Title: Exploring the use of the Internet in relation to suicidal behaviour: identifying priorities for prevention
Funder: Department of Health (England)

Abstract: Background: The Internet is transforming the environment for communication about suicide. There are examples of suicides influenced by the Internet, but also suggestions that the Internet can provide support and prevent harm. The Internet thus presents both risks and opportunities for suicide prevention but progress is hampered because systematic empirical evidence is sparse. Aims: The research aims to provide the necessary evidence to derive policy and best practice for the Internet Industry, to guide the development of future online support and suicide prevention approaches, and to inform clinical practice regarding patients’ Internet use. This will cover: how, when, for what purpose and to what effect the Internet is used by individuals with suicidal feelings; the prevalence of and factors associated with suicide-related Internet use; and description of the types of material accessed and how this is interpreted by users. Research plan and methods of investigation: The research will use multiple sources of data and qualitative and quantitative methods. There are four parts: 1) Quantitative analysis using descriptive and multivariable regression statistics to estimate the prevalence of suicide-related Internet use and factors associated with this in two datasets - a clinical sample of patients attending hospital following self-harm and a community sample of young people (ALSPAC cohort); 2) In-depth qualitative interviews exploring narratives of suicide-related Internet use and evaluations of online support and suicide prevention approaches with a) individuals drawn purposively from the above datasets (including some who have made near-fatal suicide attempts), b) relatives or friends of completed suicides with known Internet involvement, and c) a sample of suicide-related internet users drawn from an online survey; 3) Audit of suicide content easily accessed online; 4) a clinician focus group discussing experiences of taking an Internet history as part of risk assessment and the utility of this. Qualitative work will be conducted using an ethnographic approach with iterative data collection and analysis and using the constant comparison technique. Thematic coding and narrative methods will be used. Latterly, methods of meta-ethnography will be employed to synthesise data from the separate qualitative samples. Research team: The team is based at Bristol University with Samaritans as co-applicants, and has a strong record of joint working and publishing. They have been at the forefront of existing research into suicide and the Internet and include members of the National Suicide Prevention Advisory Group. They bring expertise in a range of disciplines, in the proposed research methods, and in using research to influence policy and practice. The steering group includes people with lived experience of suicide-related Internet use, representatives from three leading charities (Samaritans, PAPYRUS, and Mental Health Foundation) and a leading figure in technology and mental health development. This will ensure the research takes into account the views of those affected and is translated into policy and practice. Potential impact/ influence: The research will enable current debate and policy developments to advance with scientific grounding. Quantitative findings will offer the first UK prevalence estimates of suicide-related Internet use and aid recognition of at-risk groups. Qualitative findings will provide evidence on the risks and benefits of use, and particular types/ features of usage and material that may be harmful or preventative. This will contribute towards the development of good practice guidelines and Internet safety policy; and flag ways in which online spaces can help and support suicidal individuals so that these aspects can be maintained and enhanced. Description of current suicide content online will identify sites requiring action. Clinicians’ reflections on the potential usefulness of exploring Internet use as part of suicide risk assessment will contribute towards informing future clinical practice and potential interventions.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: MENTAL HEALTH