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  • 1.
    Durkee, Tony
    et al.
    The National Swedish Prevention of Suicide and Mental Ill-Health (NASP), Karolinska instituter .
    Hadlaczky, Gergo
    The National Swedish Prevention of Suicide and Mental Ill-Health (NASP), Karolinska instituter .
    Westerlund, Michael
    Stockholm University, Faculty of Humanities, Department of Journalism, Media and Communication (JMK).
    Carli, Vladimir
    The National Swedish Prevention of Suicide and Mental Ill-Health (NASP), Karolinska instituter .
    Internet pathways in suicidality: A review of the evidence2011In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 8, no 10, p. 3938-3952Article in journal (Refereed)
    Abstract [en]

    The general aim of this study was to review the scientific literature concerning the Internet and suicidality and to examine the different pathways by which suicidal risks and prevention efforts are facilitated through the Internet. An online literature search was conducted using the MEDLINE and Google Scholar databases. The main themes that were investigated included pathological Internet use and suicidality, pro-suicide websites, suicide pacts on the Internet, and suicide prevention via the Internet. Articles were screened based on the titles and abstracts reporting on the themes of interest. Thereafter, articles were selected based on scientific relevance of the study, and included for full text assessment. The results illustrated that specific Internet pathways increased the risk for suicidal behaviours, particularly in adolescents and young people. Several studies found significant correlations between pathological Internet use and suicidal ideation and non-suicidal self-injury. Pro-suicide websites and online suicide pacts were observed as high-risk factors for facilitating suicidal behaviours, particularly among isolated and susceptible individuals. Conversely, the evidence also showed that the Internet could be an effective tool for suicide prevention, especially for socially-isolated and vulnerable individuals, who might otherwise be unreachable. It is this paradox that accentuates the need for further research in this field.

  • 2. Hökby, Sebastian
    et al.
    Hadlaczky, Gergö
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Wasserman, Danuta
    Balazs, Judit
    Germanavicius, Arunas
    Machín, Núria
    Meszaros, Gergely
    Sarchiapone, Marco
    Värnik, Airi
    Varnik, Peeter
    Westerlund, Michael
    Stockholm University, Faculty of Humanities, Department of Media Studies.
    Carli, Vladimir
    Are Mental Health Effects of Internet Use Attributable to the Web-Based Content or Perceived Consequences of Usage? A Longitudinal Study of European Adolescents2016In: JMIR Mental Health, ISSN 2368-7959, Vol. 3, no 3, article id e31Article in journal (Refereed)
    Abstract [en]

    Background: Adolescents and young adults are among the most frequent Internet users, and accumulating evidence suggests that their Internet behaviors might affect their mental health. Internet use may impact mental health because certain Web-based content could be distressing. It is also possible that excessive use, regardless of content, produces negative consequences, such as neglect of protective offline activities.

    Objective: The objective of this study was to assess how mental health is associated with (1) the time spent on the Internet, (2) the time spent on different Web-based activities (social media use, gaming, gambling, pornography use, school work, newsreading, and targeted information searches), and (3) the perceived consequences of engaging in those activities.

    Methods: A random sample of 2286 adolescents was recruited from state schools in Estonia, Hungary, Italy, Lithuania, Spain, Sweden, and the United Kingdom. Questionnaire data comprising Internet behaviors and mental health variables were collected and analyzed cross-sectionally and were followed up after 4 months.

    Results: Cross-sectionally, both the time spent on the Internet and the relative time spent on various activities predicted mental health (P <. 001), explaining 1.4% and 2.8% variance, respectively. However, the consequences of engaging in those activities were more important predictors, explaining 11.1% variance. Only Web-based gaming, gambling, and targeted searches had mental health effects that were not fully accounted for by perceived consequences. The longitudinal analyses showed that sleep loss due to Internet use (beta =. 12, 95% CI=0.05-0.19, P =. 001) and withdrawal (negative mood) when Internet could not be accessed (beta =. 09, 95% CI=0.03-0.16, P <. 01) were the only consequences that had a direct effect on mental health in the long term. Perceived positive consequences of Internet use did not seem to be associated with mental health at all.

    Conclusions: The magnitude of Internet use is negatively associated with mental health in general, but specific Web-based activities differ in how consistently, how much, and in what direction they affect mental health. Consequences of Internet use (especially sleep loss and withdrawal when Internet cannot be accessed) seem to predict mental health outcomes to a greater extent than the specific activities themselves. Interventions aimed at reducing the negative mental health effects of Internet use could target its negative consequences instead of the Internet use itself.

