The association of exposure to suicide-related Internet content and emergency department visits in children: A population-based time series analysis

Abstract

OBJECTIVES: Suicide-related emergency department (ED) visits by children are increasing in tandem with suicide-related Internet content. Following the announcement of Amanda Todd's suicide, her YouTube video received widespread views, providing an opportunity to explore this association.METHODS: Our research question was: Among Ontario children age 11-17 years, was the release of Amanda Todd's YouTube video following her death announcement in October 2012 associated with an increase in average monthly ED visit rates for suicide-related diagnoses? We performed an interrupted time series analysis from April 2002 to December 2013, with the primary outcome as a composite of the average monthly rate of initial ED visits for suicidal ideation, intentional self-poisoning, and intentional self-harm. Secondary outcomes were average monthly rates of intensive care unit (ICU) admission and death resulting from the index visit. RESULTS:There was a statistically significant increase in the monthly ED visit rate for the composite outcome (p = 0.02) and death or ICU admission (p = 0.006) from April 2002 to December 2013. There was no significant change in ED visit rate for the composite outcome before and after the announcement of Amanda Todd's death, overall (119.8 versus 219.2 respectively, p = 0.5), among females (167.4 versus 316.8 respectively, p = 0.47) or among males (74.7 versus 116.9 respectively, p = 0.33). CONCLUSIONS:Ontario ED visits for suicide-related diagnoses in 11-17 year olds increased from 2002 to 2013. However, the increase from October 2012 to December 2013 could not be attributed to a highly publicized adolescent suicide. Our findings suggest that suicide-related Internet content is not associated with the increase in ED visits for suicidal behaviour.KEY WORDS: Internet; suicidal behaviour; emergency department La traduction du résumé se trouve à la fin de l'article.

Impact of Web-Based Sharing and Viewing of Self-Harm–Related Videos and Photographs on Young People: Systematic Review (Preprint)

“…However, the time-related analysis of images did not indicate any effects of imitation or reinforcement [31]. A separate time series analysis did not find an increase in average monthly emergency department visits for suicide-related diagnoses in Ontario children aged 11-17 years following posting and publicity of a young person's YouTube video who took their own life [37]. This showed the young person holding up cards telling a story of bullying, mental health issues, and self-harm, with an image of self-harm injuries at the end.…”

“…There was also a significant association between wound grade and number of comments [31]. Time-related analyses did not support any effects of contagion or reinforcement [31,37] • Participants reported that a lack of moderation on Tumblr and the freedom to view and share the most stark and severe images had led to normalization and exacerbation of self-harm. One participant stated that their self-harm had escalated from little gashes to severe injuries and cutting through arteries [9] Reduction in self-harm urges…”

“…Other YouTube videos varied in content, including fire challenge videos in which an individual doused themselves in a flammable liquid, set themselves alight, and attempted to extinguish the flames before serious burns are inflicted [29]. This was 1 of only 2 studies [29,37] included in this review in which the majority of participants were male (45/50, 90%).…”

“…Although time series analyses were conducted in 2 studies [31,37], the limitations of these analyses indicate the need for further studies to examine the impact of self-harm imagery.…”

“…Only English language publications were included in the analysis. Females outnumber males, where this information was available, in all but 2 studies, one of videos related to the fire challenge [29] and a time series analysis of emergency department attendance [37]. One study reported that males were more likely than females to report negative impacts of self-harm images [39].…”