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Young People's Reasons for Feeling Suicidal: An Analysis of Posts to a Social Media Suicide Prevention Forum

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Abstract

Background: While considerable attention has been given to explanations for youth suicide, less is known about the reasons that young people themselves give for suicidality. Research on online communications gives an opportunity to investigate the real-time reasons young people give for feeling suicidal. Aims: This study aimed to identify the reasons that young people provide for feeling suicidal in posts published on a suicide prevention forum, hosted on the social media platform Tumblr. Method: We filtered 2 months' worth of posts to identify those that related specifically to suicide. In total, 210 posts were thematically analyzed to identify the reasons given for suicidality and the meanings associated with these. Results: Six main reasons for suicidality were identified in the analysis: feeling lonely and socially disconnected, experiencing identity stigma, failing to meet expectations, being helpless, feeling worthless, and experiences of mental ill-health. Limitations: There are advantages as well as limitations associated with relying on Internet-based data. Limitations include the inability to establish participant demographics and the lack of context for posts. Conclusion: Suicide prevention efforts should target the reasons that young people give for feeling suicidal in the moment of crisis in order to engage this population more effectively.
Crisis: The Journal of Crisis
Intervention and Suicide Prevention
Young People's Reasons for Feeling Suicidal: An Analysis
of Posts to a Social Media Suicide Prevention Forum
Aamina Ali and Kerry Gibson
Online First Publication, March 19, 2019. http://dx.doi.org/10.1027/0227-5910/a000580
CITATION
Ali, A., & Gibson, K. (2019, March 19). Young People's Reasons for Feeling Suicidal: An Analysis of
Posts to a Social Media Suicide Prevention Forum. Crisis: The Journal of Crisis Intervention and
Suicide Prevention. Advance online publication. http://dx.doi.org/10.1027/0227- 5910/a000580
© 2019 Hogrefe Publishing Crisis 2019
https://doi.org/10.1027/0227-5910/a000580
Research Trends
Young People’s Reasons for
FeelingSuicidal
An Analysis of Posts to a Social Media Suicide
PreventionForum
Aamina Ali and Kerry Gibson
School of Psychology, University of Auckland, New Zealand
Abstract. Background: While considerable attention has been given to explanations for youth suicide, less is known about the reasons that
young people themselves give for suicidality. Research on online communications gives an opportunity to investigate the real-time reasons
young people give for feeling suicidal. Aims: This study aimed to identify the reasons that young people provide for feeling suicidal in posts pub-
lished on a suicide prevention forum, hosted on the social media platform Tumblr. Method: We filtered 2 months’ worth of posts to identify those
that related specifically to suicide. In total, 210 posts were thematically analyzed to identify the reasons given for suicidality and the meanings
associated with these. Results: Six main reasons for suicidality were identified in the analysis: feeling lonely and socially disconnected, experi-
encing identity stigma, failing to meet expectations, being helpless, feeling worthless, and experiences of mental ill-health. Limitations: There
are advantages as well as limitations associated with relying on Internet-based data. Limitations include the inability to establish participant
demographics and the lack of context for posts. Conclusion: Suicide prevention efforts should target the reasons that young people give for
feeling suicidal in the moment of crisis in order to engage this population more effectively.
Keywords: suicide, youth, Internet, suicide prevention
Suicide is estimated to be the second leading cause of
death globally for individuals between the ages of  and
 World Health Organization, . Signicantly, for
every reported youth suicide death there are estimated to
be  reports of attempted suicide,  reports of med-
ical attention for attempted suicide, and  reports of
hospitalizations for attempted suicide Cutler, Glaeser, &
Norberg, .
Suicide prevention strategies often target risk factors as-
sociated with suicidality. This has led to the identication
of a range of risk factors for youth suicide, with an empha-
sis most recently on mental health problems, contagion
eects, and a range of socioeconomic factors Hawton,
Saunders, & O’Connor, . However, there is less re-
search that explores the reasons that young people them-
selves provide for feeling suicidal. Several researchers have
argued the importance of taking young people’s views into
account in order to engage them as active participants in
the prevention of suicide White, .