  • 3. Krysinska, Karolina
    et al.
    Westerlund, Michael
    Stockholm University, Faculty of Humanities, Department of Media Studies.
    Niederkrotenthaler, Thomas
    Andriessen, Karl
    Carli, Vladimir
    Hadlaczky, Gergö
    Till, Benedikt
    Wasserman, Danuta
    A Mapping Study on the Internet and Suicide2017In: Crisis, ISSN 0227-5910, E-ISSN 2151-2396, Vol. 38, no 4, p. 217-226Article in journal (Refereed)
    Abstract [en]

    Background: Since the mid-1990s concerns have been raised regarding the possible links between suicide and the Internet, especially among adolescents and young adults. Aims: To identify the nature and extent of the scientific publications, especially original research studies, on suicide and the Internet, and to investigate how the field has developed over time. In particular, this mapping study looks at types of publications, topic areas, focus of original research papers, and suicide-related variables of interest in publications. Method: A search of three major databases (PubMED, PsycINFO, and Sociological Abstracts) was conducted to identify papers published until the end of January 2015. Results: The study identified 237 publications on suicide and the Internet published from 1997 to the end of January 2015. These included 122 original research papers. The three most frequent topic areas covered in publications were searching for information on suicide, online interventions, and online suicide-related behaviors. The online mediums most frequently studied were online forums/message boards, search engines, intervention and information websites, and social media. Limitations: The mapping study did not include an analysis of results of research studies and did not assess their quality. Conclusion: The field is rapidly evolving, as seen in the recent increase in the number of publications. However, there are gaps in terms of the countries where research is conducted and the coverage of topics.

  • 4.
    Westerlund, Michael
    Stockholm University, Faculty of Humanities, Department of Media Studies, JMK.
    Att önska dö: Samtal om självmord på internet2012In: Döden i medierna: Våld, tröst, fascination / [ed] Anja Hirdman, Stockholm: Carlsson Bokförlag, 2012, p. 159-187Chapter in book (Other academic)
  • 5.
    Westerlund, Michael
    Stockholm University, Faculty of Humanities, Department of Media Studies, JMK.
    Kommunikation om självmord på Internet: Risker och möjligheter2014In: Tidskriften för svensk psykiatri, ISSN 1653-8579, no 4, p. 34-35Article in journal (Other academic)
    Abstract [sv]

    Den digitala kommunikationen på internet har haft en omvälvande inverkan på individ och samhälle och också inneburit att skillnaden mellan den personliga, intima kommunikationen och den offentliga, publika kommunikationen delvis har suddats ut, vilket också får konsekvenser för hur självmordsämnet utvecklas och hanteras. För unga personer som överväger självmordshandlingar är internet idag den primära källan för information, kommunikation och hjälpsökande. Internet är inte en låtsasvärld, den befolkas av riktiga människor med olika sociala och kulturella bakgrunder. Och det som händer på internet får konsekvenser för verkliga människor. Delar av internet kan, och bör, därför ses som en typ av virtuella sociala miljöer där människor möts och utbyter tankar, känslor och erfarenheter. 

  • 6.
    Westerlund, Michael
    Stockholm University, Faculty of Humanities, Department of Journalism, Media and Communication (JMK).
    Självmord och Internet: Kommunikation om ett livsfarligt ämne2010Doctoral thesis, monograph (Other academic)
    Abstract [en]

    With suicide still a taboo subject in contemporary society, websites and discussion forums on the Internet have become an important and controversial source of information. Through the Internet, the distinction between personal, intimate communication and public communication has blurred, which also has consequences for how the question of suicide is addressed in society.

    The aim of this dissertation is to examine how the subject of suicide is communicated, represented and addressed in the global and increasingly dominant communication platform of the Internet. Central to this purpose is the analysis and investigation of the discourses about suicide which are constructed and reconstructed by actors on the Internet, and how these discourses relate to each other and to the overarching social and socio-cultural context.

    The dissertation’s analyses are based on three Internet materials: (1) Google searches of the terms självmord and suicide; (2) Websites with a pronounced pro-suicide or suicide prevention content; (3) Discussion on Internet forums where suicide is the main topic.

    One of the central aspects that this dissertation points to is the struggle that plays out on the Internet between two distinct approaches to suicide, which feed into completely incompatible understandings and valuations of humanity and society. The dominant suicide preventative discourse takes the position that suicide is such a threatening and destructive act for society as a whole that it cannot solely be handled by the individual. Representatives of the pro-suicide discourse support the opposite view, in which suicide is considered an acceptable way for the individual to ‘solve’ major problems in their lives. Through the Internet’s expansion, actors supporting both views have found new ways of formulating their messages and reaching out to different audiences.

