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Suicide and Self-Harm Related Internet Use : A Cross-Sectional Study and Clinician Focus Groups

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      Abstract

      Abstract. Background: The rise in Internet use adds a new dimension to suicide prevention. We investigated suicide/self-harm (S/Sh)-related Internet use among patients presenting to hospital with self-harm. Method: We asked 1,198 adult and 315 child and adolescent patients presenting to hospital following self-harm in a city in South West England about Internet use associated with their hospital presentation. Associations between Internet use and sociodemographic and clinical characteristics were investigated using multivariable logistic regression models. Focus groups with clinicians explored the acceptability and utility of asking about Internet use. Results: The prevalence of S/Sh-related Internet use was 8.4% (95% CI: 6.8–10.1%) among adult hospital presentations and 26.0% (95% CI = 21.3–31.2%) among children's hospital presentations. In both samples, S/Sh-related Internet use was associated with higher levels of suicidal intent. Mostly, clinicians found it acceptable to ask about Internet use during psychosocial assessments and believed this could inform perceptions of risk and decision-making. Limitations: It is unclear whether the findings in this study are applicable to the general self-harm patient population because only those who had psychosocial assessments were included. Conclusion: S/Sh-related Internet use is likely to become increasingly relevant as the Internet-native generation matures. Furthermore, Internet use may be a proxy marker for intent.

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      Most cited references 16

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      The Power of the Web: A Systematic Review of Studies of the Influence of the Internet on Self-Harm and Suicide in Young People

      Background There is concern that the internet is playing an increasing role in self-harm and suicide. In this study we systematically review and analyse research literature to determine whether there is evidence that the internet influences the risk of self-harm or suicide in young people. Methods An electronic literature search was conducted using the PsycINFO, MEDLINE, EMBASE, Scopus, and CINAHL databases. Articles of interest were those that included empirical data on the internet, self-harm or suicide, and young people. The articles were initially screened based on titles and abstracts, then by review of the full publications, after which those included in the review were subjected to data extraction, thematic analysis and quality rating. Results Youth who self-harm or are suicidal often make use of the internet. It is most commonly used for constructive reasons such as seeking support and coping strategies, but may exert a negative influence, normalising self-harm and potentially discouraging disclosure or professional help-seeking. The internet has created channels of communication that can be misused to ‘cyber-bully’ peers; both cyber-bullying and general internet use have been found to correlate with increased risk of self-harm, suicidal ideation, and depression. Correlations have also been found between internet exposure and violent methods of self-harm. Conclusions Internet use may exert both positive and negative effects on young people at risk of self-harm or suicide. Careful high quality research is needed to better understand how internet media may exert negative influences and should also focus on how the internet might be utilised to intervene with vulnerable young people.
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        Effectiveness of Online Self-Help for Suicidal Thoughts: Results of a Randomised Controlled Trial

        Background Many people with suicidal thoughts do not receive treatment. The Internet can be used to reach more people in need of support. Objective To test the effectiveness of unguided online self-help to reduce suicidal thoughts. Method 236 adults with mild to moderate suicidal thoughts were randomised to the intervention (n = 116) or a waitlist control group (n = 120). Assessments took place at baseline, and 2, 4 and 6 weeks later. Primary outcome was suicidal thoughts. Secondary outcomes were depressive symptoms, anxiety, hopelessness, worry, and health status. Results The intervention group showed a small significant effect in reducing suicidal thoughts (d = 0.28). Effects were more pronounced for those with a history of repeated suicide attempts. There was also a significant reduction in worry (d = 0.33). All other secondary outcomes showed small but non-significant improvements. Conclusions Although effect sizes were small, the reach of the internet could enable this intervention to help many people reduce their suicidal thoughts. Trial Registration Netherlands Trial Register NTR1689
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          Caught in the Web: A Review of Web-Based Suicide Prevention

          Background Suicide is a serious and increasing problem worldwide. The emergence of the digital world has had a tremendous impact on people’s lives, both negative and positive, including an impact on suicidal behaviors. Objective Our aim was to perform a review of the published literature on Web-based suicide prevention strategies, focusing on their efficacy, benefits, and challenges. Methods The EBSCOhost (Medline, PsycINFO, CINAHL), OvidSP, the Cochrane Library, and ScienceDirect databases were searched for literature regarding Web-based suicide prevention strategies from 1997 to 2013 according to the modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The selected articles were subjected to quality rating and data extraction. Results Good quality literature was surprisingly sparse, with only 15 fulfilling criteria for inclusion in the review, and most were rated as being medium to low quality. Internet-based cognitive behavior therapy (iCBT) reduced suicidal ideation in the general population in two randomized controlled trial (effect sizes, d=0.04-0.45) and in a clinical audit of depressed primary care patients. Descriptive studies reported improved accessibility and reduced barriers to treatment with Internet among students. Besides automated iCBT, preventive strategies were mainly interactive (email communication, online individual or supervised group support) or information-based (website postings). The benefits and potential challenges of accessibility, anonymity, and text-based communication as key components for Web-based suicide prevention strategies were emphasized. Conclusions There is preliminary evidence that suggests the probable benefit of Web-based strategies in suicide prevention. Future larger systematic research is needed to confirm the effectiveness and risk benefit ratio of such strategies.
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            Author and article information

            Affiliations
            [ 1 ]School of Social and Community Medicine, University of Bristol, Bristol, UK
            [ 2 ]Avon and Wiltshire Mental Health Partnership NHS Trust, UK
            [ 3 ]Real World Evidence, Evidera, London, UK
            [ 4 ]University Hospitals Bristol NHS Foundation Trust, Bristol, UK
            [ 5 ]NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
            Author notes
            Prianka Padmanathan, School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK, prianka.padmanathan@ 123456gmail.com
            Journal
            Crisis
            Crisis
            cri
            Crisis
            Hogrefe Publishing
            0227-5910
            2151-2396
            May 31, 2018
            2018
            : 39
            : 6
            : 469-478
            29848080
            6263311
            10.1027/0227-5910/a000522
            © 2018 Hogrefe Publishing

            Distributed under the Hogrefe OpenMind License (https://doi.org/10.1027/a000001)

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