Social media and suicide
Social media and suicide is a relatively new phenomenon, which influences suicide-related behavior. Suicide is a leading cause of death worldwide. According to the World Health Organization, in the year 2020, approximately 1.53 million people will die from suicide. There is increasing evidence that this behavior of using social media affects and changes people's lives, especially in teenagers. Suicide has been identified not only as an individual phenomenon, but it is influenced by social and environmental factors.
In one of the widely known cases, the death of Phoebe Prince, it is generally believed that her actions of suicide were motivated by cyberbullying. Cyberbullying is a huge problem linked to increases in suicide rates (Mason, 2008). One explanation that has arisen, is the cause and effect relationship between social media advertised suicides and younger generations being influenced by them. Aside from kids being influenced by suicide tendencies online, there is the psychological explanation behind "15 minutes of fame". The first person who committed suicide live on today's social media platforms - Océane Ebem, an eighteen-year-old woman from Égly in the suburbs of Paris - explicitly said, "I want to communicate a message, and I want it to be passed around, even if it’s very shocking."
The media tends to popularize videos and social media posts in order to inform the public of the rising trouble. However, the media has not taken into consideration the popular appeal it brings to the young and immature minds of teenagers. Social media could provide higher risks with the promotion of different kinds of pro-suicidal sites, message boards, chat rooms and forums. In addition, the Internet not only reports suicide incidents but documents suicide methods (for example, suicide pacts, an agreement between two or more people to commit suicide at a particular time and often by the same lethal means). The role the Internet plays, particularly social media, in suicide-related behavior is a topic of growing interest.
Social media risks
Social media is a relatively new phenomenon that has swept the world during the past decade. There is increasing evidence that the Internet and social media can influence suicide-related behavior. Internet use can cause more exposure to graphic content and lead to cyberbullying, in many cases over the past ten years cyberbullying has led to self harm and suicide (Marchant 1). Suicide is a considerable public health problem, more than 30,000 suicide deaths in the United States and nearly 1 million suicide deaths worldwide occur every year.
In a case series review of suicide, researchers looked at documentation from coroner's inquests for all deaths involving an element of self-harm between 2011 and 2013. This review's emerging evidence suggests the age group most affected by the association between social media use and suicide is older than has previously been assumed: in one small study of coroner's investigations, it was found social media evidence was more likely to be cited at inquest in cases where the deceased was aged over 45 years than under. However, the findings are unclear and may solely reflect greater use of social media. The findings also show that fewer than 20% of Facebook users are aged over 45, contrasting with the demographics of the social media subset. Given the ages of cases identified in this review, further research is needed to conclude the age of users. It is very important that more studies are done to find the age range that is most affected by social media and suicide to best address different intervention methods.
Impact of pro-suicidal sites, message boards, chat rooms and forums
Social media platforms, such as chat rooms, blogging Web sites (e.g., Tumblr, Reddit), video sites (e.g., YouTube), social networking sites (e.g., Facebook, MySpace, Twitter, Google+), as well as e-mail, text messaging, and video chat, have transformed traditional methods of communication by allowing the instantaneous and interactive sharing of information created and controlled by individuals, groups, organizations, and governments. As of the third quarter of 2015, Facebook had 1.55 billion monthly active users. An immense quantity of information on the topic of suicide is available on the Internet and via social media. The information available on social media on the topic of suicide can influence suicidal behavior, both negatively and positively.
Contributors to these social media platforms may also exert peer pressure to commit suicide, idolize those who have completed suicide, and facilitate suicide pacts. These pro-suicidal sites reported the following. For example, on a Japanese message board in 2008 it was shared that a person can kill himself/herself using hydrogen sulfide gas. Shortly after 220 people attempted suicide in this way, and 208 were successful. Biddle et al. conducted a systematic Web search of 12 suicide-associated terms (e.g., suicide, suicide methods, how to kill yourself, and best suicide methods) to analyze the search results and found that pro-suicide sites and chat rooms that discussed general issues associated with suicide most often occurred within the first few hits of a search. Recupero et al. also conducted a study that examined suicide-related sites that can be found using Internet search engines. Of 373 Web site hits, 31% were suicide neutral, 29% were anti-suicide, and 11% were pro-suicide. Together, these studies have shown that obtaining pro-suicide information on the Internet, including detailed information on suicide methods, is very easy.
