Time to start taking an internet history?

Young people are turning increasingly to the internet to meet their educational, entertainment and social networking needs, and in times of emotional or psychological difficulty, they may likewise seek information online. The scope for anonymity, information, interaction, and sometimes fantasy, without fear of repercussion, makes the web an obvious choice for young people who are reluctant to disclose their difficulties to parents or professionals.

In the aftermath of the Bridgend suicides, recognition of the dangers of life online was recently highlighted by a government pledge to strengthen the Suicide Act 1961 by specifying the illegality of any internet activity which encourages suicidal behaviour. ¹ The move comes in response to public concern over internet safety, particularly for young and vulnerable groups, who may access websites or online communities that promote suicide or self-harm. In this context, and with approximately 170 000 adolescent self-harm hospital presentations per year, ² the revised legislation is an important and timely step.

A new diagnosis of ‘internet addiction’ has been proposed ³ and much of the current research into this problem comes from Asia, where cardiopulmonary-related deaths and even game-related murders in internet cafes are now regarded as serious public health issues. In the West, most psychiatrists share the general population's ignorance and minimisation of internet-related psychopathology.

Eliciting a careful and sensitive internet history as part of routine psychiatric history taking may prove invaluable in assessing young people at risk of self-harm and suicide and in uncovering other aspects of psychopathology associated with excessive or unhelpful internet use. Above all, further research into the relationship between online activity and mental health among adolescents and the general population is crucial if we are to manage risks associated with internet use and also take advantage of potential benefits of new technologies.