Internet Pathways in Suicidality: A Review of the Evidence

The general aim of this study was to review the scientific literature concerning the Internet and suicidality and to examine the different pathways by which suicidal risks and prevention efforts are facilitated through the Internet. An online literature search was conducted using the MEDLINE and Google Scholar databases. The main themes that were investigated included pathological Internet use and suicidality, pro-suicide websites, suicide pacts on the Internet, and suicide prevention via the Internet. Articles were screened based on the titles and abstracts reporting on the themes of interest. Thereafter, articles were selected based on scientific relevance of the study, and included for full text assessment. The results illustrated that specific Internet pathways increased the risk for suicidal behaviours, particularly in adolescents and young people. Several studies found significant correlations between pathological Internet use and suicidal ideation and non-suicidal self-injury. Pro-suicide websites and online suicide pacts were observed as high-risk factors for facilitating suicidal behaviours, particularly among isolated and susceptible individuals. Conversely, the evidence also showed that the Internet could be an effective tool for suicide prevention, especially for socially-isolated and vulnerable individuals, who might otherwise be unreachable. It is this paradox that accentuates the need for further research in this field.

[1]  C. Dowrick,et al.  The prevalence of suicidal ideation in the general population: results from the Outcome of Depression International Network (ODIN) study , 2008, Social Psychiatry and Psychiatric Epidemiology.

[2]  Richard A. Davis,et al.  Validation of a New Scale for Measuring Problematic Internet Use: Implications for Pre-employment Screening , 2002, Cyberpsychology Behav. Soc. Netw..

[3]  Michael Westerlund,et al.  The production of pro-suicide content on the internet: A counter-discourse activity , 2012, New Media Soc..

[4]  K. Subrahmanyam,et al.  Youth Internet use: risks and opportunities , 2009, Current opinion in psychiatry.

[5]  F. Cao,et al.  The relationship between impulsivity and Internet addiction in a sample of Chinese adolescents , 2007, European Psychiatry.

[6]  S. Watkins The Young and the Digital: What the Migration to Social Network Sites, Games, and Anytime, Anywhere Media Means for Our Future , 2009 .

[7]  Sujin Lee,et al.  Internet Over-Users' Psychological Profiles: A Behavior Sampling Analysis on Internet Addiction , 2003, Cyberpsychology Behav. Soc. Netw..

[8]  D. Brent,et al.  Delinquent accounts: does delinquency account for suicidal behavior? , 2007, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[9]  Milton P. Huang,et al.  The Internet and the future of psychiatry. , 1996, The American journal of psychiatry.

[10]  Abraham Weizman,et al.  Depression and suicidal behavior in adolescent inpatients with obsessive compulsive disorder. , 2003, Journal of affective disorders.

[11]  R. C. Hall,et al.  Suicide risk assessment: a review of risk factors for suicide in 100 patients who made severe suicide attempts. Evaluation of suicide risk in a time of managed care. , 1999, Psychosomatics.

[12]  C Pawlak,et al.  Anxiety disorders, comorbidity, and suicide attempts in adolescence: a preliminary investigation , 1999, European Psychiatry.

[13]  P. Yip,et al.  Charcoal burning is also popular for suicide pacts made on the internet , 2005, British medical journal.

[14]  M. Gould,et al.  Bullying, depression, and suicidality in adolescents. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[15]  M. Blettner,et al.  Substance use disorders as risk factors for suicide in an Eastern and a Central European city (Tallinn and Frankfurt/Main) , 2009, Psychiatry Research.

[16]  P. Byrne Stigma of mental illness , 1999, British Journal of Psychiatry.

[17]  Stuart Linke,et al.  Internet-Based Interactive Health Intervention for the Promotion of Sensible Drinking: Patterns of Use and Potential Impact on Members of the General Public , 2007, Journal of medical Internet research.

[18]  C. Chee,et al.  Stigma of mental illness. , 2001, Singapore medical journal.

[19]  King-wa Fu,et al.  Internet addiction: prevalence, discriminant validity and correlates among adolescents in Hong Kong , 2010, British Journal of Psychiatry.

[20]  J. Lochman,et al.  The Coping Power program at the middle-school transition: universal and indicated prevention effects. , 2002, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[21]  A. Beautrais,et al.  Risk factors for serious suicide attempts among youths aged 13 through 24 years. , 1996, Journal of the American Academy of Child and Adolescent Psychiatry.

