title: Predictors of psychological improvement on non-professional suicide message boards: content analysis.
abstract: Suicide message boards have been at the core of debates about negative influences of the Internet on suicidality. Nothing is currently known about communication styles that may help users to psychologically improve in these settings.
  
  
  
  In all, 1182 archival threads with 20 499 individual postings from seven non-professional suicide message boards supporting an 'against-suicide', 'neutral' or 'pro-suicide' attitude were randomly selected and subject to content analysis. Initial needs of primary posters (i.e. individual who open a thread), their psychological improvement by the end of the thread, their responses received and indicators of suicidality were coded. Differences between 'pro-suicide', 'neutral' and 'against suicide' boards, and correlations between primary posters and respondents in terms of suicidality were assessed. Logistic regression was used to test associations with psychological improvement.
  
  
  
  'Pro-suicide' boards (n = 4) differed from 'neutral' (n = 1) and 'against-suicide' (n = 2) boards in terms of communicated contents. Indicators of suicidality correlated moderately to strongly between primary posters and respondents on 'pro-suicide' message boards, but less on other boards. Several communicative strategies were associated with psychological improvement in primary posters, including the provision of constructive advice [adjusted odds ratio (aOR) 4.10, 95% confidence interval (CI) 2.40-7.03], active listening (aOR 1.60, 95% CI 1.12-2.27), sympathy towards the poster (aOR 2.22, 95% CI 1.68-2.95) and provision of alternatives to suicide (aOR 2.30, 95% CI 1.67-3.18).
  
  
  
  Respondents resemble primary posters with regard to suicidality in 'pro-suicide' boards, which may hinder psychological improvement. Still, opportunities to intervene in these settings using simple communication techniques exist and need to be taken and evaluated.
authors.affiliation: Medical University of Vienna,Center for Public Health,Institute of Social Medicine,Suicide Research Unit,Kinderspitalgasse 15,A-1090 Vienna,Austria.
authors.forename: T
authors.initials: T
authors.lastname: Niederkrotenthaler
authors.affiliation: Columbia University/NYS Psychiatric Institute 1051 Riverside Drive,Unit 72, New York,NY 10032,USA.
authors.forename: M
authors.initials: M
authors.lastname: Gould
authors.affiliation: Crisis Intervention Center Vienna,Lazarettgasse 14a, A-1090 Vienna,Austria.
authors.forename: G
authors.initials: G
authors.lastname: Sonneck
authors.affiliation: Department of Criminal Justice,Wayne State University;3293 Faculty/Administration Building,656 W. Kirby,Detroit, MI 48202,USA.
authors.forename: S
authors.initials: S
authors.lastname: Stack
authors.affiliation: Medical University of Vienna, Center for Public Health, Institute of Social Medicine,Suicide Research Unit,Kinderspitalgasse 15,A-1090 Vienna,Austria.
authors.forename: B
authors.initials: B
authors.lastname: Till
mesh_terms: D006801:Humans; D020407:Internet; D016015:Logistic Models; D016017:Odds Ratio; D012657:Self-Help Groups; D012944:Social Support; D013405:Suicide
keywords: Communication; message boards; prevention; social media; suicide