Exploring Suicide-Related Internet Use Among Suicidal Mental Health Patients in the United Kingdom: Cross-Sectional Questionnaire Study

Background: The dual nature of suicide-related internet use (SRIU) as preventative or harmful is well-documented, but its characteristics in the mental health patient population remain underresearched. Some evidence suggests mental health patients engage in SRIU differently from the general population. Objective: This study aims to explore the types, motivations, frequency, and perceived impacts of SRIU in suicidal mental health patients, as well as their engagement with web-based prevention resources. Methods: A cross-sectional study was conducted using an anonymous web-based survey distributed between June and December 2023. Participants (n=696) were UK adults with secondary mental health service contact and recent suicidal thoughts or behaviors. Of these, 523 (75%) participants engaged in SRIU. Collected data included sociodemographic details, clinical history, types and motivations for SRIU, and interactions with suicide prevention resources. Analysis used descriptive statistics, chi-square, and Wilcoxon tests, with multiple testing corrections applied. Results: The most common SRIU type was searching for suicide-related content (456/523, 87.4%), followed by connecting with others (271/523, 51.8%). Motivations included seeking information on suicide methods (313/523, 60.8%) and support for suicidality (271/523, 57.2%), with significant overlap. Participants perceived SRIU as neither harmful nor helpful overall, with those seeking suicide methods rating it as more harmful. Most participants encountered suicide prevention messaging, but less than half engaged with it. Only 27.5% (n=144) participants disclosed their SRIU to clinicians, with only 1 in 10 being asked about it by their clinician. Conclusions: This study underscores the dual role of SRIU as both a source of support and a potential risk for mental health patients. Despite high exposure to suicide prevention messaging, engagement was limited, suggesting inefficiencies in current intervention designs. Clinicians rarely inquired about SRIU, and voluntary disclosure by patients was low, representing missed opportunities for intervention. Proactive discussions about SRIU in clinical settings could improve risk identification and support planning. Addressing its harmful aspects while leveraging its potential for support requires integrated online and offline strategies.