Online Gatekeeping and Email Consultation

A study in Japan used online search-related advertisements to identify people at risk for suicide and offer them email consultations to assess their suicide risk, provide support, and help them locate behavioral health services.

Researchers created an advertisement for an email consultation service, which was displayed to people using key Google search terms that might indicate they were thinking about suicide. These terms included “want to die,” “suicide methods,” “want to end my life,” and “why should I live,” which are English translations of Japanese phrases.

The searches generated 356,745 advertisement displays. Of the individuals exposed, 1.2 percent clicked through to the consultation offer and, of those, 5.3 percent used the service. Among users, 80 percent were female, 74.1 percent reported suicidal ideation, and 12.2 percent had attempted suicide at least once. The mean age was 23.8.

The email consultation service consisted of supportive listening, risk assessment, and support provision. Among those who received services, 25.9 reported at least one of three positive outcomes: a positive change in their mood (10.8 percent), an intention to seek mental health services (16.5 percent), and taking action to find help (10.1 percent).

According to the authors, these results demonstrate the feasibility of online gatekeeping. However, they cautioned that results were preliminary. They suggested the possibility that people who accepted services were at less risk for suicide than people who did not click through or accept services. In addition, they could not definitively determine the effects of the intervention because the study lacked a control group.

Sueki, H., & Ito, J. (2015). Suicide prevention through online gatekeeping using search advertising techniques. Crisis, 36(4), 267–273.