Motivation and emotion/Book/2022/Social media and suicide prevention

Social media and suicide prevention:
How can social media be used to help prevent suicide?

Multimedia presentation (3 min)

Overview

Suicide among young people worldwide is a major cause of death with it comprising of 1/3 of Australians under 25 and approximately 80,000 worldwide according to the World Health Organisation (Robinson et al., 2017; Choi & Noh, 2019). South Korea has the highest suicide rates compared to other developed countries creating a serious social and health problem (Choi & Noh, 2019). Suicide has detrimental impacts on family, friends and society and studies have revealed that this can be prevented through understanding ones attitude towards suicide (Choi & Noh, 2019). Reports have also found that increases in suicide rates are potentially due 'copy cat events' whereby one event may lead another to end their life (Robinson et al., 2017). Research suggests that internet and social media impact suicide-related actions, with platforms frequently used for communication of suicidal emotions, cognition and health issues (Luxton et al., 2012; Robinson et al., 2015; Robinson et al., 2017).

Focus questions: What are the advantages and disadvantages of social media use? What theories apply to suicide? How can social media prevent suicide?

Advantages & Disadvantages of Social Media

Advantages

Figure 1. Social media platforms are used to express suicidal thoughts and feelings.

Social media provides chances for medical practitioners to communicate and respond to those expressing suicidal ideations with subsequent increases in acceptance, reductions in costly intervention strategies and greater accessibility with remote options (Robinson et al, 2017). Social media creates greater knowledge of suicide, benefits suicide attitude and help-seeking (Robinson et al., 2017). More chances are available to intervene such as activities, social support, safe ways to express feelings and opportunities provide help and advice for others (Robinson et al, 2015). Additionally, one can act quickly if experiencing expression of suicidal emotions and cognitions online (Robinson et al., 2015).

Disadvantages

Social media is quick paced and anonymous, it is impossible to frequently assess risk without violating anonymity and privacy (Robinson et al., 2015; Robinson et al., 2017). When used inappropriately, social media can display harmful information such as suicide methods, provide grounds for cyber, harassment or be used to create suicide pacts (Luxton et al., 2012; Robinson et al., 2015; Robinson et al., 2017). Additionally, there is a risk for already vulnerable individuals of persuasion from 'extreme communities' promoting and supporting abnormal behaviours, including but not limited to anorexia and suicide (Luxton et al., 2012).

How can psychology help?

Application of psychological theory along with social media can work to ensure that platforms are used appropriately to increase social support, provide helpful resources, assist in meeting innate human needs and provide easy and cost effective access to professional help resources (Robinson et al., 2017). Communication online can assist in identifying one at risk providing extra opportunity to intervene before one reaches the stage of taking action (Stanley et al., 2015).

Cyber-victimisation Studies found an association between cyber-victimisation and suicidal ideations in young people due to features of publicity and accessibility creating interpersonal risks (Schaffer & Nesi, 2019). Social media creates an environment for victimising encounters, those harassed increase in likelihood to have experienced self-harm, suicide ideation, or attempts (Schaffer & Nesi, 2019).

Theories of suicide

Interpersonal theory of suicide

The interpersonal theory of suicide (ITS) displays structure for selecting changeable aspects, and implies that individuals will commit suicide if they obtain both the ability and desire to cause fatal self-injury (Stanley et al, 2015). Individuals must additionally conquer the fundamental self-preservation predisposition (capability for suicide), this is a unique feature of ITS acknowledging that suicidal inclinations defy biological survival instincts (Heffer & Willoughby, 2018) (Stanley et al, 2015). This requires two dynamic psychological circumstances; thwarted belongingness including loneliness and absence of relationships and perceived burdensomeness which involves aspects including illness, unemployment and self loathing (Stanley et al., 2015). Central to the ITS is the phrase 'perceived' alluding that individuals believe suicide is more valuable than their life to peers (Stanley et al, 2015).

Those at risk of suicide tend to confront suicidal desire:

1. Perceived sense of burdensomeness: belief that one burdens others
2. Thwarted Belongingness: pronounced feeling of isolation, disconnection or insufficiency of belonging (Schaffer & Nesi, 2019).
3. Acquired Capability for suicide

These factors correspond with a capability to perform fatal self-harm overriding the self-preservation instinct (Rice et al, 2016). Increased perceived burdensomeness, thwarted belongingness, paired with hopelessness are hypothesised to create suicide inclination but aren't adequate to create action without acquired capability for suicide (ACS) (Schaffer & Nesi, 2019). ACS comprises of lack of fear regarding death and superior pain tolerance, developing over time from multiple harmful events (Heffer & Willoughby, 2018) (Shaffer & Nesi, 2019) (Stanley et al, 2015). Subjection to these experiences contributes to the development of ACS, meaning that ITS potentially reveals why family history of suicide, combat exposure, childhood maltreatment, abuse, and bullying all lead to heightened suicide risk (Stanley et al, 2015).

