It may have been a cry for help. It may have been a futile search for a companion in death. But when the anguished Hong Kong woman shared her thoughts over the Internet as she contemplated ending her life, it led her to a depressingly tragic conclusion.

In the months before her death, the woman, whose case has been studied by University of Hong Kong psychologist Paul Wong, joined a secret online suicide group whose members exchange ideas on how to kill themselves and encourage each other to step over the brink.

“She joined and posted an invitation for people to kill themselves together with her,” said Wong. “She disappeared for four or five months, and then she was invited by another member to join the group again.

“Soon after that happened, she posted a brief message saying ‘I am not afraid of the process. If the process goes quickly, I can die.’ Ten days later, she hanged herself.”

The woman was 23 years old. For Wong and his colleagues, her death reflects an evolving new frontier in suicide prevention: the potential of the Internet to encourage suicide and its potential to reach out and help people who are contemplating suicide.

“Groups like this make it easier for people to get together and die,” said Wong. “In the past, they were socially isolated from each other, but now it is quite easy to find similar people through the Internet and it will reinforce their suicidal thoughts.

“On the other hand, it might be a good thing as well, because the more people know about a person’s suicidal tendencies, the more opportunity there is to do something.”

Now, 10 years after it began its pioneering work, the university’s Centre for Suicide Research and Prevention, headed by Director Paul Yip who works with Wong, is confronting the paradox and looking at ways to reach out and help people through social networking sites.

Thanks in part to initiatives by the center to reach out and help people at risk, Hong Kong’s suicide rate has fallen from 18.6 cases per 100,000 people to 13.6 over the past decade. Nevertheless, the city’s suicide rate remains high in international terms with some 950 people a year — more than two a day — still taking their own lives.

More troubling still, the rate among young people in their late teens and early 20s is on the increase — and these are the people Yip and his colleagues want to reach out to by taking their work online. “We need new forms of engagement,” he said. “If you stick to the old methods, it just doesn’t work.

 “The people who call telephone hotlines are more the middle aged groups or the elderly, not young people. However, it is among young people that we have seen a steady rise in suicide in the past five years. The overall suicide rate is coming down but the suicide rate among young people is going up.”

Internet penetration among 15 to 19 years olds is around 95 percent in Hong Kong, said Yip, and he believes there is an opportunity to engage them using the new social media.

Yip’s center is working on setting up an interactive website site and wants to work with major social networking sites and search engines to find ways of reaching out to people who may express suicidal thoughts or join suicide groups online.

An important part of that process is to understand the kind of language people use when they go online to discuss suicide and distinguishing the bogus from those genuinely in danger. “We have to understand the pattern of usage and the language they use if they cry out for help,” Yip said.

“There are some people who commit suicide who write a blog before they die. We go back and investigate the blogs. We would like to build up a library of knowledge about how these distressed people communicate themselves and what sort of things they want help with.”

A core belief of suicide prevention worker is that in many cases there is a window of opportunity in which, if the person can be reached out to effectively, there is the chance to prevent them taking their life.

“We believe that when they say they are so distressed and hopeless, when you induce hope, they might change their mind,” said Yip. “We want to use social media as a platform to engage them. We want to devise a website where they can go to for information and advice.

“Most of the blogs people write when they are contemplating suicide are exclusive to their own friends. So we also want to raise awareness in the community so that if you belong to that subgroup and you identify someone who has a problem, please send your friends to see professionals. Please engage them.”

The potential power of blogs encouraging suicide has already been demonstrated in Hong Kong. Police intervened and tracked down members of a Facebook group which when around 200 people signed up to a call for mass suicide in December 2009.

“Negativism is very contagious,” said Yip. “It spreads faster than an epidemic. If I want to die and I post a bog, it doesn’t take long before someone says ‘Can I join you?’

“These things are so instantaneous. On these blogs, some people say they helped their friends to commit suicide. Some say ‘I want to do it but I don’t have the guts to do it. Can you help me? Can we do it together?’”

Intervention is critical to tackle the menace of contagion, Yip argued. “There is the question of privacy but when you are talking about a matter of life and death, there should be an overriding concern,” he said.

Yip and his colleagues want to work in future with Facebook, Yahoo! and Google to devise ways of responding to the danger of online suicide groups, possibly through the use of pop-up advertisements directing people to websites where they can seek help.

“They (the companies) gather a lot of information about their users and if kindly agree to share some of their knowledge, we can get in there and do something,” Yip said. “I believe they have a corporate social responsibility to act on this.”

One member of Yip’s research team, PhD student Emily Cheng, got a chilling insight into the mechanics of online suicide groups when she signed up to one and became a member. The experience gave her a powerful insight into the power of the Internet for good and bad.

“I spoke to a girl in China who attempted suicide and posted her suicide note online,” said Cheng. “People saw the note and called the police. The police found this girl at home and she had already taken over 100 pills.

“Her parents were in the next room and they were totally unaware of what had happened. The girl was taken to hospital and she recovered.”

Cheng asked the rehabilitated woman what advice or guidance would have helped her before her suicide attempt. “She told me she would have wanted people to tell her depression is a kind of illness and you are a patient,” Cheng said. “That would have helped her feel people understood her situation.”

A key lesson Cheng drew from her experience was that shutting down and banning online suicide groups — something that happened to the Facebook group she joined herself — is not necessarily productive.

“After the group was deleted by Facebook, some of the members formed a different group with a disguised name,” she said. “Some people had really negative thoughts about simply deleting the groups.

“They said it was an infringement of their freedoms and they said ‘they might stop the group, but they can’t stop us thinking about suicide’. This kind of action erodes their trust in authority and pushes them further into the margins of society.

“So I don’t agree with simply deleting these kinds of groups. They can form another group and they can disguise these groups with positive names and that makes it more difficult to find these groups and reach out to them.”

Yip said: “We believe you should try to intelligently engage these people. Engagement is always the best way to approach these problems. When they go underground it is even more difficult to detect.”

Not every young person who commits suicide joins an online group of course. Some do post blogs, however — but as research assistant Helen Ma at the center’s Pokfulam headquarters has discovered, the messages those blogs send out can be misleading.

Scrolling through a blog posted by a young woman who took her own life in 2008, Ma, who has analyzed dozens of blogs and hundreds of suicide notes, points out how the final entry talks of plans for the weekend ahead and promises to meet up with friends.

“If you read it, it doesn’t give much of an indication that this person is suicidal,” said Ma. “This is a contrast to other efforts where we try to identify emotionally disturbed adolescents online. They show their tendencies openly online but for people who actually commit suicide, it isn’t exactly the same. This shows some of the challenges we face when we try to reach out and help people.”

However challenging, Yip believes reaching out to young people online is critical if suicide rates are to be kept from rising. With rising social tension and the prospect of tougher economic times ahead, the chances of a spike in the suicide rate is high, he believes.

 “The rate has fallen and now it is at a plateau. It is like a pressure cooker and the pressure is building up now,” Yip said. “You can see the frustration and the hopelessness of people. We worry that the suicide rate is building up momentum to go up again.

“Hong Kong people have put up with so much hardship and hopelessness in recent years. Rent has gone up. Prices have gone up. Everything has gone up except people’s salary. The only people earning more money are the top 10 percent of the population. The other 90 percent are suffering.

“It is like you are drawing money from a bank to deal with this, but then our level of savings is going down to very low and we will be in the red very soon. If we do not have anything good to boost the level of savings, our mental health bank will go bankrupt.