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Keywords:

  • deliberate self-harm;
  • Internet;
  • search engine;
  • self-injury;
  • young adults

Abstract

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. ACKNOWLEDGMENTS
  7. REFERENCES

This study aimed to clarify the association between the experience of searching for deliberate self-harm (DSH)-related Internet content and the mental states and lifetime suicidal behaviors of Japanese young adults (n = 1000) using an online questionnaire. The results were assessed using χ2 and t-tests, which revealed that the experience of DSH-related Internet searches may be significantly associated with lifetime suicidal behaviors (including DSH), suicidal ideation, and tendencies towards depression/anxiety. We discussed the possibility of using search engines to increase the motivation of Japanese young adults who deliberately harmed themselves with regard to seeking help.

DELIBERATE SELF-HARM (DSH) is a common mental health problem among young adults.1 Although its association with future suicide is well known,2 people who have deliberately harmed themselves have low motivation to seek help.3

The Internet, particularly search engines, may provide an effective solution to this problem, as this technology gives users anonymity and reduces the economic and temporal costs of seeking help.4 Therefore, DSH countermeasures that use search engines have been implemented in Japan. These include a facility whereby, when a search for DSH-related information is performed, links to websites that provide information on available consulting services are shown in a prominent position on the results page.

However, little is known about mental states and lifetime suicidal behaviors in young adults searching for DSH-related information. Therefore, this study aimed to clarify the association between the experience of conducting DSH-related searches and the mental states and lifetime suicidal behaviors of Japanese young adults.

METHODS

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. ACKNOWLEDGMENTS
  7. REFERENCES

Participants

This study was conducted after a review by the research ethics committee of the university to which the first author belonged. In February 2011, a survey was carried out with registrants of a major Internet survey company in Japan. Given the research budget, we agreed to obtain 250 responses from each group consisting of male and female respondents in their twenties or thirties (1000 responses in total). A total of 1836 persons who were randomly selected from among the registrants received requests to answer the online questionnaire via email. The number of requests was determined considering the expected response rate that was calculated on the basis of the past survey conducted by this company. A total of 1302 people agreed to participate and 1060 people completed the questionnaire. The data of 1000 respondents, who were randomly selected from the 1060 people according to the agreement with the research company, were used. The final sample of 1000 respondents comprised 500 men and 500 women with a mean age of 30.6 years (SD = 5.4).

Procedure

Participants were asked whether they had used each of the three search terms (jishou[self-injury], risuto katto[wrist-cutting], and obadozu[overdose] in the past; e.g. ‘Have you ever searched for the word “self-injury” on the Internet?’). These three terms were selected from among commonly used ones in DSH-related Internet searches. We used Google Insights for Search (http://www.google.com/insights/search/) to identify frequently used search terms related to DSH. The Japanese Version of the Scale for Suicidal Ideation was used to measure this variable.5 This scale consists of one factor and 13 items. Participants assigned a score in the range of 0–2 to each response, with higher scores representing higher suicidal ideation. The Japanese version of K6 (six items) was used to measure tendencies of depression/anxiety.6 For each item, a response to the question asked was rated using a 5-point scale, ranging from one point for ‘Not at all’ to five points for ‘Always.’ Participants were asked whether they had deliberately harmed themselves in the past, thought of death in the past, planned suicide, and whether they had previously attempted suicide. All questions were binary-choice items (Yes/No).

Statistical analysis

The data were analyzed using spss (version 19, spss, Chicago, IL, USA). Data for participants who had searched for the target words (DSH-search group) were aggregated, and compared to participants who did not search for these words. In a comparison of participants with and without DSH-related search experience, the t-test was employed for continuous data and the χ2-test was used for categorical data. The dependent variables investigated reflected the present mental state deeply relevant to suicide and lifetime suicidal behaviors, including DSH. The significance level was set at P < 0.05, and all P were two-tailed.

RESULTS

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. ACKNOWLEDGMENTS
  7. REFERENCES

The number of people who had searched for jishou (self-injury) was 20 (2.0%), while 43 (4.3%) had searched for risuto katto (wrist-cutting), and 35 (3.5%) had searched for obadozu (overdose). A t-test showed that scores of suicidal ideation and tendency towards depression/anxiety were significantly higher in the DSH-search group (mean = 6.5, SD = 5.2; mean = 14.7, SD = 6.3) compared with the non-DSH-search group (mean = 2.4, SD = 3.4; mean = 10.3, SD = 4.9) (t = 6.34, P < 0.001; t = 5.57, P < 0.001) (see Table 1). Furthermore, χ2-test analysis showed that there was a significantly higher ratio of lifetime DSH (χ2 = 100.56, d.f. = 1, P < 0.001), thoughts of death (χ2 = 43.41, d.f. = 1, P < 0.001), suicide plan (χ2 = 56.71, d.f. = 1, P < 0.001), and previous attempted suicide (χ2 = 20.87, d.f. = 1, P < 0.001) in the DSH-search group compared to the non-DSH-search group.