A variety of methods have been used to investigate
youth perspectives on suicide including surveys, focus
group discussions, and interviews Curtis, ; Gibson,
Wilson, Le Grice, & Seymour, ; Heled & Read, ;
Shilubane et al., ; Stubbing & Gibson, . The
limited research available suggests youth in general view
suicide as an understandable response to life’s diculties,
rather than a product of a mental health problem e.g.,
Lake, Kandasmy, Kleinman, & Gould, ; however,
this may be dierent for suicidal youth who have been re-
cruited through a mental health service Bennett, Coggan,
& Adams, . It is especially important to understand
how young people who have not accessed health servic-
es account for their suicidality given the high risks in this
group. Furthermore, while most existing studies rely on
retrospective recall, it is also crucial to develop knowledge
about young people’s real-time expressions of suicidality
in the moment of crisis in order to enhance prevention.
Suicide and the Internet
Recent research has highlighted the appeal of the Inter-
net as a medium for young people to express distress. The
Internet provides isolated youth with increased opportu-
nities to communicate Lewis, Heath, Michal, & Duggan,
 and the anonymity enables users to share personal
information with greater ease Suler, . This combi-
nation of factors has resulted in the Internet becoming the
A. Ali & K. Gibson, Reasons for Feeling Suicidal
2
© 2019 Hogrefe PublishingCrisis 2019
preferred medium for young people to discuss sensitive is-
sues such as suicide Baker & Fortune, . Inasmuch as
the Internet provides young people with a forum in which
to discuss suicide, it also provides a unique opportunity for
researchers to capture real-time expressions of suicidality.
In general, studies of youth engagement with suicide via
the Internet have focused much more on the dangers of
this, rather than the opportunities it provides to understand
young people’s perspectives on suicide Mok, Jorm, & Pirk-
is, . There are a surprisingly small number of studies
to date that explore young people’s expressions of suicid-
ality in online environments. Some researchers have ana-
lyzed Internet posts related to suicide more generally, but
have not focused on the reasons that people give for their
suicidality e.g., Cavazos-Rehg etal., ; Jashinsky etal.,
. We have only been able to identify two previous
studies that focused specically on the reasons youth of-
fer for their suicidality on Internet forums. Cash, Thelwall,
Peck, Ferrell, and Bridge  described a content anal-
ysis of  posts to a suicide forum on MySpace, concluding
that while the majority of posts did not specify a context for
suicidality, relationship diculties featured prominently in
those that did. However, the methodology used to identify
the relative frequency of dierent sets of reasons did not
allow for a fuller exploration of the meanings associated
with these. A second study that explored young people’s
posts to a Swedish chat forum identied a range of dicult
emotions implicated in suicide, with loneliness emerging
as a particularly important issue Westerlund, . The
ethnographic approach used in this study captured some
valuable insights but did not provide a systematic overview
of the range of reasons oered for suicidality. The current
study was designed to provide further knowledge about the
range of reasons young people give for feeling suicidal in
real time and the meanings they associated with these.
Method
The key question addressed in this research is: What rea-
sons do young people provide for feeling suicidal on an
Internet suicide help forum? We adopted a social construc-
tionist approach to the study accepting that suicide may
take on dierent meanings at dierent times and for dif-
ferent groups Marsh, .
Data Collection
Data for this research were collated from a suicide preven-
tion forum hosted on Tumblr. While there are no restric-
tions on who can participate in Tumblr, recent statistics
indicate that  of Tumblr users worldwide are between
the ages of  and , the greatest share of younger users
among the top  social platforms Business Insider Aus-
tralia, . Usage by young men and women is estimat-
ed to be similar Statistica, . On the forum, queries
are submitted to moderators who vet these and publish
each request for help anonymously as a separate post. This
is accompanied by a reply from one of the volunteers who
identify as a non-mental health professional. The page is
open to the public, and is intended to serve as a resource
for both those who post to the forum and those who read it.
