In a World Report in this week's Lancet, Senior Editor Niall Boyce looks at the relationship between suicidal people and the internet, and gauges opinion from scientific and community leaders on what can be done to prevent suicide in the online age of today.
Recent media reports have focused on suicide pacts that have been formed Online, often between people that have never met. In the UK, such reports have suggested this could become a growing phenomenon. Some steps have already been taken to combat the problem. When a person searches Google UK using suicide-related terms, the contact details for the charity Samaritans appears at the top of the page. This was introduced last month. The USA-based National Suicide Prevention Lifeline introduced a Google search mechanism similar to that of Samaritans in April, 2010: it can also be found on MySpace, Facebook, and YouTube. Futhermore, Samaritans is also in touch with social networking sites about creating a system by which friends or family can raise concerns about an individual.
Boyce says: "The balance of risks and benefits is hard to quantify. On the one hand, use of the internet can cement social connections, and provide an anonymous, confidential space in which to express oneself and find sympathetic listeners...On the other hand, the internet can be used in less constructive ways. It can be used as a method of bullying, and for the vulnerable it can provide free, immediate access to potentially harmful information and interactions."
Two recent reports from the Australian Mindframe National Media Initiative (on television and news media) concluded that "there is a need to err on the side of caution", and that "presentations of suicide in news and information media can influence copycat acts in particular circumstances". But co-author of both reports Professor Jane Pirkis,University of Melbourne, says the internet is "much harder to research than traditional media because it's such a changing medium—so the evidence base surrounding its potential for positive or negative impacts is much weaker than that for media like newspapers and television".
Suicide expert David Gunnell, Professor of Epidemiology at Bristol University, suggests a watershed has been reached, saying there is "an increasing degree of shared understanding [between suicide prevention experts and the media] regarding concerns", but pointed out that the speed and volume of information turnover mean "regular reminders" are necessary.
Head of Policy and Research Clare Wyllie questions how much one can extrapolate from the old media model to the emerging world of user-generated online content. It is just one of the points they want answered. "How do vulnerable people use the internet?" she asks. "Why do they use it? What helps them? And what is destructive?"
Professor Stephen Platt of Edinburgh University, a trustee of Samaritans, suggests that a blanket ban on so-called suicide forums (as well as being impossible if the website is based outside the UK), is arguably not the way to go, and that the positive force of the internet in combating mental health problems has hardly been tapped. Boyce says that suicide researchers now need to emulate Samaritans founder Chad Varah's approach: to understand the path that people with suicidal thoughts travel online, and to work out when and how to intervene.
He concludes: "It might help if we think of online space not as a separate, virtual world, but as an extension of this one, albeit with different modes and styles of interaction. It is an area that is ripe for new public health initiatives. Clare Wyllie points out that with their experience and expertise, Samaritans is already making progress. But it is not something they can do alone. Will the research community hear their call for action?"
Niall Boyce, Senior Editor, The Lancet. T) +44 (0) 20 7424 4386 E) niall.boyce@lancet.com
The Lancet Press Office. T) +44 (0) 20 7424 4949 E) tony.kirby@lancet.com
For full World Report, see: http://press.thelancet.com/wr0412.pdf
THIS WEEK'S EDITORIALS: (CANCER CARE IN THE USA, CARDIOVASCULAR HEALTH CRISIS WORLDWIDE, RECKLESS AND PREMATURE WORDS FROM HEAD OF UNAIDS)
For full Editorials, see: http://press.thelancet.com/editorials0412.pdf
Journal
The Lancet