Although, the public opinion is that message boards are harmful, the following studies show how they point to suicide prevention and have positive influences. A study using content analysis analyzed all of the postings on the AOL Suicide Bulletin Board over 11 months, and concluded that most contributions contained positive, empathetic and supportive postings (Eichenberg, 2008). Then, a multi-method study was able to demonstrate that the users of such forums experience a great deal of social support and only a small amount of social strain. Lastly, in a survey participants were asked to assess the extent of their suicidal thoughts on a 7-level scale (0, absolutely no suicidal thoughts, to 7, very strong suicidal thoughts) for the time directly before their first forum visit and at the time of the survey (Eichenberg, 2008). The study found significant reduction after using the forum. The study however cannot conclude the forum is the only reason for decrease. Together, these studies show how forums can reduce the number of suicides.
An example of how social media can play a role in suicide is that of a male adolescent who arrived at the emergency department (ED) with his parents after a suspected medication ingestion in which he attempted to overdose. Beforehand he had sent an ex-girlfriend a Snapchat picture of himself holding a bottle of acetaminophen, which was forwarded to the young male's parents. This picture was used by medical experts to establish a time of his ingestion, oral N-acetylcysteine was discovered and he was brought to a pediatric care facility, where he had an uneventful recovery and psychiatric evaluation.
In 2013, the main cause of nine teen suicides was due to hateful anonymous messages on Ask.fm 
Suicide is the third leading cause of death for youth between the ages of 10 and 24. Cyberbullicide is the term used to define suicide due to having indirect or direct experiences with online aggression (Napolitano, 2013). Cyberbullying and cyber harassment are two prevalent ways to lead to pro-suicide behavior. In the past, bullying needed a physical location to harass the victim. Yet, this is not the case in the 21st century. Bullies have additional mediums such as social media to harass victims, often without consequence (Mason, 2008). Cyberbullying typically refers to when a child or adolescent is intentionally and repeatedly targeted by another child or teen in the form of threats or harassments or humiliated or embarrassed by means of cellular phones or Internet technologies such as e-mail, texting, social networking sites, or instant messaging. Cyberbullying usually occurs in the form of rumours, embarrassment, gossip, exclusion and attacks on the reputation and relationships of individuals. As a result, the victims may develop problems with their mental health and in some extreme cases, some have become suicidal. Cyber harassment and cyber stalking typically refer to these same actions when they involve adults. Social networking sites, regardless of security measures, can only offer a certain amount of protection to the privacy of the users, and this often overlooked by younger users. By being on sites such as Facebook or Instagram, users are making them open to harassment from online predators. Since there is an enormous amount of information available on these sites, concerns have been raised that sex offenders may access these sites and, using the personal information displayed, attempt to gain the trust of the user, making them vulnerable to online attacks, seduction, or sexual grooming. The offenders may then lure the users into a face to face meeting where they may be molested or sexually assaulted. (Mitchell et al., 2008). A review of data collected between 2004 and 2010 via survey studies indicated that lifetime cyberbullying victimization rates ranged from 20.8% to 40.6% and offending rates ranged from 11.5% to 20.1%.
Media contagion effect
Suicide contagion can be viewed within the larger context of behavioral contagion, which has been described as a situation in which the same behavior spreads quickly and spontaneously through a group (Gould, Jamieson, & Romer, 2003). Persons most susceptible to suicide contagions are those under 25 years of age. A recent study by Dunlop et al. specifically examined possible contagion effects on suicidal behavior via the Internet and social media. Of 719 individuals aged 14 to 24 years, 79% reported being exposed to suicide-related content through family, friends, and traditional news media such as newspapers, and 59% found such content through Internet sources. These information may pose a hazard for vulnerable groups by influencing decisions to die by suicide. In particular, interactions via chat rooms or discussion forums may foster peer pressure to die by suicide, encourage users to idolize those who have completed suicide, or facilitate suicide pacts. Recently there has been a trend in creating memorial social media pages in honor of a deceased person. In New Zealand, a memorial page was made after a person committed suicide, this resulted in the suicide of 8 other persons thereafter, which further shows the power of the media contagion effect.
