Pro-suicide web sites can spell danger for suicidal patients.

WASHINGTON -- Physicians might be surprised by just how easy it is for their patients to access very detailed information about suicide methods on the Internet, a study using five Internet search engines shows.

"A determined suicidal person can easily and quickly find a way to commit suicide and even find a suicide support group ... if they go online," Dr. Patricia Recupero of Brown University, Providence, R.I., said at the annual meeting of the American Psychiatric Association.

"The time has come in which part of the routine evaluation of anyone has to include [the questions] 'Do you use the Internet and what do you use it for?' " said Dr. Recupero, who also is a lawyer.

The good news is that suicide prevention and crisis information might be even easier to access. "Conversely, a desperate person who is open to getting help might easily find support," Dr. Recupero added.

For the study, Dr. Recupero and her colleagues entered four suicide-related search terms into five popular Internet search engines--Google, Yahoo, Ask, Lycos, and Dogpile. The terms included "suicide," "how to commit suicide," "suicide methods," and "how to kill yourself."

They included the first 30 hits for each term using each search engine, along with any sponsored link. "We figured that people generally look at about 30 [hits] before they get tired and move on to the next search," Dr. Recupero said.

The Web site hits were coded by three different raters, with disagreements settled by consensus. Web sites were coded as pro-suicide, anti-suicide, suicide-neutral, not a suicide site (a Web site featuring a song about suicide for example), or error (the link did not work). The Wikipedia entry on suicide was classified as suicide-neutral, for example.

They identified 373 Web sites. Of these, most were suicide-neutral (31%), followed by anti-suicide (29%), not suicide Web sites (20%), pro-suicide (11%), and error (9%). They also looked at whether a Web site linked to a crisis intervention program and if it included detailed suicide methods.

In all, almost a third (29%) linked to suicide prevention resources. However, 14% of the Web sites provided detailed methods or instructions for suicide. "You can see that it's quite easily obtained and quite common," Dr. Recupero said.

Most of the pro-and how-to resources were associated in some way with the Church of Euthanasia, whose Web site offers a lengthy pro-suicide guide, including detailed instructions. That site also describes several unusual and highly lethal suicide methods. Another Internet resource is alt.suicide.holiday, a nonmoderated news group, which includes an archive of suicide methods.

"The Internet is also a source of help and support. We would definitely want to encourage our patients to be familiar with this," Dr. Recupero said. The National Institute of Mental Health's Web page on suicide prevention is one of the more popular hits when using the search term "suicide."

Of the 74 Web sites that were coded as not a suicide Web site, 8 linked to Internet pharmacies. The advent of Internet pharmacies has made suicide even easier. "It's very easy for patients to go online, answer a few brief questions, and obtain drugs--licit and perhaps illicit as well," said Dr. Recupero, president and CEO of Butler Hospital, also in Providence, R.I.

In all, 18 of the 20 searches yielded at least one pro-suicide Web site. Two searches for suicide methods each yielded 16 pro-suicide hits out of 30. In four searches, pro-suicide sites ranked as the No. 1 hit.

The researchers also asked patients about Internet use. Most did not have Internet access. However, of those who did have access and had gone online looking for suicide information, none had told their clinicians nor had they been asked by their clinicians about online suicide information.

"It's really important that we take advantage of the good things on the Internet ... giving patients the right URLs that lead them to NIMH- or APA-type Web sites, and [having] a candid discussion with them about what they're doing online."

Dr. Recupero cautioned that the Internet is always changing and repeating the study might produce different results. The investigators conducted the study twice, about a year apart, with the same results.

BY KERRI WACHTER

Senior Writer