Suicide on Instagram - Content Analysis of a German Suicide-Related Hashtag

Debunking Mental Health Misperceptions in Short-Form Social Media Videos: An Experimental Test of Scientific Credibility Cues

In recent years, short-form social media videos have emerged as an important source of health-related advice. In this study, we investigate whether experts or ordinary users in such videos are more effective in debunking the common misperception that talking about suicide should be avoided. We also explore a new trend on TikTok and other platforms, in which users attempt to back up their arguments by displaying scientific articles in the background of their videos. To test the effect of source type (expert vs. ordinary user) and scientific references (present or absent), we conducted a 2 × 2 between-subject plus control group experiment (n = 956). In each condition, participants were shown a TikTok video that was approximately 30 seconds long. Our findings show that in all four treatment groups, participants reduced their misperceptions on the topic. The expert was rated as being more authoritative on the topic compared to the ordinary user. However, the expert was also rated as being less credible compared to the ordinary user. The inclusion of a scientific reference did not make a difference. Thus, both experts and ordinary users may be similarly persuasive in a short-form video environment.

Assessing the impact of Instagram use and deliberate self-harm in adolescents: A scoping review

The use of Instagram by adolescents to access deliberate self-harm content is a growing concern among scholars, mental health professionals and families, with many adolescents (10-19-year-olds) imitating offline what they have seen online. This scoping review aims to investigate the extent to which Instagram use impacts the mental health of its adolescent users, identifying whether there is a relationship between time spent on Instagram and engagement in deliberate self-harm. The databases, PubMed, Web of Science, Google scholar, APA PsycInfo, CINAHL and child development and adolescent studies were explored, and after applying the inclusion/exclusion criteria, 15 papers were included in this review. Thematic analysis indicated that there was a relationship between time spent on Instagram and deliberate self-harm; desensitization of deliberate self-harm resulting in normalization; social contagion and that Instagram provided a sense of belonging to its users who engaged in deliberate self-harm. Implications of this research is that it is quickly outdated as new social media platforms are developed and that the reliance on self-reports does not have high validity or reliability.

Online suicidal thoughts and/or behaviours talk: A scoping review protocol

The anonymity that the internet and social media affords users means that suicidal thoughts and/or behaviours can be talked about with a sense of freedom and disinhibition that is often not possible in face-to-face contexts. Better understanding online suicidal thoughts and/or behaviour talk is critical as more people turn to online spaces for support. Without this the potentiality of such spaces as sites for suicide prevention and intervention is likely to remain unrealised. Currently there are no scoping or systematic review syntheses focusing on internet and/or on social media suicidal thoughts and/or behaviour talk. This lack of synthesis is problematic as it makes it more difficult for online suicide prevention and intervention practices, policies, and our understanding of suicide to advance in a coherent and evidence-based manner. A scoping review protocol following Arksey and O'Malley's six-step modified framework has been developed to address this synthesis gap. It aims to systematically map the empirical literature that has investigated online suicidal thoughts and/or behaviours talk. It is anticipated that review outcomes could inform the training of health practitioners and peer/professional online moderators in how to best talk with people experiencing suicidal thoughts and/or behaviours. Outcomes could also form an evidence-base for developing policies and practices that focus on online places as safe spaces to talk about suicidal thoughts and/or behaviours. Developers of safe language guidelines could also use the outcomes to audit how well current guidelines reflect empirical evidence. Outcomes could enable researchers to design future online suicidal thoughts and/behaviours talk studies that extend our understandings of suicide leading to potential refinements of contemporary suicide theories/models.