  • 7.
    Westerlund, Michael
    Stockholm University, Faculty of Humanities, Department of Media Studies, JMK. Karolinska Institutet, Sweden.
    Talking Suicide: Online Conversations about a Taboo Subject2013In: Nordicom Review, ISSN 1403-1108, E-ISSN 2001-5119, Vol. 34, no 2, p. 35-46Article in journal (Refereed)
    Abstract [en]

    The present article discusses intimate conversations about suicide that are pursued on the Internet. Computer-mediated communication has made it possible for participants to remain anonymous and, simultaneously, enter into a public space to share personal thoughts about a stigmatized and taboo subject. This has also created new and unique opportunities to study a type of communication that was previously very difficult to access. Most of the participants on the studied forum are teenagers or young adults who communicate based on a need to recognize themselves in others, and to receive acknowledgement for their thoughts, feelings and experiences, thereby gaining acceptance and understanding. However, there are also destructive elements in the form of an exchange of suicide methods and participants exhorting each other to go ahead with their suicide plans. Moreover, participants are able to practise suicide behaviour in a mediated, conversational form, thereby making the act seem less fearful. The participants are furthermore involved in constructing and re-constructing a counter-discourse in which established society’s perceptions and values concerning suicide are questioned, as expressed in a critique against public institutions, mainly psychiatry.

  • 8.
    Westerlund, Michael
    Stockholm University, Faculty of Humanities, Department of Journalism, Media and Communication (JMK).
    The production of pro-suicide content on the Internet: A counter-discourse activity2012In: New Media and Society, ISSN 1461-4448, E-ISSN 1461-7315, Vol. 14, no 5, p. 764-780Article in journal (Refereed)
    Abstract [en]

    Pro-suicide websites are topping search engine result lists, raising fears about the internet's detrimental influence on behaviour and attitudes related to suicide. Based on a qualitative analysis, this article argues that the production of pro-suicide content on the internet should be seen as a counter-discourse, directed against socially dominant perceptions of suicide. On pro-suicide websites, the description of technical, chemical and anatomic details, the expression of honourable and clearly individualistic ideals, the depictions of morbid bodily violence, together with the absence of emotional content could all be said to represent a kind of constructed Western masculinity. Furthermore, because of its potential for identity gain and the acting out of aggressive impulses, it is crucial - although this may seem somewhat paradoxical - to understand the production of the pro-suicide content as a manifestation of what is, for the participants, a meaningful practice.

  • 9.
    Westerlund, Michael
    et al.
    Stockholm University, Faculty of Humanities, Department of Media Studies, JMK. Karolinska Institutet, Sweden.
    Hadlaczky, Gergo
    Wasserman, Danuta
    Case study of posts before and after a suicide on a Swedish internet forum2015In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 207, no 6, p. 476-482Article in journal (Refereed)
    Abstract [en]

    Websites and discussion forums have become an important and sometimes controversial source of information on suicide. Using a case report, our aim was to examine the responses, attitudes and beliefs that were communicated on a forum before, during and after a suicide act. We undertook two related analyses: a qualitative investigation of the messages that were posted before the suicide and a combined qualitative-quantitative analysis of the messages posted during and after the suicide. Nearly half the posted messages before the suicide encouraged the victim to complete the suicidal act, and a surprising number of posts after the suicide expressed excitement, although around half of the posts considered the suicide to be tragic. It is of great importance to increase awareness of suicide signals and understanding about how to respond to individuals who communicate suicide intentions on different forums on the internet.

  • 10.
    Westerlund, Michael
    et al.
    Stockholm University, Faculty of Humanities, Department of Media Studies, JMK. Karolinska Institutet, Sweden.
    Hadlaczky, Gergo
    Wasserman, Danuta
    The Representation of Suicide on the Internet: Implications for Clinicians2012In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 14, no 5, article id e122Article in journal (Refereed)
    Abstract [en]

    Background: Suicide is one of the major causes of death in the world, leading to approximately 1 million deaths per year. While much of what is said about suicide and its causes is still taboo in most contemporary societies and cultures, internet websites and discussion forums have become an important and controversial source of information on the subject. A great deal of ambivalence is discernible as to whether online communication about suicide primarily should be seen as an opportunity or a serious threat. Objective: To investigate how the subject of suicide is represented on the Internet, based on hits generated by the search engine Google. Methods: In an exploratory design, Google search results on the target word "suicide", for the years 2005, 2009, and 2012 respectively, were systematically analyzed and compared. Results: The study shows that web pages of institutional origin on the subject predominate, that the content provided by these institutions concerns primarily research and prevention, and that the form of communication used by these senders is almost exclusively monological. However, besides these institutional pages there are a substantial number of private senders and pages, often anti-medical and against treatment of depression and other mental problems, characterized by dialogue, confessions and narratives, and to a higher degree, an alternative pro-suicide stance. Conclusions: To counteract the influence of anti-medical and pro-suicide information, the role of the Internet should be discussed with the patient in clinical practice. Dialogical and confessional communications provide an opportunity for the clinician to gain a deeper perspective into perceptions of patients, regarding both their afflictions and the role of medical treatment in their lives.

