Residents of the cities with the lowest suicide rates located in the state of São Paulo (Registro and São José dos Campos) posted more about the subject on Twitter but, contrary to what one imagined, most posts did not contain harmful content, did not express suicidal intentions, behavior or suffering.
The results are part of the doctoral thesis of Camila Corrêa Matias Pereira, defended at the EERP (Ribeirão Preto School of Nursing) at USP.
The study also presented general advice on how to communicate on the subject. The replacement of terms such as “commit suicide” (which associates suicide with crime), “successful suicide attempt” (which can give a positive connotation), “attempt to end one’s life”, “non-fatal suicide attempt “, “consummate suicide” by “death by suicide” was strongly recommended.
The objective of this work was to analyze the messages on the social network Twitter about suicide, to investigate the scientific evidence on recommendations and best practices for safe communication about suicidal behavior in the online environment, in addition to identifying the obstacles and facilitators of safe communication in the discursive productions and messages, support related to the subject.
In the first part of the work, Camila examined 804 posts made from the start of Twitter, in 2006, until the period in which the research was carried out, June 21, 2018.
The posts came from four cities in the state of São Paulo: Marília and Ribeirão Preto, which had the highest suicide rates during the study period (rates greater than 7.5 deaths per 100,000 inhabitants); and Registro and São José dos Campos, which had the lowest figures (less than 5.5 deaths per 100,000 inhabitants).
Data is from State Data Analysis System Foundation (SEADE) 2016.
In the state of São Paulo, data published by the Secretary of State for Health showed that in 2019 alone, 2,365 people died by suicide, which is equivalent to a rate of 6.13 deaths for 100,000 inhabitants.
Most of the posts consisted of tweets (84%) written by women (60%) in the first person (64%), without mentioning a method of suicide (98%) or individual suicidal behavior (72%).
It was also found that posts with preventive content were about eight times more likely to receive likes compared to pro-suicide posts (25% vs. 12%, respectively).
“One issue that caught our attention was that people who expressed grief and suicidal ideation posted more pro-suicide messages and had little feedback about the needs they were expressing,” says Kelly Giacchero, a professor at the Camila’s EERP and Mentor. “This finding shows that seeking support on virtual social networks has been a dangerous way to ask for help.”
In the second step, the researcher performed a systematic review of the literature to determine whether scientific evidence supports recommendations and best practices for safe communication about suicidal behaviors in the online environment. Of the 429 articles initially selected, four were included in the study after application of the eligibility criteria.
Camila identified several recommendations. Among them, encouraging help-seeking, emphasizing prevention, encouraging the search for social support, among others.
The use of clichéd imagery (such as a person holding their head in their hands) has also emerged in literature as something to be avoided. “But it is important to emphasize that the observations are not supported by empirical data, that is to say that they are intuitive suggestions,” emphasizes Camila. “Nevertheless, we saw that the change could reduce stigma or the perception of a pejorative term.”
third phase
In the last stage of the research, Camila carried out a qualitative study and identified barriers, facilitators and ambiguous aspects regarding safe communication and suicidal behavior.
Through an online questionnaire, 338 literate Internet users with an active email or Facebook account were interviewed between October 2018 and February 2019. Questions ranged from personal matters to past experiences with people at risk of suicide.
Facilitators related to professional help, the propensity to offer help and the possibility of overcoming have been identified.
According to Camila, approaches to improving young people seeking mental health help should consider the role of the internet and online resources as an important complement to offline help.
At the same time, health professionals working with young people must be informed of crisis management plans to better understand a risky situation.
The role of social, family and friend support is associated with a reduced risk of suicidal behavior. Suicide prevention strategies should aim to develop psychological skills, reduce risk factors and promote protective factors, such as resilience, for example.
Lack of preparedness to process information was highlighted as one of the barriers to safe suicide communication. “There is a deficit in the formation of society to deal with the issue, which can contribute to the emotional discomfort of professionals and to the limitation of the possibilities of taking care of people with suicidal behavior”, describes Camila in her thesis. .
Among the ambivalent possibilities, a very present category was that of religiosity. The relationship between suicidal behavior is complex, according to the researcher.
“In the same way that it presents protective factors, it can also represent risk factors,” explains Camila. “Each religion manifests different strategies to deal with the situation.”
“Overall, the study revealed how communication about suicide on the Internet is still not safe, that is, it has weaknesses that can increase risk and make it difficult to looking for help,” says Kelly.
“It also presents a synthesis of some international recommendations on safe communication for the prevention of suicide in the virtual environment and reveals some gaps in scientific knowledge on this subject.”
worldwide mortality
A report published by the World Health Organization (WHO) in June 2021 pointed out that suicide is one of the leading causes of death worldwide, ahead of diseases such as HIV infections, malaria and breast cancer. breast, and even wars and homicides.
In 2019 alone, 700,000 people committed suicide, which equates to 1 in 100 deaths. These figures have prompted the WHO to produce new guidance to help countries improve suicide prevention.
As Kelly tells Jornal da USP, there are still many gaps related to suicide prevention in our country, including the lack of a national plan with goals, strategies, resources, responsible people and indicators. feedback.
“There are promising prevention programs, but there are still significant gaps that compromise the sustainability and reach of the actions.”
Camila has been working on the subject since graduating, when she started her science initiation project. At the master’s level, the nurse did a study on suicidal behavior in preventive and pro-suicide blogs. In his doctorate, he decided to delve a little deeper.
“In addition to my thesis itself, my group has done several other works on this subject on other platforms, such as Tumblr. According to social networks, suicidal behaviors can be expressed differently and this question deserves to be deepened” , he explains. . .
Camila’s research has prompted several questions and actions related to suicide prevention. “We are currently developing an e-book on mental health, suicidal behaviors and screen use, and we are also developing strategies to train professionals in suicide prevention in virtual environments, including high-fidelity simulation scenarios where students can have hands-on care experiences after a previous training period,” Kelly concludes.