Different linguistic features within this framework, like heightened self-attentional focus and poor interaction with the community characterized shifts from mere discussion of mental health issues to expressing suicidal ideation [ 19 ]. Current literature shows that it is possible to distinguish the level of concern among suicide related posts in social media using language-based classifiers [ 16 , 17 , 20 , 21 ].
LIWC allows for a quantitative analysis of text with a focus on psychometric properties [ 23 ] and psychologically meaningful linguistic categories [ 24 ]. In the context of suicidal ideation, relevant linguistic markers include heightened self-attentional focus [ 18 , 25 ], a rise in negative emotion words [ 25 ], and changes in cognitive wording [ 26 , 27 ]. Additionally, authors reported poor readability FRE; [ 28 ] i. This is the first study to investigate language use on Instagram, one of the most prominent social media platforms among adolescents, concerning suicidality.
The current study had two major aims: 1 to investigate the experience with expressions of acute suicidal thoughts on Instagram of young people using a qualitative approach and 2 to use LIWC as a quantitative approach to analyze differences in the language and Instagram activity of vulnerable young people using qualitative interview data and captions on Instagram with regard to their current suicidal ideation.
Regarding the first aim it was hypothesized that the majority of participants had come across expressions of acute suicidal thoughts on Instagram and that common reactions would include showing empathy or being shocked. We further hypothesized that expressions of acute suicidal thoughts would be met with an activation of a social help system on Instagram.
Qualitative and Quantitative Research Techniques
Regarding the second aim of the study, we hypothesized that in comparison to participants with past suicidal ideation only, participants with current suicidal ideation would use significantly more words related to a self-attentional focus e. Participants were identified from a larger data-set investigating the occurrence of non-suicidal self-injury NSSI on Instagram [ 33 ]. All pictures and user accounts associated with the 16 German hashtags most commonly related to featuring pictures of NSSI wounds i. For details on how those hashtags were identified see Brown et al. During data collection it was recorded how many followers users had, how many other users they were following, how many pictures they had posted and how many comments each picture had received.
Interviews were conducted on Instagram messenger using chats, which allowed participants to stay anonymous. Additionally, socio-demographic variables i. Procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of , as revised in Written informed consent via Instagram messenger was obtained from all subjects.
Participants were informed about the purpose and risks of the study and about the use of their data for anonymous scientific publication via Instagram messenger.
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They agreed to those terms in written form via the messenger. All participants had to indicate to be over the age of In case of acute suicidality they were provided with emergency help advice nation-wide telephone numbers and were offered to talk to a trained child and adolescent psychotherapist RB on the phone or via Instagram messenger.
None of the participants made use of this option. Two independent raters were thoroughly trained. Taking an example of three interviews, and paraphrasing them, categories from those paraphrased responses were generated in order to facilitate standardized ratings. The rest of the interviews were rated under ongoing supervision. Whenever there was a disagreement between two ratings, an agreement was found between both raters and one of the authors of the paper RB. Features measuring linguistic style were extracted. The LIWC is a computer-based text analysis software tool whose algorithms count words according to pre-defined criteria word categories [ 34 ].
The resulting output file from this analysis contains information in percent frequency of specific words in relation to the total number of words. Furthermore, we used the Flesch-Reading-Ease index FRE; [ 28 , 30 ] to calculate the ease with which one can read or understand responses given by adolescents.
The FRE is normalized to values between 0 and with higher values indicating high reading ease 0—30 very low reading ease, comprehensible for academics; 30—50 low, 50—60 medium, 60—70 well understandable texts; 70—80 medium understandable, 80—90 easy and 90— very high reading ease, comprehensible for eleven-year old pupils [ 35 ].
Incorporating Qualitative Indicators of Well - Being into Quantitative Economic Research
The index is calculated using the average sentence length ASL and the average number of syllables per word ASW [ 28 ]. Based on previous research on language use and suicidality, we chose the following specific variables from the LIWC and the automated readability index for analyses:. As a further feature of the quantitative analysis, activity on Instagram number of followers, number of following others, number of pictures posted, average number of comments per picture within the past month was taken into account.
Statistical analyses were performed with R [ 36 ]. Differences between participants with acute vs. Based on previous research [ 19 ], logistic regression analysis was calculated with acute vs. Participants were on average All participants reported a lifetime-history of suicidal ideation and NSSI and Around half of all participants The majority Gender, age, occupational status, or lifetime attempted suicide were not associated with acute suicidality, and neither was activity on Instagram in the past four weeks.
That is, number of followers on Instagram, number of users on Instagram they were following, number of pictures posted within the past month, or number of comments other users posted in response to those pictures on average per picture did not differ between the two groups see Table 1. Language analyses were calculated separately for language use in interviews and language use in captions on Instagram, respectively.
All other differences were not significant see Table 2. The final model with negative emotion as associated variable was applied to the data to calculate the odds for AS of each individual.
Predicted AS was compared to reported AS by participants. Accuracy, sensitivity and specificity varied depending on cut-off: Maximal accuracy of Participants in the acute suicidality group did not differ from participants in the non-acute suicidality group regarding their use of language in captions on Instagram in the four weeks prior to the interview for details see Table 3. Prediction models with pronouns, negative emotion, cognitive mechanism, and emotion expression as factors were applied to language in the captions.
In this sample of young Instagram users with a lifetime history of suicidal ideation and NSSI, half of all participants had attempted suicide at least once and half of them were expressing acute suicidality on the day of the interview. These characteristics constitute this group of Instagram users as a very vulnerable at-risk group for suicidality. A quarter of all participants in this study reported to have expressed acute suicidal thoughts on Instagram. Reactions by other Instagram users indicated empathy, the activation of a social help system by other users offering help, trying to talk them out of it, or indicating sadness or shock.
However, only in around a third of the cases, action was taken by informing the police or parents. Again, reactions of other Instagram users were mainly trying to offer help, by showing empathy, being worried, or reporting the user to Instagram. However, in both cases either actively posting online about their thoughts or plans of suicide or coming across a suicide announcement online , a small percentage of participants reported incidents of other users encouraging the person to commit suicide or suggesting a joint suicide.
No actions by Instagram i. These results are in line with former studies investigating responses to expressions of acute suicidal thoughts in social media [ 20 ]. These should comprise the discussion of ethical questions and practical implications for future suicide prevention in social media [ 13 ] which could result in stricter legal requirements for social media providers regarding comments in the context of suicidality.
The detection of suicide risk through social media might be an opportunity for accurate and timely identification of acute suicidality [ 9 ], e. In this line, the second aim of this study was to investigate whether participants with current suicidal ideation would differ in their language use as well as in their Instagram activity from participants with non-acute suicidality in this German speaking sample.
In order to control for situational biases of language used in captions on Instagram, data of qualitative interviews was also used to test for differences in language use.
Overall, Instagram activity did not distinguish between participants with acute versus non-acute suicidality neither language use in captions nor number of followers, pictures posted, comments, etc. This is somewhat contrary to a study by De Choudhury et al. However, this might be due to the different nature of Reddit where the main content is shared in language based discussion forums and Instagram where the main content is shared through pictures. According to our results, in this highly vulnerable group of participants posting pictures with NSSI on Instagram, automated linguistic analyses of data shared on Instagram might not be feasible to detect persons at risk.
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Qualitative Research Studies: An Introduction
Messer, Jeanne C. He has published widely on outcome management in psychotherapy, therapist effects and the prediction of treatment progress for individual patients. She is Co-Editor-in-Chief for Counselling Psychology Quarterly , and has served on the editorial board of several journals. She also publishes extensively on the psychotherapy process, as well as on training and supervision.