Initially  month’s worth of help-seeking posts were re-
viewed for suitable material but when this did not gener-
ate a sucient number of posts suitable for analysis, this
was extended to a -month period approximately 
posts. All the posts were read and re-read by the rst au-
thor before deciding which types of posts to include. Af-
ter discussion between the researchers it was decided to
include all of the following types of posts: statements that
explicitly stated an intention to end one’s life, for example,
“I want to kill myself”; statements in which the poster ac-
knowledged suicidal thoughts, for example, “I have been
thinking about suicide,” as well as statements expressing
passive suicidality for example, “I have nothing to live for.
All posts that related to nonsuicidal distress or third-party
concerns were excluded. This provided a nal sample size
of  posts, ranging from a single sentence to a lengthy
paragraph. While this sample size is relatively smaller than
that used in some other studies e.g., Cavazos-Rehg etal.,
, who code a much larger number of posts into prede-
termined content categories, the thematic analysis used
in this study does not lend itself to very large sample siz-
es. Sample size in this method is determined by saturation
Guest, Bunce, & Johnson, .
Data Analysis
The data were analyzed using Braun and Clarke’s 
guidelines for thematic analysis, which enables the iden-
tication and reporting of patterns within data. In this
analysis, we were guided by our research question, which
aimed to explore the reasons or contexts posts oered for
suicidality. Following conventions in this kind of qualita-
tive research, the rst author read and re-read the mate-
rial in order to become familiar with its content. She then
individually coded each post with the dierent reasons
for suicidality that were judged to be present in the post.
The second author then reviewed a random selection of
each identied code to strengthen the accuracy of coding.
Finally, both researchers conducted a careful process of
searching for commonalities and dierences between the
codes, which were then sorted into overarching themes
A. Ali & K. Gibson, Reasons for Feeling Suicidal 3
© 2019 Hogrefe Publishing Crisis 2019
which represented “some level of patterned response or
meaning within the data set” Braun & Clark, , p..
Once possible themes were identied from the dierent
codes, these themes were analyzed in comparison with the
raw data, to ensure the themes captured the most promi-
nent patterns in the dataset. The rigor of the analysis was
determined by criteria used in qualitative research includ-
ing careful documentation of the analytic process and a
reexive awareness of the researchers’ inuence on the re-
search Morrow, . To facilitate the latter, the themes
were discussed and debated between the two researchers
in a manner that draws from Hill and coworkers’ 
consensual qualitative analysis. In these discussions we
were conscious of our position as psychology professionals
and attempted to keep alert to interpretations that reected
priorities dierent to our own.
The qualitative descriptors of many, some, and few were
used in the analysis to indicate the prevalence of a theme
across the entire dataset Guest, Namey, & Mitchell, .
More specic frequency counts are not considered appro-
priate for thematic analysis, where the aim is to describe
the dataset rather than to imply statistical generalization.
Ethical Considerations
The Internet provides an opportunity for nonintrusive data
collection and analysis of material that is already in the
public domain. Although there are ethical challenges asso-
ciated with Internet research, there are fewer risks with the
current research in which the data come from anonymous
postings, as opposed to an interactive forum in which indi-
viduals might be able to be identied British Psychological
Society, . To further protect the identities of young
people posting on this forum, we removed any contextual-
ly identifying information from the posts, and also decid-
ed to exclude information about the specic time period
in which the posts were made. Consent to use posts from
this forum was obtained from the moderators of the forum,
and we acceded to their request not to name the forum. We
followed the guidelines of the University of Auckland Eth-
ics Committee, which did not require specic approval for
research using publicly available online data.
Results
Feeling Lonely and Socially Disconnected
A prominent theme in the data was loneliness and the ab-
sence of a sense of connection to others. Many of the posts
that spoke about loneliness specically mentioned feeling
isolated from peers or lacking friendship. “I feel so alone.
