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Cited by 82Suicide and Self-Harm StudiesImpact of Technology on AdolescentsGun Ownership and Violence Research

The DOI matches its Crossref record; 37 of the 39 references it cites were found in a registry or an index; 6 of the 30 sources its claims cite were checked for support.

Associations Between Social Media and Suicidal Behaviors During a Youth Suicide Cluster in Ohio

Open access
Swedo, Elizabeth A., Beauregard, Jennifer L., de Fijter, Sietske, Werhan, Luke, Norris, Kirkland, Montgomery, Martha P., Rose, Erica B., David-Ferdon, Corinne, Massetti, Greta M., Hillis, Susan D., Sumner, Steven A.·2021·Journal of Adolescent Health
DOI 10.1016/j.jadohealth.2020.05.049PMC PMC8366066
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Abstract

Purpose Youth suicide clusters may be exacerbated by suicide contagion-the spread of suicidal behaviors. Factors promoting suicide contagion are poorly understood, particularly in the advent of social media. Using cross-sectional data from an ongoing youth suicide cluster in Ohio, this study examines associations between suicide cluster-related social media and suicidal behaviors. Methods We surveyed 7th- to 12th-grade students in northeastern Ohio during a 2017-2018 suicide cluster to assess the prevalence of suicidal ideation (SI), suicide attempts (SAs), and associations with potential contagion-promoting factors such as suicide cluster-related social media, vigils, memorials, news articles, and watching the Netflix series 13 Reasons Why before or during the cluster. Generalized estimating equations examined associations between potential contagion-promoting factors and SI/SA, adjusting for nonmodifiable risk factors. Subgroup analyses examined whether associations between cluster-related factors and SI/SA during the cluster varied by previous history of SI/SA. Results Among participating students, 9.0% (876/9,733) reported SI and 4.9% attempted suicide (481/9,733) during the suicide cluster. Among students who posted suicide cluster-related content to social media, 22.9% (267/1,167) reported SI and 15.0% (175/1,167) attempted suicide during the suicide cluster. Posting suicide cluster-related content was associated with both SI (adjusted odds ratio 1.7, 95% confidence interval 1.4-2.0) and SA during the cluster (adjusted odds ratio 1.7, 95% confidence interval 1.2-2.5). In subgroup analyses, seeing suicide cluster-related posts was uniquely associated with increased odds of SI and SA during the cluster among students with no previous history of SI/SA. Conclusions Exposure to suicide cluster-related social media is associated with both SI and SA during a suicide cluster. Suicide interventions could benefit from efforts to mitigate potential negative effects of social media and promote prevention messages.

Overview

Integrity signals

Registry

Crossref · 10.1016/j.jadohealth.2020.05.049

Cites

37 of 37 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

6 of 30 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Safe social media guidelines have not yet been widely adopted by the public.

    “Although journalists may receive training on safe suicide reporting, safe social media guidelines have yet to be widely adopted by the public [19].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [19] Robinson, 2018, The #chatsafe project. Developing guidelines to help young people communicate safely about suicide on social media: A Delphi study, PLoS One source

      The Introduction identifies a lack of evidence-based guidelines for safe communication about suicide on social media. The Discussion says the newly developed #chatsafe guidelines will be implemented through a future campaign. This supports the idea that guidance for the public was not yet established, but the paper does not assess how widely the public had adopted existing guidelines. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
  • Interpretationcitation

    Even with the development and adoption of safe social media recommendations, the ways youth discuss suicide on social media may not change.

    “Importantly, even with the development and adoption of safe social media recommendations, the ways youth discuss suicide on social media may not change [42].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [42] Robinson, 2017, Developing social media-based suicide prevention messages in partnership with young people: Exploratory study, JMIR Ment Health source
  • Findingown data

    Among students without prior history of suicidal ideation or suicide attempt, posting suicide cluster-related social media content was associated with increased odds of suicide attempt during the cluster (adjusted odds ratio 2.0, 95% CI 1.3-3.0).

