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

Offensive, hateful comment: A networked discourse practice of blame and petition for justice during COVID-19 on Chinese Weibo

Using data from user comments to the official social networking account of the Hubei Red Cross Foundation on a participatory web platform, this study attends to the offensive and hateful comments produced by ordinary Internet users to blame the elite authorities for their malfeasance in managing the donation during the COVID-19 in China. Drawing on Discursive Psychology, we focus on the rhetorical strategies that users employ to legitimise their actions as well-founded evidential blame against a norm-breaking act rather than radical extremist speech. The associated hatred among discussants are moral, social judgements. That said, hate speech also helps construct the moral standards of a normalised society.

"You Are By No Means Alone": A Netnographic Study of Self-Care Support in an Online Community for Older Adults

Online peer-to-peer communities provide environments in which people with similar health concerns can interact and exchange information that can support self-care of long-term conditions. However, current theories have not adequately accounted for how self-care support is enacted in online communities. We conducted an observational netnography to identify and analyze posts in a publicly accessible online community (discussion forum boards) designed for older people. A Straussian grounded theory approach was used to examine 659 posts in health-related message boards. Self-care support involved the construction of three interrelated identities: (1) the support seeking self, in which members described problems and requested information; (2) the empathizing self, in which they described similar experiences and offered support; and (3) the influencing self, in which they provided information or advice. Online communities appear to be an important source of peer support and information and may be a cost-effective approach to supplement standard care.

Youths' attitudes toward open discussion of suicide, preferred contexts, and the impact of Internet use: An exploratory sequential mixed-methods study in Hong Kong

BACKGROUND

Although the necessity and benefits of having the open and public discussion about suicide have been recognized, youths' opinions regarding such discussion remain unknown.

AIMS

To explore youths' attitudes toward open suicide discussion, particularly concerning their preference of discussion contexts and impacts of Internet use.

METHOD

This exploratory sequential mixed-methods study targeted Hong Kong youths aged 15 to 19. A total of six focus groups and 12 individual interviews were held (N = 40). Topics included adolescents' views of open suicide discussion, concerns, perceived benefits, and preferred contexts. The questionnaire survey (N = 1,676) was conducted subsequently to investigate the prevalence of youths' perspectives on public discussion of suicide and relationships with discussion contexts, use of social media platforms, and motivations of online expression.

RESULTS

Qualitative findings revealed three types of attitudes toward open suicide discussion: reluctance, support, and indifference. Major barriers included cultural norms, topic sensitivity, privacy concerns, contagion effect, fear of embarrassment, and unpleasant experiences in school programs. Results of quantitative analyses showed that reluctance was the dominant attitude among adolescents, and taboo was the top concern. Variations in youths' attitudes were related to gender, school academic banding, and suicide-related experiences. Notably, adolescents who had been exposed to suicide messages in contexts of peer networks and online platforms were more likely to endorse open suicide discussion. In addition, an increased likelihood of engaging in public suicide discussion was associated with the use of Instagram, WhatsApp, and Snapchat, and the motive of 'expressing emotions and opinions' online.

CONCLUSIONS

Our results indicated a prevalent rejection among adolescents toward open suicide discussion, suggesting the issue of stigma, the need for tailored programs, the value of appropriate contexts, and the impact of Internet use. These findings may facilitate the development of school-based suicide prevention initiatives and the efficacy of online services for suicide-related communication.

Suicide Prevention Outreach on Social Media Delivered by Trained Volunteers

Background: There is a need to develop new ways to reach and engage people at risk for suicidal behavior. Suicide prevention outreach on social media (SPOSM) represents a promising strategy, and trained volunteers could potentially provide the needed human resources. Aims: We aimed to investigate users' perception of SPOSM delivered by volunteers of the Israeli Sahar organization and its potential to promote help-seeking behavior. Methods: Outreach messages written by Sahar volunteers between July 2015 and June 2020 in response to suicidal posts on a social media site were screened. User responses were analyzed using inductive thematic analysis. Results: One hundred sixteen user responses were analyzed. Positive impact themes were identified in 69.8% of responses, while 16.4% of responses mentioned barriers to care and 10.3% were negative. Limitations: As the study is based on real-life data, the data are limited to users who chose to respond to outreach. Conclusion: The findings suggest that volunteer-based SPOSM is viewed positively by many users and may foster help-seeking behavior. The findings also outline challenges such as emotional barriers to care and privacy concerns.

