• Although a large proportion of FB users are willing to reach out to a peer with such manifestations to provide emotional support, majority unwilling to ask about suicide

Although a significant proportion of social media users are willing to reach out to and contact a peer with manifestations of depression on social media, many mostly to provide emotional support, a significant majority are unwilling to ask about suicide, mostly due to misconceptions, while even among those who opted to ask, only a few would question directly.

These findings were made in an oral presentation on the “Approach of Facebook users towards possible suicide risk of a peer with online manifestations of depression: A descriptive study among Sri Lankan Facebook users” which was authored by H. Amanda and P. Ruwanpathirana (both attached to the Colombo University’s Medical Faculty), P. Chulasiri (attached to the Health Ministry), and M. Rajasuriya (attached to the same Faculty's Psychiatry Department), and an oral presentation on “Initial reaching out behaviours of Sri Lankan Facebook users towards a peer profile with manifestations of depression: An online descriptive study” which was authored by Ruwanpathirana, Amanda, Chulasiri, and Rajasuriya, both of which were published in the Ceylon Journal of Medical Science's 56th volume’s second issue in December 2019, by the Editorial Board.

Social media behaviour is considered as predictive of depression and suicide. Understanding the social media users’ approach to these would aid in devising preventive strategies via social media.

Amanda et al. sought to describe the response of Sri Lankan Facebook users towards the possible suicide risk of a peer with “manifestations of depression” (features that indicate possible depression on social media). An online-based, self-administered, interactive questionnaire was posted on Facebook. It included a video-based case vignette with a friend (named Z) showing manifestations of depression. 

Participants were given a choice to contact and those who did were shown a “chat history” indicating symptoms of severe depressive disorder according to the International Statistical Classification of Diseases and Related Health Problems – 10th Revision (ICD-10) criteria. The approach towards possible suicide risk was assessed.

A total of 208, representative of the Sri Lankan Facebook using population, participated in the study and 116 were females. The mean age was 26.03 years (range 16-57 years). While 23 (11.1%) had a personal history of depression, 105 (50.5%) knew a person with depression. The majority continued to contact Z (152 [73.1%]), but of them, only 15 (9.9%) would ask about suicide. Only four chose direct questioning, of whom two had “promised” not to disclose. 

The reasons given for not asking were common misconceptions such as “asking would promote/suggest suicide” (43), “not wanting for Z to know that they suspected” (16), and “people who have suicidal thoughts, usually don’t tell others” (three). A total of 27 (19.71%) considered Facebook as an unsuitable platform to ask and 34/24.82% wanted more information.

Programmes to address these misconceptions would render social media a potential platform for suicide prevention strategies.

Social networking systems have been identified as an expression mode of manifestations of depression. There is growing interest in developing protocols to identify depression using social media platforms like Facebook. 

Ruwanpathirana et al.’s study was conducted to understand the reaction of the Facebook-using population, specifically the initial reaching-out behaviour of local Facebook users, towards such manifestations of depression on a peer profile. An online-based, self-administered, interactive questionnaire was made available through Facebook. It included a video-based case vignette with a friend (named Z) showing manifestations of depression through his/her Facebook account. The gender of Z was sequentially interchanged for male and female participants separately. The initial reaching-out behaviour was assessed.

The majority decided to contact Z (169 [81.3%]). The strongest reasons were “providing emotional support” (81 [47.9%]), “suspecting mental illness” (45 [26.6%]), and “suspecting a problem” (39 [23%]). The commonly used methods of contact were “meeting in person” (69 [40.8%]), “sending a text message” (58 [34.3%]), or “giving a telephone call” (39 [23.1%]). Of those who declined to reach (39), 12 (60%) believed the strongest reason to be that it is “usual behaviour on social media”.

This reaching out behaviour can be utilised to direct people with depression to professional help by empowering and guiding Facebook users.