Death by chat room?

April 10, 2008 In prototypical crime drama fashion, plot twists abound and the story turns out to be more than a case of free speech taken to the extreme.

Sound like an episode of "Law and Order."

That's because it is, but a just released study from the British Medical Journal suggests that the Internet may play a significant role in the outcomes of suicide attempts -- or even whether such attempts are made at all.

The study's lead author, Lucy Biddle, a research associate in medical sociology at the University of Bristol, reports that there has long been a direct correlation between suicide methods displayed in traditional media outlets such as television and film, and the methods people use to kill themselves.

Because some methods are more likely to result in death than others, the study reports, the images that vulnerable people see on TV may indirectly affect whether they live or die.

By extension Internet news and interactive chat rooms are at least as influential as television, given the largely unfettered access.

By imagining that they were people looking to kill themselves, Biddle's team searched Google, Yahoo, MSN and Ask using unambiguous search phrases like "pain-free suicide" and "how to kill yourself."

Because people tend to click on the first hits that come up, they analyzed the first 10 sites that appeared in each engine from each search. Discounting repeats, they had 240 sites to work with.

Out of those 240, about 40 sites "encouraged, promoted, facilitated" or described methods of suicide. Some described suicide in what researchers called "fashionable terms."

An additional 40 or so sites described personal experiences and other accounts of suicides, but without direct encouragement.

Twenty-four sites provided information about methods of suicide in a purely factual way.

There were sites that discouraged suicide or offered alternatives to desperately sad people, but they tended to be at the bottom of the list, where, researchers believe, people are least likely to click. So what to do?

Countries like Australia, Korea and Japan (the latter has the highest suicide rate in the world) have attempted to block pro-suicide sites altogether, but that has proven an uphill battle.

Such efforts are ultimately unhelpful, said Dr. Elmer Victor Bernstam, an associate professor of health informatics and internal medicine at the University of Texas.

"If a person is very motivated to post controversial or illegal content, they will find a way to do so," he said. "Even if it means using a server in a country where it's not illegal. At the university we have software that blocks pornographic sites but it also sometimes blocks breast cancer sites. It's very difficult to block content effectively."

The British researchers have similar reservations when it comes to blocking content, but Biddle's team noted that, depending on the search engine, a variety of sites appeared first.

On Google and Yahoo, for example, more than a few pro-suicide sites like Alt.Suicide.Holiday appeared first. On MSN, however, there was a preponderance of academic or policy sites.

And, according to the report, it may be up to the search engine owners to figure out a way to take responsibility for what appears first, if that's what they choose to do.

"In general, Web sites use a certain proprietary algorithm," said Bernstam. "Many pages are ranked in terms of popularity. Google does not consider the content. It does not say 'this is a good site and we recommend it.' What it does indicate is that other sites reference it."

But there are other ways. Web sites could rank pages by domain extension, for example, thereby giving education institutions and not-for-profits the top 10 or so slots.

But regulation of any sort is controversial when it comes to the Internet, and Bernstam, of the University of Texas, believes the most effective approach is to "treat people at risk -- it's very unlikely that the Internet will drive a healthy person to suicide."

The trouble is, researchers note, that a person who could possibly be talked off the edge has a better chance of reaching a how-to manual than a help line when he turns to the computer.