Through the technological progress of our society and the rise of social media, the increase in number of reported cases of depression soar [1]. In the World Health Organization [2] report, the age-standardized suicide rate in the Philippines is 5.8 for males, 1.9 for females, and 3.8 for both sexes. The rate is established from the number of cases affecting a sample size of 100,00 people. According to the WHO, suicide is the second leading cause of death among 15 to 29-year-olds, and 78 percent of global suicides occur in low and middle-income countries. Furthermore, an alarming number of adolescents and young adults reported anxiety, depression, and some form of mental illness [3-5].

Additionally, the increase in mental illness is, at least in part, linked to the upturn in social media use among adolescents [6]. It was found that the younger generations are the most active users of social media and have more tendency toward mental health problems [7]. Furthermore, a study shows that the prevalence of mental health problems was positively associated with the frequency of social media exposure [8]. Adolescents also perceive social media use as a threat to their mental well-being for the following reasons: (1) it causes mood and anxiety disorders; and (2) it is a platform for cyberbullying [9].

Social media is now being utilized to understand mental well-being, wherein computer scientists are using quantitative techniques to predict depression, suicidality, and anxiety [10]. However, despite the increase of research in this field, it was found that the studies lack construct validity and lack reflection used to define and identify mental health status. There is also an issue with biases in data collection methods, the management of consent, and selecting the proper analysis techniques [11]. The majority of the studies on the relationship between the duration of consumption of social media and mental health issues were done through cross-sectional research that lacks examining individual change over time. Balsamo et al. presented biases in data collection methods, which include the limitation in gathering clinically diagnosed samples and the possibility of social desirability in answering the research instruments [12].

An 8-year longitudinal study shows that the increase in time spent on social media was not associated with mental health issues when examined at an individual level [13]. Another study shows a relationship between the time spent on social media and the number of engagements on the different social media platforms and the symptoms of depression and anxiety [14]. In essence, the study indicates that people are more likely to experience symptoms of anxiety and depression the more time they spend on social media. An increasing number of social media use was also related to online harassment, poor sleep, low self-esteem, and poor body image related to higher depressive symptoms [14]. On the other hand, individuals who deactivated their Facebook account for a month reported lower depression and anxiety, as well as increases in happiness and life satisfaction [15]. Furthermore, it was found that social media use does not predict impairment of mental health functioning, wherein vague booking (posting unclear but alarming posts to get attention) was found to predict suicidal ideation [16].

A study explored the value of social media for mental health awareness. The result shows that adolescents view social media as (1) its potential to promote positive mental health; (2) its utilization to seek information about mental health; and (3) there are both benefits and challenges to using social media in this manner [17]. However, mental health stigma and trivialization are still common on social media [18]. Some people with suicidal ideation go to online social media to share their personal experiences and communicate with others to get advice, support, or empathy from other users [19]. This rise of unsolicited communications among online communities with the same mental health concerns is referred to as peer-to-peer support [20].

The current study explores the investigation of the relationship between internet content and users who engage in suicidal behavior in online spaces. It seeks to comprehend the dynamics and effects of online interactions on this particular demographic. Examining the digital landscape, the study aims to provide possible insights into how people struggling with suicidal thoughts may be influenced by online content. With the high sensitivity of this subject matter on ethical consideration, there has been a minimal number of studies to understand better the phenomenon of suicidality [21]. A study of people with non-suicidal self-injury (NSSI) shows that these people go online to establish a sense of connection with other people with the same experience [22]. This behavior is done to gather more social support online. However, mental health professionals also view this as a reinforcement of suicidal behaviors. In addition, it was also seen that the longer time spent on social networking websites leads to higher psychological distress and increased suicide ideation [23].

Even though the number of suicide memes is proliferating, there are minimal studies regarding the interaction between these two variables. In the context of the hypotheses of imitation of suicidal behavior, the effects of the mass media as transmitters of models for imitation have to be discussed. However, the possible influences of mass media have been a particular source of controversy. From a psychological point of view, the expression and the theory of imitation are deemed appropriate. The use of this theoretical framework makes it easier to explain some results concerning imitative behavior in suicidology. The majority of the papers published on this matter revolve around theoretical methodologies and least on empirical methods.

This paper aims to explore the interaction between suicide memes and suicidality among Filipino internet users. The study’s relevance stems from its examination of the complex connection between users of digital spaces who engage in suicidal behavior and online content. Comprehending the effects of digital interactions on this population is essential for online community well-being. Furthermore, the study fills a vacuum in the literature by illuminating a delicate subject that has received little attention. Interventions and support networks for people dealing with suicidality in the digital age can benefit from this knowledge. Specifically, this study aims to answer the following questions:

1. What is the suicidal profile of the respondents?

2. What are the suicide behaviors and attitudes of the respondents towards suicide memes?

3. Is there a significant difference in the attitude towards suicide memes between the intensity of suicidal behavior?

4. What are the respondents’ perceptions of suicide memes?

5. Based on the results of both qualitative and quantitative studies, what results can be integrated?

Table 2 presents the suicidality profile of the respondents based on suicidal and self-injury behavior, suicide ideation, activating events, and treatment history. Based on the data, most of the respondents have self-injury behavior without suicide intent (53.9%), wish to be dead (57%) and suicidal thoughts (53.5%), are experiencing current or pending isolation or feeling alone (69.6%) and did not receive any treatment (80%).