ITS implies that thwarted belongingness and perceived burdensomeness relate to suicidal ideation and that acquired capability is related to suicidal actions. This difference is important because more individuals experience ideation than attempts, due to the fact that suicidal actions are frightening and defy a innate survival instincts (Stanley et al, 2015).

According to the interpersonal theory of suicide, which of the following is not a factor of suicidal desire:

	Sense of burdensomeness
	Lack of social support
	Thwarted belonging
	Acquired capability

ACS is associated with:

	Suicidal ideation
	Suicidal behaviour

Emotional Dysregulation Emotional dysregulation Hypothesised as a risk factor for each of the main components of the ITS with a link found between emotional dysregulation and ACS (Heffer & Willoughby, 2018). When easily overwhelmed by aversive feelings people heighten their predisposition to suicidal ideations. Emotional dysregulation theory Initially developed for patients with borderline personality disorder (BPD) suggesting that suicidal behaviour is due to a relationship amongst emotional dysregulation and invalidation (Stanley et al, 2015). Harmful behaviours are revealed as a distraction from overwhelming emotions and environments (Stanley et al, 2015).

Whilst emotional dysregulation increases risk of suicidal ideation, it can alternatively serve as a protection from fatal self-harm due to associated fear.

Social pain model

Figure 3. The social pain model operates as a negative feedback loops

The social pain model is an augmentation of the ITS whereby negative group evaluations including rejection and abandonment along with 'suicidogenic' cognitions (perceived burdensomeness, thwarted belongingness and hopelessness) create the feeling of social pain (Schaffer & Nesi, 2019). Social pain feeds back into social and suicidal feelings, amplifying undesirable evaluations and forming a feedback loop subsequently increasing risk (Schaffer & Nesi, 2019). Once this accomplishes a predetermined threshold level of pain, suicide creates as a motivation to get away from pain (Schaffer & Nesi, 2019).

Integrated motivational–volitional model

The integrated motivational-volitional (IMV) model maps the evolution of motivational aspects of suicide including inclination, intentions and beliefs into plans and actions. This model is more comprehensive than the ITS, but the two can be studied within each other (Stanley et al, 2015). IMV assures that suicidal cognitions develop into intent to actions due to feelings of entrapment caused by perceived inescapable defeat and humiliation (Stanley et al., 2015).

The IMV describes three phases of suicidal behaviour:

1. Pre-motivational phase: background risk, protective factors and triggering events
2. Motivational phase: Suicidal thoughts, desires and intentions develop
3. Volitional phase: Suicidal behaviours occur

The transfer through phases is dependant on relevant components such as perceived threats to core sense of self, motivational moderators including perceived burdensomeness and social support and volitional moderators such as obtaining means and ACS (Stanley et al, 2015). IMV proposes that detachment from unattainable goals, along with reduced interest in other goals create for increased suicide motivation (Stanley et al, 2015). In older adults, the cycle of disinterest of goals without alternate goals to achieve creates emotional distress and increased likelihood of suicide efforts (Stanley et al, 2015). Research has also revealed disability in constructive future thinking moderates the connection between feeling trapped and suicidal cognitions, independent of psychopathology (Stanley et al, 2015). IMV's cornerstone of moderating aspects facilitating transitions from pre-motivational to the volitional phase could serve as a guide to assess and conceptualise risk of suicide (Stanley et al, 2015).

Volitional Moderators: Factors that impact the magnitude of connection between suicidal thoughts and behaviours, obtaining means for an attempt and diminished fear of death are two important moderators (Stanley et al, 2015).

Figure 4. Hopelessness is a known risk factor of suicide risk

Hopelessness theory

Theory in which hopelessness is the main causal mechanism incorporating modal processing whereby five cognitive systems (cognitive, affective, motivational and behavioural, physiological and conscious control) are impacted by suicidal actions (Stanley et al, 2015). Feeling hopeless is suggested to stimulate the cognitive system leading activation of all other affective systems which can create depressive symptoms, suicidal ideations and behaviour development (Stanley et al, 2015). Research implies that predicting suicide risk within adults is more accurate with hopelessness rather than depression with hopelessness being significantly related to suicide attempt status (Stanley et al, 2015). Hopelessness is moderated by perceived responsibility meaning that greater responsibility and increased feelings of hopelessness relate to increased suicide risk (Stanley et al, 2015).

