It’s quality and quantity: the effect of the amount of comments on online suicidal posts (2021)

Abstract: Every day, individuals post suicide notes on social media asking for support, resources, and reasons to live. Some posts receive few comments while others receive many. While prior studies have analyzed whether specific responses are more or less helpful, it is not clear if the quantity of comments received is beneficial in reducing symptoms or in keeping the user engaged with the platform and hence with life. In the present study, we create a large dataset of users’ first r/SuicideWatch (SW) posts from Reddit (N=21,274), collect the comments as well as the user’s subsequent posts (N=1,615,699) to determine whether they post in SW again in the future. We use propensity score stratification, a causal inference method for observational data, and estimate whether the amount of comments —as a measure of social support— increases or decreases the likelihood of posting again on SW. One hypothesis is that receiving more comments may decrease the likelihood of the user posting in SW in the future, either by reducing symptoms or because comments from untrained peers may be harmful. On the contrary, we find that receiving more comments increases the likelihood a user will post in SW again. We discuss how receiving more comments is helpful, not by permanently relieving symptoms since users make another SW post and their second posts have similar mentions of suicidal ideation, but rather by reinforcing users to seek support and remain engaged with the platform. Furthermore, since receiving only 1 comment —the most common case— decreases the likelihood of posting again by 14% on average depending on the time window, it is important to develop systems that encourage more commenting.

## introduction suicide is among the leading causes of death in the us and worldwide and the second leading cause of death among youth, 10 to 34 years old @xcite . despite a century of scientific research on suicide prevention, suicide rates are similar to what they were 100 years ago because suicide is still very hard to predict and treat @xcite and because many individuals at risk do not receive optimal treatment due to known perceived barriers such as stigma and cost @xcite . instead of seeking professional help, many individuals seek support online from peers, which could have negative consequences including learning about suicide methods, receiving ineffective responses, and being subject to suicide contagion @xcite . therefore, there is an urgent need to model and understand the effect of these responses. ## discussion non-professional online support groups for suicide are often considered dangerous in that untrained peers may invalidate emotions or inspire more suicidal thoughts and behaviors @xcite . however, prior research on reddit has shown responses are generally positive @xcite . this may be due to strict moderation that removes responses containing guilt-tripping (e.g., one sw guideline asks to report "abuse or 'tough love' including any guilt-tripping like 'suicide is selfish' or 'think of your loved ones'"), prosuicide comments, or descriptions of suicide methods. the question remains whether a few comments is enough to keep the user engaged with peers and whether responses actually reduce symptoms indefinitely. a positive outcome after a suicidal post would be that either the comments decrease the poster's suicidal ideation or that the user engages by responding to comments and returning when symptoms persist. we estimated the effect of dosing comments on the likelihood of posting in sw again after having posted for the first time. in the case of receiving a single comment, first-time sw users are 14% less likely on average to post again on sw (range: 23% -8%). the plausible explanation is that the user did not receive enough support and was not reinforced to use the platform again. as users received more comments they are more likely to post in sw again, supporting hypothesis 2 (h2) at least up until 5 comments and again for 9 or more comments. receiving 4-8 comments had mean likelihoods closer to 0, which would mean first-time sw posters are equally likely to return. given how difficult treating suicidal thoughts and behaviors has shown to be @xcite , it is likely that positive peer responses may only provide in-the-moment reduction given effective treatment for stbs include cognitive behavioral therapy, mindful emotion awareness, generating cognitive flexibility, emotion exposure and learning skills that prevent crises for when therapy is discontinued @xcite . therefore, positive comments on reddit that include validating emotions, providing resources towards more professional help such as crisis hotlines, and keeping the user socially supported @xcite should result not in less likelihood of returning but rather in re-engaging with the platform when or if symptoms return. furthermore, out of the users posting on sw a second time, it does not seem to be the case that users are generally returning to express signs of improvement; we found measures of suicidality concerns (as approximated through custom lexicons) remain similar between first and second posts (see fig. 4 and appendix section a.2). keeping users engaged on a platform is extremely important. stbs can be chronic and have very different longitudinal trajectories, with one study finding the median onset for suicidal ideation occurs 1 to 5 years prior to attempting @xcite . furthermore, taking into account the type of ideation as we did in this work (active vs. passive vs. self-harm) seems to be key for more accurate estimation given more active stbs where individuals describe planning future attempts @xcite . furthermore, it is also worth considering how many samples are available for estimation. compared with trying to estimate the effects of specific ngrams (i.e., the content of comments), estimating effects of the amount of comments as was done here will tend to have many more samples for a more accurate estimation (e.g., the amount of times "it gets better" is responded is likely lower than the amount of posts receiving 1 to 10+ comments).