suicide and social media - jo robinson #digfestival

Suicide and social mediaA review of the literature and a stakeholder consultationResearch team & partners:Jo Robinson, Maria Rodrigues, Steve Fisher, Helen HerrmanConducted in partnership with Community Works, the Young and Well CRC and the Western Pacific Office of the WHO, with funding from the Young and Well CRC and Orygen, the National Centre of Excellence in Youth Mental Health

Suicide and Social MediaJo Robinson

Background: Australian suicide rates 2012 (ABS, 2014)

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85 and over

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Background: Suicide & the media

─ Concerns have been expressed with regard to the safety of talking about suicide using traditional forms of media

─ Social media sites, in particular blogs & social networking sites are commonly used for the expression of suicidal feelings and for the communication about suicide-related behaviour with others & present new challenges

─ E.g. Concerns exist about the potential for social media to be used to convey information about suicide methods and/or establish suicide pacts

─ However, given its increasing popularity, in particular among young people, it also leads us to question the potential for social media to be used a preventative tool


Social media: a group of Internet applications that build on the foundations of Web 2.0 and allow the creation and exchange of user generated contents (Kaplan & Haenlein, 2010)

Background: A definition of social media

Collaborative projects (e.g. Wikipedia) Blogs and micro blogs (e.g. Twitter) Content communities (e.g. YouTube) Social networking sites (e.g. Facebook) Virtual game worlds (e.g. World of Warcraft) Virtual social worlds (e.g. Second Life)

Social media include:


Background: Social media features

─ Facebook had 901 million monthly active users at the end of March 2012

─ Twitter reaches over 160 million monthly unique users worldwide

─ YouTube is visited monthly by 800 million users, 4 million movies are watched in YouTube every day

─ Social media are capable of reaching global audience and highly accessible for any person who uses the Internet

─ They require minimal skills and financial resources but open possibility to interactive dialogue beyond time and geographical boundaries

─ Responses to the content shared as well as communication via social media can be immediate

─ Participants can constantly shape the contents by making comments, editing, loading pictures or movies

─ Social media enhance sharing private thoughts, experiences, feelings and needs without the necessity of revealing personal details

─ Anonymity plays especially important role in gathering information considered by user as sensitive or maintaining relationship with strangers


Background: Suicide and social media study

Aims:1. To conduct a literature review in order to examine

current knowledge relating to social media & suicide prevention

2. To conduct a stakeholder consultation in order to determine gaps in knowledge and future priorities for work in this field

Literature review


Literature review: MethodologySearch strategy:─ Databases: Medline, PsycINFO, Embase, The

Cochrane Library and the World Health Organisation (WHO) International Clinical Trials Registry Platform (ICTRP)

─ Search terms: (suicid* OR Self-Injurious Behavior* OR DSH OR deliberate self-harm) AND (web* OR online OR Internet OR computer* OR social media).

─ Inclusion criteria: Studies that related to suicide-related behaviour and to social media. No restriction was placed on study design, or publication date

Classification system:1. Papers that reported on the relationship

between suicide & social media2. Studies that reported on the development of

interactive suicide prevention support programs

3. Studies that examined and analysed the content of social media sites for suicide prevention

4. Network analytical studies 5. Individual case studies6. Review articles or editorials 7. Studies that examined sites relating to suicide

bereavement


Results: Studies identified (n=40)

Type of studyIntervention studies n=0

Target group

4

10

2

8

7

6

3Studies describing the development of an on-line forum / website

Reviews

Network analytic studies

Content analytical stud-ies

Case studies

Risk factor type studies

Other

12

22

42

Young people

Not specified

Bereaved people

Adults


Literature review: Some key themesStudy type N Some emerging themes

Development studies 4 Multi-faceted & moderatedInternet is an effective, cost effective way of delivering support & info to suicidal peopleIs familiar, accessible & less stigmatisingCould be used as an adjunct to treatment

