Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Suicide and Search Engines
- John M. Grohol (12 April 2008)
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The Internet Cannot be controlled
- Rachel J Radcliffe (13 April 2008)
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Suicide and the internet: perspectives from abroad
- Satnam S Kunar (15 April 2008)
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Too flawed to publish
- paul m canning (18 April 2008)
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Emerging suicide methods in Asia and the Internet
- King-wa Fu, Paul S.F. Yip (19 April 2008)
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Use of search engines ("web dragons")
- Dallas N Knight (20 April 2008)
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Outreach in the Real World
- Masatoshi Inagaki, Yukie Ouchi, Tadashi Takeshima, and Mitsuhiko Yamada (21 April 2008)
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Suicide and internet use levels-- the evidence is lacking
- Jean H. Kim, Johnson C.H. Lau and Sian M. Griffiths (21 April 2008)
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Positive and negative influences of the Internet on suicide
- In Han Song (23 April 2008)
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Use of Internet Prevention sites on suicide
- In Han Song (24 April 2008)
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Suicide and the Internet: authors' response
- David Gunnell, Jenny Donovan, Lucy Biddle, Keth Hawton, Nav Kapur (2 May 2008)
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Industry collaboration the way forward
- paul m canning (6 May 2008)
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John M. Grohol, Publisher PsychCentral.com, 01950
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The methods chosen for this study don't seem to logically follow from the introduction, namely, "The influence of the internet on suicidal behaviour is less well understood, although it is an increasingly popular source of information, especially for people confronting embarrassing issues such as mental illness, and concerns have been raised about the existence of sites that promote suicide." Which seems like a reasonable investigation to undertake. So I'm a bit perplexed why the authors felt necessary to focus virtually exclusively on one specific aspect of suicide -- methods of suicide -- rather than on support, treatment, interventions, crisis hotlines, or information on how to stop or prevent suicide. Suicidal behavior encompasses all of this and much more. People who are suicidal simply aren't this homogeneous group looking for the best ways to kill themselves. By stacking the deck with the keywords and search phrases chosen, it is reasonable to assume one would find a plethora of websites and information resources that answer the query typed into the search engine; that is precisely the nature of search engines. I suspect the researchers would have discovered completely different results had they taken a less biased approach to this question and typed in queries such as "suicide support group," "suicide help," "suicide crisis," or "suicide prevention." In fact, on the main keyword that most Internet users type into a search engine for suicide ("suicide"), I couldn't find a single pro-suicide website in the top ten search results. Instead, the researchers made a conscious decision to focus on suicide methods and, by doing so, discovered exactly what any reasonable person would expect to find -- a great number of websites that offer information on methods of suicide. Even an informational resource might briefly mention such methods in order to inform and describe what the act of suicide encompasses (but this, by no means, would make such an information resource a "pro suicide" site). We host one of the most popular suicide pages on the Internet ("Suicide: Read This First" found at http://metanoia.org/suicide/ ) and are saddened when research of this nature emphasizes the negatives of the Internet over the positives. Every week we receive emails from people who have chosen not to take their lives because of something they've read on one of our websites. Instead of even noting that such websites greatly outnumber the pro-suicide websites, the researchers designed a study that could only emphasize the negative. This is too bad, as the researchers have painted a pessimistic, biased, and bleak picture of the Internet and the suicidal resources it offers. A picture that, while may be true for a small subset of all possible suicidal keywords and search phrases, is not an accurate portrayal of the Internet's greater collection of suicidal resources, organizations and support websites. Competing interests: None declared |
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Rachel J Radcliffe, Scientist and Freelance Journalist Manchester
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The internet has evolved at such a rapid rate that cyberpsychology has not caught up with its impact on human behaviour. No matter how many websites are banned in this country, realistically websites abroad beyond UK jurisdiction cannot be controlled. What is required is education in our schools and information about the dangers of the internet. This is also a product of the way society is evolving. For instance, many people simply live their lives on the internet - Second Life is an example. It is well known that disinhibition is a feature of those within the cyberworld. I am of the view that more education is required about the impact of the cyberworld on human psychology. Only then will a effective solution be found. Rachel Radcliffe Competing interests: None declared |
