15-30 years (N = 3,567). Data were analyzed by using linear regression separately for women and men for each country.

RESULTS

A higher level of belonging to a primary group buffered the negative association of pro-suicide site exposure with mental health, measured as happiness, although the results were not consistent in the subgroups. US male subjects showed a significant buffering effect of the sense of belonging to family while the belonging to friends had a buffering effect among four other subgroups: British female and male subjects and Finnish female and male subjects.

CONCLUSION

The results underline the positive potential of primary groups to shield young people's mental health in the situation of pro-suicide site exposure.

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

PURPOSE

Some East/Southeast Asian countries have experienced a rapid increase in suicide by charcoal burning over the past decade. Media reporting and Internet use were thought to contribute to the epidemic. We investigated the association between method-specific suicide incidence and both Internet search volume and newspaper reporting in Taiwan.

METHOD

Weekly data for suicide, suicide-related Google search volume, and the number of articles reporting suicide in four major newspapers in Taiwan during 2008-2011 were obtained. Poisson autoregressive regression models were used to examine the associations between these variables.

RESULTS

In the fully adjusted models, every 10 % increase in Google searches was associated with a 4.3 % [95 % confidence interval (CI) 1.1-7.6 %] increase in charcoal-burning suicide incidence in the same week, and a 3.8 % (95 % CI 0.4-7.2 %) increase in the following week. A one-article increase in the United Daily was associated with a 3.6 % (95 % CI 1.5-5.8 %) increase in charcoal-burning suicide in the same week. By contrast, non-charcoal-burning suicide was not associated with Google search volume, but was associated with the Apple Daily's reporting in the preceding week.

CONCLUSIONS

We found that increased Internet searches for charcoal-burning suicide appeared to be associated with a subsequent increase in suicide by this method. The prevention of suicide using emerging methods may include monitoring and regulating online information that provides details of these methods as well as encouraging Internet service providers to provide help-seeking information.

Exposure to websites that encourage self-harm and suicide: prevalence rates and association with actual thoughts of self-harm and thoughts of suicide in the United States

This article provides 12-month prevalence rates of youth exposure to websites which encourage self-harm or suicide and examines whether such exposure is related to thoughts of self-harm and thoughts of suicide in the past 30 days. Data were collected via telephone from a nationally representative survey of 1560 Internet-using youth, ages 10-17 residing in the United States. One percent (95% CI: 0.5%, 1.5%) of youth reported visiting a website that encouraged self-harm or suicide. Youth who visited such websites were seven times more likely to say they had thought about killing themselves; and 11 times more likely to think about hurting themselves, even after adjusting for several known risk factors for thoughts of self-harm and thoughts of suicide. Given that youth thinking about self-harm and suicide are more likely to visit these sites, they may represent an opportunity for identification of youth in need of crisis intervention.

Caught in the web: a review of web-based suicide prevention

Background

Suicide is a serious and increasing problem worldwide. The emergence of the digital world has had a tremendous impact on people’s lives, both negative and positive, including an impact on suicidal behaviors.

Objective

Our aim was to perform a review of the published literature on Web-based suicide prevention strategies, focusing on their efficacy, benefits, and challenges.

Methods

The EBSCOhost (Medline, PsycINFO, CINAHL), OvidSP, the Cochrane Library, and ScienceDirect databases were searched for literature regarding Web-based suicide prevention strategies from 1997 to 2013 according to the modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The selected articles were subjected to quality rating and data extraction.

Results

Good quality literature was surprisingly sparse, with only 15 fulfilling criteria for inclusion in the review, and most were rated as being medium to low quality. Internet-based cognitive behavior therapy (iCBT) reduced suicidal ideation in the general population in two randomized controlled trial (effect sizes, d=0.04-0.45) and in a clinical audit of depressed primary care patients. Descriptive studies reported improved accessibility and reduced barriers to treatment with Internet among students. Besides automated iCBT, preventive strategies were mainly interactive (email communication, online individual or supervised group support) or information-based (website postings). The benefits and potential challenges of accessibility, anonymity, and text-based communication as key components for Web-based suicide prevention strategies were emphasized.

Conclusions

There is preliminary evidence that suggests the probable benefit of Web-based strategies in suicide prevention. Future larger systematic research is needed to confirm the effectiveness and risk benefit ratio of such strategies.

Supportive interchanges and face-work as 'protective talk' in an online self-harm support forum

Within a context of concern about inappropriate advice-giving online, we examined how young people who self-harm behave online, and how professionals might engage with them. We use Discourse Analysis to focus on participant interactions (posts)from a forum's crisis/support rooms, and highlight the prevalence of disclaimers, hedges, questions and tags in the young people's online interactions. We use the concept of face-work as a framework to help understand interactions in the forum SharpTalk. The findings demonstrate the use of a range of mitigation devices, and suggest that the young people orientate to a 'protective' line in their supportive interactions. These findings echo Goffman's (1967) 'supportive interchanges' in that the young people's online interactions may help to preserve face, in an emotionally complex setting, whose vulnerable members also need 'protective'and sensitive support. Taking this 'line' may enable members to create a more open and trusting context for support, and to remain in a forum which they find both helpful and challenging. In light of concerns about online support, the findings provide a new perspective on online peer-support for young people who self-harm.