    “In subgroup analyses of students without prior history of SI or SA, both SI and SA during the cluster were significantly associated with seeing (SI: AOR 2.0, CI 1.3–3.0; and SA: AOR 1.6, CI 1.1–2.3) and posting (SI: AOR 1.7, CI 1.2–2.4; and SA: AOR 2.0, CI 1.3–3.0) cluster-related social media content (Tables 4 and 5).”
    Quote in the paperSubstantial claim
  • Findingown data

    Among students who posted suicide cluster-related content to social media, 15.0% (175/1,167) attempted suicide during the suicide cluster.

    “Among students who posted suicide cluster–related content to social media, 22.9% (267/1,167) reported SI and 15.0% (175/1,167) attempted suicide during the suicide cluster.”
    • Also stated in: § Results · plain
      “Among youth posting about the cluster on social media (n = 1,167), one in five reported SI (22.9%, n = 267) and one in six reported SA during the cluster (15.0%, n = 175).”
    Quote in the paperSubstantial claim
  • Findingown data

    Seeing suicide cluster-related social media content was associated with increased odds of suicidal ideation during the cluster (adjusted odds ratio 1.3, 95% CI 1.1-1.7).

    “seeing (adjusted OR [AOR] 1.3, CI 1.1–1.7) and posting (AOR 1.7, CI 1.4–2.0) suicide cluster–related social media content were significantly associated with SI during the cluster (Table 2).”
    • Also stated in: § Discussion · plain
      “In general, passive exposure to content (seeing suicide cluster–related posts) was associated with SI but not SAs.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim. 24
  • It may state two separate claims as one. 7

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Social media has been associated with positive outcomes such as reinforcement of healthy behaviors and help-seeking.

    “Although excessive social media use has been linked to adverse outcomes like depression and anxiety [39], social media has also been associated with positive outcomes such as reinforcement of healthy behaviors and help-seeking [40].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [40] Powell, 2003, Cross-sectional survey of users of Internet depression communities, BMC Psychiatry source

      The Results (Self-perceived effects of communities; page unavailable) report that 36% of respondents who answered the consultation question felt an Internet depression community was an important factor in deciding to seek professional help. The paper does not report reinforcement of healthy behaviors, and its findings concern Internet depression communities rather than social media generally. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    For some vulnerable youth, online social platforms can be protective, linking otherwise isolated individuals with supportive communities.

    “For some vulnerable youth, online social platforms can be protective, linking otherwise isolated individuals with supportive communities [41].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [41] Naslund, 2014, Naturally occurring peer support through social media: The experiences of individuals with severe mental illness using YouTube, PLoS One source

      The Results identify minimizing isolation and finding support through peer exchange as themes, and the Conclusion reports peer support among people with severe mental illness using YouTube. But the study concerns adults, not youth specifically, and the Conclusion says whether the platform benefits a wider group remains uncertain; it does not establish a protective effect for vulnerable youth. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.

    Interpretationcitation

    Some strategies-policies on how to respond to potentially suicidal users, timeliness of response to suicidal content, and information on where to refer potentially suicidal individuals-may be easily integrated into digital platforms.

    “Some strategies–policies on how to respond to potentially suicidal users, timeliness of response to suicidal content, and information on where to refer potentially suicidal individuals–may be easily integrated into digital platforms [16].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [16] Luxton, 2012, Social media and suicide: A public health perspective, Am J Public Health source

      The paper describes Facebook’s suicide-content reporting system, says alerts are purportedly given top priority, and describes connecting reporters with the Samaritans (Abstract, page not provided). Its Conclusions recommend simple reporting methods and easy access to help through social media sites. These passages support platform-based reporting and referral, but do not establish that response policies or specific timeliness requirements can be easily integrated into digital platforms. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Several suicide prevention organizations have already created recommendations for social media.

