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Purpose: Some East/Southeast Asian countries have experienced a rapid increase in suicide by charcoal burning over the past decade. Media reporting and Internet use were thought to contribute to the epidemic. We investigated the association between method-specific suicide incidence and both Internet search volume and newspaper reporting in Taiwan., Method: Weekly data for suicide, suicide-related Google search volume, and the number of articles reporting suicide in four major newspapers in Taiwan during 2008-2011 were obtained. Poisson autoregressive regression models were used to examine the associations between these variables., Results: In the fully adjusted models, every 10 % increase in Google searches was associated with a 4.3 % [95 % confidence interval (CI) 1.1-7.6 %] increase in charcoal-burning suicide incidence in the same week, and a 3.8 % (95 % CI 0.4-7.2 %) increase in the following week. A one-article increase in the United Daily was associated with a 3.6 % (95 % CI 1.5-5.8 %) increase in charcoal-burning suicide in the same week. By contrast, non-charcoal-burning suicide was not associated with Google search volume, but was associated with the Apple Daily's reporting in the preceding week., Conclusions: We found that increased Internet searches for charcoal-burning suicide appeared to be associated with a subsequent increase in suicide by this method. The prevention of suicide using emerging methods may include monitoring and regulating online information that provides details of these methods as well as encouraging Internet service providers to provide help-seeking information.

Background: This study evaluates the association between Internal Addiction (IA) and psychiatric co-morbidity in the literature., Methods: Meta-analyses were conducted on cross-sectional, case-control and cohort studies which examined the relationship between IA and psychiatric co-morbidity. Selected studies were extracted from major online databases. The inclusion criteria are as follows: 1) studies conducted on human subjects; 2) IA and psychiatric co-morbidity were assessed by standardised questionnaires; and 3) availability of adequate information to calculate the effect size. Random-effects models were used to calculate the aggregate prevalence and the pooled odds ratios (OR)., Results: Eight studies comprising 1641 patients suffering from IA and 11210 controls were included. Our analyses demonstrated a significant and positive association between IA and alcohol abuse (OR = 3.05, 95% CI = 2.14-4.37, z = 6.12, P < 0.001), attention deficit and hyperactivity (OR = 2.85, 95% CI = 2.15-3.77, z = 7.27, P < 0.001), depression (OR = 2.77, 95% CI = 2.04-3.75, z = 6.55, P < 0.001) and anxiety (OR = 2.70, 95% CI = 1.46-4.97, z = 3.18, P = 0.001)., Conclusions: IA is significantly associated with alcohol abuse, attention deficit and hyperactivity, depression and anxiety.

Background: Internet-based learning programs provide people with massive health care information and self-help guidelines on improving their health. The advent of Web 2.0 and social networks renders significant flexibility to embedding highly interactive components, such as games, to foster learning processes. The effectiveness of game-based learning on social networks has not yet been fully evaluated., Objectives: The aim of this study was to assess the effectiveness of a fully automated, Web-based, social network electronic game on enhancing mental health knowledge and problem-solving skills of young people. We investigated potential motivational constructs directly affecting the learning outcome. Gender differences in learning outcome and motivation were also examined., Methods: A pre/posttest design was used to evaluate the fully automated Web-based intervention. Participants, recruited from a closed online user group, self-assessed their mental health literacy and motivational constructs before and after completing the game within a 3-week period. The electronic game was designed according to cognitive-behavioral approaches. Completers and intent-to-treat analyses, using multiple imputation for missing data, were performed. Regression analysis with backward selection was employed when examining the relationship between knowledge enhancement and motivational constructs., Results: The sample included 73 undergraduates (42 females) for completers analysis. The gaming approach was effective in enhancing young people's mental health literacy (d=0.65). The finding was also consistent with the intent-to-treat analysis, which included 127 undergraduates (75 females). No gender differences were found in learning outcome (P=.97). Intrinsic goal orientation was the primary factor in learning motivation, whereas test anxiety was successfully alleviated in the game setting. No gender differences were found on any learning motivation subscales (P>.10). We also found that participants' self-efficacy for learning and performance, as well as test anxiety, significantly affected their learning outcomes, whereas other motivational subscales were statistically nonsignificant., Conclusions: Electronic games implemented through social networking sites appear to effectively enhance users' mental health literacy.

