JMIR Publications

ABSTRACT

Background:

Social networking sites (SNSs) have gained popularity in recent years for help-seeking and self-distress expression among adolescents. Although online suicidal expression is believed to have major benefits, various concerns have also been raised, particularly the privacy issues. Understanding youths' help-seeking on SNS is critical for effective suicide prevention, while most discussions on the topic neglect the impacts of private SNS context.

Objective:

This study aimed to examine youths' private SNS use via the new Instagram feature named Close Friends, and its association with both online and offline help-seeking willingness as well as youths’ suicidality.

Methods:

This study employed a mixed-methods approach targeting youths aged 15-19 in Hong Kong. The motivations for utilizing Close Friends and concerns regarding online expression were addressed in the focus group and individual interviews (N = 40), and most participants had lived suicide-related experiences. In addition, a cross-sectional survey (N = 1,676) was conducted subsequently with eligible secondary school students to examine the prevalence of Close Friends usage, their online and offline help-seeking willingness, and suicide-related experiences.

Results:

Three primary motives for using Close Friends were recognized during interviews, including (i) interaction and help-seeking, (ii) release of negative emotions, and (iii) ventilation and self-expression. The majority of participants also highlighted the privacy concerns associated with public online communication, and the importance of contacting close friends for emotional support. Survey results showed Close Friends was quite prevalent among adolescents (70.6%) and around 46% of the respondents were frequent users. Differences by gender and school academic banding were also revealed. Regarding the help-seeking intentions, youths were generally positive about help-seeking from peers and friends offline (79.8%), yet negative about seeking assistance from online friends or professionals with whom they had not developed a real-world connection (13.7%). Most notably, frequencies of Close Friends usage were differentially associated with online and offline help-seeking willingness and youths’ suicidality. Compared to nonusers, those who had ever used the feature were more likely to seek offline support (adjusted odds ratios [AORs] 1.82-2.36), while the heavy use of Close Friends was associated with increased odds of online help-seeking willingness (AOR 1.76, 95% confidence interval [CI] 1.06-2.93) and higher risk of suicidality (AOR 1.53, 95% CI 1.01-2.31).

Conclusions:

The popularity of Close Friends reflects the increasing needs for private online expression among youths. This study demonstrates the importance of Close Friends for self-expression and private conversation and inadequacy of peer support for suicidal adolescents. Further research is needed to identify the causal relationship between Close Friends usage and help-seeking willingness to guide the advancement of suicide prevention strategies. Researchers and social media platforms may cooperate to co-design a risk-monitoring system tailored to the private SNS context, assisting professionals in identifying youths at risk of suicide.