Instances of online suicide, the law and potential solutions

Special Report from the CDC: Suicide rates, sodium nitrite-related suicides, and online content, United States

BACKGROUND

In 2022, suicide ranked as the 11th leading cause of death in the United States with 49,513 deaths. Provisional mortality data from 2022 indicate a 2.8% increase in the number of suicides compared to 2021. This paper examines overall suicide trends, sodium nitrite ingestion as an emerging suicide method, and the role that online forums play in sharing information about suicide methods (including sodium nitrite ingestion).

METHODS

Suicides were identified from CDC's National Vital Statistics System (2018-July 2023 provisional) multiple cause-of-death mortality files using International Classification of Diseases (ICD), Tenth Revision underlying cause-of-death codes U03, X60-X84, and Y87.0 and T code T50.6 (antidotes and chelating agents). Google search popularity metrics were captured from January 2019 to January 2023. Case reports of sodium nitrite related suicide and suicide attempts (through February 2024) were identified in the medical and forensic literature.

RESULTS

At least 768 suicides involving antidotes and chelating agents (including sodium nitrite) occurred between 2018 and July 2023, set in the context of 268,972 total suicides during that period. Overall, suicides involving antidotes and chelating agents (including sodium nitrite) represent <1% of all suicides, however, numbers are rising.

CONCLUSIONS

Suicide methods are known to change over time. These changes can be influenced by, among other factors, online forums and means accessibility, such as internet purchase availability. CDC remains committed to prevention through comprehensive public health strategies that protect individuals, families, and communities.

PRACTICAL APPLICATIONS

States and community partners might consider leveraging physicians, emergency responders, and other appropriate crisis response groups to disseminate information on sodium nitrite self-poisoning and its antidote, methylene blue. Efforts should be part of a comprehensive public health approach to suicide prevention.

High achievers, Schadenfreude and Gluckschmerz in New Zealanders and Chinese

The willingness to support (or denigrate) high-profile individuals online was examined across cultures using the Tall Poppy Scale. A sample of 106 Chinese and 164 New Zealand Europeans answered an online questionnaire addressing their preference for high achievers to be rewarded or fail. Participants were asked whether they would vote to support reality TV contestants, and offered further information (about success or failure) on a debrief page. The Favour Reward scale predicted willingness to vote and support others. The Favour Fall subscale tended to predict time spent viewing achievement-related information on a debrief page. The Chinese sample did not prefer reward of high achievers, instead favoring their fall, but spent less time per click on the debrief page, suggesting they disliked recognizing individual achievement.

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.

Need to establish a new adolescent suicide prevention programme in South Korea

Adolescent suicide is the leading cause of death among South Korean (Korean) youth. Despite great efforts being made towards suicide prevention in Korea, the suicide rate has not decreased significantly. There is an urgent need for a new adolescent suicide prevention strategy. This paper describes the seriousness of the issue of adolescent suicide in Korea, evaluates its current management by the SWOT analysis (strengths, weaknesses, opportunities and threats) and further recommends a new suicide prevention programme that integrates national/social involvement (State Suicide Intervention Committee, suicide posts’ monitoring, parental divorce information sharing and Adolescence Mental Health Promotion Foundation), school-based programmes (continuous monitoring system, psychology consultation team and mental health educational curricula) and family-based programmes (parental education and family-school communication). In addition, genetic analysis, biochemical tests and psychological disease registration are the indispensable elements that aid in suicidal behaviour prevention and prediction.