This paper was submitted for the 2016 Stanford MedX / Symplur “Everyone’s Included” Research challenge. Although the paper did not win the contest, I was thrilled to be a semi-finalist. Thank you to the organizers of Stanford Medicine X and the team at Symplur for giving me access to Symplur Signals to complete this work.
Co-Authors: Amelia Roberts BSN RN CPN (Solutions by Amelia) , Milan Balakrishnan, Maha Yaqoob, BSc
Background:
Suicide statistics are daunting. According to the Center for Disease Control, “There were 41,149 suicides in 2013 in the United States—a rate of 12.6 per 100,000 is equal to 113 suicides each day or one every 13 minutes”. When you think about this on the global scale, The World Health Organization identifies that someone dies by suicide every 40 seconds. Also from the Healthcare perspective, suicide deaths are just the beginning. In the U.S., over 494,169 people with self-inflicted injuries were treated in U.S. emergency departments in 2013.
There are vibrant twitter communities talking about both suicide prevention and healthcare on twitter. Given these numbers these communities should be talking about suicide together. This research sought to understand how these communities are talking about suicide and examine if they are “talking” with each other or not.
Approach to analysis:
Using #ZeroSuicide, #SPSM, #MHChat, #HCLDR, and #MedED as anchors, the team explored various relationships between suicide prevention and healthcare communities and how they talk about suicide on twitter. In looking at Table 1, the number of tweets containing the word suicide increased over time. Figure 1 demonstrates spikes in the word “suicide” paired with #MedEd and #HCLDR in the last 3 years. The team examined trends during these mentions to see if #hcldr and #meded hashtags might be “talking” with suicide and mental health hashtags.
Results:
There were some interesting trends of note. The first noticeable spike in the word suicide in the #MedED community way the week of 11/24/15. On this day Dr. Andre Picard released an article “Suicide Should Not Be An Occupational Hazard For Physicians”. The word suicide was paired with #MEDed 108 times. Of note there was not an increase on #spsm at this time. However, on 3/20/16 the #MEDed and #SPSM hashtags were tweeting more about “suicide” and were paired together frequently. This was due to the appearance of Dr. Pamela Wible on #spsm chat. She is also an expert and advocate on physician suicide. The examined hashtags tweeted the word suicide 77 (#MedED) and 863 (#spsm) times that day. This was also a time where #meded and #spsm were frequently paired together in tweets 61 times. On the average day that year they were paired 0.8 times per day.
#HCLDR increased the word suicide at several points, once was in conjunction with and #spsm chat on 9/28/15. The tweets shared the hashtag #spsm and #hcldr 14 times that day. This represents an increase in the average of them being paired that year (1.4 per day). This was a chat about helping primary care physicians gain access to suicide support tools in the electronic health record. Of note on that day, #hitsm was paired 114 times that night. This represents an increase in the average of 3.56 tweet per day of this pairing in 2015.
We examined conversations on 9/21-22/15 on #ZeroSuicide this was the days the the “#ZeroSuicide In Healthcare: International Declaration” was being held. The hypothesis being that these days would reach the healthcare hashtags. On these days it only reached two people that identified themselves as nurses. This did represent a spike in conversation between #hcldr and #ZeroSuicide with a combined 59 tweets of the hashtag being paired on those days. This pairing again averaged 1.4 tweets per day. There were no pairing of #ZeroSuicide and #MEDed on those days.
A sample of a few weeks of spike in the word suicide in #MHchat lead to some interesting results. The week of August 9th 2014, the main topics discussed during this time were suicide & depression. There were 375 tweets containing the word suicide & 84 with the word depression. There was little or no interaction with influencers who identified themselves as healthcare providers. The week of June 18th, 2015 represented another spike in the word suicide but the words ‘‘friendship’ & ‘mental health’ were highly represented. Of note #MHchat rarely is paired with the healthcare hashtags examined. For the calendar year ending July 29, 2016 it was paired with #MEDed 5 times and #hcldr 15 times.
Discussion:
Overall there does not appear to be a sustained conversation between suicide and healthcare communities on twitter. There are moments where these communities collaborate and talked with each other. This appears to be around twitter chats, conferences, and release of articles. Suicide prevention and healthcare communities are “talking” with each other at times. There were many data points requiring further examination.
Further research is needed to discover the implications of this. There is an overall trend of examined hashtags talking about “suicide” but it uncertain if resources are being exchanged. Further examination and conversation is needed to see how these increased conversations are impacting patient care. We would also like to further examine the hashtag #HITsm and it’s relationship with suicide prevention. It would be interesting to see how the larger healthcare conferences are mentioning the word suicide. A survey of healthcare communities about suicide resources may also shed further light on this.
Conclusion or Key Finding
The most fascinating finding was that all hashtags have had an overall increase being paired with the word suicide. The exception was #MHchat (mental health chat) in the last year actually had a decrease. These spikes in conversation about suicide often represented interaction between healthcare and suicide prevention communities. One can hope that this trend will continue to drive more information sharing and collaboration between suicide prevention and healthcare communities both on twitter and in real life.
References: (Vancouver style):
Suicide: Facts at a Glance [Internet] Atlanta, GA: Center for Disease Control. [2015] Avalible from http://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf
Suicide Prevention: A Global Imperative [Internet] New York: World Health Organization (2014) Available from: http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/
WISQARS Fatal and Non-Fatal Reports, All ages, All injures [Internet] Atlanta, GA: Center For Disease Control (2016) Available from: https://www.cdc.gov/injury/wisqars/
Table 1: Tweets Per Week With The Mention of the Word “Suicide”
( A year ends on July 29)
| #hcldr | #meded | #spsm | #zerosuicide | #Mhchat | ||||||||
| 2013 | 0.9 | 3.4 | 165 | 26 | 20.2 | |||||||
| 2014 | 5.3 | 12.7 | 365 | 192 | 44.6 | |||||||
| 2015 | 11.5 | 17.4 | 704 | 378 | 30.7 | |||||||
Figure 2.
#MedED and #HCLDR paired with the word “Suicide” In The Last 3 Years
(Year ending July, 29)