Risk factor studies 6 Cyberbullying increases risk of SI/SA in school & college studentsNo evidence to suggest that use of suicide forums increases riskSuicidal people spend more time online than controls & less likely to seek help elsewhere; less perceived social support

Content analytic studies

8 Use forums for peer support & to share experiences not to obtain prof helpOpen discussion forums/blogs = most helpful; prof-run sites = less helpfulPotential to provide support as well as receive it was v beneficial

Case studies 7 Several studies described cases whereby individuals had used social media to express their suicidality or engaged in a suicidal act online. This has implications for contagion & can present clinicians with ethical challenges regarding privacy, boundaries etc.Facebook and Twitter have been used to post suicide notes, and because of their immediate nature, enabled attempts to be made to intervene in the suicide attempt

Network analytical studies

2 Large numbers of traditionally hard-to-reach people can be reached for both research and delivery of interventionsPro-suicide sites were 'rare and marginal' while sites dedicated to prevention and the provision of information are more visible and more readily accessibleHelp sites should maximise strategies to be visible


Discussion

Limitations1. Although the search strategy was

as thorough as possible, it is possible that some studies were missed, in particular those that were not available in English

2. No restrictions were placed on study design, as a result quality of included studies varied

3. Finally, because of the inclusive nature of this review, some studies did not neatly fall into the categories developed, and in some cases it was extremely hard to classify the articles retrieved

However─ Social media platforms enable people to

access info, support & counselling and to share their experiences in a flexible, timely and readily accessible format

─ They also allow people to create unique & positive identities in a way that they may not otherwise have been able to do e.g. as a helper as well as being helped

─ Many highly valued the ability to engage in online peer-to-peer support as an add-on (not alternative) to face-to-face Tx

─ Health profs should engage more successfully with this form of media in order that the two avenues for support and treatment may coexist

Stakeholder survey


Stakeholder consultation: Methodology

─ A 12-week stakeholder consultation exercise that involved the online administration of 3 specifically designed questionnaires, distributed to:

1. People who conduct research into suicide and social media2. Organisations and agencies that use social media for

suicide prevention purposes 3. Users of social media (aged 18+)


Recruitment

1. Researchers & organisations were identified using a snowball technique whereby an initial list of stakeholders was developed from the literature search & an Internet search. This was supplemented by individuals, or organisations known to the research team. Each of these stakeholders received a direct email inviting them to participate & asking them to identify others whom they consider to have relevant experience. They were also sent an email invitation. This continued until data saturation was reached and no new information was emerging. In total 44 researchers and 69 organisations were invited to participate.

2. Individual users of social media were identified using a two-stage process. Stage 1: In order to identify individual users an advertisement with a link to the survey was placed on the Orygen Facebook page and via their Twitter feed. Stage two: Participants were then asked to re-post the survey by any form of social media that they normally use. As an incentive, participants were given the option of providing their contact details to enter into a draw to win an iPad.


Results: Researchers (N=10; 25%)─ The primary focus of research was on suicide and the media, including social media─ With regard to the frequency of their use of social media, Twitter was most frequently used (n=7), followed

by Facebook & YouTube (n=6)─ Studies most commonly conducted were those that examined the ways in which users discuss suicide using

social media, followed by studies that described the types of social media sites that are used to discuss suicide

─ All respondents indicated that there is currently insufficient research examining the effects of social media based interventions on either suicide risk or ways in which social media can be used to support people bereaved by suicide

─ Most commonly cited barriers were: methodological challenges (n=10); ethical issues (n=8); lack of funding (n=6); tech issues (n=6); safety issues (n=3) & lack of researcher interest (n=2)

─ Future priorities (rated as high or very high) were: research examining relationship between suicide & social media (n= 9); research examining the ways people use social media to talk about suicidal feelings (n=8); intervention studies for suicide risk (n=8); research examining ethics or safety of delivering suicide prevention programs via social media (n=8); research examining the ways people use social media to talk about being bereaved by suicide (n=7); & intervention studies for people bereaved by suicide (n=6)