It has generally been found that those who post suicide notes online tend to not receive help.
Several notable cases support this argument below:
- Kevin Whitrick and Abraham K. Biggs webcast both of their suicides. "I am going to leave this for whoever stumbles across my bookmarks later on."
- Paul Zolezzi indicated via a Facebook update his intent to commit suicide.
- In 2010, John Patrick Bedell left a Wikipedia user page and YouTube videos interpreted by some as a suicide note; the former was deleted by Wikipedia administrators.
- Joe Stack also posted a suicide note online.
- Chris McKinstry, an AI researcher, committed suicide after posting a note to both his blog and the Joel on Software off-topic forum explaining the reasons for his demise, which was discontinued shortly afterwards.
- A girl who attended a Louisville High School posted a video suicide note and then killed herself back in 2014. The girl did not receive any help leading H. Eric Sparks the director of the American School Counselor Association, to say that troubled students should be directed to help hotlines or to trusted authorities to seek an intervention as quickly as possible (Herold 14).
A suicide pact is an agreement between two or more people to die by suicide at a particular time and often by the same lethal means. Suicide pacts are found to be rare (Gould, Jamieson, & Romer, 2003). Traditional suicide pacts have typically developed among individuals who know each other, such as a couple of friends. A suicide pact that has been formed or developed in some way through the use of the Internet is a cybersuicide pact. A primary difference between cybersuicide pacts and traditional suicide pacts is that these pacts are usually formed among complete strangers. They use online chat rooms and virtual bulletin boards and forums as an unmediated avenue to share their feelings with other like-minded individuals, which can be easier than talking about such thoughts and feelings in person.
The first documented use of the Internet to form a suicide pact was reported in Japan in 2000. It has now become a more common form of suicide in Japan, where the suicide rate increased from 34 suicides in 2003 to 91 suicides in 2005. South Korea now has one of the world's highest suicide rates (24.7/100 000 in 2005), and evidence exists that cybersuicide pacts may account for almost one third of suicides in that country.
There are at least 2 suicide interventions through social media:
- Demi Moore and her followers intervened to stop a suicide that had been announced on Twitter.
- A German was prevented from killing himself after Spanish internet users saw him announcing his decision.
Discussion and support groups
Some online groups, such as alt.suicide.holiday, have emerged as discussion and support groups for suicidal individuals. Research indicates that providing more online support for suicidal people would be more effective than shutting down pro-suicide websites. The Defense Centers of Excellence have expressed interest in using social media for suicide prevention. Facebook groups have sometimes been set up for suicide prevention purposes, including one that attracted 47,000 members. Although many teens and preteens encounter suicide related posts from peers on different social media apps, they also encounter suicide prevention hotlines and website links as well (Martin 2).
SAMHSA's Suicide Prevention Lifeline operates on Twitter, Facebook, and YouTube. AFSP (American Foundation For Suicide Prevention) is trying to understanding and preventing suicide through research, education, and advocacy.
Recently, Reidenberg, the executive director of the United States-based prevention organization Suicide Awareness Voices of Education (SAVE), has become very involved in responding to suicidal messages. Facebook, the world's largest social network, has now implemented a direct intervention method. 25 of the 50 American states, when a user posts a message on Facebook containing a phrase that its algorithms flag as indicating suicidal thoughts or intentions, a banner pops up on the user's page (Eggertson, 2015). If the user's page is flagged the user is provided with the number of the National Suicide Prevention Lifeline and given tips and links to support videos aligned with best prevention practices.
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- Number of monthly active Facebook users worldwide as of 3rd quarter 2015 (in millions)
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