Background: The Internet's potential impact on suicide is of major public health interest as easy online access to pro-suicide information or specific suicide methods may increase suicide risk among vulnerable Internet users. Little is known, however, about users' actual searching and browsing behaviors of online suicide-related information., Objective: To investigate what webpages people actually clicked on after searching with suicide-related queries on a search engine and to examine what queries people used to get access to pro-suicide websites., Methods: A retrospective observational study was done. We used a web search dataset released by America Online (AOL). The dataset was randomly sampled from all AOL subscribers' web queries between March and May 2006 and generated by 657,000 service subscribers., Results: We found 5526 search queries (0.026%, 5526/21,000,000) that included the keyword "suicide". The 5526 search queries included 1586 different search terms and were generated by 1625 unique subscribers (0.25%, 1625/657,000). Of these queries, 61.38% (3392/5526) were followed by users clicking on a search result. Of these 3392 queries, 1344 (39.62%) webpages were clicked on by 930 unique users but only 1314 of those webpages were accessible during the study period. Each clicked-through webpage was classified into 11 categories. The categories of the most visited webpages were: entertainment (30.13%; 396/1314), scientific information (18.31%; 240/1314), and community resources (14.53%; 191/1314). Among the 1314 accessed webpages, we could identify only two pro-suicide websites. We found that the search terms used to access these sites included "commiting suicide with a gas oven", "hairless goat", "pictures of murder by strangulation", and "photo of a severe burn". A limitation of our study is that the database may be dated and confined to mainly English webpages., Conclusions: Searching or browsing suicide-related or pro-suicide webpages was uncommon, although a small group of users did access websites that contain detailed suicide method information.

Objective: This study analyzed the online suicide-related contents of Chinese-language Web sites compared with contents observed in an American study that considered English-language Web sites, so as to examine what differences there might be between Chinese online information and its English counterpart., Method: Online contents were generated by entering 4 suicide-related search queries into 5 popular search engines (Google China, Yahoo! China, Live search, Baidu, and Sogou) in mainland China in September 2008. The search queries were simplified Chinese translations of terms used in a 2008 American study that used similar methodology: Zi Sha (suicide), Ru He Zi Sha (how to commit suicide), Zen Yang Zi Sha (how to kill yourself), and Zi Sha Fang Fa (suicide method). Three coders from mainland China reviewed the first 3 pages of results from each search and rated their contents in terms of the attitude toward suicide reflected therein (pro-suicide, anti-suicide, neutral, not a suicide site, or error [page would not load]). Other characteristics of the Web sites were analyzed. The results were then compared with those of the earlier study of English-language Web sites., Results: Of the Chinese Web sites, a smaller proportion carried pro-suicide information compared with the corresponding results obtained from the study of English-language Web sites (4.2% vs 11.7%), whereas the proportion of anti-suicide Web sites in both languages was almost the same (32.3% vs 34.9%). Anti-suicide Web sites in Chinese, however, provided less information on seeking help, and there were fewer government or professional mental health Web sites in Chinese (1.3% vs 13.3%). The pro-suicide information on Chinese Web sites was mostly found in personal blogs or online forums., Conclusion: Psychiatrists and public health researchers dealing with suicide prevention in China should be aware of the differences between online suicide-related information in the Chinese and English languages., (© Copyright 2011 Physicians Postgraduate Press, Inc.)

Background: Despite increasing concern over the potential adverse effects of excessive internet use, especially in young people, there is some debate over its definition, magnitude and discriminant validity., Aims: To examine the prevalence of adolescents' internet addiction in Hong Kong, China; to test its differentiation from other correlates; and to examine its relationships with correlates in a representative community sample of adolescents., Method: A two-wave panel household survey with 208 adolescents (aged 15-19 years) was conducted. Participants were asked to self-report their patterns of internet usage, symptoms of internet addiction, suicidal ideation, psychiatric symptoms and psychosocial conditions during the study period., Results: The prevalence rate for having five or more symptoms of internet addiction was estimated to be 6.7% (95% CI 3.3-10.2). The discriminatory characteristic of internet addiction was marginally demonstrated. Positive dose-response relationships were found between the number of symptoms of internet addiction and 1-year changes in scores for suicidal ideation and depressive symptoms., Conclusions: Evidence supports the specificity of internet addiction and its symptoms seem to co-occur with individuals' suicidal ideation and depressive symptoms.