Internet suicide: communities of affirmation and the lethality of communication

As a tool of instant information dissemination and social networking, the Internet has made possible the formation and affirmation of public identities based on personality traits that are usually characterized by clinicians as pathological. The wide variety of online communities of affirmation reveals new conditions for permissiveness and inclusiveness in expressions of these socially marginal and clinically pathologized identities. Much the same kind of discourse common to these online communities is evident in some suicide forums. Web sites with suicide as their central raison d'être, taken together, encompass a wide range of ideas and commitments, including many that provide collective affirmation outside of (and often with hostility toward) professional intervention. The paradox of a potentially life-affirming effect of such forums runs counter to a stark dualism between online therapy versus "prochoice" forums and, by extension, to simple models of the influence of ideas on the lethality of suicide. Different forums either intensify or mitigate self-destructive tendencies in ways that are significant for understanding the place of communication in the occurrence of suicide and for therapeutic practice.

Building an online community to promote communication and collaborative learning between health professionals and young people who self-harm: an exploratory study

BACKGROUND

Online communities are known to break down barriers between supposed experts and non-experts and to promote collaborative learning and 'radical trust' among members. Young people who self-harm report difficulties in communicating with health professionals, and vice versa.

AIM

We sought to bring these two groups together online to see how well they could communicate with each other about self-harm and its management, and whether they could agree on what constituted safe and relevant advice.

METHODS

We allocated 77 young people aged 16-25 with experience of self-harm and 18 recently/nearly qualified professionals in relevant health-care disciplines to three separate Internet discussion forums. The forums contained different proportions of professionals to young people (none; 25%; 50% respectively) to allow us to observe the effect of the professionals on online interaction.

RESULTS

The young people were keen to share their lived experience of self-harm and its management with health professionals. They engaged in lively discussion and supported one another during emotional crises. Despite registering to take part, health professionals did not actively participate in the forums. Reported barriers included lack of confidence and concerns relating to workload, private-professional boundaries, role clarity, duty of care and accountability. In their absence, the young people built a vibrant lay community, supported by site moderators.

CONCLUSIONS

Health professionals may not yet be ready to engage with young people who self-harm and to exchange knowledge and experience in an anonymous online setting. Further work is needed to understand and overcome their insecurities.

Nurses' roles in systematic patient education sessions in psychiatric nursing

The purpose of this study is to gain understanding of nurses' expectations of their roles in systematic patient education in psychiatric inpatient care. Qualitative design was used in the study. The data were collected through interviews with nurses participating in the implementation of systematic patient education (information technology (IT) based patient education n= 14, or conventional patient education n= 16). The data were analysed using inductive content analysis. The analysis showed that nurses had different roles in both IT-based and conventional patient education. Nurses acted as learners, advisors, collaborators, teachers or limiters. The nurses tailored the role in each session according to the patients' interest and mental status. We can conclude that nurses working in psychiatric hospitals have different roles in systematic patient education and they are ready and willing to tailor their roles according to patients' individual needs. Information technology should be adopted without delay as a new treatment method in daily practice in psychiatric services. It has potential to support equality between patient and nurse in secluded environments.

Hyperlinked Suicide

Background: The relationship between the Internet and suicide is a topic of growing concern among suicide researchers and the public, though to date few have actually attempted to investigate the accessibility and prominence of suicide-related information online, and there have been no comprehensive studies of site networking structure. Aims: To assess the visibility of various types of online information to suicide-risk individuals, and to assess the prominence and accessibility of “pro-suicide,” suicide prevention, and support sites by measuring their networking structure. Methods: Employing empirically derived search terms, we used the web-based Virtual Observatory for the Study of Online Networks (VOSON) to conduct hyperlink network analysis (HNA) of suicide-related websites. Results: Pro-suicide sites are rare and marginal, while sites dedicated to information about suicide as well as sites dedicated to prevention policy and advocacy are readily accessible. Conclusions: The networking structure of suicide-related Internet content has not been described previously. Our analysis shows that HNA is a useful method for gaining an indepth understanding of network traffic in relation to suicide-content websites. This information will be useful for strengthening the web presence of support and suicide prevention sites, and for monitoring changes over time.

The scope of nonsuicidal self-injury on YouTube

OBJECTIVE

Nonsuicidal self-injury, the deliberate destruction of one's body tissue (eg, self-cutting, burning) without suicidal intent, has consistent rates ranging from 14% to 24% among youth and young adults. With more youth using video-sharing Web sites (eg, YouTube), this study examined the accessibility and scope of nonsuicidal self-injury videos online.

METHODS

Using YouTube's search engine (and the following key words: "self-injury" and "self-harm"), the 50 most viewed character (ie, with a live individual) and noncharacter videos (100 total) were selected and examined across key quantitative and qualitative variables.