I literally have no friends anymore. I just graduated high
school, and nobody that I thought was my friend talks to
me anymore. Literally nobody.” In some instances, writers
expressed also feeling isolated from their family: “I feel so
depressed and so suicidal. I’m all alone, I have no one to talk
to, I have no friends, my family doesn’t care about me.” Sev-
eral posts implied that loneliness was not simply about the
absence of others, but also feeling disconnected from those
who were there: “I have my family around me but I spend so
much of my time alone.” Loneliness was also often described
as a permanent rather than a temporary state: “I really don’t
want to be alive. I often feel very alone and I’m afraid it’ll
stay that way”. Many of the posters expressed a longing for
connection with others: “I really want someone to talk to and
give me a hug but I have no one … I’m so lonely. I don’t know
what to do.” A sense of loneliness and the absence of people
to talk to in meaningful ways emerged across the data as a
commonly expressed reason for feeling suicidal.
Experiencing Identity Stigma
Identity stigma was another notable theme in the data.
The majority of posts that reected this described stigma
related to the poster’s gender or sexuality. These posts of-
ten referred to active rejection from others, many of these
in the context of the family:
And my mom just keeps threatening me to kick me out – I’m
gay, she’s super religious who will try to take me to conversion
therapy or berate me until I attempt to date a guy…I feel so
lonely and so sad all the time and I just want it to stop.
In some cases, posters described distress at having to hide
their sexuality or gender from their families with the ex-
pectation that this would not be accepted:
I can’t come out of the closet as gay. If I do I risk losing my fam-
ily and my entire support system. I risk ruining my life. I don’t
want to do that. But I also don’t want to date guys and live a life
of lies. I don’t know how much more I can take of this life.
Many of these posts also conveyed the pain of internal-
ized stigma: “I will always be a freak and no one will love a
tranny freak. Drs don’t know how to deal with me and how
could they in a world that doesn’t want me?”
There were also a signicant number of posts that fo-
cused on aspects of the person’s physical body that were
seen to be unacceptable to others:
i just want to die. i cant leave my apartment anymore cos im fat
and ugly and its summer and everyone talks about how they’ve
lost their winter fat and i have gained so much this past year
and always get stared at by people.
A. Ali & K. Gibson, Reasons for Feeling Suicidal
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© 2019 Hogrefe PublishingCrisis 2019
This theme captured the intense distress associated with
being subject to identity stigma in relation to gender, sexu-
ality, or the physical body.
Failing to Meet Expectations
Many posts portrayed distress about failing to meet expec-
tations. Often this was related to the everyday demands of
school or university as the following post exemplies:
I can’t handle all of this stress. My parents are on my ass about
it saying it’s my fault. I have  pages of homework due tomor-
row and its stressing me out so much its making me … wanna
kill myself what do I do?
Posters often emphasized their own feeling responsibility
for failing to meet these expectations:
I failed one my college classes and it’s making me feel like
complete shit and even suicidal... It was all my fault and I was
just simply too lazy to do any of the work. I feel like such a fuck-
ing failure.
While many of the posts in this theme related to academic
situations, others seemed to reect a concern that the post-
er had failed to meet more general social expectations: “I
have very big disapproval issues and i constantly feel as if
I’m not good enough.” In many cases the posts suggested
that young people were evaluating their own performance
against those of their peers: “Everyone is progressing more
than me. All my friends are learning to drive and I haven’t
even got my permit yet.” Posts in this theme highlighted
the distress that posters felt in their inability to match up to
what they believed was expected of them and the respon-
sibility they felt for failing to do this.
Being Helpless
Another dominant theme identied in the data related
to posters’ helplessness to change their situation. Many
posts started with an expression of helplessness such as:
“I don’t know what to do anymore...” In some instances,
posters elaborated on their inability to try to work out a
solution to their problems: “It feels so hopeless and di-
rectionless and I get so disheartened by the idea of trying
to gure things out and I often feel like I’d rather die than
face all of this.” While some posts expressed diculty
knowing what to do, many others posts reected young
people’s inability to change their circumstances by their
own eorts: “I waited  fucking years and endless tor-
ture to get through high school and i did, it’s been a year
since i graduated and life has if anything gotten worse.”