    “Several suicide prevention organizations have already created recommendations for social media [18,19,35]; widely sharing and incorporating these recommendations into social media platforms may save lives.”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [18] 2015

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [19] Robinson, 2018, The #chatsafe project. Developing guidelines to help young people communicate safely about suicide on social media: A Delphi study, PLoS One source

      The Introduction describes guidelines developed in several countries for responsible reporting of suicide, and the References list guidance on responding to suicidal content online. But the Introduction also identifies a lack of evidence-based guidelines specifically for safe communication about suicide on social media; the paper does not establish that several organizations had already created recommendations for that setting. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [35] Acosta, 2017, Best practices for suicide prevention messaging and evaluating California's "Know the signs" Media Campaign, Crisis source

  • It may state two separate claims as one.

    Findingnone given

    Within weeks of the investigation, local stakeholders used survey results to increase mental health counselors and educators at schools, increase the availability of behavioral health mobile response teams, strengthen cross-system collaboration and improvements to address suicide risk and prevention factors, and expand gatekeeper training in the community.

    “Within weeks of the investigation, local stakeholders used survey results to increase mental health counselors and educators at schools, increase the availability of behavioral health mobile response teams, strengthen cross-system collaboration and improvements to address suicide risk and prevention factors, and expand gatekeeper training in the community.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationcitation

    The association between seeing online news and decreased odds of suicide attempt may be explained in part by displacement of conventional news sources in favor of social media or viewing news-related content on social media rather than traditional sources, or by adherence by journalists to safe suicide reporting guidelines.

    “This may be explained in part by the displacement of conventional news sources in favor of social media or viewing news-related content on social media rather than traditional sources or adherence by journalists to safe suicide reporting guidelines [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Twenge, 2018, Trends in US Adolescents’ media use, 1976–2016: The rise of digital media, the decline of TV, and the (near) demise of print, Psychol Popular Media Cult source

  • Probably not a substantial claim. It may be too vague to check against evidence.

    Interpretationreasoning

    Without increased public awareness, user-created posts are likely to include potentially harmful content, such as sensationalized language or information about suicide location and methods.

    “Without increased public awareness, the inclusion of potentially harmful content in user-created posts is likely, including sensationalized language or information about suicide location and methods.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    One mechanism by which news media is theorized to confer risk-differential identification-may be amplified by exposure to peers' social media posts.

    “Furthermore, one of the mechanisms by which news media is theorized to confer risk–differential identification–may be amplified by exposure to peers’ social media posts [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Stack, 1987, Celebrities and suicide: A taxonomy and analysis, 1948-1983, Am Soc Rev source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Previous research demonstrates negative impacts of exposure to traditional media on suicide and suicide clusters.

    “Previous research demonstrates the negative impacts of exposure to traditional media on suicide and suicide clusters [6,25].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [6] Gould, 2003, Media contagion and suicide among the young, Am Behav Scientist source
    • cites [25] Mueller, 2017, Does the media matter to suicide?: Examining the social dynamics surrounding media reporting on suicide in a suicide-prone community, Social Sci Med source

  • Probably not a substantial claim.

    Study design and conductreasoning

    A major strength of the study was the use of data from an ongoing suicide cluster.

    “A major strength of our study was the use of data from an ongoing suicide cluster.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Differential identification holds that social similarity between an individual and a model is an important factor in identification and imitative behavior.

    “Differential identification speculates that social similarity between an individual and a “model” (e.g., same age and sex) is an important factor in identification and imitative behavior [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Glaser, 1956, Criminality theories and behavioral images, Am J Sociol source

  • Probably not a substantial claim.

    Interpretationreasoning

    Social media may heighten differential identification, leading to increased risk of identification and suicidal behaviors in vulnerable individuals.

    “Social media may heighten differential identification, conveying subsequent increased risk of identification and suicidal behaviors in vulnerable individuals.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    One study of youths' exposure to 13 Reasons Why found that most high-risk youth viewed the show alone and did not discuss their reaction with a parent or other adult.

    “One study of youths’ exposure to 13 Reasons Why found that the majority of youth at high risk of suicide viewed the show alone and did not discuss their reaction with a parent or other adult [31].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Hong, 2018, 13 Reasons Why: Viewing patterns and perceived impact among youths at risk of suicide, Psychiatr Serv source

  • It may state two separate claims as one.

