Association between pro-suicide website searches through Google and suicide death in the United States from 2010-2021. (Preprint)

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Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The rate of suicide death has been increasing, making understanding risk factors of growing importance. While exposure to explicit suicide-related media, such as description of means in news reports or sensationalized fictional portrayal, is known to increase population suicide rates, it is not known whether pro-suicide website forums, which often promote or facilitate information about fatal suicide means, are related to change in suicide deaths overall or by specific means. Objective: The present study aimed to estimate the association of the frequency of Google searches of known pro-suicide web forums and content with death by suicide over time in the US, by age, sex, and means of death. Methods: National monthly Google search data for names of common pro-suicide websites between January 2010 and December 2021 were extracted from Google Health Trends API. Suicide deaths were identified using the CDC National Vital Statistics System (NVSS), and three primary means of death were identified (poisoning, suffocation, and firearm). Distributed lag non-linear models (DLNMs) were then used to estimate the lagged association between the number of Google searches on suicide mortality, stratified by age, sex, and means, and adjusted for month. Sensitivity analyses, including using ARIMA modelling approaches, were also conducted. Results: Months in the US in which search rates for pro-suicide websites increased had more documented deaths by intentional poisoning and suffocation, among both adolescents and adults. For example, the risk of poisoning suicide among youth and young adults (age 10-24) was 1.79 (95% CI 1.06, 3.03) times higher in months with 22 searches per 10 million as compared to 0 searches. The risk of poisoning suicide among adults aged 25-64 was 1.10 (95% CI 1.03, 1.16) times higher one month after searches reached 9 per 10 million compared with zero searches. We also observed that increased search rates were associated with fewer youth suicide deaths by firearm with a three-month time lag for adolescents. These models were robust to sensitivity tests. Conclusions: Although more analysis is needed, the findings are suggestive of an association between increased pro-suicide website access and increased suicide deaths, specifically deaths by poisoning and suffocation. These findings emphasize the need to further investigate sites containing potentially dangerous information and their associations with deaths by suicide, as they may affect vulnerable individuals.

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