Self-harm and suicidal content online, harmful or helpful? A systematic review of the recent evidence

Purpose

There are calls for greater regulation of online content related to self-harm and suicide, particularly that which is user-generated. However, the online space is a source of support and advice, including an important sharing of experiences. This study aims to explore what it is about such online content, and how people interact with it, that may confer harm or offer benefit.

Design/methodology/approach

The authors undertook a systematic review of the published evidence, using customised searches up to February 2021 in seven databases. The authors included empirical research on the internet or online use and self-harm or suicide content that had been indexed since 2015. The authors undertook a theoretically driven narrative synthesis.

Findings

From 4,493 unique records, 87 met our inclusion criteria. The literature is rapidly expanding and not all the evidence is high quality, with very few longitudinal or intervention studies so little evidence to understand possible causal links. Very little content online is classifiable as explicitly harmful or definitively helpful, with responses varying by the individual and immediate context. The authors present a framework that seeks to represent the interplay in online use between the person, the medium, the content and the outcome.

Originality/value

This review highlights that content should not be considered separately to the person accessing it, so online safety means thinking about all users. Blanket removal or unthinking regulation may be more harmful than helpful. A focus on safe browsing is important and tools that limit time and diversify content would support this.

Representing suicide: Giving voice to a desire to die?

Drawing on interview and online ethnographic data from a study of suicide on the railways, this paper describes the ways in which many of the concepts, assumptions and practices of mainstream suicide prevention are challenged in the accounts of those who are planning, or have enacted, a suicide attempt. We reflect on the ethical dilemmas which can arise for researchers (and practitioners) when lived experience accounts diverge - theoretically, morally and in terms of practical implications - from present-day expert ones. In online, 'pro-choice' suicide discussions, people describe beliefs, attitudes, ways of thinking and acting which stand in contrast to existing professional and clinical descriptions of suicide and suicidal behaviour. Most obviously, there is often a rejection of 'pro-life' positions, which are framed as ideological, oppressive and naïve. For researchers engaging in online ethnography of 'pro-choice' spaces, dilemmas can arise in relation to the representation of perspectives which fundamentally challenge not only prevailing norms within suicide research and prevention practice but socio-cultural norms more widely. Similar issues can arise when considering how best to represent research participants when their accounts diverge from accepted 'expert' knowledge and beliefs. In-depth qualitative interviews with those who have thought about or attempted to take their own life indicate that existing theories and models of suicide which start from assumptions of deficit and pathology underestimate the extent to which suicide, as the end result of an often-complex series of actions, requires a person to engage in logistical processes of planning, decision-making, imagination and adaptation. The accounts described here, gathered using two different methodological approaches, highlight the ethical issues which can surface when there are competing claims to (expert) knowledge, as well as differences in beliefs, attitudes and moral stance towards life and death. We argue that researchers need to reflect on their own ethical-moral position in relation to suicide, and on the practical consequences of their privileging of some voices at the expense of other, less well represented, ones.

Suicidal behaviours and moderator support in online health communities: a scoping review

OBJECTIVES

Online support can be a crucial source of support for individuals experiencing suicidal behaviours, with forum moderators being pivotal in terms of the role they play in times of personal mental health emergencies. This study identified what is empirically known about the professional practices of health professionals who are online mental health forum moderators and provide support to individuals experiencing suicidal behaviours.

DESIGN

The Levac, Colquhoun and O'Brien extension of the Arksey and O'Malley scoping review framework was used.

SEARCH STRATEGY

The Psychology Collection (EBSCO), PsycINFO (EBSCO), Web of Science, Taylor and Francis Online, SAGE Journals and Science Direct databases were searched for articles that featured a result relating to an online forum; included participants who worked as online moderators or facilitators and focused on suicide or self-harm. Results were limited to peer-reviewed articles published in English from 1990 onwards. As a quality assurance measure, grey literature (nonacademic literature) was not included. Reference lists of included articles were hand-searched.

RESULTS

There were 397 articles initially identified after applying inclusion and exclusion criteria, with five articles included for synthesis. All articles received a moderate quality rating. Only one article featured a moderator who was a qualified health professional; the moderators in the remaining articles were volunteers who undertook preservice training. We found that there is little research that examines the professional working practices of online moderators who support individuals experiencing suicidal behaviours.

