The Effects of Social Media on Suicide

Social media has a profound influence on the teenage and adolescent population in the United States (U.S.). As the largest consumers of social media, it shall come as no surprise that 95% of teens have access to a smartphone and an estimated 45% have revealed that they are online "almost constantly" (Anderson, M. and JingJing, J., 2018). The effects of social media on teens and adolescents should serve as an area of significant interest and concern to researchers as this particular population is perceived as one of the most developmentally vulnerable. It is estimated that 31% of teens in the United States believe that social media has had a positive influence on people their own age, 45% claim social media has had neither a positive nor negative effect on people their own age and 24% of teens believe that social media has had a negative impact on the lives of individuals their own age (Anderson, M. and JingJing, J., 2018). Furthermore, historic trends have illustrated that social media usage amongst the teenage and adolescent population in the U.S. remains on the rise. Teens' usage of electronic devices, which includes smartphones, for five hours or more per day, rose from 8% in 2009 to 19% in 2015 (Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N., 2018).

While social media holds great potential, such as fostering safe communities and the ability to connect with family and friends, it can also cultivate communities of hate, bullying, depression, anxiety and suicidal ideation in the teenage and adolescent population. It has been observed that lower-income teens are the heaviest users of social media, and they are also the least likely demographic to seek professional mental health assistance, which further perpetuates the influence social networking has on their life (Anderson, M. and JingJing, J., 2018). It has been reported that teens who used electronic devices for more than five hours per day were 70% more likely to report experiencing suicidal thoughts or actions than those who limited their use to one hour per day (Twenge et al., 2018). According to the Center for Disease Control and Prevention (CDC) suicide among the youth aged 10-24 years old has become the second leading cause of death in the United States (Twenge et al., 2018). The first cause of death would be unintentional injuries. Since teenagers and adolescents are the most susceptible demographic to the harmful effects of social media, schools have taken action to reduce the negative influence social media has on their students' lives. For instance, in 2016 California approved the Safe Place to Learn Act, which aims to deter cyberbullying by charging the crime as charged as a misdemeanor punishable by up to one year in jail and/or a fine of up to $1,000 (Cyberbullying Laws.).

The influence social media has had on the U.S. teen and adolescent population has become a tremendous area of concern for social workers. Social workers who specialize in serving the teen and adolescent population now operate as a safeguard to ensure that this vulnerable demographic understands both the positive, such as support groups and greater access to information, and negative, such as misinformation and cyberbullying, aspects of social media (Tooley, A., Ph.D., 2018). It is imperative that social workers study and recognize the interventions that have successfully prevented suicidal ideation and completion for this vulnerable population. Therefore, this research brief will analyze and assess the influence social media has had on suicide-related behavior observed in the U.S. teen and adolescent population and the programs available to prevent suicidal ideation and completion.

It has been difficult to locate credible research on studies that have conducted interventions for suicidal ideation and completion influenced by social media amongst teens and adolescents, so this research brief will focus on interventions conducted to prevent suicidal ideation and completion in general. There have been multiple strategies and interventions implemented to reduce suicide-related behavior in the past. The public health approach to suicide prevention includes universal strategies, such as media campaigns and reducing access to means, selective strategies, such as school-based programs, and indicated strategies, such as youth programs (Institute of Medicine Committee on Pathophysiology and Prevention of Adolescent and Adult Suicide., 1970). The CDC also provides various strategies to prevent suicide, including strengthening economic supports, strengthening access and delivery of suicide care, promoting connectedness, teaching coping and problem-solving skills, creating protective environments, identifying and supporting people at risk and lessen harms and prevent future risk (2018).

Evidence Search Summary

Approach to the Search

Diving into the research behind the effects of social media on suicide-related behavior observed in the teen and adolescent population and the programs available to prevent suicidal ideation and completion involved searching through the University of Southern California's (USC) library under "Libraries Catalog", "Digital Library" and the "Social Work Database". Additionally, the JSTOR, EBSCO, Child Development & Adolescent Studies and Family Studies Databases were explored on the USC online library server. Google Scholar was also utilized as a primary search engine to yield results for this research brief. The keywords searched for included social media influence on teens and suicide and prevent, social media teens adolescents and suicide and mental health and intervention, social media and teens and mental health and suicide and interventions and prevent. The number of results yielded from the search was approximately 17,800. The type of results that were reviewed and used for the compilation of this brief included: peer-review journals, federal and state level policies, books, statistical epidemiological data, qualitative research articles, pre-experimental designs method articles, quasi-experimental/correlational design method articles, and experimental design method articles.