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Satnam S Kunar, Specialist Registrar in Psychiatry Caludon Centre, Clifford Bridge Road, Coventry. CV2 2TE
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Controlling the content of internet sites is notoriously difficult. Since the introduction in Australia of The Criminal Code Amendment (Suicide Related Material Offences) Act 20051, a person is guilty of an offence if they use a carriage service to access, transmit, publish or distribute material "which directly or indirectly counsels or incites committing or attempting to commit suicide". The Act specifically states that an individual is not guilty if they are engaged in debate or public discussion about euthanasia or suicide or even if they advocate reform of the law relating to these matters. Unsurprisingly, this has resulted in a huge debate about grey areas of the law where people may be prosecuted for enquiries suggesting they are actually procuring information about suicide. In October 2004, seven people, all in their teens or early twenties, were found dead in a van in Saitama, Japan. This appeared to have been a suicide pact arranged over the internet and highlighted an increasing problem in a country with a suicide rate three times greater than Britain2. Three main arguments have been put forward for this. The first is extreme alienation amongst some young Japanese. An unknown proportion of these withdraw from society, spending months or even years in their bedrooms, rarely venturing out. This phenomenon has been termed hikikomori. Their main form of communication is the virtual world of the web. It is not known how many hikikomori have committed suicide but some have been involved in well-publicised incidents of extreme violence. Secondly, the hierarchical structure of Japanese society places great emphasis on uniformity. The honne or true feelings is very different to one's tatemae or public face. These values are becoming increasingly difficult to sustain in the modern world of global forces and the end of the era of jobs for life, as with previous generations. The third problem is stigma of mental illness and the fact that psychological and counselling therapies are not widely available in many parts of Japan. The real challenge therefore is not only legislation controlling the internet but the underlying reasons why young people are visiting these sites. Only introspection, as in Japan, will allow us to help these vulnerable individuals. References 1. Criminal Code Amendment (Suicide Related Material Offences) Act 2005. No. 92,205. Commonwealth of Australia Law. Attorney-General's Department. Government of Australia. 2. World Health Organization. Suicide rates as of May 2003. Competing interests: None declared |
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paul m canning, webbie cambridge city council, cb4 3dh
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"Recent reports of suicide by young people have highlighted the possible influence of internet sites. Lucy Biddle and colleagues investigate what a web search is likely to find." Those recent reports are of the Bridgend, Wales suicide cluster. Shock horror newspaper headlines often pointed at the web as a reason why a bunch of young people might have killed themselves or at least encouraged them. Of course, virtually none of the media reports looked at the research which has repeatedly shown that the media itself, particularly when it describes methods, has been demonstrated to encourage so-called 'copycat' suicide, but that's for another day. What Biddle and colleagues from Bristol, Oxford and Manchester universities claimed to find, and what the BBC and media around the world subsequently and dutifully reported, was that it's search engines that encourage suicide. Methods are "easy to find" - and they'd proved it. "The three most frequently occurring sites were all pro-suicide, prompting researchers to call for anti-suicide web pages to be prioritised." The trouble was the research was flawed in its methodology and Biddle et al aren't experts in how search actually works. Worse, ways in which pro-suicide websites can be countered online are relatively easy and the methods used well established - so how this 'prioritisation' might happen wasn't explained. Starting with their idea of "most frequently occurring sites", this is nonsense as the vast, vast majority of searchers don't get past the first ten results and most of those don't get past the top three. So to rank, as they did, the 'top ten' searches as having equal value is false. This alone discounts their findings. They also counted from searches on four search engines. Yet fully 86% of UK searches are via Google - they'd again counted each search on each search engine as having equal value. As well, they gave each of ten search terms equal value when those terms have vastly different uses. Using a keyword suggestion tool, you can see that 'Suicide' has a daily UK search number of 7788 whereas one they picked, 'Most effective methods for committing suicide', has 0. This tool also throws up terms they didn't use, such as 'suicide poetry'. You can actually see this vast different in usage recognised by commercial sites as well as church and other small charity bodies who pay for advertising next to search results ('Cremated ashes made into glass: "Keep the memory"'). They will naturally only pick the terms of most value. Most tellingly they failed to understand that two terms they used 'Methods of suicide' and 'Suicide methods' are exactly the same term because 'of' is discounted. In their paper they state that their 'Search strategy' was: "To replicate