Words Matter: Reaching People in Distress on the Internet

Suicidal ideas and behaviors may vary across cultures. Depressed individuals worldwide do not always seek treatment, or are undertreated, thus there is a need for effective and appropriate interventions for at-risk individuals via the internet. The anonymity of the internet may help many people who are hesitant to talk with others or to reach out for help feel more comfortable. The internet also provides opportunities for connecting across the globe. Language and culture play a role in reaching individuals who might be depressed.

In a scientific study by Dr. Yen Leykin, a global multilingual participant group was recruited via the internet. This was one of the first studies to use the internet to recruit participants, which allowed for the assessment of global predictors and contributors to suicidal ideation and behavior.

The Question
Do words matter when assessing for depression and suicidal ideation and behavior?

The Study
Individuals seeking depression and sad mood related material on the internet were presented with a free depression mood screener and survey of suicidal behaviors, beliefs and plans. The survey was translated into five different languages (Arabic, Chinese, English, Russian, and Spanish). People were recruited to complete the in-depth questionnaire and survey using Google AdWords. The survey responses were analyzed to assess how many people reported current suicidal ideation, suicide attempts made in the past two weeks, and a lifetime history of attempts. Recruitment exceeded the initial goal of 1,400 participants, with 3,800 participating worldwide, amounting to about 700 participants in each language.

The Results
This study provides a rich data set that can be used by researchers to learn about people who access information about depression and complete a self-assessment on the internet. Distress was evident in this group. Over a span of two weeks, across all 5 languages, approximately 72 percent of participants reported thoughts of death, 54.7 percent reported wanting to die, and 46.4 percent had thoughts of suicide. One out of eight participants (13 percent) worldwide reported they had attempted suicide, and approximately only one out of five was receiving some type of mental health treatment or medication over the two-week period assessed. Success of the specific key words for recruitment depended on the language of the ad. Identification of contributors and predictors of suicidal behavior requires an accessible and culturally relevant approach. This study shows the effectiveness of the internet when it comes to recruiting individuals who are looking for mental health related information.

The Takeaway
The internet is a viable recruitment platform for reaching people with suicidal ideation and behavior from many cultures, and gathering information about contributors and predictors. This study shows that efforts to reach out to people around the world with respect to mental health must take culture and language into account.

From this study we have learned that while suicide is an infrequent cause of death, many people around the world report suicidal ideation and suicide attempts.

People in distress will reach out and connect through the internet, opening the door for mental health intervention.

Grant-related Publications

  • Gross, M. S., Liu, N. H., Contreras, O., Muñoz, R. F., & Leykin, Y. (2014). Using Google AdWords for international multilingual recruitment to health research websites. Journal of medical internet research, 16(1), e18.
  • Liu, N. H., Contreras, O., Muñoz, R. F., & Leykin, Y. (2014). Assessing suicide attempts and depression among Chinese speakers over the internet. Crisis, 35: 322-329. DOI: 10.1027/0227-5910/a000261.
  • Leykin, Yan, Ricardo F. Muñoz, and Omar Contreras. “Are consumers of Internet health information “cyberchondriacs”? Characteristics of 24,965 users of a depression screening site.” Depression and anxiety 29.1 (2012): 71-77.

Click here to read about Dr. Leykin’s Standard Research Grant.


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