Equal access to online information? Google’s suicide-prevention disparities may amplify a global digital divide

Abstract

Worldwide, people profit from equally accessible online health information via search engines. Therefore, equal access to health information is a global imperative. We studied one specific scenario, in which Google functions as a gatekeeper when people seek suicide-related information using both helpful and harmful suicide-related search terms. To help prevent suicides, Google implemented a “suicide-prevention result” (SPR) at the very top of such search results. While this effort deserves credit, the present investigation compiled evidence that the SPR is not equally displayed to all users. Using a virtual agent-based testing methodology, a set of 3 studies in 11 countries found that the presentation of the SPR varies depending on where people search for suicide-related information. Language is a key factor explaining these differences. Google’s algorithms thereby contribute to a global digital divide in online health-information access with possibly lethal consequences. Higher and globally balanced display frequencies are desirable.

Detecting Intentional Self-Harm on Instagram: Development, Testing, and Validation of an Automatic Image-Recognition Algorithm to Discover Cutting-Related Posts

“…Given the importance of language for NSSI-related stigma, on the one hand, and facilitating NSSI disclosure and help-seeking, on the other hand (see Hasking & Boyes, 2018), the context in which NSSI posts are likely to appear is relevant. The meaning of language for individual suicidality (Arendt, Scherr, Niederkrotenthaler, & Till, 2018) and in algorithm-shaped online environments (Scherr, Haim, & Arendt, 2019) has only recently begun to attract more scholarly attention. The present findings can thus be regarded as a continuation of this line of research, particularly shedding light on the role of language on users’ self-categorized NSSI-related behaviors that are publicly shared online.…”

The Opioid-Overdose Crisis and Fentanyl: The Role of Online Information Seeking via Internet Search Engines

“…Before elaborating further on the info box (i.e. a "drug overdose-prevention result"), research has yet to show, in a first step, that users' searches for fentanyl are actually linked to opioid-related overdose deaths (for a similar argumentation, see Scherr et al, 2019). In fact, the strength of the relationship between the number of fentanyl searches and actual death statistics points to the potential importance of such info boxes.…”

“…There is already existing research related to using Google as a public health intervention (Scherr et al, 2019): The info box in the drug domain should be similar to the suicide domain where the search engine Google already presents an info box called the "suicide-prevention result" to some of its users (e.g., when searching for "painless suicide method"; see). This info box in the suicide domain is prominently displayed at the top of the search results and depicts important online and offline help resources such as country-specific helpline telephone numbers, crisis chat rooms, and websites.…”

“…Such an info box can be understood as a tailored awareness message that appears exactly when users search for drug-related terms (Scherr et al, 2019): Accordingly, this info box can present potentially protective information at the exact moment when it is apparently needed, which is a beneficial temporal contiguity. Thus, while Young et al (2018) focused on opioid-related search engine use for monitoring opioid use (because of the poor data quality)a very important endeavor -, we emphasize the search engine's potential as a public health intervention.…”

“…Thaler and Sunstein (2008) argued that good architects make design choices that will elicit benefical effects. Importantly, the relevance of an info box containing potetnially protective information such as a reference to counseling services cannot be underestimated (Scherr et al, 2019): First, there was an estimated increase in hotline calls in the United States of around 9% in the months after the implementation of an info box in the suicide domain which presented the telephone number (Google Official Blog, 2010, November). Second, field studies show that callers' suicidal ideation, suicidal urgency, intent to die, hopelessness, and psychological pain could be reduced during telephone counseling, and even continued to decrease in the weeks after the call (Gould et al, 2017;Knox and Bossarte, 2009).…”