International Study of Definitions of English-Language Terms for Suicidal Behaviours: protocol of an opinion survey

International study of definitions of English-language terms for suicidal behaviours: a survey exploring preferred terminology

OBJECTIVES

Explore international consensus on nomenclatures of suicidal behaviours and analyse differences in terminology between high-income countries (HICs) and low/middle-income countries (LMICs).

DESIGN

An online survey of members of the International Organisation for Suicide Prevention (IASP) used multiple-choice questions and vignettes to assess the four dimensions of the definition of suicidal behaviour: outcome, intent, knowledge and agency.

SETTING

International.

PARTICIPANTS

Respondents included 126 individuals, 37 from 30 LMICs and 89 from 33 HICs. They included 40 IASP national representatives (65% response rate), IASP regular members (20% response rate) and six respondents from six additional countries identified by other organisations.

OUTCOME MEASURES

Definitions of English-language terms for suicidal behaviours.

RESULTS

The recommended definition of 'suicide' describes a fatal act initiated and carried out by the actors themselves. The definition of 'suicide attempt' was restricted to non-fatal acts with intent to die, whereas definition of 'self-harm' more broadly referred to acts with varying motives, including the wish to die. Almost all respondents agreed about the definitions of 'suicidal ideation', 'death wishes' and 'suicide plan'. 'Aborted suicide attempt' and 'interrupted suicide attempt' were not considered components of 'preparatory suicidal behaviour'. There were several differences between representatives from HICs and LMICs.

CONCLUSION

This international opinion survey provided the basis for developing a transcultural nomenclature of suicidal behaviour. Future developments of this nomenclature should be tested in larger samples of professionals, including LMICs may be a challenge.

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.