Electronic media use and suicidal ideation in ... - Wiley Online Library

Psychiatry and Clinical Neurosciences 2008; 62: 744–746

doi:10.1111/j.1440-1819.2008.01880.x

Short Communication

Electronic media use and suicidal ideation in Japanese adolescents Yotaro Katsumata, MA,* Toshihiko Matsumoto, Tadashi Takeshima, MD, PhD

MD, PhD,

Masahiko Kitani,

MA

and

National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan

The present study found that a lifetime history of suicidal ideation may be significantly associated with a history of searching the Internet for information about suicide or self-injury, experiences of anxiety or emotional pain related to the use of electronic media, and adolescents’ distrust of the

ECENTLY SUICIDE HAS become a serious public health problem, particularly among young people; it is one of the three leading causes of death among adolescents worldwide.1 To prevent suicides among adolescents, it is essential to identify any suicide-related factors in their daily living environment. Electronic media has been suggested as one such factor.2 Recently, young people in Japan have begun to use new electronic media technologies, including cell phones and the Internet, with increasing frequency. They regularly communicate with others by text messages, email, blogs, and websites. Indeed, half of all junior high school students in Japan access at least one website and send >10 email messages every day.3 Two potential suicide risk factors have been linked with the use of such media technologies. One is that the recent expansion of media use may make information about suicide more easily accessible, thereby causing a ‘contagion’ of suicidal behavior, particularly among young people.2 The other factor is that

R

*Correspondence: Yotaro Katsumata, MA, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan. Email: [email protected] Received 9 April 2008; revised 29 July 2008; accepted 12 August 2008.

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people around them. The impact of experiences using electronic media on suicidal ideation among Japanese adolescents is discussed. Key words: adolescents, electronic media, suicidal ideation, suicide.

anonymous communication among adolescents often involves cyber-bullying,4 which can lead to mental health problems in victims.5 The aim of the present study was to clarify the association between the experience of using electronic media and suicidal ideation in Japanese adolescents.

METHODS The subjects were 590 junior high school students (299 boys and 291 girls; mean age ⫾ SD, 13.7 ⫾ 0.78 years) who consented to participate in the study; a total of 720 students were asked to participate (81.9% participation). The students were enrolled at two public junior high schools located in suburban areas of Kanagawa Prefecture. This study was approved by each school’s principal and Parent– Teachers Association. Both schools invited the second author (a psychiatrist) to present a drug abuse prevention class in December 2007. After the class, the second author asked students to participate in the study, and then administered the self-reporting questionnaire. Students were instructed to turn in a blank questionnaire if they did not want to participate. The second author then gave the students his phone number and email address in case any of the students wanted to consult with him about any problem at a later date.

© 2008 The Authors Journal compilation © 2008 Japanese Society of Psychiatry and Neurology


The self-reporting questionnaire was designed to evaluate lifetime history of suicidal ideation, experience of electronic media use, and personal communication in daily life. Specifically, the items were as follows: Question 1 (suicidal ideation): ‘Have you ever felt that you wanted to die?’ Question 2 (accessing suicide or self-injury information on the Internet): ‘Have you ever searched for information about suicide or self-injury on the Internet?’ Question 3 (reliable acquaintances on the Internet): ‘Do you have any reliable acquaintances with whom you communicate only through the Internet, without ever having met in person?’ Question 4 (anxiety about not getting email replies): ‘Are you worried that you are disliked by your friends when they don’t reply to your emails immediately?’ Question 5 (hurtful experiences on the web): ‘Have you ever felt hurt by a message you have seen on the Internet or on a mobile website?’ Question 6 (trusting schoolmates): ‘Do you trust your schoolmates?’ Question 7 (trusting adults): ‘Do you have any reliable adults around you?’ All questions were answered with ‘Yes’ or ‘No.’ Unsigned completed questionnaires were collected by teachers and sent to the second author. To determine which of the aforementioned factors (questions 2–7) were associated with a history of suicidal ideation, logistic regression was used for gender and all

Electronic media and suicidal ideation

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six factors as independent variables. Statistical significance was evaluated using two-sided design-based tests and a 5% level of significance. All statistical analyses were performed using SPSS 14.0J for Windows (SPSS Japan, Tokyo, Japan).

