Distraught over a poor grade that she thought would ruin her life, the honor-roll student broadcast her suicide for anyone to see. Hours later, she was in the inpatient psychiatric unit where I work, thanks to the quick thinking and action of anonymous viewers.
As a psychiatrist, I have seen a number of adolescents who tried to commit suicide. But this patient was a first. She decided to take her own life by overdosing on pills and share the event with strangers on Periscope, a live video-streaming mobile application. Fortunately, several people viewing her video stream called the police. They got to her in time, and she was brought to the emergency room.
Attempting suicide online has, sadly, become commonplace among children and adolescents. It even has its own name — cybersuicide. It takes several forms, such as suicide pacts or “deathcasting.” The increase in youth suicides over the past 15 years, including an over 200 percent increase in suicides among girls and young women, underscores that health professionals — and parents — need to better understand social media and its role in suicide.
Many health care providers, especially those over age 55, aren’t familiar with social media other than Facebook and are generally misinformed about it. After a female high school student was admitted to my hospital after leaving a suicidal message to her followers on Tumblr, several staff members asked me, “What is Tumblr?”
This lack of knowledge tends to lead to a black-and-white conception that social media is bad for mental health. We often hear about the negative effects of social media: too much time spent on Facebook or other platforms, cyberbullying on Twitter, online blogs for sharing purging and food restriction in eating disorders.
The American Academy of Pediatrics has warned that social media use can cause depression. Writing in the New York Times, psychologist Dr. Leonard Sax told parents that curtailing their children’s use of social media could decrease anxiety and promote better self-image.
Can these social networks also be used for good? I believe they can. Social media provides a forum for communication. Youths can share information online that they can’t convey in-person to parents, teachers, or even friends. The popularity of Snapchat is built on the desire to disclose personal information but only for a finite period of time.
There is a popular notion that the internet disconnects youths from the “real world,” leading to distress and poor self-esteem. The evidence shows the opposite. Online communication improves friendship quality. Sharing depressive thoughts on Facebook can garner social support.
Posting suicidal thoughts online is a form of coping, though not one the health care community currently knows how to handle. For example, Suicide Watch, a forum on Reddit moderated by nonprofessionals, serves as an online suicide hotline. And just last week, Facebook announced it had added new features aimed at preventing suicide. Users can now flag friends’ posts that seem suicidal. A team at the social network will review these posts. The author will get a message from Facebook saying that someone was concerned about his or her post, along with options to talk with a trusted friend, call a helpline, get tips and support, or skip.
Youths tend to be closer to their peers than their parents and other adult figures regarding their emotional well-being. Around the world, there is a dearth of child and adolescent mental health providers. Social media fills a need for many youths who may have nowhere else to turn to express their distress. In the United States, less than half of adolescents who attempt suicide receive treatment within a year of their attempt. The anonymity and 24-hour access provided by the internet and social media can circumvent some of the barriers of seeking help.
Social media need not be merely a modern-day repository for a suicide note. If harnessed properly, it can also serve a therapeutic purpose. Internet and mobile phone interventions for mental health are increasingly incorporating aspects of social media to facilitate more interpersonal communication for youths. Koko, for example, is a social networking application similar to Stack Exchange or Yahoo Answers where people solicit feedback from others about their dysfunctional thoughts. In essence, Koko provides cognitive behavioral therapy, one of the most effective and widely used therapies for mental disorders, through a social media platform.
We have much to learn about suicide. Social media could become an important teacher. We don’t know how best to reassure parents, who are often stressed and searching for answers about why their child decided to take his or her life and what they can do to prevent another suicide attempt. We know little about how to predict the risk for suicide. It is hard to build evidence of effective treatments and prevention efforts from the small number of private, individual conversations that far-flung clinicians have with suicidal patients and their parents.
There is, however, a treasure trove of data from suicide conversations that could be analyzed to help clinicians better understand how to interact and treat patients with suicidal thoughts. Mental health researchers are increasingly analyzing tweets and Facebook messages to find out who is suicidal. One startup, Qntfy, has even asked individuals to donate their social media posts to better understand suicide prevention.
Social media is not going anywhere. Trying to keep young people from using it is unrealistic. Rather than closing our eyes to it, clinicians should leverage this extraordinary opportunity to improve mental health care by using social media. And we also have a responsibility to meet our patients where they are — online.
Kunmi Sobowale, MD, is a resident in psychiatry at Yale-New Haven Hospital.