the results of a typical search that might be undertaken by a person seeking information about methods of suicide. We conducted searches using the four most popular UK search engines and 12 broad search terms—a total of 48 searches. The terms entered were those likely to be used by distressed individuals, determined partly from interview data collected in an ongoing qualitative study of near-fatal suicide attempts and by using search suggestions provided by the engines upon entering terms such as 'suicide.'" There isn't any further detail on just how they could know what search terms were actually entered 'by distressed individuals' as opposed to ones without distress or how relevant 'interview data' would be in working that out. If they had even bothered to ask some of the search marketing/search optimisation specialists probably around the corner from them, or possibly even within the same universities, they would have realised that their methodology doesn't show anything. But as a result of this article being in the hallowed BMJ we now have web-bashing headlines around the world. I would suggest that this article devalues the BMJ itself as a source of scientific information unless it is withdrawn. There was nothing scientific about this study. Biddle told the BBC that: "This research shows it is very easy to obtain detailed technical information about methods of suicide." Her research did not demonstrate that finding pro-suicide websites is "very easy". But, yes, if you are determined to find it you will find it. Just like the determined can find bomb making recipes and the Chinese in China can find rants against the Chinese government. But this is not how most people operate, which you can see from what gets typed in most frequently. Contrary to assumptions, I haven't seen any evidence that shows that kids and teens are that much better, if at all, at finding things online using search engines than anyone else. What I can say is that, using Google Trends, which covers searches going back four years, for general searches for 'suicide' (tweaked to exclude unrelated Iraq/Afghanistan 'suicide bombers' searches), the trend is clearly down. There's some good news you won't read in reporting. Apart from no numbers on what the actual usage is of 'pro-suicide' sites, another point is whether the websites which charities and government create are actually helping kids and teens. I don't know but I'd like to - there's nothing about that in this research, why some kids and teens might be turning to these pro-suicide websites instead of 'official' ones. The BBC quoted Marjorie Wallace, chief executive of the mental health charity Sane, saying the proverbial 'something should be done'. There's actually a lot which could be done. For example: 1. How about running text ads next to more search terms than just 'suicide'. 2. Or employing some Search Engine Optimisation specialists to make sure that your pages come up first. They might even do it for nothing or just the publicity. 3. Or working with other charities to make sure you cover every possible term and intervene via content and ads on other sites or through social networks (simply creating a page on Mind's website, already high-up results, which is titled 'How to commit suicide' would immediately help). 4. Or fixing your own websites, not only to make them more appealing to your target audience but also to fix errors such as the first result on a search for 'suicide' on Sane's website being 'The National Suicide Prevention Strategy report'. On one term you can see how smaller, more agile bodies aren't moaning but are learning how to use the web to their own ends. 'How to commit suicide' includes a top result which redirects people to an anti-suicide web page. My issue with the research and its reaction is that the complainants are making no effort to ensure that their pages turn up tops on such search terms as 'How to commit suicide' . There are no excuses for this and to behave as if this is someone else's responsibility - let alone ISPs - is childish and pathetic Simply put, it is not ISPs but health practitioners, charities and government who are not doing their job properly online. They are failing the very kids and teens they claim to be helping and looking for someone else to blame - there's an abdication of responsibility. This is exactly what happens when you set up online walled gardens and fail to relate to the wider web - I am not seeing the NHS or government portal directgov anywhere in these results - and that 'can't be bothered' 'it's all too complicated' mentality apparently dominates the charity sector as well. Hardly surprising when the 'National suicide prevention strategy for England' contains no mention of either the web, the internet or even chatrooms. Here's what could be done: 1. Talk to the search engines, they are very interested in getting results right and can and do 'tweak' them. They won't 'censor' sites or stop indexing the whole web but they will help and advise on improving positioning. 2. Don't talk to the ISPs! Talk to the search engine experts such as the Search Marketing Association. 3. Talk to social networks about teaming up with them and others to create widgets and other tools so kids and teens can help others. As well, these people would potentially do it for free or cheaply or for publicity. It would be very straightforward to out-manoeuvre the pro- suicide websites - what resources do they have vs. what resources do you have? Research on how search may contribute to actual suicide may well be valuable, but it needs to be done by specialists who can use the tools established by the industry to track and analyse which sites are the most dangerous and where the traffic to them is coming from - it may well not be primarily search. That could be done. But the best course is a concerted effort by charities and government to direct 'distressed individuals' to websites which can really help them. I am afraid that none of these people are listening though. What they are instead developing is an righteous effort, like has happened in Australia, which will end up in a censored Internet for all of us - and no real help for those they claim to be helping. Links to references are on my blog, paulcanning.me.uk Competing interests: None declared |
