Eight online factors linked to suicidal behavior in youth

Cyberbullying, as well as content related to drugs, depression and violence, were major risk factors for subsequent youth suicide-related behavior, according to results of a matched case-control study published in JAMA Network Open.

“Most prior studies on youth suicide and online activities have focused only on screen time,” Steven A. Sumner, MD, MSc, of the CDC’s National Center for Injury Prevention and Control, told Healio Psychiatry. “In our study, we took a detailed look at the specific online activities that came before youth suicidal behavior.”

Prior studies that examined possible links between online activities and youth suicide were limited by their reliance on survey data and a focus on risk related to overall screen time. In the current study, Sumner and colleagues aimed to investigate the correlation between various online risk factors and youth suicide-related behavior via real-world online activity data between July 27, 2019, and May 26, 2020. The sample included more than 2,600 U.S. schools that participated in an online safety monitoring program via the Bark online safety tool.

The researchers matched 227 youths who had a severe suicide/self-harm alert that required notification of school administrators in a 1:5 ratio to 1,135 controls (all participants, mean age, 13.3 years; 51.3% boys) on location, amount of follow-up time and general online activity volume. Evaluated online risk factors included eight related to cyberbullying, violence, drugs, hate speech, profanity, sexual content, depression and low-severity self-harm, which were assessed through text, image and video data.

Results showed differences between case and control populations, as well as significant associations with subsequent severe suicide/self-harm alerts upon assessing total direct and indirect pathways, for all eight online risk factors. The researchers reported adjusted ORs for the associations ranged from 1.17 (95% CI, 1.09-1.26) for drug-related content to 1.82 (95% CI, 1.73-2.03) for depression-related content. They noted an exponentially increased risk for severe suicide/self-harm alerts upon consideration of the total number of varying types of online risk factors among the eight measured. The risk for subsequently having a severe suicide/self-harm alert increased 70 times among those with at least five of the eight risk factors present in their online activity (aOR = 78.64; 95% CI, 34.39-179.84).

“Many parents are concerned about youth suicide and want to help their children more but don’t know how to address the new online risks that children are facing today,” Sumner said. “It’s important to emphasize that suicide is preventable, and our study shows that close attention to what children are exposed to and posting online can potentially help parents and caregivers assist them earlier.”