CONCLUSIONS

The dearth of research focusing on the professional practices of online forum moderators is cause for concern given that individuals experiencing suicidal behaviours are increasingly turning to online forums when in crisis. Future research should focus on online moderators' practice through interviewing moderators about their professional practices and by examining online moderator practice as it occurs in situ.

Identity and action: Help-seeking requests in calls to a victim support service

The nature of the link between identity and action is a fundamental question for social science. One focus in psychology is how actions like seeking help are implicated in matters of identity. This paper presents a discursive psychology study of identity and help in social interaction. Drawing on a corpus of nearly 400 recorded calls to a victim support helpline, I analysed how participants oriented to the link between identity and help. With attention to epistemic, deontic, and affective relations between participants, I analysed how identity was demonstrably relevant and procedurally consequential for building and interpreting help-seeking requests. Participants displayed an understanding that seeking help from Victim Support necessarily implicates identity. Callers' identities as victims or clients rendered their help-seeking accountable and invoked identities for call-takers as representatives of a support service. The findings show that identity and help are mutually constitutive. Seeking help constituted callers' identities as victims; and their identities as victims constituted their requests for help. I suggest that analysing identity and help in social interaction provides evidence for the mutually constitutive link between identity and action.

'Does anyone else have this?' The role of emotion in forum discussions about medical conditions affecting sex characteristics

When people experience rare medical conditions or variations, searching online may be the only way to find others with similar experiences. This study examines what happens when people do just that. The dataset for the research has been generated from online posts by people living with variations of sex characteristics, which some call intersex variations. Our analysis focuses on how emotion appears in online posts, how affect becomes embodied in digital contexts, and how norms are negotiated as people relate to one another about the variations that some of them experience. We offer an analysis grounded in digital affect theory to contribute to health research literature. We suggest how health researchers and healthcare providers might develop more nuanced understandings of the emotional realities of people living with variations of sex characteristics.

Exploration of Benefits and Potential Harmful Effects of an Online Forum for Visitors to the Suicide Prevention Platform in The Netherlands

Abstract. Background: Online forums that enable peer-to-peer interaction are widespread and readily available. Aim: This study aimed to identify the reach, benefits, and potential harmful effects for visitors to an online forum embedded in a suicide prevention platform in The Netherlands. Method: The study collected web-based questionnaires from online forum users and moderated posts. Descriptive quantitative and qualitative analyses were performed. Results: The online forum had 330 members in 2017, of whom 130 were active users (posting at least one message). Respondents ( n = 106) experienced from a high severity of suicidal ideation (78%). A minority (12%) visited the forum to find suicide methods and 3% to find a suicide partner. Among respondents who had visited the forum more than once ( n = 49), 53% reported no changes in feelings directly after forum use, 35% felt better and 12% felt worse. Peer support and anonymity were the most mentioned benefits, whereas no personal contacts and few reactions to postings were perceived as limitations. Suicide threats and the search for methods were the main reasons for moderating posts. Limitations: Usage habits and user experiences were available from a relatively small group that visited the forum more than once. Conclusion: In its current form, the forum has a low reach with few benefits and a potential for harm for its users. With a questionable benefit-to-risk ratio, the added value of the online forum appears to be small.

Suicidal behaviours and moderator support in online health communities: protocol for a scoping review

INTRODUCTION

Suicidal ideation and suicidal behaviours are common yet complex mental health presentations that can pose significant challenges for health professionals. The inability to accurately predict the individuals who may move from experiencing suicidal ideation and associated behaviours, to completing suicide, presents one such challenge. This can make it difficult to provide interventions and support to those most in need. Online health communities are one possible source of support for individuals who experience suicidal ideation and behaviours. These communities are becoming an increasingly popular way of accessing support, often with life-saving consequences. Within online communities, support is offered by various individuals including, in some instances, health professionals from various backgrounds, who work as online health community moderators. Given the growth of online communities and the increasing number of health professionals working as moderators, this scoping review seeks to map the literature that has focused on health professionals working as online community moderators, who interact with members experiencing suicidal ideation and behaviours. Mapping the existing literature offers benefits to both research and practice by identifying gaps in the research and providing a beginning knowledge base of current practice that can inform the training and development of health professionals working as community moderators.