Results of the Search

It had been difficult to locate credible research on studies that have conducted interventions for suicidal ideation and completion influenced by social media amongst the teenage and adolescent population, so it was determined that this research brief will focus primarily on interventions conducted to prevent suicidal ideation and completion in general not in correlation to social media. However, it is very important to note the influence social media does have on the teen and adolescent population, which has been explained above. There were plenty of search results that were retrieved to support the correlation social media has on the mental health of teens and adolescents. Once the term "social media" was removed from the search, the number of hits that were received multiplied. Finally, there were enough results to analyze and compare studies that implemented programs and interventions to reduce suicide-related behavior amongst teens and adolescents.

Critical Appraisal of the Evidence and State of the Knowledge Base

Quality of the Evidence

Upon analyzing the quality of evidence, three studies, in particular, have been selected to be discussed in this research brief. One study is titled Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial and was published in the Journal of the American Academy of Child and Adolescent Psychiatry in 2010. The Journal of the American Academy of Child and Adolescent Psychiatry has the highest impact factor (IF) out of the three bodies of work at 6.250. The study attempts to prove that attachment-based family therapy (AFBT) is more effective at reducing suicidal ideation and depression than enhanced usual care (EUC). AFBT upholds the notion that establishing and maintaining higher quality family relationships and interconnectedness can help buffer against depression and suicide, whereas EUC is a referral process with continuous clinical monitoring (Diamond, G., Wintersteen, M., Brown, G., Diamond, G. M., Gallop, R., Shelef, K., & Levy, S., 2010).

The second study is titled Preliminary Effectiveness of Surviving the Teens?® Suicide Prevention and Depression Awareness Program on Adolescents' Suicidality and Self???Efficacy in Performing Help???Seeking Behaviors and was published in the Journal of School Health in 2011. The Journal of School Health had the lowest impact factor of 1.935, however, for a social work journal this IF is decent. This particular study examines the effectiveness of implementing suicide prevention education programs in schools. Surviving the Teens?® Suicide Prevention and Depression Awareness Program was administered in 24 schools throughout greater Cincinnati. The program aims to teach students positive ways to increase self-esteem, manage anger, communicate with their parents, increase family interconnectedness, increase knowledge of symptoms and risk factors of depression, increase knowledge of suicide risks and warning signs, decrease mental health stigma, improve mental health coping methods and encourage help-seeking behavior when suicidal (King, K., Strunk, C., & Sorter, M., 2011).

The final study that will be discussed in this brief is titled An Outcome Evaluation of the Sources of Strength Suicide Prevention Program Delivered by Adolescent Peer Leaders in High Schools and was published in the American Journal of Public Health in 2010. The American Journal of Public Health has a great impact factor of 4.380. The study examines the effectiveness of the school implemented Sources of Strength suicide prevention program, which trains youth opinion leaders to change the social norms and behaviors of their peers through well-defined messaging activities with adult mentoring (Wyman, P., Brown, H., LoMurray, M., Schmeelk-Cone, K., Petrova, M., Yu, Q., Walsh, E., Tu, X., & Wang, W., 2010). 18 high schools in New York, North Dakota and Georgia participated in the program. The programs consisted of a three-pronged-approach. Peer leaders encourage fellow students to increase youth-adult communication ties, reduce implicit suicide acceptability by encouraging friends to ask adults for help regarding suicidal friends and explore coping resources (Wyman et al., 2010).