Posts in this theme reected strong feelings of helpless-
ness sometimes due to not knowing what to do, while
others reected the constraints on posters’ ability to alter
their circumstances.
Feeling Worthless
A strong theme present in the data was an expression of
worthlessness as a contributor to suicidal feelings. These
were expressed through statements of self-hatred: “I hate
myself. I consider myself to be a piece of shit. Lower than
it actually.” Some posts suggested specic reasons for
self-hatred such as a person’s weight or other physical fea-
tures: “I’ve always struggled with self-esteem… my body
is still disgusting.” In some cases, this self-loathing was
attributed to the physical gender of their body not repre-
senting the gender with which they identied: “why am i
expected to go through an entire lifetime looking at some-
thing i hate in the mirror, something that stole my life?”
A number of posts reected the poster’s view that they
could not contribute to the world in a meaningful way,
for example: “I feel like I can’t contribute anything to this
world. I’m talentless. I can’t draw, write, sing nor play any
instruments.” This theme often contained intense expres-
sions of self-loathing.
Experiences of Mental Ill-Health
Although less predominant than other themes, posts also
sometimes mentioned a mental health problem as a rea-
son for feeling suicidal. Some posts contained talk of issues
relating to a specic diagnosis, most often, depression:
My depressions getting worse because I no longer know how
to be happy, no matter how hard I try. My thoughts are getting
stronger, I have a really strong urge to both cut and kill myself.
In some cases, the poster’s distress seemed to have been
exacerbated because they felt their mental health prob-
lems were not taken seriously by others:
she suddenly felt the need to say that ... i am just making up my
problems. i was diagnosed with bpd, severe depression, ocd,
social anxiety and more, but apparently i am just making this
up…i just want to kill myself.
Importantly, in this theme, posters often seemed to have
diagnosed their own problems rather than relying on a
professional opinion, as the following post suggests: “For
the past  years I’ve been going through depression. It’s on
and o. I haven’t talked to anyone about it. I haven’t got
any professional help on it either.” Mental health problems
A. Ali & K. Gibson, Reasons for Feeling Suicidal 5
© 2019 Hogrefe Publishing Crisis 2019
were implicated in posters feelings of suicidality in a varie-
ty of ways including as a source of distress in themselves as
well as well as in response to the reactions of others.
Discussion
This study identied a range of issues that posters provid-
ed as reasons for their suicidality. Loneliness and a lack of
connection with others emerged as a key issue for young
people wanting to end their lives. This is consistent with
other research that notes the importance of belonging
for young people, and the absence of this as a risk to their
well-being Schinka, VanDulmen, Bossarte, & Swahn,
. This also coincides with Westerlund’s  anal-
ysis of postings to a Swedish Internet forum. While lone-
liness is a signicant risk factor for suicide, it may feature
particularly on Internet forums that provide an important
source of support for otherwise isolated youth Lewis,
Heath, Michal & Duggan, . These ndings highlight
the importance of meaningful relationships for young peo-
ple, also found in Cash and colleagues’  analysis of a
smaller sample of posts on MySpace.
Being subject to identity stigma also featured strongly
in these posts. Unsurprisingly, this analysis highlights the
particular challenges for young people with stigmatized
gender or sexual identities that contribute to the high su-
icide rates among this group McDermott & Roen, .
Young people may also be particularly sensitive to social
stigma related to their physical appearance Puhl & King,
; Troop-Gordon, .
While research often highlights negative life events in
accounting for suicidality, there is increasing recognition of
the insidious pressure and high expectations that are part of
young people’s lives in contemporary societies Furlong &
Cartmel, . The ndings of this research highlight the
pressures that young people face in their lives and the sense
of failure that goes with not being able to meet the expecta-
tions of those around them. This external pressure seems to
be mirrored in the nding that posters to this forum appeared
to be preoccupied by their own inadequacies. Campos, Bess-
er, Abreu, Parreira, and Blatt  note that young people
may be particularly self-critical and be inclined to blame
themselves for diculties rather than blame external factors.