METHODS AND ANALYSIS

This scoping review will follow the methodological framework of Arksey and O'Malley, later adapted by Levac et al. To ensure appropriate rigour, this protocol uses the 20-item Preferred Reporting Items for Systematic Reviews and Meta-Analyses and extension for Scoping Reviews. Literature will be identified using a search strategy developed in consultation with a specialist research librarian at the university where the researchers are employed. Ten multidisciplinary databases will be independently searched by two researchers, and both researchers will screen for inclusion, and undertake the data extraction. The first author will perform a quality assessment of the articles that are selected for inclusion. A second researcher will complete a random audit of 20% of the included articles to assess for quality and suitability in answering the research questions. The first author will complete the analysis and synthesis of the data. A numerical and narrative synthesis of the included studies will be provided.

ETHICS AND DISSEMINATION

The scoping review has been deemed as being exempt from ethical review as no data will be collected from human participants. The results of the scoping review may be published in a peer-reviewed journal, thesis, presented at relevant conferences, and shared with relevant knowledge users.

"I just might kill myself": Suicide expressions on Twitter

In order to examine how Twitter can be a significant indicator of how suicidal thoughts occur and spread, we used content analysis to analyze 4524 Twitter messages. Although expressions of "wanting to die" occurred frequently, most of the tweets appeared to be non-threatening. In addition, discussions about suicide on Twitter mostly involved sharing suicide prevention resources with fellow users. This finding suggests that Twitter could offer an efficient way to circulate suicide awareness materials across geographical bounds.

Suicidality, psychopathology, and the internet: Online time vs. online behaviors

This study investigated whether several psychopathology variables, including suicidality, could predict the time people spend using the internet (hours online). Next, we examined a specific at-risk population (suicidal individuals) by their online behaviors, comparing suicidal individuals who went online for suicide-related purposes with suicidal individuals who did not go online for suicide-related purposes. An anonymous online sample of 713 (aged 18-71) reported hours online, psychiatric histories, and completed several standardized scales. After accounting for age and education, hierarchical regression modeling showed that the assessed psychopathology variables, including suicidality, did not explain significant variance in hours online. Hours online were better predicted by younger age, greater willingness to develop online relationships, higher perceived social support, higher curiosity, and lower extraversion. Suicidal participants, who did or did not go online for suicide-related purposes, did not differ on hours online. Multiple regression modeling showed that those who went online for suicide-related purposes were likely to be younger, more suicidal, and more willing to seek help from online mental health professionals. These findings revealed that hours online are not a valid indicator of psychopathology. However, studying online behaviors of specific at-risk groups could be informative and useful, including for suicide prevention efforts.

Dying online: live broadcasts of Chinese emerging adult suicides and crisis response behaviors

BACKGROUND

Social media and online environments are becoming increasingly popular and integral to modern lives. The online presentation of suicidal behaviors is an example of the importance of communication technologies, and the need for professionals to respond to a changing world. These types of behaviors, however, have rarely been scientifically analyzed. This study aimed to examine the behaviors of both suicide broadcasters and their audience, with attention on prevention/crisis opportunities.

METHODS

Multiple case studies were employed to explore live-broadcast suicide by Chinese emerging adults (aged 18-25 years). Six cases were selected (four males, two females; aged 19-24, M = 21.60, SD = 2.25), retrieved from 190 public documents (case range = 5 to 32; M = 11.50, SD = 10.37). A qualitative study based on grounded theory was adopted. Information on case background, stages, participants and their behaviors were collected.

RESULTS

(1) Five stages of blogcast suicide incidents were revealed, including: Signaling, Initial reactions, Live blogcast of suicide attempts, Crisis responses, and Final outcomes. (2) Common behavioral trends (e.g., comforting, verbal abuse) were identified from the blogcast participants (e.g., active audience, peers, parents and police). (3) Suicide blogcasters exhibited tendencies to communicated signs of pain and cries for help.

CONCLUSIONS

This multi-case study found live presentations of suicidal behaviors offered unique opportunities to respond to suicidal crises, and also to learn more about the relationships between suicidal people and potential help sources. Findings showed many audience members wanted to be helpful but lacked appropriate skills or knowledge. Others engaged in suicide cyberbullying. The social media is an environment in the making. This study revealed that increasing knowledge and skills for crisis response and suicide prevention is needed. Such efforts could lead to empowered netizens and a more hospitable online world.