Design. Analyzing the design of the three experiments, most of the studies conducted had a solid experimental design. The strength of the experiment's design will determine whether cause and effect can be inferred and the internal validity of the results, which can be assessed using HIMSTRI. HIMSTRI stands for history, instrument, maturation selection, testing, regression, and interactions. Using the AFBT trial as an example for design, the study was a randomized control trial with a treatment and a control group that consisted of suicidal adolescents between the ages of 12 and 17 years old (Diamond et al., 2010). While 341 adolescents were screened in primary care and emergency departments only 66 individuals were eligible to participate in the study based on how they scored during on the Suicidal Ideation Questionnaire (SIQ-JR) and the Beck Depressive Inventory (BDI-II) (Diamond et al., 2010). Notably, 77% of the participants were African-American old (Diamond et al., 2010). The study provided three months of treatment with one group receiving AFBT and the other EUC (Diamond et al., 2010). AFBT treatment included individual and family meetings and EUC treatment consisted of a facilitated referral process to other providers. All participants in the study were provided weekly monitoring and access to a 24-hour crisis phone. Suicidal ideation and depressive symptoms were assessed at baseline, 6 weeks, 12 weeks and 24 weeks (Diamond et al., 2010). The outcomes were measured face-to-face. The primary outcomes assessed were suicidal ideation and depressive symptoms. The primary outcomes were assessed using the self-report SIQ-JR and an assessor administered Scale for Suicidal Ideation (SSI) that had been dichotomized to properly evaluate treatment based on the absence of ideation. The secondary outcome that was measured was treatment retention, which was determined by the number of sessions attended. In regard to internal validity in the first study, HIMT can be ruled out due to having two groups and SRI can also be ruled out due to the groups being randomly assigned. Furthermore, all three studies can cancel out HIMSTRI because they all had two or more groups that were randomly assigned.

Measurement. Determining how consistent the measurements were that were used in a study will demonstrate how reliable the results are. A researcher can test reliability a number of ways, including by conducting a test re-test, determining an internal consistency rate and utilizing inter-rater reliability. All three of the studies discussed in this research brief had consistent measures to test reliability. For instance, the second study implementing the Surviving the Teens?® Suicide Prevention and Depression Awareness Program had a Pearson correlation coefficient that was calculated to be >.74 on all parametric subscales (King et al., 2011). The internal consistency reliability was determined for parametric scales and generated Cronbach alphas >.80 (King et al., 2011). Additionally, all three studies had solid validity or accuracy. Continuing to use the second experiment as an example, in order to establish face and content validity for the program the survey was distributed to a number of experts who reviewed the instrument (King et al., 2011). All recommendations received from the experts were incorporated into the final instrument (King et al., 2011). Stability reliability of the instrument was ensured by distributing the survey to a convenience sample of students on 2 separate occasions and 7 days apart (King et al., 2011).

Sampling. External validity of an experiment can be determined by examining the sampling frames of the study. If an experiment has strong external validity, then the results can be applied to a larger population. In terms of sampling frames, all three bodies of work discussed in this brief established great external validity because all three studies utilized random sampling. For example, the third study that examined the effectiveness of the Sources of Strength suicide prevention program had random assignment occur at the school level to ensure that the intervention can be implemented schoolwide (Wyman et al., 2010). The Sources of Strength suicide prevention program randomly assigned eighteen high schools??”6 metropolitan and 12 rural??”to either the immediate intervention group or the wait-list control group (Wyman et al., 2010). Once high schools were assigned to a group, surveys were distributed at baseline and 4 months after the program had been implemented (Wyman et al., 2010).

Answering the Practice Question

Based on the literature and information gathered in this research brief, the evidence would suggest that a program that focuses on strengthening family interconnectedness and improving familial relationships would be the best method to reduce suicidal ideation and completion for the teen and adolescent population. The findings from the first study, which examines the effectiveness of AFBT and EUC, suggests that teens and adolescents treated with AFBT will demonstrate greater and quicker reductions in suicidal ideation and depression (Diamond et al., 2010). However, while the other two studies focused on implementing intervention programs on a school population level, both programs promoted family connectedness as well. The results from the Sources of Strength suicide prevention program demonstrated that the school implemented intervention improved perceptions of adult support for suicidal teens and the acceptability of seeking professional help (Wyman et al., 2010).

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