Feelings of helplessness also appear to be prominent in
the expression of suicidality, which is consistent with ex-
isting literature Portes, Sahndhu, & Grice, . Young
people may lack the resources to deal with life’s challenges
and, importantly, often also lack the power to change their
circumstances Baker, .
Mental health problems emerged as a less prominent
theme than others. While it may be that the emotional ex-
periences e.g., helplessness, hopelessness, low self-worth
posters described are indicative of mental health problems,
young people may not always understand their suicidality
in this way. This supports other research suggesting young
people do not see suicidality as a form of pathology e.g.,
Bennett etal., ; Heled & Read, . Some posters
did, however, attribute their suicidal feelings to a diagnosis
and seemed sometimes to use this as a way of seeking le-
gitimacy for their distress.
Limitations
While the Internet provides unique opportunities to in-
vestigate real-time expressions of suicidality, there are
also limitations associated with this mode of data collec-
tion. Although most Tumblr users are thought to be young
people, this cannot be conrmed. Furthermore, the Inter-
net allows users to be selective of what information they
would like to reveal or hide, which may limit the relevance
of these ndings to nonvirtual settings. Additionally, the
lack of opportunity to explore beyond the relatively brief
information contained in postings further constrains the
ndings of this study. These ndings may also have limit-
ed relevance for other social media forums, not specically
designed to provide help for young people who are suicidal.
Conclusion
While this research does not detract from the value of risk
factors already identied in mainstream literature on su-
icide prevention, it gives important insights into reasons
that young people themselves ascribe to feeling suicidal
at the moment in which they experience this. This study
provides insight into the real-time expressions of suici-
dality and may provide useful information about how to
engage young people in crisis. As other researchers have
noted, it is important to increase the relevance of suicide
prevention to young people by addressing concerns that
seem salient to them. Suicide prevention eorts aimed at
reaching young people who are at immediate risk of sui-
cide may benet from focusing on loneliness, identity stig-
ma, pressure to meet academic and social expectations,
and feelings of helplessness or worthlessness. Prevention
programs should use language that speaks directly to these
experiences and emotions associated with them.
The openness that young people demonstrate in talking
about suicide online also suggests the value of approaches
that reach them via this medium Best, Manktelow, & Tay-
lor, . Online prevention resources might talk directly
A. Ali & K. Gibson, Reasons for Feeling Suicidal
6
© 2019 Hogrefe PublishingCrisis 2019
to young people’s identied reasons for feeling suicidal,
for example, by letting them know that they are not alone,
that dierence is acceptable, or by challenging unrealis-
tic expectations of achievement in this age group. Suicide
prevention may have something to learn from the informal
online support resources, often developed by young people
themselves.
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History
Received February 20, 2018
Revision Received October 19, 2018
Accepted October 19, 2018
Published online March 19, 2019
Aamina Ali is completing a doctorate in Clinical Psychology at the
University of Auckland, New Zealand. This study formed part of her
honors degree in psychology.
Kerry Gibson is a clinical psychologist and an associate professor
in the School of Psychology at the University of Auckland, New
Zealand.
Kerry Gibson
School of Psychology
University of Auckland
New Zealand
kl.gibson@auckland.ac.nz
... Mumsnet has also been the focus of research studying the topics of motherhood and entrepreneurship (Makola, 2022). Scholars have also studied non-suicidal-self-injury (Eliseo-Arras et al., 2019), suicidal ideation (Ali & Gibson, 2019;Cavazos-Rehg et al., 2017), and eating disorders (Gies & Martino, 2014) on the public picture and comment sharing platform Tumblr. ...
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... A cursory PubMed review of recently published research on youth suicide offers a wide array of ages studied ranging from those aged 5-17 (Bridge et al., 2018), 10-19 (Knopov, . Similarly, young people may refer to those 24 years old or younger (Robinson, Too, Pirkis, & Spittal, 2016) or to a more delimited cohort between the ages of 16 and 24 (Ali & Gibson, 2019). Miron, Yu, Wilf-Miron, and Kohane (2019) refer to youth as those aged 15-24 years, and, as if to further confuse matters, in the same report describe those aged 20-24 years as young adults, a group defined by the US Food and Drug Administration (USFDA) in one study as being 18-24 years old, given that the USFDA defines adolescents as those aged 12-17! ...