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King-wa Fu, Researcher The University of Hong Kong, Paul S.F. Yip
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Emerging suicide methods in Asia and the Internet Biddle et al. offer an interesting, but not surprising, finding by investigating the suicide-related information on the web and revealing that pro-suicide websites are far more common and more easily located by a number of generic search engine keywords like "suicide", "suicide methods" or "suicide sure method" etc.[1] But we suspect that some suicidal web-users look for information about a specific suicide method, which involve some technical details on how to carry them out. This group of vulnerable people may instead enter specific keywords like "charcoal burning" or "homemade gas" to actively seek information about that method to die. It is worth exploring further the role of the Internet in the rapid emergence of some suicide methods across several Asian countries. For instance, carbon monoxide poisoning by burning charcoal has been portrayed by the mass media in Hong Kong as an easy, painless and effective means of ending one's life since 1998.[2] It appeared to be spread more widely from Hong Kong to other places through the media, including the Internet.[2, 3] In Japan, it is commonly known as a suicide method associated with Internet suicides and suicide pacts.[4] Suicides by gas poisoning (mainly charcoal-burning) skyrocketed from 31 in 1998 to 1,300 in 2005 in Taiwan and became the second most prevalent suicide method in that country.[5] Recently, Japanese media reported that at least six people committed suicide over a weekend by gas poisoning which was "home-made" by mixing cleaning liquid and bath salts. These people are believed to have learned this rare and sophisticated method of committing suicide from the Internet. It is not uncommon for people in Hong Kong, Taiwan and Japan to be aware of these novel ways of committing suicide through the mass media reporting on the suicide cases. For instance, 47% of suicide deaths in Hong Kong were found to have newspaper coverage in 2000. The extensive and sensational coverage of suicide death among the media in Asia is much more serious than that of western countries.[6] Some readers, especially the more vulnerable ones, may conceive that suicide by that specific method is a "normal" or "common" response to their personal problems. These people who have thought about suicide may intend to seek more information and understand the technical descriptions of some suicide methods. More than that, being exposed to web postings that encourage people to consider suicide may reinforce those vulnerable people to move from suicidal thought to action. So the Internet itself becomes a catalyst, and provides this group of people an interactive, privacy-protected and self-initiated medium to acquire the information they need and to reconfirm the "correctness" of their suicidal thought. Self-regulation is suggested as an approach to reducing the potential harm of Internet suicide. But in the Web 2.0 era, the user-initiated media like applications of Wikipedia, blog or social network have been growing rapidly every minute and these media are virtually impossible to be regulated by the traditional modes, such as self-regulation by code of practice or licensing. Lawful enforcement may be effective but care should be taken to avoid sacrificing the freedom of expression enjoyed by the whole Internet world. Apart from the legislation in Australia[1], Taiwanese lawmakers are currently drafting a bill to protect teenagers against the suggestive suicide through the Internet. In view of the global nature of Internet, it seems logical that a global effort is needed to contain the negative effect of Internet on suicides. References: 1. Biddle L, Donovan J, Hawton K, Kapur N, Gunnell D. Suicide and the Internet. BMJ 2008;336(7648):800-2. 2. Chan KP, Yip PS, Au J, Lee DT. Charcoal-burning suicide in post- transition Hong Kong. Br J Psychiatry 2005;186:67-73. 3. Liu KY, Beautrais A, Caine E, Chan K, Chao A, Conwell Y, et al. Charcoal burning suicides in Hong Kong and urban Taiwan: an illustration of the impact of a novel suicide method on overall regional rates. J Epidemiol Community Health 2007;61(3):248-53. 4. Naito A. Internet suicide in Japan: Implications for child and adolescent mental health. Clinical Child Psychology and Psychiatry 2007;12(4):583-597. 5. Lin JJ, Lu TH. Suicide mortality trends by sex, age and method in Taiwan, 1971-2005. BMC Public Health 2008;8:6. 6. Au JS, Yip PS, Chan CL, Law YW. Newspaper reporting of suicide cases in Hong Kong. Crisis 2004;25(4):161-168. Competing interests: None declared |
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Dallas N Knight, Student of Health Informatics Otago University, New Zealand
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The selection of suitable query terms is an important factor in returning relevant information. The selection of terms in this study did not include 'prevention', 'help', 'assistance', 'counselling' and were designed to return the sites they retrieved. Search engines ("web dragons") need skillful handling. Competing interests: None declared |