Hopelessness: Ongoing pessimistic views about the future and permanency of a circumstance, seen as a seperate assumed risk factor of suicidal ideation with hope opposing as a protective factor (Stanley et al, 2015).

Escape theory

The escape theory comprises of a six step causal chain:

1. Not meeting standards because of impractical goals or issues and setbacks
2. Aversive internal attributions of guild and lack of self-esteem
3. Negative states of increased self-awareness due to comparison to others
4. Undesirable feelings due to self-awareness not meeting high standards
5. Cognitive interpretations, the individual attempts to escape negative feelings through rejection and avoidance
6. Consequences of interpretation including disinhibition, passivity, lack of emotion and irrational thoughts

These implications, particularly disinhibition are seen as central to suicidal processes providing insight into relevant mental states, suicide is seen as an effort to escape self-awareness and overwhelming aversive emotions (Stanley et al, 2015). This means it should be a rare circumstance, requiring one to go through each step within the chain (Stanley et al, 2015).

Social media can alter victimisation experiences by opening all places and times, diminishing chances to escape and making victimisation overt and easy (Schaffer & Nesi, 2019).

How can social media be used to prevent suicide?

Figure 5. How can social media be used to prevent suicide?

There is an obvious requirement of effective and youth-friendly suicide intervention strategies, social media provides a chance to influence adolescents, with evidence supporting the potential for online strategies to assist mental health outcomes (Sala et al, 2021). Studies have recognised that social media creates an accessible and accepting environment for adolescents to speak about suicide, find support and also provide support with additional facilitation of specialist care (Sala et al., 2021). Individuals at risk can identify with others and receive social support at all times, identification of those at risk is made easier with communication patterns, responses to exposure to suicide communication (Parrott et al, 2020). People universally share suicide letters online and others mediate directly by offering resources or indirectly by involving authorities (Parrott et al., 2020).

Social Isolation & Attitudes

Mental health and social isolation mediate the relationship between social media use and attitude towards suicide (Choi & Noh, 2019). Media use is positively related to well-being and negatively related to isolation, increased well-being is related to negative attitudes towards suicide whereas higher social isolation is associated with positive attitudes towards suicide and implications for prevention strategy using social media (Choi & Noh, 2019). It is likely that social media use may be related to forming peoples attitudes towards suicide, social media can play a role in promoting interaction among people via online interpersonal networks (Choi & Noh, 2019). Social media is strongly related to ones mental health, social support and isolation, which alternatively can be associated with attitude towards suicide (Choi & Noh, 2019). This corresponds with the IMV model where changing ones attitude and offering support acts as a buffer stopping one from transitioning into the volitional phase (Stanley et al., 2015).

Interpersonal Relationships & Social Support

Figure 6. Communication can be used to intervene

Social media enables exchange of emotions and resources between people with a followed increase of social support and psychological well-being (Choi & Noh, 2019). Social media can additionally create an enhanced feeling of connectedness via online channels, which is negatively related to isolation, loneliness and negative suicide attitudes (Choi & Noh, 2019). Contrastingly, social isolation creates an experience of reduced social connectedness which shows relation to positive suicide attitudes, therefore social media is anticipated to have impact on ones attitude towards suicide mediated by mental health, social isolation and support (Choi & Noh, 2019). Social media plays a key part in promotion of communication between people, enhancing communication and establishing new and existing relationships (Choi & Noh, 2019). Relationships and interactions online have the grounds to impact the formation of users psychological well-being suggesting a relationship between social media and well-being (Choi & Noh, 2019). Because relationships have positive links to well-being, social media can clearly assist in communication and enhance well-being acting as a tool to establish and preserve relationships (Choi & Noh, 2019). Online interactions between individuals can increase affective status and quality of life by potentially fostering social support by offering countless opportunities to receive support (Choi & Noh, 2019). This aligns with the ITS where receiving social support and boosting relationships reduces perceived burdensomeness, thwarted belonging and ACS (Heffer & Willoughby, 2018).

Communication

A vital warning sign is communication, helping family and friends identify individuals at risk, effectual communication can assist individuals with important crisis and mental health programs (Parrot et al, 2020). Ideations are commonly expressed in multiple ways to many people within ones social network including family, partners and friends (Parrot et al., 2020). Communication events can occur in which receivers do not realise or ignore the help seeking suicide expressions, people at risk may display warning signals where recognition creates early detection and intervention (Parrot et al., 2020). Guidelines advocate for safe communication about suicide online as a broadly accepted prevention strategy in multiple countries including Australia, with associated decreases in suicide rates (Sala et al., 2021). By communicating suicidal thoughts and ideations ones likelihood to transition through the phases of the IMV model are reduced (Stanley et al., 2015).

