Suicide-related internet use among mental health patients who died by suicide in the UK: a national clinical survey with case - control analysis

Background Suicide-related internet use (SRIU) has been shown to be linked to suicide. However, there is limited research on SRIU among mental health patients, who are at 4 to 7 times increased risk of suicide compared to the general population. This study aims to address this gap by exploring the prevalence of SRIU among mental health patients who died by suicide in the UK and describing their characteristics. Methods The study was carried out as part of the National Con fi dential Inquiry into Suicide and Safety in Mental Health (NCISH). Data were collected on sociodemographic, clinical, suicide characteristics and engagement in SRIU of patients who died by suicide between 2011 and 2021. The study utilised a case - control design to compare patients who engaged in suicide-related internet use with those who did not. Findings The presence or absence of SRIU was known for 9875/17,347 (57%) patients; SRIU was known to be present in 759/9875 (8%) patients. The internet was most often used to obtain information on suicide methods (n = 523/759, 69%) and to visit pro -suicide websites (n = 250/759, 33%) with a signi fi cant overlap between the two (n = 152/759, 20%). Engaging in SRIU was present across all age groups. The case - control element of the study showed patients who were known to have engaged in SRIU were more likely to have been diagnosed with autism spectrum disorder (OR = 2.13, 95% CI: 1.43 - 3.18), have a history of childhood abuse (OR = 1.70, 95% CI: 1.36 - 2.13) and to have received psychological treatment (OR = 1.43, 95% CI: 1.18 - 1.74) than controls. Additionally, these patients were more likely to have died on or near a salient date (OR = 2.11, 95% CI: 1.61 - 2.76), such as a birthday or anniversary. Interpretation The fi ndings affirm SRIU as a feature of suicide among patients of all ages and highlight that clinicians should inquire about SRIU during assessments. Importantly, as the most common type of SRIU can expand knowledge on suicide means, clinicians need to be aware of the association between SRIU and choice of methods. This may be particularly relevant for patients approaching a signi fi cant calendar event. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).