    Premisecitation

    Most studies take place after a cluster concludes, and this is one of the first studies to collect data from an ongoing suicide cluster.

    “Most studies take place after a cluster concludes; to the authors’ knowledge, this is one of the first studies to collect data from an ongoing suicide cluster [11,32,33].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [11] Askland, 2003, A public health response to a cluster of suicidal behaviors: Clinical psychiatry, prevention, and community health, J Psychiatr Pract source
    • cites [32] Brent, 1989, An outbreak of suicide and suicidal behavior in a high school, J Am Acad Child Adolesc Psychiatry source
    • cites [33] Fowler, 2013, Epidemiological investigation of a youth suicide cluster: Delaware 2012, Del Med J

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    More than half of the viewers in that previous study believed the series increased their suicide risk to a nonzero degree, especially those who strongly identified with the lead female character.

    “More than half of this previous study’s viewers believed the series increased their suicide risk to a nonzero degree, particularly those individuals who strongly identified with the lead female character.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Hong, 2018, 13 Reasons Why: Viewing patterns and perceived impact among youths at risk of suicide, Psychiatr Serv source

  • Probably not a substantial claim. It may be too vague to check against evidence.

    Interpretationreasoning

    Better comprehension of social media's influence on suicidal behaviors may prevent suicide.

    “Just as improved understanding of traditional media’s effects on suicide contagion led to safer suicide reporting, better comprehension of social media’s influence on suicidal behaviors may prevent suicide.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    The analyses represent students with nonmissing data from participating public schools in the affected county.

    “Our analyses represent students with nonmissing data from participating public schools in the affected county.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Excessive social media use has been linked to adverse outcomes like depression and anxiety.

    “Although excessive social media use has been linked to adverse outcomes like depression and anxiety [39], social media has also been associated with positive outcomes such as reinforcement of healthy behaviors and help-seeking [40].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Woods, 2016, #Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem, J Adolesc source

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Interpretationcitation

    The warning signs and response plans outlined in this toolkit may be adopted by online communities and adapted for use by parents and peers.

    “The National Suicide Prevention Lifeline developed a toolkit to help digital community managers identify and respond to concerning suicidal content online [36]; the warning signs and response plans outlined in this toolkit may be adopted by online communities and adapted for use by parents and peers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.

    Interpretationcitation

    Widely sharing and incorporating these recommendations into social media platforms may save lives.

    “Several suicide prevention organizations have already created recommendations for social media [18,19,35]; widely sharing and incorporating these recommendations into social media platforms may save lives.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Resources developed for parents, providers, and journalists by the American Association of Suicidology promote social media strategies rooted in journalism ethics and suicide prevention.

    “Similarly, resources developed for parents, providers, and journalists by the American Association of Suicidology promote social media strategies rooted in journalism ethics and suicide prevention [37,38].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [37] 2018

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [38]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Study design and conductreasoning

    Exclusion of participants with missing data and potential hesitance to participate by youth with higher prevalence of suicidal ideation or suicide attempt may lead to underrepresentation of the true prevalence and associations.

    “Third, exclusion of participants with missing data and potential hesitance to participate by youth with higher prevalence of SI/SA may lead to underrepresentation of the true prevalence and associations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Study design and conductnone given

    Risk factors associated with dying by suicide may differ from risk factors for nonfatal suicidal behaviors in a cluster.

    “We analyzed the risk factors for nonfatal suicidal behaviors in a cluster; risk factors associated with dying by suicide may differ.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductown data

    The Northeast Ohio Youth Health Survey assessed passive exposure to vigils or moments of silence using a single question.

    “Finally, the Northeast Ohio Youth Health Survey assessed passive exposure to vigils or moments of silence using a single question: “During this school year (2017–2018), have there been any vigils or moments of silence at your school for teenagers who died by suicide?””
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisereasoning

    Available research suggests that both protective and harmful effects of social media are possible.