RESULTS

The top 100 videos analyzed were viewed over 2 million times, and most (80%) were accessible to a general audience. Viewers rated the videos positively (M = 4.61; SD: 0.61 out of 5.0) and selected videos as a favorite over 12 000 times. The videos' tones were largely factual or educational (53%) or melancholic (51%). Explicit imagery of self-injury was common. Specifically, 90% of noncharacter videos had nonsuicidal self-injury photographs, whereas 28% of character videos had in-action nonsuicidal self-injury. For both, cutting was the most common method. Many videos (58%) do not warn about this content.

CONCLUSIONS

The nature of nonsuicidal self-injury videos on YouTube may foster normalization of nonsuicidal self-injury and may reinforce the behavior through regular viewing of nonsuicidal self-injury-themed videos. Graphic videos showing nonsuicidal self-injury are frequently accessed and received positively by viewers. These videos largely provide nonsuicidal self-injury information and/or express a hopeless or melancholic message. Professionals working with youth and young adults who enact nonsuicidal self-injury need to be aware of the scope and nature of nonsuicidal self-injury on YouTube.

Self- and other-diagnosis in user-led mental health online communities

This article consists of a qualitative analysis of discussion forums in online mental health communities whose members routinely write about diagnosis. The analysis concerns the function of diagnosis from the perspective of personal identity, with particular focus on the status of official diagnosis, as well as community members' discussions of symptoms and psychiatric syndromes that amount to informal diagnosis or consultation. Self-diagnosis sometimes takes the form of recommended "quizzes" and other online quasi-diagnostic tools. Other-diagnosis, in which a third party is discussed by community members, is also considered. We discuss the implications of such online discourse for Internet users themselves as well the challenges for the health and medical professions.

The relationship between elderly suicide rates and the internet: a cross-national study

BACKGROUND

Suicide rates generally increase with age. Internet websites and chat rooms have been reported both to promote suicides and to have a positive beneficial effect on suicidal individuals. The role of the internet in elderly suicides has not been studied.

METHODS

The relationship between elderly suicide rates and the prevalence of internet users was examined in a cross-national study using data from the World Health Organization and the United Nations website.

RESULTS

The prevalence of internet users was significantly and positively correlated with suicide rates in both genders in the age bands 65-74 years and 75+ years. On multiple regression analysis the prevalence of internet users was independently associated with suicide rates in both genders in both age bands.

CONCLUSION

Caution should be exercised in the attribution of a causal relationship and the direction of this relationship because of the cross-sectional and ecological study design whereby the findings are subject to ecological fallacy. However, the findings identify and support a need for further research.

The relationship between general population suicide rates and the Internet: a cross-national study

Internet Web sites and chat rooms have been reported both to promote suicides and have a positive beneficial effect on suicidal individuals. There is a paucity of studies examining the role of the Internet in general population suicide rates. The relationship between general population suicide rates and the prevalence of Internet users was examined in a cross-national study using data from the World Health Organization and the United Nations Web sites. The prevalence of Internet users was significantly and positively correlated with general population suicide rates in both sexes. On multiple regression analysis the prevalence of Internet users was independently associated with general population suicide rates in males, and this independent relationship in females approached statistical significance. Caution should be exercised in the attribution of a causal relationship and the direction of this relationship because of the cross-sectional and ecological study design whereby the findings are subject to ecological fallacy. However, the findings identify and support a need for further research.

Perceived connections between information and communication technology use and mental symptoms among young adults - a qualitative study

Background

Prospective associations have been found between high use of information and communication technology (ICT) and reported mental symptoms among young adult university students, but the causal mechanisms are unclear. Our aim was to explore possible explanations for associations between high ICT use and symptoms of depression, sleep disorders, and stress among young adults in order to propose a model of possible pathways to mental health effects that can be tested epidemiologically.

Methods

We conducted a qualitative interview study with 16 women and 16 men (21-28 years), recruited from a cohort of university students on the basis of reporting high computer (n = 28) or mobile phone (n = 20) use at baseline and reporting mental symptoms at the one-year follow-up. Semi-structured interviews were performed, with open-ended questions about possible connections between the use of computers and mobile phones, and stress, depression, and sleep disturbances. The interview data were analyzed with qualitative content analysis and summarized in a model.

Results

Central factors appearing to explain high quantitative ICT use were personal dependency, and demands for achievement and availability originating from the domains of work, study, social life, and individual aspirations. Consequences included mental overload, neglect of other activities and personal needs, time pressure, role conflicts, guilt feelings, social isolation, physical symptoms, worry about electromagnetic radiation, and economic problems. Qualitative aspects (destructive communication and information) were also reported, with consequences including vulnerability, misunderstandings, altered values, and feelings of inadequacy. User problems were a source of frustration. Altered ICT use as an effect of mental symptoms was reported, as well as possible positive effects of ICT on mental health.

Conclusions

The concepts and ideas of the young adults with high ICT use and mental symptoms generated a model of possible paths for associations between ICT exposure and mental symptoms. Demands for achievement and availability as well as personal dependency were major causes of high ICT exposure but also direct sources of stress and mental symptoms. The proposed model shows that factors in different domains may have an impact and should be considered in epidemiological and intervention studies.