Online suicidal thoughts and/or behaviours talk: A scoping review protocol

The anonymity that the internet and social media affords users means that suicidal thoughts and/or behaviours can be talked about with a sense of freedom and disinhibition that is often not possible in face-to-face contexts. Better understanding online suicidal thoughts and/or behaviour talk is critical as more people turn to online spaces for support. Without this the potentiality of such spaces as sites for suicide prevention and intervention is likely to remain unrealised. Currently there are no scoping or systematic review syntheses focusing on internet and/or on social media suicidal thoughts and/or behaviour talk. This lack of synthesis is problematic as it makes it more difficult for online suicide prevention and intervention practices, policies, and our understanding of suicide to advance in a coherent and evidence-based manner. A scoping review protocol following Arksey and O'Malley's six-step modified framework has been developed to address this synthesis gap. It aims to systematically map the empirical literature that has investigated online suicidal thoughts and/or behaviours talk. It is anticipated that review outcomes could inform the training of health practitioners and peer/professional online moderators in how to best talk with people experiencing suicidal thoughts and/or behaviours. Outcomes could also form an evidence-base for developing policies and practices that focus on online places as safe spaces to talk about suicidal thoughts and/or behaviours. Developers of safe language guidelines could also use the outcomes to audit how well current guidelines reflect empirical evidence. Outcomes could enable researchers to design future online suicidal thoughts and/behaviours talk studies that extend our understandings of suicide leading to potential refinements of contemporary suicide theories/models.

Understanding information behavior of South Korean Twitter users who express suicidality on Twitter

Objective

Although there were few studies on how suicidal users behave on Twitter, they only investigated partial aspects such as tweeting frequency and tweet length. Therefore, we aim to understand the various information behavior of suicidal users in South Korea.

Methods

To achieve this goal, we annotated 20,000 tweets and identified 1097 tweets with the expression of suicidality (i.e. suicidal tweets) and 229 suicidal users (i.e. experimental group). Using the data, a user profile analysis, comparative analysis with control group, and tweets/hashtags analysis were performed.

Results

Our results show that many suicidal users used suicide-related keywords in their user IDs, usernames, descriptions, and pinned tweets. We also found that, compared to the control group, the experimental group show different patterns of information behavior. The experimental group did not frequently use Twitter and, on average, wrote longer texts than the control group. A clear seasonal pattern was also identified in the experimental group's tweeting behavior. Frequently used keywords/hashtags were extracted from tweets written by the experimental group for the purpose of understanding their concerns and detecting more suicidal tweets.

Conclusions

We believe that our study will help in the understanding of suicidal users' information behavior on social media and lay the basis for more accurate actions for suicide prevention and early intervention on social media.

Associations between social contagion, group conformity characteristics, and non-suicidal self-injury

The current study aimed to better understand the relationship between exposure to non-suicidal self-injury (NSSI) through peers, group conformity characteristics (i.e., over-dependency, need-to-belong), and personal NSSI engagement. Methods: One hundred thirty-eight undergraduate students (n = 40 with history of NSSI) completed an online survey about NSSI history and exposure as well as their interpersonal dependency and need-to-belong in a group. Results: Results indicated that NSSI participants (NSSI+) were more likely to be exposed to NSSI in-person (IP+). NSSI+/IP + participants were more likely to think about NSSI post-media exposure and reported higher over-dependency and need-to-belong than NSSI-/IP-. Conclusions: Findings suggest that being exposed to NSSI in-person and having higher over-dependency and need-to-belong are associated with personal NSSI engagement.

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.

Impact of Web-Based Sharing and Viewing of Self-Harm-Related Videos and Photographs on Young People: Systematic Review

BACKGROUND

Given recent moves to remove or blur self-harm imagery or content on the web, it is important to understand the impact of posting, viewing, and reposting self-harm images on young people.

OBJECTIVE

The aim of this study is to systematically review research related to the emotional and behavioral impact on children and young people who view or share web-based self-harm-related videos or images.

METHODS

We searched databases (including Embase, PsychINFO, and MEDLINE) from January 1991 to February 2019. Search terms were categorized into internet use, images nonspecific and specific to the internet, and self-harm and suicide. Stepwise screening against specified criteria and data extraction were completed by two independent reviewers. Eligible articles were quality assessed, and a narrative synthesis was conducted.

RESULTS

A total of 19 independent studies (20 articles) were included. Of these, 4 studies focused on images, 10 (11 articles) on videos, and 5 on both. There were 4 quantitative, 9 qualitative, and 7 mixed methods articles. In total, 11 articles were rated as high quality. There has been an increase in graphic self-harm imagery over time. Potentially harmful content congregated on platforms with little moderation, anonymity, and easy search functions for images. A range of reactions and intentions were reported in relation to posting or viewing images of self-harm: from empathy, a sense of solidarity, and the use of images to give or receive help to potentially harmful ones suggesting new methods, normalization, and exacerbation of self-harm. Viewing images as an alternative to self-harm or a creative outlet were regarded in 2 studies as positive impacts. Reactions of anger, hostility, and ambivalence have been reported. There was some evidence of the role of imitation and reinforcement, driven partly by the number of comments and wound severity, but this was not supported by time series analyses.