RESULTS In total, 208 subjects (35.3%) reported a history of suicidal ideation; of these, 83 (39.9%) were male, 33 (15.9%) had accessed information about suicide on the Internet, 23 (11.1%) had reliable acquaintances on the Internet, 67 (32.2%) reported anxiety about not getting replies to their emails, 53 (25.5%) reported having a hurtful experience on the web, 159 (76.4%) trusted their schoolmates, and 148 (71.2%) trusted adults around them. Table 1 shows the results of the logistic regression analysis undertaken to clarify factors associated with a history of suicidal ideation. All independent variables except ‘reliable acquaintances on the Internet’ were significantly associated with a history of suicidal ideation: ‘male’ (odds ratio [OR], 0.513; 95% confidence interval [CI]: 0.352–0.748), ‘accessing suicide or self-injury information on the Internet’ (OR, 5.105; 95%CI: 2.43–10.709), ‘anxiety about not getting email replies’ (OR, 2.061; 95%CI: 1.326–

Table 1. Association of suicidal ideation with electronic media use and quality of personal relationships Non-adjusted

Independent variables Gender (male percentage) Access of suicide or self-injury information on the Internet Reliable acquaintances on the Internet Anxiety about not getting email replies Hurtful experiences on the web Trusting schoolmates Trusting adults

Suicidal ideation n = 208

Adjusted Non-suicidal ideation n = 382

B

OR (95%CI)

B

OR (95%CI)

83 (39.9%)

216 (56.5%)

-0.673

0.510 (0.362–0.719)***

-0.667

0.513 (0.352–0.748)**

33 (15.9%)

12 (3.1%)

1.760

5.814 (2.932–11.531)***

1.630

5.105 (2.434–10.709)***

23 (11.1%)

24 (6.3%)

0.618

1.855 (1.019–3.375)*

0.100

1.105 (0.555–2.202)

67 (32.2%)

61 (16.0%)

0.916

2.501 (1.677–3.728)***

0.723

2.061 (1.326–3.202)**

53 (25.5%)

42 (11.0%)

1.018

2.768 (1.770–4.329)***

0.536

1.710 (1.028–2.843)*

159 (76.4%) 148 (71.2%)

348 (91.1%) 330 (86.4%)

-1.149 -0.945

0.317 (0.197–0.510)*** 0.389 (0.256–0.591)***

-0.915 -0.533

0.400 (0.234–0.685)** 0.587 (0.365–0.944)*

*P < 0.05; **P < 0.01; ***P < 0.001. CI, confidence interval; OR, odds ratio.


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3.202), ‘hurtful experiences on the web’ (OR, 1.710; 95%CI: 1.028–2.843), ‘trusting schoolmates’ (OR, 0.400; 95%CI: 0.234–0.685), and ‘trusting adults’ (OR, 0.587; 95%CI: 0.365–0.944).

DISCUSSION To our knowledge, this is the first study to examine the association between the experience of using electronic media and suicidal ideation. Although studies have found that electronic media negatively affect adolescents’ mental health and increase their propensity to violence, these studies did not consider suicidal behaviors.4–6 The present study found that a history of suicidal ideation may be significantly associated with a history of searching the Internet for information about suicide-related topics, experiences of anxiety or emotional pain related to the use of electronic media, and adolescents’ suspicions regarding the people around them. Why are these variables associated with suicidal ideation? Although the present study did not demonstrate how these variables might cause suicidal ideation, we propose two hypotheses as possible explanations. One is that many adolescents receive hurtful messages online, or observe offensive remarks about others in anonymous online communications, which are often viewed as being in a different category from statements made in the ‘offline’, or ‘real’, world. Seeing these hurtful messages can lead adolescents to become suspicious of others; for example, having been a victim of cyberbullying or even just a witness to it, they may think that everyone is saying bad things about them behind their backs. Our second hypothesis is that adolescents who are suspicious of the people around them might be more likely to partake of the anonymity provided by online communication when they need to talk to others about their feelings, including suicidal ideation. Whichever hypothesis holds true, the results of the present study suggest at least two possible actions for the prevention of adolescent suicide. First, it will be helpful to create anti-suicide websites that provide supporting information to adolescents who are dealing with self-injury and suicidal ideation. The


present study found that adolescents who are considering suicide tend to access information about suicide or self-injury via the Internet; ideally, their searches would lead them to sources for help. Second, it is essential that educational programs are immediately developed to increase media literacy. These programs should help adolescents acquire skills for establishing trustful relationships with the people they interact with in their daily lives, in addition to skills for properly utilizing online information. The present study has some limitations. These include sampling bias and a lack of consideration of the possible influences of the lecture on drug abuse prevention, or other hurtful experiences in the students’ daily lives. Furthermore, the present result cannot be seen as confirming that using the electronic media directly causes an increase in teenage suicide, because the dependent variable in the present study was not ‘completed suicide’ but ‘suicidal ideation’. Despite these limitations, the present findings contribute to the useful information available on antisuicide behaviors in Japanese adolescents.

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