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Masatoshi Inagaki, Researcher Center for Suicide Prevention, NIMH, NCNP, Japan, Yukie Ouchi, Tadashi Takeshima, and Mitsuhiko Yamada
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Biddle et al. describes the display of results for suicide-related search terms on the Internet. Similarly, although the language is different, introduction of suicide methods through the Internet and suicide pacts among strangers who meet online have been a concern in Japan. There are various approaches for regulating Internet content, as discussed by Biddle et al., including self-regulation by Internet service providers, installation of filtering software by users, and helping support sites to appear higher up in searches. These approaches are also being considered and implemented in Japan. For example, while the Internet Hotline Center (http://www.internethotline.jp) does not have any legal power, it recommends providers and site administrators to take action against problematic sites. In addition, Yahoo! JAPAN (http://www.yahoo.co.jp) displays sites that provide support information (http://www.ncnp.go.jp/ikiru-hp) on the top pages of results for suicide- related search terms. Not only are online approaches expanding, but outreach-based interventions in the real world are expanding as well. The "Guidelines for Response to Advance Suicide Warning Cases on the Internet," released in October 2005, includes a statement that Internet community organizations can disclose the content of private communications to a third party in emergency situations. As a result, the National Public Safety Commission in Japan reported that among 121 cases of suicide warning on the Internet in 2007, the police identified 105 individuals based on provider information. Of these, 72 cases were intervened by police and other aid measures, while the remaining 33 cases were determined as pranks. Sixteen cases could not be identified because of access from unspecified terminals, such as Internet cafes. Independent of the argument regarding "balance between freedom of expression and public protection" and the global nature of the Internet, outreach-based interventions in the real world can be effective in preventing suicide. Competing interests: None declared |
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Jean H. Kim, Professor The Chinese University of Hong Kong, Johnson C.H. Lau and Sian M. Griffiths
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The article by Biddle and her colleagues (1) describe the plethora of pro-suicide information available online with the implication that the internet represents the primary source of knowledge for younger-aged individuals seeking reliable methods for taking one’s own life. It should be clarified that although the internet undeniably provides much information about methods of committing suicide, the evidence for an association between internet use levels per se and suicide ideation are scant (2). Extreme care should be taken to highlight this, given the general public’s tendency to misinterpret the reported harms of internet use. In an anonymous pilot study of 2433 university students in Hong Kong, we have found that the 4% of students reporting suicide ideation had virtually identical levels of internet use (2.8 hours/day) with students without suicide ideation. Of heavy internet users (>4 hours/day), 4.0% reported suicide ideation, a figure comparable to the 4.3% of casual internet users (<1 hr/day). Furthermore, there was no statistically significant difference in the proportion of students with suicidal ideation that had engaged in online chatting (66.7%) or had visited web boards (67.8%) in the preceding 7 days with their non-suicidal counterparts (70%, 60.1%, respectively). Although the actual content of these online activities is unknown, it must be noted that among university students in Hong Kong, there is no evidence of a correlation between suicide ideation and time spent online. While the study by Biddle et al. (1) is interesting, it is difficult to make definitive conclusions without information about purpose of the online visits to suicide sites. As it is practically impossible to differentiate visitors drawn by morbid curiosity, boredom, transient dysphoric mood or even academic interest from those with actual suicidal intent, caution should be exercised in interpreting their results. 1. Biddle L, Donovan J, Hawton K, Kapur N, Gunnell D. Suicide and the Internet. BMJ 2008;336(7648):800-2. 2. Kim K, Ryu E, Chon MY, Yeun EJ, Choi SY, Seo JS, Nam BW. Internet addiction in Korean adolescents and its relation to depression and suicidal ideation: a questionnaire survey. Int J Nurs Stud. 2006: 43(2):185-92. Competing interests: None declared |
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In Han Song, Assistant Professor Adelphi University, Garden City, NY 11530