CONCLUSIONS

Although the results of this review support concern related to safety and exacerbation of self-harm through viewing images of self-harm, there may be potential for positive impacts in some of those exposed. Future research should evaluate the effectiveness and potential harms of current posting restrictions, incorporate user perspectives, and develop recovery-oriented content. Clinicians assessing distressed young people should ask about internet use, including access to self-harm images, as part of their assessment.

Pinning Despair and Distress - Suicide-Related Content on Visual Social Media Platform Pinterest

Background: The World Health Organization (WHO) estimates that an individual dies by suicide every 40 s. Aim: Our aim was to analyze how suicide is portrayed on the visual social media platform Pinterest. Method: This study used a quantitative content analysis of 500 suicide-related Pinterest posts. Content codes included the presence of factors related to the WHO media reporting guidelines. Results: The majority of posts were published by individual Pinterest users, with public and mental health entities rarely present. Suicidal ideation content was more prevalent in visuals than in accompanying text on Pinterest. Considering the WHO media suicide-reporting guidelines, posts featured more helpful than harmful content, but explicit details of suicides and suicide attempts were still prevalent. Finally, comments were more likely to identify with suicidal ideation or post negative content than post supportive content. Limitations: Content analysis cannot discern motivations behind posts; future studies should include other methods. Conclusion: This study suggests there is a critical need for further research into Pinterest and suicide-related topics.

Instagram as a Window to Societal Perspective on Mental Health, Gender, and Race: Observational Pilot Study

BACKGROUND

Gender and race are known to impact attitudes toward mental health topics and help-seeking behavior. Men and minorities are more likely to cite stigma as a reason for not seeking help for mental health concerns, which is of particular relevance given the high rate of suicide in men and challenges of historic proportion currently facing minority communities. Instagram provides a platform to discuss mental health, though a lack of male and minority representation may further alienate these populations.

OBJECTIVE

We aimed to investigate whether men and nonwhite individuals are underrepresented in Instagram photos tagged with #mentalhealth (compared to photos tagged with #health) to better understand how gender and race-based representations are manifested on this popular social media platform and discuss the implications.

METHODS

Three investigators of different genders and racial backgrounds met on nine different days via teleconference to analyze a total of 215 publicly available Instagram photos tagged with #mentalhealth and 215 with #health. These photos were generated using Instagram's search function, and search results were sorted by most recently published at the time of data collection. For each photo, the three investigators recorded their observations about the gender (male versus female) and race (white versus nonwhite versus racially unclassifiable) of subjects featured in the photo, which they did not discuss with other investigators. Chi-squared analysis was performed on each investigator's data set to compare the frequency of male versus female and white versus nonwhite subjects identified in each hashtag category. Kappa interrater agreement was calculated for each investigator pair, category (gender or race), and hashtag.

RESULTS

All three investigators observed significantly more female as compared to male subjects in photos tagged with #mentalhealth (X²=14.4, P<.001 for all investigators) while observing no significant difference between numbers of male and female subjects in photos tagged with #health (X²=1.533, P=.22; X²=1.241, P=.27; X²=0.096, P=.76). All three investigators identified significantly more white than nonwhite subjects in photos tagged with both #health and #mentalhealth (X² values range from 11.912 to 98.927, P<.001 for all). Kappa interrater agreement revealed almost perfect agreement for gender (kappa=0.908-0.992) with the agreement for race ranging from 0.614 to 0.822, depending on hashtag and rater pair.

CONCLUSIONS

Women are featured more frequently than men in Instagram photos tagged with #mentalhealth. The topic of #health, meanwhile, is not gendered this way. Low visibility of mental health among men may both represent and exacerbate existing stigma and barriers to care. White subjects are featured significantly more frequently than nonwhite subjects in photos tagged with both #mentalhealth and #health. Directed interventions using the Instagram platform may be indicated to increase the visibility of underrepresented groups and break the cycle of stigma.

