Background: Crisis helplines aim to provide a short-term intervention or guide users to professional mental health services, but many users return to helplines despite having professional mental health contacts. Aims: To contribute knowledge on users’ perspectives on the role of crisis helplines in relation to their professional mental health contacts, we aimed to investigate how online helpline users describe such services. Methods: We used thematic analysis of 100 naturally occurring interactions from a Swedish online crisis helpline. Results: The users viewed the helpline as a safe space, a partner, or an alternative to bad professional services. Users oriented to ongoing helpline usage as crucial for their well-being while they described using professional mental health services to be able to stay alive. Limitations: The findings are limited to the nature of the different themes. Conclusion: The view on crisis helplines as a short-term intervention relies on an idealized view on crisis intervention that does not represent users’ views. User control is at the core of the appeal of helplines, but it is also a key challenge for organizations and volunteers.

Previous studies have shown that suicide-bereaved individuals may suffer increased risk of suicidal thoughts and behaviors (STBs) due to traumatic grief. In this paper, we present the self-reported rate of STB among Swedish suicide-bereaved women (N= 293). Data was collected in a cross-sectional anonymous survey on the homepages of Sweden's leading suicide survivor organization, SPES. We used logistic regression to evaluate risks (of any STB event) related to losing a child compared to other relatives and the experience of social avoidance from family members, as well as feelings of shame and guilt. The self-reported rate of suicidal thoughts, plans, and attempts was 60, 24, and 5 percent, respectively, considerably higher than in the general population. Results showed that all of the investigated variables were independent risk factors for STB (ORs ranged between 1.29 and 2.69). Women who had both lost a child and experienced family avoidance reported the highest STB rate (87.5%), and we found an interaction effect between these two risk factors (OR = 3.45; 95% CI = 1.05-11.32) that was related to self-reported shame. It is concluded that perceived responsibility for someone else's suicide, and the social avoidance associated with it, may play an important role for suicide survivors and should be targeted by postvention activities.

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.

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.

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.

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. 

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.

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.