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Suicide websites on the Internet have often been reported as suicide- facilitating stimuli and many studies focus on the negative influence of the Internet on suicide. However, as the authors pointed out, the Internet may have beneficial effects on suicide (1) and to better understand the phenomenon both positive and negative influences of the Internet on suicide should be considered. To test whether the use of Internet support groups for mental health is associated with suicidal ideation during the last 12 months, data were derived from 2002-2003 U.S. National Latino and Asian American Study (NLAAS; n=2,095; male=997; female=1,097). After controlling for gender, age, acculturative stress, perceived discrimination, and the level of English proficiency, logistic regression analysis was used to examine the association between the use of Internet support groups and suicidal ideation. Asian Americans (age 18-95) were included for analysis. 9.11% of participants reported that they had suicidal ideation during the past 12 months. 2.77% of participants reported that they used Internet support groups for mental health. After controlling for covariates, a statistically significant association was found between the use of Internet support groups for mental health during the past 12 months and suicidal ideation during the past 12 months (t=2.67, p=.008). The data shows that people with suicidal ideation are more likely to participate in Internet support groups for mental health. This association does not necessarily show the causal relationship and it is unclear how beneficial the Internet support group for mental health was. However, the findings may suggest that suicide prevention and intervention can be provided through the Internet for those who have suicidal ideation and visit those sites. Further research is needed to ensure the beneficial effects of the Internet on suicide. 1. Biddle L, Donovan J, Hawton K, Kapur N, Gunnell D. Suicide and the Internet. BMJ 2008;336(7648):800-2. Competing interests: None declared |
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In Han Song, Assistant Professor Adelphi University, Garden City, NY 11530
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Suicide websites on the Internet have often been reported as suicide- facilitating stimuli and Biddle et al. (1) described the great potential harm of these pro-suicide internet sites. Yet as Dr. Grohol stated above, a less biased search strategy may have revealed a a more balanced picture of the effects of internet use on suicidal ideation. A preliminary analysis of the 2002-2003 U.S. National Latino and Asian American Study (n=2,095) noted that of the 9.11% reporting suicide ideation, 18% of them had used internet-based mental health support groups in the past year versus 11% of those without suicide ideation. Even after controlling for socio-demographic covariates, the data indicate that those with suicidal ideation were more likely to make use of online mental health resources than those without suicidal ideation (p<0.05). These data are only suggestive, and there is no information about the use of potentially harmful websites among suicidal individuals for comparison. Hence, we suggest further studies to be conducted by Biddle and her colleagues comparing the actual traffic to both pro-suicide and suicide prevention websites and focusing future studies on the actual online behaviors of suicidal individuals. 1. Biddle L, Donovan J, Hawton K, Kapur N, Gunnell D. Suicide and the Internet. BMJ 2008;336(7648):800-2. Competing interests: None declared |
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David Gunnell, Professor of Epidemiology Department od Social Medicine, University of Bristol BS8 2PR, Jenny Donovan, Lucy Biddle, Keth Hawton, Nav Kapur
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We are pleased to see the interest and broad range of views provoked by our paper.[1] There appears to be consensus amongst correspondents about the potential of the Internet both to provide help and to cause harm. Several correspondents have helpfully highlighted additional approaches to altering the results of Internet searching in favour of minimising risk to individuals experiencing serious suicidal thoughts and planning suicide. Some contributors (Grohol, Canning, Fu, Knight) express surprise at our focus on methods of suicide. Furthermore Fu points out that some suicidal web-users may have already decided on their method of suicide and be searching for technical information about its implementation. We agree. However, as we explained in the opening paragraph of our paper, we focused on methods of suicide (rather than Internet resources for suicide in general) because research evidence suggests that one of the strongest media influences on suicidal behaviour concerns its affect on the choice of suicide method used.[2,3] Choice of method, in turn, influences the likelihood that a suicidal act will result in death,[4] and so may have an impact on suicide rates. We assumed that some Internet influences on suicide are likely to be similar to those of other media such as TV and newspaper reporting. In keeping with this Fu highlights the possible role of the Internet in relation to the spread of carbon monoxide poisoning as a method of suicide in Hong Kong. Thus we chose the search terms likely to be used by individuals with serious suicidal thoughts who are planning their suicide attempt. We felt it important that organisations offering support to suicidal individuals should endeavour to ensure their sites occur high up on the list of “hits” retrieved by searches making inquiries about suicide methods. We agree with Grohol and other correspondents that additional aspects of the Internet in relation to preventing and provoking suicide are worthy of academic study. Indeed this is something we wish to pursue. However, we felt in an area about which much is conjectured, but little empirical data exist, a focussed inquiry into one relevant aspect was appropriate. In a single brief research paper it would not have been possible to cover the range of aspects suggested by Grohol. We disagree with Grohol’s suggestion that we painted a pessimistic picture. We described a number of beneficial aspects of the Internet – highlighting