Changes in Suicide Ideation Among Users of Online Gatekeeping Using Search-Based Advertising

Recently, the practice of "online gatekeeping" related to suicide prevention-placing online advertisements directed at users who search the web for suicide-related terms and leading them to email-based consultations-has been implemented. However, the effectiveness of this practice has not been examined. Therefore, we quantitatively examined the effectiveness of suicide-related online gatekeeping. This was a non-randomized, single-arm study of online gatekeeping among Japanese Internet users. Outcomes were measured at the beginning of the use of the consultation service (T1) and approximately four weeks later (T2). The primary outcome measured was suicidal ideation. In total, 167 participants completed two assessment surveys; approximately 80% were women, and 59.3% were young people (in their twenties or younger). Data analysis of 167 online gatekeeping service users showed that the mean suicidal ideation at T2 was statistically significantly lower than that at T1, and its effect size was small to medium (d = 0.37, 95% confidence interval: 0.15-0.59). Online gatekeeping is a promising suicide-prevention tool, although further research is warranted to examine its effectiveness using a randomized controlled trial.HighlightsWe examined the effectiveness of email-based consultations for suicide prevention.About 4 weeks later, users' suicidal ideation was significantly reduced (d = 0.37).This was a single-arm study and requires a more rigorous study design in the future.