Investigating Suicide-Related Subliminal Messages on Instagram

Background: Suicide is the second-leading cause of death among 15-29-year-olds and Instagram is one of the most popular and fastest-growing social media platforms among this age group. A previous study presented preliminary evidence for suicide-related "subliminal messages" on Instagram, defined as very brief presentations of suicide-related content in video posts that users have no conscious awareness of. Aim: A systematic quantitative study was pending. Method: We conducted a quantitative content analysis of 100 Instagram video posts. A frame-by-frame coding procedure allowed for an assessment of whether suicide-related content was depicted in very brief segments, even when this content could not be consciously recognized when watched at regular speed. Results: Analysis indicates that a substantial amount of suicide-related content is presented in very brief shots. We identified 67 very brief shots that appeared in 21 video posts. Of interest, 13 of these video posts presented more than one very brief suicide-related shot. Limitation: The subjective threshold of conscious awareness differs inter-individually. This complicates the operationalization of subliminal messages. Conclusion: Subliminal messages are ethically highly problematic. There is a need for a greater awareness of possible suicide-related subliminal messages on Instagram.

Suicide and self-harm content on Instagram: A systematic scoping review

Given concerns about suicide or self-harm content on Instagram, we conducted a systematic scoping review of peer-reviewed English language primary studies published between 2010–2019. Only ten studies had been published. Looking into purposive samples of Instagram posts tagged with self-harm related hashtags, studies report finding self-harm or suicide content in between 9–66% of their studied posts. Studies assessing Instagram’s efforts to tackle such content found they had not been very effective. Despite heterogeneity in study aims, use of terminology, samples, methods of analysis, and study outcomes, we aggregated and distinguished ‘content studies’ and ‘user studies’. Most studies showed concern for self-harm risk, but only one examined the relationship between self-harm posts and actual self-harm behaviours offline. It found such content had negative emotional effects on some users and reported preliminary evidence of potential harmful effects in relation to self-harm related behaviours offline, although causal effects cannot be claimed. At the same time, some benefits for those who engage with self-harm content online have been suggested. More research directly interviewing Instagram users to understand this phenomenon from their perspective is required. Finally, some ethical issues are discussed.

Content analysis of suicide-related online portrayals: changes in contents retrieved with search engines in the United States and Austria from 2013 to 2018

BACKGROUND

In recent years, efforts in suicide prevention in the United States and Europe have been made to change the conversation on suicide to incorporate more preventive aspects. The majority of information-seeking occurs online. Structured analyses assessing qualitative changes in retrieved online material on suicide over time, however, are scarce. We replicated a content analysis of suicide-related websites retrieved with popular search engines in the United States and Austria aiming to assess how suicide-related online portrayals have changed in the past five years.

METHOD

We retrieved 396 websites using the search term suicide, method-related search terms (e.g., how to hang yourself), and help-related search terms (e.g., suicide help) in the United States and 286 websites from Austrian searches. We performed a content analysis based on media recommendations for suicide reporting and compared the findings to 335 websites in the United States and 396 websites in Austria retrieved in 2013 with the same procedure.

RESULTS

In both countries, the number of both protective (United States: p < .001, Austria: p < .001) and harmful characteristics (United States: p < .001, Austria: p < .001) increased. The ratio of protective to harmful characteristics improved to 3.3:1 in the United States and to 2.4:1 in Austria.

LIMITATIONS

No assumptions about the actual impact of the retrieved contents can be assumed.

CONCLUSION

There has been an increase in potentially protective aspects in online portrayals of suicidality, but also an increase in potentially harmful characteristics, which may suggest an increasing polarization of suicide-related contents. Future prevention efforts need to address this potential polarization.

Developing a Suicide Prevention Social Media Campaign With Young People (The #Chatsafe Project): Co-Design Approach

BACKGROUND

Young people commonly use social media platforms to communicate about suicide. Although research indicates that this communication may be helpful, the potential for harm still exists. To facilitate safe communication about suicide on social media, we developed the #chatsafe guidelines, which we sought to implement via a national social media campaign in Australia. Population-wide suicide prevention campaigns have been shown to improve knowledge, awareness, and attitudes toward suicide. However, suicide prevention campaigns will be ineffective if they do not reach and resonate with their target audience. Co-designing suicide prevention campaigns with young people can increase the engagement and usefulness of these youth interventions.