Results: Organisations (N=13; 19%)─ The primary focus of most organisations that responded was suicide prevention

specifically─ Half were based in Australia─ The most commonly used social media site was Facebook ─ All of the organisations reported using social media for the purpose of raising

awareness, and 39% for advocacy purposes ─ 46% of organisations reported hosting discussion forums about suicide & its

prevention and 31% hosted discussion forums about other MH issues - although these were hard to find

─ Almost 40% hosted blogs discussing suicide prevention, and 31% hosted blogs about other MH issues – as above these were hard to find

─ Almost one third reported provided online counselling


Results: Organisations cont’d – management of social media sites

─ 54% employed a marketing professional to promote their site & 23% also used a marketing professional to keep their site up to date

─ All but one had someone to clinically moderate their sites. In 83% of cases the site was moderated at least once a day and often this was done by a trained staff member or volunteer

─ 77% of organisations reported that their social media page prominently displayed details of a crisis line and/or other information regarding emergency services

─ 31% had a prominent link to directly connect site visitors with crisis response services ─ 46% had a disclaimer on the site stating its intent & purpose; 39% had clear protocols & 23%

had a code of ethics─ All reported social media to be either ‘somewhat or very beneficial’ to both their organisation

& to the target audience and 91% considered the site to have been ‘somewhat or very beneficial’ to people at risk of suicide


Results: Users (N=76)

─ 66% female; just over half were aged < 30; 57% were in either full or part time work; 28% were full time students and the remainder were unemployed; almost 60% based in Australia

─ Most reported having felt suicidal at some time and/or supported someone else who had been suicidal or bereaved by suicide

─ In terms of help-seeking offline, 79% had sought help from a friend for an emotional or mental health-related problem and 71% had received professional help; 41% had called a telephone helpline and 88% had encouraged a friend or peer to seek professional help

─ The most commonly used social media site among respondents was Facebook, followed by Twitter

─ 37% reported having used social media for an emotional problem, although not usually for the purpose of gaining professional help, rather, they were typically used to obtain emotional support from others


The most helpful aspects of using social media for an emotional problem Percentage and number of respondents who endorsed either ‘helpful’ or ‘somewhat helpful’

% (n=22)

Expressing your feelings 91% (20)

Receiving emotional support from others 82% (18)

Talking to people with a similar problem 73% (16)

Helping others 73% (16)

Receiving information about your problem 55% (12)

Connecting with a community that understands your problem 55% (12)

Receiving information regarding how to obtain professional help 46% (10)

Receiving information about events, services or activities related to your problem 23% (5)

Getting professional help 5% (1)


Suicide and social media in generalPercentage and number of respondents who endorsed either ‘agree’ or ‘strongly agree’

Researchers% (n=10)

Organisations% (n=11)

Users% (n=54)

Social media has the potential to be a useful tool for delivering suicide prevention activities

100% (10) 82% (9) 87% (47)

Social media is a useful way for people to communicate with others about their suicidal feelings

60% (6) 73% (8) 70% (38)

Social media provides an opportunity to intervene early if someone expresses suicidal thoughts or feelings

70% (7) 82% (9) 85% (46)

Social media is a useful way for people who have felt suicidal to support others

70% (7) 73% (8) 82% (44)

Social media is a useful way for people who have been bereaved by suicide to share their experiences

60% (6) 82% (9) 87% (47)

Social media is a useful way for people who have been bereaved by suicide to support others

60% (6) 82% (9) 85% (46)

Social media is a useful way for people who feel suicidal to seek/receive professional help

60% (6) 64% (7) 56% (30)


The importance of different uses of social media Percentage and number of respondents who endorsed either ‘important’ or ‘very important’

Researchers% (n=10)


Users% (n=50)

To promote activities, services, events or training programs

100% (10) 82% (9) 86% (43)

Awareness raising

90% (9) 73% (8) 82% (41)

