Suicide and social media presentation by Jo Robinson, Orygen Youth Health for DiG Festival mental health stream 2014.

1. Suicide and social media
A review of the literature and a stakeholder consultation
Research team & partners:
Jo Robinson, Maria Rodrigues, Steve Fisher, Helen Herrman
Conducted 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

2. Background: Australian suicide rates
2012 (ABS, 2014)
Suicide and Social Media
Jo Robinson
300
250
200
150
100
50
0
Female
Male

3. 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
Suicide and Social Media
Jo Robinson

4. Background: A definition of social
media
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)
 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)
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Social media
include:

5. Background: Social media features
─ Facebook had 901 million monthly active
users at the end of March 2012
─ Twitter reaches over 160 million monthly
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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

6. 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
Suicide and Social Media
Jo Robinson

7. Literature review

8. Literature review: Methodology
Search 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
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Classification system:
1. Papers that reported on the relationship
between suicide & social media
2. 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 studies
6. Review articles or editorials
7. Studies that examined sites relating to suicide
bereavement

9. Results: Studies identified (n=40)
Type of study
Intervention studies n=0
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Jo Robinson
Target group
4
10
2
8
7
6
3
Studies describing the
development of an
online forum / website
Reviews
Network analytic
studies
Content analytical
studies
Case studies
Risk factor type studies
12
4
22
2
Young people
Not specified
Bereaved people
Adults

10. Literature review: Some key themes
Study type N Some emerging themes
Development studies 4 Multi-faceted & moderated
Internet is an effective, cost effective way of delivering support & info to suicidal people
Is familiar, accessible & less stigmatising
Could be used as an adjunct to treatment
Risk factor studies 6 Cyberbullying increases risk of SI/SA in school & college students
No evidence to suggest that use of suicide forums increases risk
Suicidal people spend more time online than controls & less likely to seek help elsewhere; less
perceived social support
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Content analytic
studies
8 Use forums for peer support & to share experiences not to obtain prof help
Open discussion forums/blogs = most helpful; prof-run sites = less helpful
Potential 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
interventions
Pro-suicide sites were 'rare and marginal' while sites dedicated to prevention and the provision of
information are more visible and more readily accessible
Help sites should maximise strategies to be visible

11. Discussion
Limitations
1. 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
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Jo Robinson
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

12. Stakeholder survey

13. 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 media
2. Organisations and agencies that use social media for
suicide prevention purposes
3. Users of social media (aged 18+)
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14. Suicide and Social Media
Jo Robinson
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.

15. 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)
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16. Results: Organisations (N=13; 19%)
─ The primary focus of most organisations that responded was suicide prevention
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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

17. 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%
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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

18. 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
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19. The most helpful aspects of using social media for an emotional problem
Percentage and number of respondents who endorsed either ‘helpful’ or ‘somewhat
helpful’
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% (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)

20. Suicide and social media in general
Percentage and number of respondents who endorsed either ‘agree’ or ‘strongly agree’
Suicide and Social Media
Jo Robinson
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)

21. The importance of different uses of social media
Percentage and number of respondents who endorsed either ‘important’ or ‘very
important’
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Researchers
% (n=10)
Organisations
% (n=11)
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)

22. Results: Potential risks associated with using social media for suicide prevention
Percentage and number of respondents who endorsed either ‘moderate’ or ‘high risk’
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Researchers
% (n=10)
Organisations
% (n=11)
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)

23. 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
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24. 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
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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

25. Bayside ‘safe conversations’
project

26. Safe conversations
Overall 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
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27. Thank you!
Contact details:
Jo Robinson, Senior Research Fellow
Orygen, The National Centre of Excellence in
Youth Mental Health
orygen.org.au
jr@unimelb.edu.au