[22]  C. Richardson,et al.  Adolescents' self-reported suicide attempts, self-harm thoughts and their correlates across 17 European countries. , 2012, Journal of child psychology and psychiatry, and allied disciplines.

[23]  S H Teo,et al.  The stigma of mental illness. , 1978, The Nursing journal of Singapore.

[24]  G. Andersson,et al.  Treating university students with social phobia and public speaking fears: internet delivered self‐help with or without live group exposure sessions , 2008, Depression and anxiety.

[25]  Zoltán Rihmer,et al.  Strategies for suicide prevention , 2002 .

[26]  Martin H. Schmidt,et al.  Internet chat rooms and suicide. , 2004, Journal of the American Academy of Child and Adolescent Psychiatry.

[27]  Barbara Stanley,et al.  Depressive symptoms and clinical status during the Treatment of Adolescent Suicide Attempters (TASA) Study. , 2009, Journal of the American Academy of Child and Adolescent Psychiatry.

[28]  Scott E. Caplan Relations Among Loneliness, Social Anxiety, and Problematic Internet Use , 2007, Cyberpsychology Behav. Soc. Netw..

[29]  M. Hitosugi,et al.  A voluntary effort to save the youth suicide via the Internet in Japan. , 2007, International journal of nursing studies.

[30]  D. Leo,et al.  Who are the kids who self-harm ? An Australian self-report school survey , 2004 .

[31]  Trevor I Prior,et al.  Suicide methods from the internet. , 2004, The American journal of psychiatry.

[32]  Michael Westerlund Självmord och Internet : Kommunikation om ett livsfarligt ämne , 2010 .

[33]  M. Leboyer,et al.  Social phobia is associated with suicide attempt history in bipolar inpatients. , 2007, Bipolar Disorders.

[34]  Alfred A Bove Internet-Based Medical Education , 2008, Perspectives in biology and medicine.

[35]  L. Brown,et al.  Suicide Attempt and Sexual Risk Behavior: Relationship among Adolescents , 2008, Archives of suicide research : official journal of the International Academy for Suicide Research.

[36]  Alfredo Avellaneda Fernández,et al.  Chronic fatigue syndrome: aetiology, diagnosis and treatment , 2009 .

[37]  Robert E. Kraut,et al.  Internet paradox. A social technology that reduces social involvement and psychological well-being? , 1998, The American psychologist.

[38]  Amanda Aitken Ba Pgce DipCouns Suicide and the internet , 2009 .

[39]  J. Beer,et al.  Depression, Suicide Ideation, and Aggression among High School Students Whose Parents are Divorced and Use Alcohol at Home , 1992, Psychological reports.

[40]  R. Brunner,et al.  Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents. , 2007, Archives of pediatrics & adolescent medicine.

[41]  I. Lyoo,et al.  Depression and Internet Addiction in Adolescents , 2007, Psychopathology.

[42]  D. Webster,et al.  A youth violence prevention program. Description and preliminary evaluation. , 1993, Archives of surgery.

[43]  Kimberly Young,et al.  Internet Addiction: The Emergence of a New Clinical Disorder , 1998, Cyberpsychology Behav. Soc. Netw..

[44]  M. Large,et al.  Risk Factors for Suicide Within a Year of Discharge from Psychiatric Hospital: A Systematic Meta-Analysis , 2011, The Australian and New Zealand journal of psychiatry.

[45]  Nicki A. Dowling,et al.  Screening for Internet Dependence: Do the Proposed Diagnostic Criteria Differentiate Normal from Dependent Internet Use? , 2009, Cyberpsychology Behav. Soc. Netw..

[46]  A. Sourander,et al.  Childhood bullying behaviors as a risk for suicide attempts and completed suicides: a population-based birth cohort study. , 2009, Journal of the American Academy of Child and Adolescent Psychiatry.

[47]  K. Young,et al.  Psychology of Computer Use: XL. Addictive Use of the Internet: A Case That Breaks the Stereotype , 1996, Psychological reports.

[48]  Ronald Pies,et al.  Should DSM-V Designate "Internet Addiction" a Mental Disorder? , 2009, Psychiatry (Edgmont (Pa. : Township)).

[49]  D. Mackinnon,et al.  Effects of a community-based prevention program on decreasing drug use in high-risk adolescents. , 1998, American journal of public health.

[50]  Chikako Ozawa-de Silva,et al.  Too Lonely to Die Alone : Internet Suicide Pacts and Existential Suffering in Japan , 2008 .

