Nora Clancy Kelsall

Searches for “pro-suicide” websites in the United States peaked during the week a high-profile news story was published and remained elevated for 6 months afterward, highlighting the need to avoid mentioning specific sources of explicit suicide instructions in media publications.

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 Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn.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.

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 prosuicide 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 This study aimed to estimate the association of the frequency of Google searches of known prosuicide web forums and content with death by suicide over time in the United States, by age, sex, and means of death. METHODS National monthly Google search data for names of common prosuicide websites between January 2010 and December 2021 were extracted from Google Health Trends API (application programming interface). Suicide deaths were identified using the CDC (Centers for Disease Control and Prevention) National Vital Statistics System (NVSS), and 3 primary means of death were identified (poisoning, suffocation, and firearm). Distributed lag nonlinear 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 autoregressive integrated moving average (ARIMA) modeling approaches, were also conducted. RESULTS Months in the United States in which search rates for prosuicide 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 years) 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 1 month after searches reached 9 per 10 million compared with 0 searches. We also observed that increased search rates were associated with fewer youth suicide deaths by firearms with a 3-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 prosuicide 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. CLINICALTRIAL

UNSTRUCTURED Searches for “pro-suicide” websites in the United States peaked during the week a high-profile news story was published and remained elevated for 6 months afterward, highlighting the need to avoid mentioning specific sources of explicit suicide instructions in media publications.

When a family member has depression at a level that generates disability in various functional spheres, the informal primary caregiver (IPC) is the individual who provides the majority of emotional and basic needs of the patient. This person is usually a relative and is extremely important in the health-disease-care process. This phenomenological qualitative study aimed to analyze the illness perception, in IPCs of undergraduate medical students previously diagnosed with mild depression. It was found that IPCs generate perceptions about depression based on a lack of knowledge of the disorder, which leads to feelings of sorrow, anger, frustration, and fear, that could interfere with the evolution of patients. Psychiatric disorders, such as depression, strongly impact both patients and people around them. For mental health professionals, in order to provide a more complete clinical approach, it is important to understand the illness perceptions not only of patients but of family IPCs as well.