    “Available research suggests that both protective and harmful effects are possible; further research is needed to clarify how social media can be used to better protect and promote youth mental health.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.

    Premisecitation

    Social media provide a valuable resource for suicidal people in need of support, particularly on platforms that offer constructive help and actively avoid normalizing or condoning suicidal behavior.

    “Social media provide a valuable resource for suicidal people in need of support, particularly on platforms that offer constructive help and actively avoid normalizing or condoning suicidal behavior [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] 2017

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Gatekeeper training on identification and support of people at risk for suicide empowers peers, parents, educators, and community members to monitor and provide assistance.

    “Gatekeeper training on identification and support of people at risk for suicide empowers peers, parents, educators, and community members to monitor and provide assistance [43].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Isaac, 2009, Gatekeeper training as a preventative intervention for suicide: A systematic review, Can J Psychiatry Revue canadienne de psychiatrie source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    The National Suicide Prevention Lifeline developed a toolkit to help digital community managers identify and respond to concerning suicidal content online.

    “The National Suicide Prevention Lifeline developed a toolkit to help digital community managers identify and respond to concerning suicidal content online [36]; the warning signs and response plans outlined in this toolkit may be adopted by online communities and adapted for use by parents and peers.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

28 of 28

  • The paper relies on this without support.

    The factors that promote suicide contagion are not well understood, especially with the rise of social media.

    “Factors promoting suicide contagion are poorly understood, particularly in the advent of social media.”

  • The paper relies on this without support.

    Most studies focus on people who died in suicide clusters, and little research has involved attempted suicide survivors in a cluster.

    “Most studies focus on cluster decedents; very little work has been done with attempted suicide survivors in the context of a cluster.”

  • The paper relies on this without support.

    CDC recommendations for suicide cluster prevention and control have not been updated since social media became widespread.

    “Centers for Disease Control and Prevention (CDC) recommendations exist to inform prevention and control of suicide clusters [2] but have not been updated since the advent of social media.”

  • The paper relies on this without support.

    More understanding is needed of the mechanisms in suicide clusters, especially how suicidal behaviors spread.

    “Further understanding of the mechanisms involved in clusters is needed–particularly how suicidal behaviors propagate.”

  • The paper relies on this without support.

    This study is the first quantitative study to examine associations between social media and suicidal behaviors in a suicide cluster.

    “This is the first quantitative study to examine associations between social media and suicidal behaviors in a suicide cluster.”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Online news is described as both unrelated to and associated with suicidal behavior

    Minor

    The discussion says online news articles were not associated with suicidal behaviors, but the results report a statistically significant association with lower odds of suicide attempts.

1 of 1

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Metadata

Authors
Swedo, E. A., Beauregard, J. L., de Fijter, S., Werhan, L., Norris, K., Montgomery, M. P., Rose, E. B., David-Ferdon, C., Massetti, G. M., Hillis, S. D., & Sumner, S. A.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • Ohio Department of Health (US)
Corresponding author
Swedo, Elizabeth A.
ORCID
Venue
Journal of Adolescent Health
Publisher
Elsevier BV
Published
2021-02
Volume
68
Issue
2
Pages
308-316
ISSN
1054-139X (ISSN-L)
DOI
10.1016/j.jadohealth.2020.05.049
PMC
PMC8366066
OpenAlex
W3040525252
Cited by
82
References
39
Citations by year
2026: 13 · 2025: 14 · 2024: 22 · 2023: 14 · 2022: 10 · 2021: 9
FWCI
3.07
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Adolescent Health (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
Centers for Disease Control and Prevention
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
  • Social Sciences › Health › Gun Ownership and Violence Research
Keywords
suicide contagion, social media, suicidal ideation, suicide attempts, adolescents, 13 Reasons Why, news exposure, suicide prevention
MeSH terms
Adolescent, Cross-Sectional Studies, Humans, Ohio, Risk Factors, Suicide, Attempted, Suicidal Ideation, Social Media

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