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This book addresses the fundamental question of why young people whose sexualities and genders are marginalised may become distressed and sometimes harm themselves. Youth who are minoritised in relation to sexuality or gender identity can face a range of embodied, emotional, discursive and material challenges. These challenges are sometimes evoked in explanations for suicide and self-harm among queer(ed) young people. Previous studies in this field have often asked, how many lesbian, gay, bisexual and transgender (LGBT) youth self-harm? Many have asked, what are the risk factors for LGBT youth suicide and self-harm? We take the inquiry deeper, focusing on a wide range of queer(ed) youth, and addressing questions about norms, emotions and embodiment. We are specifically interested in both the material and the discursive conditions through which it comes to make sense to some queer(ed) youth to harm their bodies. We are concerned with the ‘incredible weight of cultural obligation that makes specific claims on the subjectivities of young people — to act in accordance with certain norms, to make a “success” of one’s life and avoid “failure” at all costs’ (Fullagar, 2003: 292).
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To systematically review research on how people use the Internet for suicide-related reasons and its influence on users. This review summarises the main findings and conclusions of existing work, the nature of studies that have been conducted, their strengths and limitations, and directions for future research. An online search was conducted through PsycINFO, PubMed, Ovid MEDLINE and CINAHL databases for papers published between 1991 and 2014. Papers were included if they examined how the Internet was used for suicide-related reasons, the influence of suicide-related Internet use, and if they presented primary data, including case studies of Internet-related suicide attempts and completions. Findings of significant relationships between suicide-related search trends and rates of suicide suggest that search trends may be useful in monitoring suicide risk in a population. Studies that examine online communications between people who are suicidal can further our understanding of individuals' suicidal experiences. While engaging in suicide-related Internet use was associated with higher levels of suicidal ideation, evidence of its influence on suicidal ideation over time was mixed. There is a lack of studies directly recruiting suicidal Internet users. Only case studies examined the influence of suicide-related Internet use on suicidal behaviours, while no studies assessed the influence of pro-suicide or suicide prevention websites. Online professional services can be useful to suicide prevention and intervention efforts, but require more work in order to demonstrate their efficacy. Research has shown that individuals use the Internet to search for suicide-related information and to discuss suicide-related problems with one another. However, the causal link between suicide-related Internet use and suicidal thoughts and behaviours is still unclear. More research is needed, particularly involving direct contact with Internet users, in order to understand the impact of both informal and professionally moderated suicide-related Internet use. © The Royal Australian and New Zealand College of Psychiatrists 2015.
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The research literature consistently indicates that self-criticism is related to suicidality. Evidence for the role of dependency, however, is more controversial. This study examines the extent to which these personality vulnerabilities are mediated by psychological distress in the prediction of suicidality. As part of a study of adolescent psychopathology, a sample of 260 Portuguese adolescents (148 [56.9 %] female and 112 [43.1%] male), ranging in age from 15 to 18 years (M = 16.32, SD = 1.19) completed measures of personality, suicidal behavior, and current distress, in counterbalanced order. The measures were: self-criticism and dependency from the Depressive Experiences Questionnaire for Adolescents; two psychological distress scales, social withdrawal from the Youth Self Report and depression from the Center for Epidemiologic Studies of Depression Scale; and a measure of suicidality from the Suicide Behaviors Questionnaire Revised. Structural equation modeling indicated that self-criticism and dependency were both significantly associated with suicidality. Psychological distress, however, as measured by withdrawal and depression, fully mediated these relationships, but did not moderate them. The authors conclude that adolescents with higher levels of self-criticism and dependency are at greater risk for experiencing intense psychological distress-high levels of social withdrawal and depression-that account for their vulnerability to suicide risk.