Table 1.  Comparison between internet users with and without search experience related to DSH
Dependent variablesInternet users with search experience related to DSHInternet users without search experience related to DSHTest statisticP
(n = 67)(n = 933)tχ2
  • Cronbach's coefficient alpha.

  • DSH, deliberate self-harm.

Mental state scores: mean (SD)     
 Suicidal ideation (a = 0.92)6.5 (5.2)2.4 (3.4)6.34 <0.001
 Depression/anxiety tendency (a = 0.93)14.7 (6.3)10.3 (4.9)5.57 <0.001
Lifetime suicidal behaviors: n (%)     
 Deliberate self-harm31 (46.3)72 (7.7) 100.56<0.001
 Thought of death46 (68.7)277 (29.7) 43.41<0.001
 Suicide plan26 (38.8)84 (9.0) 56.71<0.001
 Attempted suicide13 (19.4)50 (5.4) 20.87<0.001

DISCUSSION

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. ACKNOWLEDGMENTS
  7. REFERENCES

To our knowledge, this is the first study to examine the association between the experience of DSH-related Internet searches and mental state and lifetime suicidal behaviors. The present study found that 46.3% of young adults in the DSH-search group reported a lifetime of DSH. It also determined a significant correlation between all lifetime suicidal behaviors (DSH, thought of death, suicide plan, and attempted suicide) and DSH-related searches. In addition, at the time of the survey, the DSH-search group had significantly high suicidal ideation and depression/anxiety tendency compared to the non-DSH-search group. These findings suggest that an individual from the DSH-search group is more likely to require help than an individual from the non-DSH-search group and that the display of keyword-targeted advertisements which provide information about support services on DSH-related search pages may facilitate help-seeking behaviors.

What is the suicide risk in the DSH-search group? A K6 (depression/anxiety tendency) score of 12 to 24 was considered very high risk of being diagnosed with mental disorders.6 A look at the results of the present research reveals that the K6 point average of the DSH-search group (14.7) is comparable to that figure, and that there is therefore a high possibility of this group including a large number of individuals who may have a diagnosable mental disorder. In addition, approximately 20% of the DSH-search group had previously attempted suicide, which is the major predictor of future suicide.7 Over 90% of young adults use the Internet,8 so implementing care for those who have deliberately harmed themselves may link to suicide prevention in this entire subpopulation.

The present study has some limitations. These include sampling bias and a lack of consideration of the possible influence of the search experience on subsequent suicidal behaviors and mental health. However, despite these shortcomings, the results of the present study contribute to the possibility of using Internet search engines to prevent DSH and suicide in Japanese young adults.

ACKNOWLEDGMENTS

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. ACKNOWLEDGMENTS
  7. REFERENCES

This research was supported by the Japan Society for the Promotion of Science (10J09470). There is no conflict of interest.

REFERENCES

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. ACKNOWLEDGMENTS
  7. REFERENCES
  • 1
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    Evans E, Hawton K, Rodham K. In what ways are adolescents who engage in self-harm or experience thoughts of self-harm different in terms of help-seeking, communication and coping strategies? J. Adolesc. 2005; 28: 573587.
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    Huang MP, Alessi MP. The internet and the future of psychiatry. Am. J. Psychiatry 1996; 153: 861869.
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    Otsuka A, Seto M, Kanno J, Agari I. Development of the suicide ideation scale for Japanese and a study of the factors related to suicide ideation. Jpn. J. Counsel. Sci. 1998; 31: 247258 (in Japanese).
  • 6
    Furukawa TA, Kessler R, Andrews G, Slade T. The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being. Psychol. Med. 2003; 33: 357362.
  • 7
    Suokas J, Suominen K, Isometsä E, Ostamo A, Lönnqvist J. Long-term risk factors for suicide mortality after attempted suicide: Findings of a 14-year follow-up study. Acta Psychiatr. Scand. 2001; 104: 117121.
  • 8
    Japanese Ministry of Internal Affairs and Communications. Trend survey on telecom use in 2010. 2011. [Cited 16 Nov 2011.] Available from URL: http://www.soumu.go.jp/johotsusintokei/statistics/pdf/HR201000_002.pdf (last accessed 16 November 2011).