[51]  Bethany A. Koestner,et al.  An Interactive Web-Based Method of Outreach to College Students at Risk for Suicide , 2008, Journal of American college health : J of ACH.

[52]  P. Allebeck,et al.  Risk factors for suicide among patients with schizophrenia , 1987, Acta psychiatrica Scandinavica.

[53]  Karen Rodham,et al.  Deliberate self harm in adolescents: self report survey in schools in England , 2002, BMJ : British Medical Journal.

[54]  I. Iancu,et al.  Anger, impulsivity, social support, and suicide risk in patients with posttraumatic stress disorder. , 2001, The Journal of nervous and mental disease.

[55]  Jerald J. Block Issues for DSM-V: internet addiction. , 2008, The American journal of psychiatry.

[56]  Xiangming Fang,et al.  Victimization by peers and adolescent suicide in three US samples. , 2009, The Journal of pediatrics.

[57]  D. Wasserman,et al.  Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey , 2005, Psychological Medicine.

[58]  Adekola O. Alao,et al.  Cybersuicide: Review of the Role of the Internet on Suicide , 2006, Cyberpsychology Behav. Soc. Netw..

[59]  L T Lam,et al.  The association between internet addiction and self-injurious behaviour among adolescents , 2009, Injury Prevention.

[60]  J. de Pina-Cabral,et al.  World , 2004, Science.

[61]  D. Olweus,et al.  Bullying in School , 2017 .

[62]  P. Recupero,et al.  Googling suicide: surfing for suicide information on the Internet. , 2008, The Journal of clinical psychiatry.

[63]  Konstantinos Siomos,et al.  Internet Addiction among Greek Adolescent Students , 2008, Cyberpsychology Behav. Soc. Netw..

[64]  M. Griffiths Behavioural addiction: an issue for everybody? , 1996 .

[65]  R Dobson Internet sites may encourage suicide , 1999, BMJ.

[66]  G. Dunn,et al.  Risk factors for suicide in Hungary: a case-control study , 2009, BMC psychiatry.

[67]  Sarah Fortune,et al.  Understanding self-harm and suicide websites: a qualitative interview study of young adult website users. , 2008, Crisis.

[68]  M. Blettner,et al.  Smoking differently modifies suicide risk of affective disorders, substance use disorders, and social factors. , 2009, Journal of affective disorders.

[69]  Kyunghee Kim,et al.  Internet addiction in Korean adolescents and its relation to depression and suicidal ideation: a questionnaire survey. , 2006, International journal of nursing studies.

[70]  A. Perényi,et al.  Suicide in schizophrenia. , 2005, Neuropsychopharmacologia Hungarica : a Magyar Pszichofarmakologiai Egyesulet lapja = official journal of the Hungarian Association of Psychopharmacology.

[71]  G. Shahar,et al.  Emotional First Aid for a Suicide Crisis: Comparison between Telephonic Hotline and Internet , 2007, Psychiatry.

[72]  M. Griffiths Addiction, the tobacco industry and Nature , 1998, Nature.

[73]  A. Butchart,et al.  Suicide, suicide attempts and pesticides: a major hidden public health problem. , 2006, Bulletin of the World Health Organization.

[74]  Ayumi Naito,et al.  Internet Suicide in Japan: Implications for Child and Adolescent Mental Health , 2007, Clinical child psychology and psychiatry.

[75]  W. Brown,et al.  Suicide risk in patients with anxiety disorders: a meta-analysis of the FDA database. , 2002, Journal of affective disorders.

[76]  K. Taniyama,et al.  Japanese experience of hydrogen sulfide: the suicide craze in 2008 , 2010, Journal of occupational medicine and toxicology.

[77]  M. McCarthy,et al.  Internet monitoring of suicide risk in the population. , 2010, Journal of affective disorders.

[78]  D. Wasserman,et al.  Repetition of attempted suicide among teenagers in Europe: frequency, timing and risk factors , 2001, European Child & Adolescent Psychiatry.

[79]  L. Dixon,et al.  Use of the internet and other media for health information among clinic outpatients with serious mental illness. , 2009, Psychiatric services.

[80]  Teen Suicide Information on the Internet: A Systematic Analysis of Quality , 2009, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[81]  L. Hankoff Reducing Suicide: A National Imperative , 2003 .

[82]  M. Nordentoft Crucial elements in suicide prevention strategies , 2011, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[83]  S. Rajagopal Suicide pacts and the internet , 2004, BMJ : British Medical Journal.