The association of exposure to suicide-related Internet content and emergency department visits in children: A population-based time series analysis

OBJECTIVES: Suicide-related emergency department (ED) visits by children are increasing in tandem with suicide-related Internet content. Following the announcement of Amanda Todd's suicide, her YouTube video received widespread views, providing an opportunity to explore this association. METHODS: Our research question was: Among Ontario children age 11-17 years, was the release of Amanda Todd's YouTube video following her death announcement in October 2012 associated with an increase in average monthly ED visit rates for suicide-related diagnoses? We performed an interrupted time series analysis from April 2002 to December 2013, with the primary outcome as a composite of the average monthly rate of initial ED visits for suicidal ideation, intentional self-poisoning, and intentional self-harm. Secondary outcomes were average monthly rates of intensive care unit (ICU) admission and death resulting from the index visit. RESULTS: There was a statistically significant increase in the monthly ED visit rate for the composite outcome (p = 0.02) and death or ICU admission (p = 0.006) from April 2002 to December 2013. There was no significant change in ED visit rate for the composite outcome before and after the announcement of Amanda Todd's death, overall (119.8 versus 219.2 respectively, p = 0.5), among females (167.4 versus 316.8 respectively, p = 0.47) or among males (74.7 versus 116.9 respectively, p = 0.33). CONCLUSIONS: Ontario ED visits for suicide-related diagnoses in 11-17 year olds increased from 2002 to 2013. However, the increase from October 2012 to December 2013 could not be attributed to a highly publicized adolescent suicide. Our findings suggest that suicide-related Internet content is not associated with the increase in ED visits for suicidal behaviour.