If you are experiencing a crisis or having thoughts of suicide, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), the Crisis Text Line by texting HOME to 741741, or visit the nearest emergency room.

Suicide is a growing public health problem and the second leading cause of death among young people in the US and worldwide (Hedegaard & Curtin, 2018; World Health Organization, 2018). People may attempt suicide when they feel overwhelmed by problems, pain, and hopelessness but feel they lack the resources or support to cope (Verrocchio et al., 2016). Connecting people to others who can provide mental health support and assistance with coping skills helps prevent suicide (Stone et al., 2017), and video games can play an important role by fostering connections and support. Whether through in-game interactions, membership on teams or guilds of players, or interactions on communication/media platforms such as Discord and Twitch, games offer many opportunities for players to communicate and connect (Colder Carras, Rooij, et al., 2018; Kowert & Quandt, 2016). Recently, video game communities have been tackling the need for mental health support and suicide prevention for their members through a variety of innovative programs. iThrive Games is happy to be talking about our efforts in an upcoming panel called Suicide Prevention in Video Game Communities to be held April 27 at the American Association of Suicidology annual conference in Denver, Colorado.

Famous screenshot from Legend of Zelda (Nintendo, 1986), often used as a meme to encourage others to seek and utilize help.

Many different factors have been linked to suicide. According to one theory, individuals who die by suicide are driven by three factors: feeling that they are a burden to others, feeling frustrated in their efforts to make meaningful connections, and becoming numb to the pain and fear associated with the idea of dying (T. Joiner, 2005; T. E. Joiner et al., 2009). These, along with hopelessness and difficulty with solving problems, making decisions, or seeking help can drive suicide ideation and attempts (Gvion & Levi-Belz, 2018; Joiner et al., 2009). Addressing social isolation/loneliness and problems coping with life stresses can be important targets for suicide prevention programs (Stone et al., 2017). Although about half who die by suicide do not have a mental health diagnosis ("More than a mental health problem," 2018), those who have a diagnosis are more likely to feel like they don't belong (Ma, Batterham, Calear, & Han, 2019). Suicide is a particular risk for some groups such as adolescents, older adults, military veterans, the unemployed, or those with low socioeconomic status (Bryan, Jennings, Jobes, & Bradley, 2012; Nock et al., 2008; World Health Organization, 2018). Members of marginalized groups such as LGBTQI individuals, refugees and immigrants, and indigenous peoples also have higher suicide rates (Forte et al., 2018; Harlow, Bohanna, & Clough, 2014; Hottes, Bogaert, Rhodes, Brennan, & Gesink, 2016).

Preventing suicide is a challenge. Even though we know factors that are associated with more or fewer suicidal thoughts and behaviors, existing prevention programs have yet to make reduced rates of suicide worldwide. One of the most common measures in prevention is gatekeeper training-teaching individuals who are not mental health specialists how to recognize the signs of suicide risk, ask questions about suicidal thoughts and plans and manage suicidal behavior (Stone et al., 2017). Crisis intervention services such as the National Suicide Prevention Lifeline and local call or text centers provide anonymous assessment and counseling by trained individuals who often volunteer from the local community.

Twitter response to the prompt "Tell me about the happiest experience you've had either in a game or because of games? What do they add to your life?"

New approaches to suicide prevention are needed, and recent research has focused on the potential role of video games in suicide prevention. We know that video games help people connect and feel that they belong to a community (Kowert, 2016). Joining teams or guilds, or even just hanging out with people in-game helps players bond through shared activities (Steinkuehler & Williams, 2006; Williams et al., 2006). In a recent study of veterans in treatment for mental health conditions, playing games with others was found to be an important source of social interaction that helped some veterans overcome isolation or assume leadership roles (Colder Carras, Kalbarczyk, et al., 2018). Although taking a break from daily life through games or other entertainment media is a common method of recreation that can help people recharge (Oliver et al., 2015), this study found that some veterans used games to help ward off suicidal thoughts or substance cravings when other coping strategies didn't work (Colder Carras, Kalbarczyk, et al., 2018). Of course, excessive use of games can lead to other problems, so therapists should work with clients to understand the role and uses of gameplay in dealing with life challenges.

Video game groups, researchers, clinicians, and nonprofits are now seeking ways to leverage these potential benefits of video games. iThrive and academic groups such as the Games for Emotional and Mental Health Lab at Radboud University work to develop and promote games that enhance social and emotional learning, reduce anxiety, and teach problem-solving through gameplay experiences. The organization Stack Up provides a host of grassroots, game-related programs that support positive well-being through games, but is best known for its unique online suicide prevention program. STOP (the Stack Up Overwatch Program), which provides anonymous online crisis intervention services and referrals 24/7 for adult members of its Discord server.

Twitter response to the prompt "Tell me about the happiest experience you've had either in a game or because of games? What do they add to your life?"

Other organizations focus on education and messaging to reduce stigma—getting the word out about mental health problems and fostering healthy discussions about coping. The weekly Twitch broadcast PsiStream, led by a licensed mental health counselor, educates viewers about mental health problems and encourages them to ask questions about uncomfortable or challenging topics. The nonprofit organization Take This supports mental health in the game industry through initiatives such as the Ambassador program, which recognizes Twitch streamers who promote positive mental health through their streams. These emerging efforts provide exciting new opportunities to make a difference in suicide prevention and mental health support in the games industry.