Suicide communication event: A set of circumstances in which someone displays suicidal cognitions, thoughts, or plans, directly or indirectly, through interaction with others people. Suicidology researchers recognise the importance of suicide communication events, examining the content of suicide letters and conducting interviews with family members and friends who lost loved ones to suicide to better understand the role of communication in suicide (Parrot et al, 2020).

Data Collection

Online communication creates multiple chances and challenges in relation to suicide intervention, such as data collection in real time that can assist in prevention (Parrott et al., 2020). Recent technological advances present a potential for innovative and economically attainable strategies to prevent suicide with analyses of large amounts of data, with millions of online posts to examine trends of communication, information distribution patterns, interpersonal networks and alternate aspects of communication (Parrott et al., 2020). Studies have researched the idea of using social media data to predict depression and suicide risk (Parrott et al., 2020).

Early Identification

Early intervention through online forums could be vital in suicide intervention (Robinson et al., 2017), Social media creates opportunities to implement the most widespread method for suicide risk screening and detection, assessing for the presence of current (or recent) suicidal thoughts or intentions, complementing traditional health care (Parrott et al., 2020). In Western countries, advances in artificial intelligence (AI) presents opportunities for development of suicide prediction tools utilising data and social media to identify users at risk and implement interventions such as free information and counselling (Zhang et al., 2021). By identifying those at risk early we can avoid them reaching the volitional phase in the IMV model to avoid suicidal attempts (Stanley et al., 2015).

This presents potential for suicide prevention efforts in:

1. Permitting earlier identification of people at risk
2. Sharing information about resources for people in crisis
3. Challenging the stigma attached to conversations about suicide (Parrott et al., 2020).

Psychological Needs

Internet interventions can improve the human need to belong assisting those with a thwarted sense of belongingness whilst potentially assisting perceived burdensomeness seen in the ITS (Rice et al, 2016). Remote interventions have the ability to develop feelings of social connectedness and reduce loneliness which has been linked with suicidal thoughts in adolescents (Rice et al., 2016). Social media provides chances to seek help, provide peer support to others (increasing perceptions of competence and autonomy) reduce withdrawal and create opportunities to develop meaningful, supportive and positive relationships (Rice et al, 2016).

Figure 7. Maslow's hierarchy of needs

Theories proposes that internet use is motivated by two basic social needs:

1. The need to belong: innate motive to feel close and wanted by others
2. Need for self-preservation: linked with impression maintenance (Casale & Fioravanti, 2015).

The vital part the need to belong has in establishing behaviour is highlighted with the self-determination theory (SDT) which proposes that two additional intrinsic psychological needs; a need for competence (to feel able and effective) and a need for autonomy (feel that one creates and controls their own behaviour) (Casale & Fioravanti, 2015). The need to belong has commonly been reviewed as a primary motive in relation to media usage especially in individuals with social anxiety who see communication on social media as safer (Casale & Fioravanti, 2015). Fear of being evaluated undesirably is typically reduced throughout online interaction compared to face-to-face, this is consistent with the social compensation hypothesis (Casale & Fioravanti, 2015). This additionally corresponds with the IMV model where meeting ones needs will simultaneously avoid one reaching the motivational and volitional phases (Stanley et al., 2015).

Psychological well-being: An individuals evaluation of their life entirely in a positive or negative way. This typically corresponds with one's mental health status, including life satisfaction and positive feelings regarding their lives, meaning this is an important component of mental health (Choi & Noh, 2019).

Conclusion

Suicide is a worldwide public and social health issue prevalent in adults under the age of 25 that requires one to overcome fundamental human instincts to injure themselves (Stanley et al, 2015).

With application of psychological theory there is opportunity to aid in preventing suicide with social media providing prevention strategies more relevant to a younger audience. Social media gives the chances to alter attitudes towards suicide through promotion of networking and interaction, corresponding with the IMV (Stanley et al., 2015). Social isolation and social support also have a crucial role in ones attitude towards suicide, with social media providing a forum where one can reduce isolation and increase social support, the relationship social support and suicide is outlined by the ITS where an increase in ones social support would assist in decreasing thwarted belongingness and perceived sense of burdensomeness ultimately reducing ACS (Schaffer & Nesi, 2019). Social media can also help with data collection and subsequently early identification and intervention for those at risk, in the IMV model this would work to intervene at the pre-motivational or the motivational phase ultimately avoiding allowing one to reach the volitional phase (Stanley et al., 2015). Lastly, social media can address ones fundamental psychological needs such as the need to belong, competence and autonomy coinciding with both the ITS and IMV to avoid movement through suicidal phases and thwarted belongingness (Stanley et al., 2015; Heffer & Willoughby, 2018).