Table 3 presents the percentages between suicide behaviors and the attitude toward suicide memes of the respondents within one month and a lifetime. Results show that the majority of the respondents deemed suicide memes as either fun or nothing. More respondents reported having suicidality (lifetime, within one month) and also perceived suicide memes as fun: Wished to be Dead (37.80%, 37.00%), Thoughts of Killing Oneself (33.90%, 39.60%), Thinking About Detailed Process of Killing Oneself (32.60%, 22.90%), and Intention to Commit suicide (28.30%, 7.40%). Those respondents who reported the absence of suicidal behavior show that the majority deemed suicide memes as fun or had no significant differences in their attitudes.

Table 4 shows the test of difference in the intensity of suicidal behavior between their attitude towards suicide memes. The purpose of this analysis is to determine whether attitudes toward suicide memes and the degree of suicidal behavior vary significantly between groups. Finding patterns in intensity can give important information about how to modify interventions and support programs. The result shows no significant difference among respondents with lifetime suicide behavior (p=0.194) and one-month suicide behavior (p=0.053).

Following are the results of converging the qualitative and quantitative results. The researcher selected some questions from the C-SSRS and integrated the results into the perception of suicide memes of the respondents to test whether the people who have present suicidal behavior have negative perceptions of suicide memes. Note that some responses elicited more than one theme. This results in different percentage computations.

Table 5 shows the integration of suicidal behaviors and perceptions toward suicide memes. The result shows that negative perception (triggered, inappropriate, and offended) comes from the respondents who do not wish to be dead. At the same time, those respondents who have suicidal ideation deem suicide memes as either funny or relating. Furthermore, regardless of whether or not the respondents manifest thoughts of killing themselves, detailed plans on committing suicide, and intention to kill themselves, the majority still perceived suicide memes as funny and relating.

Social media sites have become a significant way to communicate. The ties between internet communication about suicide and the ability of social media to create social bonds can be perceived as intermediary ties that can be collaborated to reduce the risk of self-harm [32]. The meaning of literary humor depends on the reading process of how well the readers engage with these texts, a process facilitated by schemata [33].

The researchers observed on social media sites that social media users have different perceptions towards suicide memes. Thus, the researchers assumed that those who keep on criticizing suicide memes are people without personal experiences of suicidality or did not/have limited encounters with any suicidal person during their lifetime. There is still some misconception manifesting in our society towards suicidality. Aside from suicide memes, people also perceived songs with suicide content to be triggering. However, an experiment was done where they concluded that this type of music primes implicit cognitions related to suicide, but it does not affect variables associated with increased suicide risk, such as effect, attitudes, and perceptions [34]. The researchers believe that regardless of the person's exposure with suicidality to suicide memes, their suicidality remains unchanged.

Common myths about suicide still prevail, such as whether people who talk about suicide will commit it if there is a risk that elicits suicidal thoughts if talked about, if suicide happens without previous warning or if it cannot be prevented if a person has already made up their mind to do it [35]. There are still plenty of highly cautious people to tackle suicide, especially in public, due to their understanding that it can reinforce the suicidal risk of other people. This is one of the reasons why people condemn the posting of suicide memes. However, another research suggests that talking about suicide and acknowledging its existence reduces, rather than increases, suicidal ideation and results in improvements in mental health [36]. This is in line with the result wherein some respondents perceived suicide memes as destigmatizing and addressed the issue by being a catalyst to initiate a conversation regarding this issue.

The findings of this study have important applications for a range of stakeholders. A deeper understanding of how people with varying degrees of suicidality perceive and engage with suicide-related content on the internet can be beneficial for mental health practitioners. The creation of specialized interventions and risk-aware support plans can be influenced by this knowledge. Social media companies and content producers also need to think about how suicide memes might affect people who are already at risk. Enforcing content guidelines and offering mental health support resources can be vital in fostering a safer online community.

Additionally, by using these insights, parents and educators can have candid discussions about mental health and the consumption of online content, giving people—especially young people—the skills necessary to assess and react appropriately to sensitive content. All things considered, this study provides practical insights that can lead to better-informed and successful strategies for addressing suicidality in the digital age.

The researcher, therefore, concludes that suicide memes should not be perceived as triggering and offensive but rather should be perceived as a creative way to address the issue of suicidality. However, we cannot deny the sensitivity of the topic that there are situations in these suicide memes delivered mockingly. Thus, the researchers recommend further research on the appropriateness of delivery of suicide memes to utilize this spreading awareness more appropriately.