OBJECTIVE

This study aimed to document key elements of the co-design process; to evaluate young people's experiences of the co-design process; and to capture young people's recommendations for the #chatsafe suicide prevention social media campaign.

METHODS

In total, 11 co-design workshops were conducted, with a total of 134 young people aged between 17 and 25 years. The workshops employed commonly used co-design strategies; however, modifications were made to create a safe and comfortable environment, given the population and complexity and sensitivity of the subject matter. Young people's experiences of the workshops were evaluated through a short survey at the end of each workshop. Recommendations for the campaign strategy were captured through a thematic analysis of the postworkshop discussions with facilitators.

RESULTS

The majority of young people reported that the workshops were both safe (116/131, 88.5%) and enjoyable (126/131, 96.2%). They reported feeling better equipped to communicate safely about suicide on the web and feeling better able to identify and support others who may be at risk of suicide. Key recommendations for the campaign strategy were that young people wanted to see bite-sized sections of the guidelines come to life via shareable content such as short videos, animations, photographs, and images. They wanted to feel visible in campaign materials and wanted all materials to be fully inclusive and linked to resources and support services.

CONCLUSIONS

This is the first study internationally to co-design a suicide prevention social media campaign in partnership with young people. The study demonstrates that it is feasible to safely engage young people in co-designing a suicide prevention intervention and that this process produces recommendations, which can usefully inform suicide prevention campaigns aimed at youth. The fact that young people felt better able to safely communicate about suicide on the web as a result of participation in the study augurs well for youth engagement with the national campaign, which was rolled out across Australia. If effective, the campaign has the potential to better prepare many young people to communicate safely about suicide on the web.

Mental illness on Instagram: a mixed method study to characterize public content, sentiments, and trends of antidepressant use

BACKGROUND

Individuals with mental illness use social media to share treatment experiences and anecdotal information. Despite the significant impact of social media on individuals with mental illness, posts related to antidepressants have not been studied systematically.

AIMS

This study evaluates public sentiments and content posted on Instagram regarding the use of antidepressants.

METHODS

Instagram posts from July 2010 to June 30, 2018 containing hashtags of commonly prescribed antidepressants and anxiety/depression-related terms were gathered (n = 13,096). Approximately 1,000 posts were randomly selected and evaluated for photo content, anecdotal experiences, sentiments towards antidepressants, and mentions of psychotherapy, comorbidities, polypharmacy, or adverse effects.

RESULTS

Instagram posts describing antidepressant use have increased exponentially from 2010, and 43% provided anecdotal experiences. Among these posts, 58% expressed negative sentiments towards antidepressant usage, citing adverse effects and lack of improvement. Posts that also mentioned psychotherapy, comorbidities, or polypharmacy differed in their collective sentiments. Misinformation was present in analyzed posts, and none mentioned recovery-oriented materials (i.e., mental health facility, hotline, etc.).

CONCLUSIONS

Instagram is a useful resource for exploring public sentiments related to antidepressant use. Mental health professionals should be cognizant of these sentiments/perceptions in order to tailor communication with patients and should consider increasing their social media presence.

Neuromarketing as a strategic tool for predicting how Instagramers have an influence on the personal identity of adolescents and young people in Spain

Instagram is the fastest growing social network and has an audience that shares lifestyles related to their interest in beauty and fashion. However, the exposure of adolescents to images that promote the slender beauty ideal can lead to body dissatisfaction, as they place a lot of importance on the likes and comments they receive regarding the comparison of their appearance with that of other users. The popularity of influencers and their opinion leadership has resulted in the convergence of a given body image with the promotion of products and brands. Through the use of neuromarketing techniques -attention through eye tracking, and emotion using galvanic skin response-, the objective of this research is to determine the cognitive perception that Spanish adolescents and young people have of the stimuli transmitted by influencers on Instagram, surpassing classic content analysis of social networks and offering the innovative technique of registering unconscious reactions of the audience, both toward the body image as well as toward the brands promoted by influencers who are akin to the audience. The results suggest that adolescents place greater attention and emotional intensity on the nude body appeal of influencers compared to young adults, and show only scarce interest in brands.