Although social media does have potential to negatively impact those at risk, current studies and research concur that when used appropriately social media has positive and significant relationships with psychological well-being, outcomes and social support. This then suggests a subsequent negative relationship with suicide attitude, ideations, intentions and behaviours implying that overall social media could work to reduce suicide (Luxton et al., 2012; Robinson et al., 2015; Robinson et al., 2017).

Suicide crisis lines Suicide crisis lines are available in many countries.

See also

• Suicidality across the Lifespan (Book chapter, 2018)
• Social comparison, social media, and emotion (Book chapter, 2019)
• Suicide Prevention (Book chapter, 2014)
• Social media motivation (Book chapter, 2014)
• Youth Suicide Motivation (Book chapter, 2016)

References

Casale, S., & Fioravanti, G. (2015). Satisfying needs through social networking sites: a pathway towards problematic internet use for socially anxious people? Addictive behaviour reports, 1, 34–39. https://doi.org/10.1016/j.abrep.2015.03.008

Choi, D.H., & Noh, G.Y. (2019). The influence of social media use on attitude toward suicide through psychological well-being, social isolation, and social support. Information, communication & society, 23(10), 1427–1443. https://doi.org/10.1080/1369118X.2019.1574860

Heffer, T., & Willoughby, T. (2018). The role of emotion dysregulation: a longitudinal investigation of the interpersonal theory of suicide. Psychiatry research,260, 379–383. https://doi.org/10.1016/j.psychres.2017.11.075

Luxton, D. D., June, J. D., & Fairall, J .M. (2012). Social media and suicide: a public health perspective. American public health association, 102(2), 195–200. https://doi.org/10.2105/AJPH.2011.300608

Parrott, S., Britt, B. C., Hayes, J. L., & Albright D. L. (2020). Social media and suicide: a validation of terms to help identify suicide-related social media posts. Journal of evidence-based social work 17(5), 624–634. https://doi.org/10.1080/26408066.2020.1788478

Rice, S., Robinson, J., Bendall, S., Hetrick, S., Cox, G., Bailey, E., Gleeson J., & Alvarez-Jimenez, M. (2016). Online and social media suicide prevention interventions for young people: a focus on implementation and moderation. Child adolescent psychiatry 25(2), 80–86. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879947/

Robinson, J., Rodrigues, M., Fisher, S., Bailey, E., & Herrman, H. (2015). Social media and suicide prevention: findings from a stakeholder survey. Shanghai archives of psychiatry, 27(1), 27–35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372758/

Robinson, J., Bailey, E., Hetrick, S., Paix, S., O'Donnell, M., Cox, G., Ftanou, M., & Skehan, J. (2017). Developing social-media based suicide prevention messages in partnership with young people: exploratory study. JMIR mental health 4(4), 40. https://doi.org/10.2196/mental.7847

Sala, L. L., Teh, Z., Lamblin, M., Rajaram, G., Rice, S., Hill, N. T., Thorn, P., Krysinska, K., & Robinson, J. (2021). Can a social media intervention improve online communication about suicide? a feasible study examining the acceptability and potential impact of the #chatsafe campaign. PLOS https://doi.org/10.1371/journal.pone.0253278

Schaffer, M. M., & Nesi, J. (2019). Cybervictimisation and suicide risk in adolescence: an integrative model of social media and suicide theories. Adolescent research review, (5), 49–65. https://link.springer.com/article/10.1007/s40894-019-00116-y

Stanley, I. H., Hom, M. A., Rogers, M. L., Hagan, C. R., & Joiner, T. E. (2015). Understanding suicide among older adults: a review of psychological and sociological theories of suicide. Ageing & mental health, 20(2), 113–122. https://doi.org/10.1080/13607863.2015.1012045

Zhang, H., Wang, Y., Zhang, Z., Guan, F., Zhang, H., & Guo, Z. (2021). Artificial intelligence, social media, and suicide prevention: principle of beneficence besides respect for autonomy. The American journal of bioethics, 21(7), 43–45. https://doi.org/10.1080/15265161.2021.1928793

External links

• The Acquired Capacity for Suicide (National Library of Medicine)
• Causes of death Australia (Australian Bureau of Statistics)
• Suicide (World Health Organisation)
• Suicide Prevention Australia (Lifeline)
• Young people cite social media as main reason for worsening mental health (Headspace)