  • 11.
    Westerlund, Michael
    et al.
    Stockholm University, Faculty of Humanities, Department of Media Studies.
    Hadlaczky, Gergö
    Carli, Vladimir
    Wasserman, Danuta
    Psykisk hälsa, självmord och Internet2012In: Psykisk hälsa, ISSN 0033-3212, Vol. 53, no 2, p. 34-40Article in journal (Other academic)
  • 12.
    Westerlund, Michael
    et al.
    Stockholm University, Faculty of Humanities, Department of Journalism, Media and Communication (JMK).
    Schaller, Sylvia
    Otto-Selz-Institute fur Psychologie / University of Mannheim.
    Schmidtke, Armin
    University of Wurzburg, Department of Psychiatry.
    The role of mass-media in suicide prevention2009In: Oxford Textbook of Suicidology and Suicide Prevention: A Global Perspective / [ed] Danuta Wasserman & Camilla Wasserman, New York: Oxford University Press , 2009, p. 515-523Chapter in book (Other academic)
    Abstract [en]

    Although disputed, most researchers in the field of suicide and massmedia agree that the studies carried out to date have substantiated the existence, under certain circumstances, of genuine 'contagion' from suicide reports in the media. The fact that many studies have demonstrated an association between media reporting of suicide and actual suicidal behaviour has also prompted the issue of various types of recommendations on how the media should report on the subject of suicide to avoid imitative behaviour. The purpose of this chapter is to discuss and identify the problems associated with research on suicide and the media, with a number of seminal articles published over the years serving as examples.

  • 13.
    Westerlund, Michael
    et al.
    Stockholm University, Faculty of Humanities, Department of Journalism, Media and Communication (JMK).
    Wasserman, Danuta
    Nationell prevention av självmord och psykisk ohälsa (NASP), Karolinska institutet.
    Självmordsprevention i skolor i Sverige - hur ser det ut idag?2003In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 80, no 5, p. 462-473Article in journal (Refereed)
    Abstract [sv]

    Studien visar att beredskapen i svenska skolor är låg när det gäller att upptäcka och hjälpa elever som befinner sig i allvarlig psykisk och social nöd och därmed riskerar att utföra självmordshandlingar. Trots att en stor andel av rektorerna uppger att de har personlig erfarenhet av elever som begått självmord eller utfört självmordsförsök saknar majoriteten av skolorna skriftliga planer, förebyggande program och utbildning av personal i självmordspreventiva åtgärder. Inget i resultaten pekar heller mot några större förändringar i positiv riktning inom en nära framtid.

  • 14.
    Westerlund, Michael
    et al.
    Stockholm University, Faculty of Humanities, Department of Journalism, Media and Communication (JMK).
    Wasserman, Danuta
    National Swedish Prevention of Suicide and Mental Ill-Health (NASP), Karolinska Institutet.
    The role of the Internet in suicide prevention2009In: Oxford Textbook of Suicidology and Suicide Prevention: A Global Perspective / [ed] Danuta Wasserman & Camilla Wasserman, New York: Oxford University Press , 2009, p. 525-532Chapter in book (Other academic)
    Abstract [en]

    Among websites relating to suicide, approximately 40 per cent represent a suicide-preventive view. However, research shows that pro-suicide sites usually rank higher on search results pages, and are more frequently searched for. These pro-suicide sites and other forms of on-line pro-suicide communication have tried to spread a view of suicide as an acceptable solution of life's problems. They have also increased access to potent suicide methods, through the long lists they contain. They have added to persuasion and group pressure to fulfil suicide plans, glorifying those who have commited suicide, and given rise to a new form of suicide pact - 'net suicides'. This chapter also discusses the scope for statutory prohibition and regulation of pro-suicide websites, and ways in which Internet-based systems are used as suicide-preventive support.

  • 15.
    Westerlund, Michael
    et al.
    Stockholm University, Faculty of Humanities, Department of Journalism, Media and Communication (JMK).
    Wasserman, Danuta
    Nationell prevention av självmord och psykisk ohälsa (NASP), Karolinska institutet.
    Tips om självmord lätt att hitta på Internet2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 40, p. 2758-2759Article in journal (Other academic)
    Abstract [sv]

    En brittisk studie visar att det idag är mycket lätt att hitta information om potenta självmordsmetoder på Internet. Dessutom förekommer uppmaningar och uppmuntran till att fullfölja självmordsplaner. På sökmotorernas söklistor hamnar de tydligt prosuicida webbsidorna i topp. Sammantaget kan detta utgöra en påtaglig risk för sårbara och självmordsnära individer.

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