The provision of information/resources

100% (10) 100% (11) 94% (47)

For advocacy purposes

90% (9) 73% (8) 76% (38)

To allow users to support each other

70% (7) 100% (11) 80% (40)

To allow users to share experiences

60% (6) 82% (9) 67% (33)

The provision of tools for suicide prevention (e.g. risk assessment tools)

50% (5) 64% (7) 88% (44)

For fundraising purposes

40% (4) 55% (6) 62% (31)

For the provision of professional support or treatment

50% (5) 73% (8) 64% (32)


Results: Potential risks associated with using social media for suicide prevention Percentage and number of respondents who endorsed either ‘moderate’ or ‘high risk’

Researchers% (n=10)


Users% (n=48)

Site administrators lack the skills to operate safe and effective interventions online

80% (8) 82% (9) 73% (35)

Site visitors at risk of suicide may expect support that the organisation is not able to provide via social media

60% (6) 73% (8) 79% (38)

Site visitors may inadvertently harm other visitors at risk of suicide

80% (8) 46% (5) 83% (38)

Site visitors may deliberately harm other visitors at risk of suicide

70% (7) 46% (5) 71% (34)

Site visitors may develop unhealthy relationships with other visitors to the site

60% (6) 46% (5) 69% (33)

Incorrect information related to suicide might be spread via the site

80% (8) 46% (5) 65% (31)

People may use social media to seek information regarding methods of suicide

80% (8) 64% (7) 60% (29)

Interaction between people at risk of suicide via social media may normalise or encourage the behaviour

50% (5) 36% (4) 67% (32)


Discussion: Key findings

─ All groups reported believing that social media, in particular Facebook, has

the potential to be a useful tool for delivering suicide prevention activities

─ Key benefits: enabling people to share experiences & express feelings;

non-stigmatising; accessible; ability to help & support others; opportunities

for early intervention if someone expresses suicidal thoughts or feelings

online

─ Key risks: Contagion was raised but the ability of site administrators to

operate safe & effective interventions online; need for clinical practice/ethical

guidelines (e.g. http://www.eiconline.org/teamup/) was a bigger concern

─ Each group believed that the benefits outweighed the risks

http://www.eiconline.org/teamup/


Future directions…

─ Build on the ways consumers currently use social media platforms─ Develop and test interventions that can be safely delivered via social

media and fully utilise the potential that social media platforms offer─ Development of ethical/clinical guidelines for the safe delivery of suicide

prevention programs via social media ─ Maximum stakeholder participation e.g. iterative, co-design, ongoing

evaluation ─ Meaningful cross-sector collaboration i.e. professionals; IT companies;

consumers─ Rethinking the RCT to allow for rapid results; online/fully automated

data collection; yet not sacrificing engagement and/or adherence

Bayside ‘safe conversations’ project


Safe conversationsOverall objective: to engage a number of young people from schools in the Bayside community that have experienced a recent suicide in the development of a suite of suicide prevention interventions that can be delivered & tested via social media

Interventions will be developed in partnership with young people, but examples are:

─ A series of simple messages regarding help-seeking and mental health promotion to be delivered via Facebook specifically to young people in the Bayside area.

─ A series of 3 personal stories or ‘vox pops’ to be delivered via [a closed group] on Facebook and/or YouTube that will focus on their experiences of: a) Feeling suicidal and overcoming these feelings b) Helping a suicidal friend c) Losing a school friend/peer to suicide and how to obtain help/support.

─ A suite of evidence-based apps that can be delivered and downloaded via social media, e.g. safety planning/problem solving tools, and apps that promote behavioural activation strategies e.g. regular exercise, mindfulness skills & healthy sleep patterns.

Acceptability, safety, reach and efficacy will be examined

Thank you!

Contact details:

Jo Robinson, Senior Research FellowOrygen, The National Centre of Excellence in Youth Mental [email protected]

suicide and social media - jo robinson #digfestival

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