Gameplay provides many ways to foster mental health, and the game community is leading the way with innovative programs. Join iThrive on April 27 as we discuss our efforts along with Stack Up and Take This at the American Association of Suicidology meeting. Stay tuned for a link to our live stream on Twitch. And remember that help is available-if you or anyone you know is affected by suicidal thoughts or behavior, contact the National Suicide Lifeline at 1-800-273-TALK (8255) or the Crisis Text Line by texting HOME to 741741.

References

Bryan, C. J., Jennings, K. W., Jobes, D. A., & Bradley, J. C. (2012). Understanding and preventing military suicide. Archives of Suicide Research, 16(2), 95-110.

Colder Carras, M., Kalbarczyk, A., Wells, K., Banks, J., Kowert, R., Gillespie, C., & Latkin, C. (2018). Connection, meaning, and distraction: A qualitative study of video game play and mental health recovery in veterans treated for mental and/or behavioral health problems. Social Science & Medicine. https://doi.org/10.1016/j.socscimed.2018.08.044

Forte, A., Trobia, F., Gualtieri, F., Lamis, D. A., Cardamone, G., Giallonardo, V., ... Pompili, M. (2018). Suicide Risk among Immigrants and Ethnic Minorities: A Literature Overview. International Journal of Environmental Research and Public Health, 15(7). https://doi.org/10.3390/ijerph15071438

Gvion, Y., & Levi-Belz, Y. (2018). Serious Suicide Attempts: Systematic Review of Psychological Risk Factors. Frontiers in Psychiatry, 9. https://doi.org/10.3389/fpsyt.2018.00056

Harlow, A. F., Bohanna, I., & Clough, A. (2014). A systematic review of evaluated suicide prevention programs targeting indigenous youth. Crisis, 35(5), 310-321. https://doi.org/10.1027/0227-5910/a000265

Hottes, T. S., Bogaert, L., Rhodes, A. E., Brennan, D. J., & Gesink, D. (2016). Lifetime Prevalence of Suicide Attempts Among Sexual Minority Adults by Study Sampling Strategies: A Systematic Review and Meta-Analysis. American Journal of Public Health, 106(5), e1-12. https://doi.org/10.2105/AJPH.2016.303088

Joiner, T. E., Van Orden, K. A., Witte, T. K., Selby, E. A., Ribeiro, J. D., Lewis, R., & Rudd, M. D. (2009). Main Predictions of the Interpersonal-Psychological Theory of Suicidal Behavior: Empirical Tests in Two Samples of Young Adults. Journal of Abnormal Psychology, 118(3), 634-646. https://doi.org/10.1037/a0016500

Kowert, R. (2016). Social outcomes: Online game play, social currency, and social ability. In R. (Ed) Kowert & T. (Ed) Quandt (Eds.), The video game debate: Unravelling the physical, social, and psychological effects of digital games. (pp. 94-115). New York, NY, US: Routledge/Taylor & Francis Group. (2015-20483-006).

Ma, J. S., Batterham, P. J., Calear, A. L., & Han, J. (2019). Suicide Risk across Latent Class Subgroups: A Test of the Generalizability of the Interpersonal Psychological Theory of Suicide. Suicide & Life-Threatening Behavior, 49(1), 137-154. https://doi.org/10.1111/sltb.12426

More than a mental health problem. (2018, November 27). Retrieved April 15, 2019, from Centers for Disease Control and Prevention website: https://www.cdc.gov/vitalsigns/suicide/index.html

Niederkrotenthaler, T., Voracek, M., Herberth, A., Till, B., Strauss, M., Etzersdorfer, E., ... Sonneck, G. (2010). Role of media reports in completed and prevented suicide: Werther v. Papageno effects. The British Journal of Psychiatry: The Journal of Mental Science, 197(3), 234-243. https://doi.org/10.1192/bjp.bp.109.074633

Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., ... Williams, D. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. The British Journal of Psychiatry: The Journal of Mental Science, 192(2), 98-105. https://doi.org/10.1192/bjp.bp.107.040113

Oliver, M. B., Bowman, N. D., Woolley, J. K., Rogers, R., Sherrick, B. I., & Chung, M.-Y. (2015). Video Games as Meaningful Entertainment Experiences. Psychology of Popular Media Culture, 5(4), 390-405. http://dx.doi.org/10.1037/ppm0000066

Steinkuehler, C. A., & Williams, D. (2006). Where Everybody Knows Your (Screen) Name: Online Games as "Third Places." Journal of Computer-Mediated Communication, 11(4), 885-909. https://doi.org/10.1111/j.1083-6101.2006.00300.x

Stone, D., Holland, K., Bartholow, B., Crosby, A., Davis, S., & Wilkins, N. (2017). Preventing Suicide: A Technical Package of Policies, Programs, and Practices. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

Williams, D., Ducheneaut, N., Xiong, L., Zhang, Y., Yee, N., & Nickell, E. (2006). From Tree House to Barracks: The Social Life of Guilds in World of Warcraft. Games and Culture: A Journal of Interactive Media, 1(4), 338-361. https://doi.org/10.1177/1555412006292616

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