advice and information sites. Indeed we report that 13% of our hits were for sites offering support or information about suicide and 12% discouraged suicide. We also highlight that in England, whilst use of the Internet has increased in recent years, rates of suicide have declined. Thus harmful impacts of the Internet on individual acts of suicide are either being offset by beneficial effects or the impact of other suicide prevention activities. Some of the assertions made by Canning are incorrect. The sites we reviewed were restricted to the first 10 results for each search. The searches ‘methods of suicide’ and ‘suicide methods’, which, like most users, we carried out without the quotation marks, do, in fact, yield different sites. The interview data we used to inform our search strategy referred to interviews that were conducted with people who had survived nearly fatal suicide attempts. Two of the twelve individuals we have interviewed to date used the Internet to research their methods and indicated the terms they used. We can think of few better methods of identifying search terms than from such individuals. Canning makes some good points regarding the relative use of different search engines. We agree, weighting our findings according to site use may have been more informative. We did report that searches of Google, the most frequently used search engine, retrieved the highest number of pro-suicide hits and so weighting our findings by site would be unlikely to substantially alter out findings. Canning also provides a series of useful suggestions regarding strategies for reducing the accessibility of pro-suicide sites and working with the Search Engines themselves. The influence of the Internet upon an individual’s risk of suicide and upon population suicide rates is currently uncertain. Our study has shed some light on one aspect of the Internet. Further research is needed to ensure there is a more evidence-based debate on the Public Health impact of the Internet on suicide. References 1. Biddle L, Donovan J, Hawton K, Kapur N, Gunnell D. Suicide and the Internet: BMJ 2008; 336:800-802 2. Hawton K, Williams K. Influences of the media on suicide. BMJ 2002; 325:1374-1375 3. Schmidtke A, Hafner H. The Werther effect after television films: new evidence for an old hypothesis. Psychol Med 1988;18:665-676. 4. Miller M, Azrael D, Hemenway D. The epidemiology of case fatality rates for suicide in the Northeast. Ann Emerg Med 2004;43:723-730 David Gunnell
Jenny Donovan
Lucy Biddle
Keith Hawton
Navneet Kapur
Competing interests: None declared |
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paul m canning, web officer, local government cambridge city council
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In response to David Gunnell. (I will note that I wrote to Gunnell and he didn't reply. This is relevant in the context of this response).
We are pleased to see the interest and broad range of views provoked by our paper. There appears to be consensus amongst correspondents about the potential of the Internet both to provide help and to cause harm. Several correspondents have helpfully highlighted additional approaches to altering the results of Internet searching in favour of minimising risk to individuals experiencing serious suicidal thoughts and planning suicide. Some contributors (Grohol, Canning, Fu, Knight) express surprise at our focus on methods of suicide.Not me, wasn't expressed by me. Furthermore Fu points out that some suicidal web-users may have already decided on their method of suicide and be searching for technical information about its implementation. We agree. However, as we explained in the opening paragraph of our paper, we focused on methods of suicide (rather than Internet resources for suicide in general) because research evidence suggests that one of the strongest media influences on suicidal behaviour concerns its affect on the choice of suicide method used.[2,3] Choice of method, in turn, influences the likelihood that a suicidal act will result in death,[4] and so may have an impact on suicide rates. We assumed that some Internet influences on suicide are likely to be similar to those of other media such as TV and newspaper reporting. In keeping with this Fu highlights the possible role of the Internet in relation to the spread of carbon monoxide poisoning as a method of suicide in Hong Kong. Thus we chose the search terms likely to be used by individuals with serious suicidal thoughts who are planning their suicide attempt. We felt it important that organisations offering support to suicidal individuals should endeavour to ensure their sites occur high up on the list of 'hits' retrieved by searches making inquiries about suicide methods.But they didn't focus on methods. The search terms they chose, which they didn't explain the genesis of in detail, barely included specific methods - Fu's point. If, as there is strong evidence of, people take clues from media reporting - 'copycats' - then surely it would help to look at what methods are shown/described in reporting and take cues from there? This they didn't do. And it's difficult to make recommendations - especially such dramatic ones as they did - when the initial sources "terms likely to be used by individuals with serious suicidal thoughts who are planning their suicide attempt" are so apparently weak. We agree with Grohol and other correspondents that additional aspects of the Internet in relation to preventing and provoking suicide are worthy of academic study. Indeed this is something we wish to pursue. However, we felt in an area about which much is conjectured, but little empirical data exist, a focussed inquiry into one