Exploring Web-Based Support for Suicidal Ideation in the Scottish Population: Usability Study
Authors: McClelland Heather , O'Connor Rory C , Gibson Laura , MacIntyre Donald J 
Published: January 2025

Background
Suicide is a global health concern. In the United Kingdom, Scotland has the highest suicide rate. Lived experience and suicide prevention stakeholders in Scotland have identified a key gap in suicide prevention activities: the lack of 24-hour peer-driven web-based support for people who are suicidal.

Objective
This usability study aimed to evaluate the feasibility, acceptability, utility, and reach of a suicide prevention website (Surviving Suicidal Thoughts) specifically designed to support residents in Scotland who are experiencing suicidal thoughts themselves or suspect or know someone who is experiencing suicidal thoughts. Intended support was delivered through the provision of personal testimony videos of individuals with lived experience.

Methods
A peer-driven website was developed specifically to support residents of Scotland experiencing suicidal thoughts. The website included resources (eg, videos from lived experience and written guidance about how to respond to someone who may be experiencing suicidal thoughts) to help reduce distress, normalize experiences, and challenge distressing thoughts. The website was promoted via leading web-based social media channels and Google Ads. Evaluation of the website was based on website engagement, marketing strategy, and direct web user feedback via a cross-sectional survey.

Results
Data were collected for 41 weeks (June 2022 to February 2023) spanning the launch of the website and the conclusion of the second marketing campaign. On average, the website received 99.9 visitors per day. A total of 56% (n=14,439) of visitors were female, ages ranged from younger than 18 years to older than 70 years (commonly between 25 and 34 years) and originated from all regions of Scotland. According to Google Search terms of Scottish residents, of the individuals indicated to be experiencing suicidal thoughts but not looking for help, 5.3% (n=920) engaged with the website compared to 10.5% (n=2898) who were indicated to be looking for help for themselves. Based on participant responses to the evaluation survey (n=101), the website was associated with a significant reduction in suicidal thoughts (P=.03). Reasons for visiting the website varied. Marketing data implied that people were more likely to engage with advertisements, which they felt were more personal, and visitors to the website were more likely to engage with videos, which corresponded to their age.

Conclusions
A peer-led website may help residents of Scotland who are experiencing suicidal thoughts. Web-based interventions may have considerable reach in Scotland both in terms of age and geographic area. Engagement with the website was similar to other self-help websites for suicidal ideation; however, more nuanced methods of analyzing website engagement for help-seeking behavior are recommended. Future work would benefit from exploring the effectiveness of this website based on a larger participant sample with website modifications guided by the principles of social learning theory.