Consider a text for teen suicide prevention and intervention, research suggests

(Press-News.org) COLUMBUS, Ohio – Teens and young adults are making use of social networking sites and mobile technology to express suicidal thoughts and intentions as well as to reach out for help, two studies suggest.

An analysis of about one month of public posts on MySpace revealed 64 comments in which adolescents expressed a wish to die. Researchers conducted a follow-up survey of young adults and found that text messages were the second-most common way for respondents to seek help when they felt depressed. Talking to a friend or family member ranked first.

These young adults also said they would be least likely to use suicide hotlines or online suicide support groups – the most prevalent strategy among existing suicide-prevention initiatives.

The findings of the two studies suggest that suicide prevention and intervention efforts geared at teens and young adults should employ social networking and other types of technology, researchers say.

"Obviously this is a place where adolescents are expressing their feelings," said Scottye Cash, associate professor of social work at The Ohio State University and lead author of the studies. "It leads me to believe that we need to think about using social media as an intervention and as a way to connect with people."

The research team is in the process conducting a study similar to the MySpace analysis by examining young people's Twitter messages for suicidal content. The researchers would like to analyze Facebook, but too few of the profiles are public, Cash said.

Suicide is the third leading cause of death among youths between the ages of 10 and 24 years, according to the Centers for Disease Control and Prevention (CDC).

Cash and colleagues published the MySpace research in a recent issue of the journal Cyberpsychology, Behavior and Social Networking. They presented the survey findings at a meeting of the American Academy of Child and Adolescent Psychiatry.

Cash's interest in this phenomenon was sparked in part by media reports about teenagers using social media to express suicidal thoughts and behaviors.

"We wanted to know: Is that accurate, or are these isolated incidents? We found that in a short period of time, there were dozens of examples of teens with suicidal thoughts using MySpace to talk to their friends," she said.

The researchers performed a content analysis of public profiles on MySpace. They downloaded profile pages of a 41,000-member sample of 13- to 24-year-olds from March 3-4, 2008, and again in December 2008, this time with comments included. By developing a list of phrases to identify potential suicidal thoughts or behaviors, the researchers narrowed 2 million downloaded comments to 1,083 that contained suggestions of suicidality, and used a manual process to eventually arrive at 64 posts that were clear discussions of suicide.

"There's a lot of drama and angst in teenagers so in a lot of cases, they might say something 'will kill them' but not really mean it. Teasing out that hyperbole was an intense process," Cash said. Song lyrics also made up a surprising number of references to suicide, she added.

The three most common phrases within the final sample were "kill myself" (51.6 percent), "want to die" (15.6 percent) and "suicide" (14.1 percent). Though in more than half of the posts the context was unknown, Cash and colleagues determined that 42 percent of the posts referred to problems with family or other relationships – including 15.6 percent that were about break-ups – and 6.3 percent were attributable to mental health problems or substance abuse.

Very few of the posts identified the method the adolescents would consider in a suicide attempt, but 3 percent mentioned guns, 1.6 percent referred to a knife and 1.6 percent combined being hit by a car and a knife.

With this information in hand, Cash and co-investigator Jeffrey Bridge of the Research Institute at Nationwide Children's Hospital surveyed young people to learn more about how they convey their depression and suicidal thoughts. Bridge also co-authored the MySpace paper.

Collaborating with Research Now, a social marketing firm, the researchers obtained a sample of survey participants through a company that collects consumer opinions. The final sample included 1,089 participants age 18-24 with an average age of almost 21, half male and half female, and 70.6 percent white.

They were asked about their history of suicidal thoughts and attempts, general Internet and technology use, social networking activity and whether they had symptoms of depression.

More than a third reported they have had suicidal thoughts; of those, 37.5 percent had attempted suicide, resulting in a 13 percent rate of suicide attempts among the entire sample. That figure compares to the 8 percent of U.S. high-school students who reported in a 2011 CDC national survey that they had attempted suicide at least once in the previous year. According to that survey, almost 16 percent of youths had seriously considered suicide and almost 13 percent had made a suicide plan in the previous 12 months.

Results of Cash's survey showed that respondents would favor talking to a friend or family member when they were depressed, followed by sending texts, talking on the phone, using instant messaging and posting to a social networking site. Less common responses included talking to a health-care provider, posting to a blog, calling a suicide prevention hotline and posting to an online suicide support group.

Response trends suggested, though, that participants with suicidal thoughts or attempts were more willing to use technology – specifically the phone, instant messaging, texting and social networking – to reach out compared to those with no suicidal history. In light of this trend, the fact that the participants were active online consumers might have contributed to the relatively high percentage of suicide attempts among the study sample. In addition, the survey also asked about lifetime suicide history, not just recent history, Cash noted.

The survey also showed that this age group looks to the Internet for information on sensitive topics, and again suggested that young adults of both sexes with a history of suicidal thoughts or attempts consulted the Internet for information about topics that are difficult to discuss – specifically drug use, sex, depression, eating disorders or other mental health concerns. Females with past suicide attempts used social networking the most, according to the results.

"It appears that our methods of reaching out to adolescents and young adults is not actually meeting them where they are. If, as adults, we're saying, 'this is what we think you need' and they tell us they're not going to use it, should we keep pumping resources into suicide hotlines?" Cash said. "We need to find new ways to connect with them and help them with whatever they're struggling with, or, in other words, meet them where they are in ways that make sense to them."

### A notable resource already available is http://www.reachout.com, a website geared toward adolescents who are struggling through a tough time. Some Internet-based resources exist that could serve as models for new suicide prevention interventions, she noted. They include teen.smokefree.gov and http://www.thatsnotcool.com.

The survey research was supported by an Ohio State University College of Social Work Seed Grant.

Additional co-authors of the MySpace paper include Michael Thelwall of the University of Wolverhampton in the United Kingdom, Sydney Peck of Elmira College and Jared Ferrell of the University of Akron.

Contact: Scottye Cash
Cash.33@osu.edu
(Email is the best way to reach Cash.)

Written by Emily Caldwell
(614) 292-8310
Caldwell.151@osu.edu