relevant aspect was appropriate.In which case they picked the wrong area. Surely going to source - what is known about how suicidal people connect to information and then act on that information, taking cues from well-developed experiences like the Japanese - would be a more productive avenue. For example, what is the role of UK social networks? Where is research lacking on the actual connections prior to suicides? The assumption here was 'search engines' - and everything flowed from those assumptions. Again and again, the main issue here is researchers who aren't webbies, don't understand how the web works, make assumptions, don't talk to the right experts, then leap off with claims which are - plainly - false and suggest solutions they are not qualified to suggest and lead people down more false trails. In a single brief research paper it would not have been possible to cover the range of aspects suggested by Grohol. We disagree with Grohol's suggestion that we painted a pessimistic picture.Talk to the PR, what headlines have they generated? How helpful are those headlines? It is highly irresponsible for such researchers to step back here and say 'we're not responsible'. We described a number of beneficial aspects of the Internet - highlighting advice and information sites. Indeed we report that 13% of our hits were for sites offering support or information about suicide and 12% discouraged suicide. We also highlight that in England, whilst use of the Internet has increased in recent years, rates of suicide have declined. Thus harmful impacts of the Internet on individual acts of suicide are either being offset by beneficial effects or the impact of other suicide prevention activities.Yes, they mentioned this. But it wasn't their headline. As I showed, searches for 'suicide' appear to be going down. But this wasn't their headline or reported anywhere at all in the subsequent headlines generated from the cues they gave reporters (i.e. the press release). Look at it this way, if the media is a causal factor the researchers just failed to get the media to report the existence of suicide help and to only focus on the existence of harmful websites. Some of the assertions made by Canning are incorrect. The sites we reviewed were restricted to the first 10 results for each search. The searches 'methods of suicide' and 'suicide methods', which, like most users, we carried out without the quotation marks, do, in fact, yield different sites.Ok, point taken. Search engines are improving. Though results are barely different. What else makes up "some .. are incorrect". The interview data we used to inform our search strategy referred to interviews that were conducted with people who had survived nearly fatal suicide attempts. Two of the twelve individuals we have interviewed to date used the Internet to research their methods and indicated the terms they used. We can think of few better methods of identifying search terms than from such individuals.This detail wasn't in the paper. Two individuals? And remembering terms they used? On this headlines around the world was built? If you want 'better methods', look to the Japanese. It is actually possible to backtrack from the machine they used and find exactly what they searched on. Security services and police do this sort of thing all the time. Further, Gunnell's response doesn't take on board my point that existing industry methods will tell you what terms are most searched on. They couldn't think of methods because they didn't think to ask experts in that field. Canning makes some good points regarding the relative use of different search engines. We agree, weighting our findings according to site use may have been more informative.No, not doing it completely undermines the credibility of the numbers reported. Especially the headline numbers cited at the top of the paper. We did report that searches of Google, the most frequently used search engine, retrieved the highest number of pro-suicide hits and so weighting our findings by site would be unlikely to substantially alter out findings. Canning also provides a series of useful suggestions regarding strategies for reducing the accessibility of pro-suicide sites and working with the Search Engines themselves.Why do I have 'useful suggestions'? Because I work in the web area. These researchers don't. They couldn't 'think of few better methods' because they didn't 'think' to collaborate with people such as myself (from local government) or - actually - true experts who do this sort of thing for a living. The influence of the Internet upon an individual's risk of suicide and upon population suicide rates is currently uncertain. Our study has shed some light on one aspect of the Internet. Further research is needed to ensure there is a more evidence-based debate on the Public Health impact of the Internet on suicide. But the paper still stands and the publicity is out there. Is this response letter going to do anything about that? Are the researchers going to take their public responsibility seriously? This is not an academic question. Decision makers are, unfortunately, far more likely to listen to people like Gunnell than people like me. Gunnell does not indicate here that they have learnt from the reaction that further research must happen by drawing on collaborations with industry and experts in the web field. This is defensive. This is about covering their academic asses. How does this approach help us actually deal with doing the right sort of research which will lead to the right sort of solutions and actually help those they claim to want to help?Competing interests: None declared |
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