William Melchert-Dinkel, a former nurse who lives in Minnesota, was convicted last month for assisting the suicide of a British man online. Melchert-Dinkel spent his time visiting suicide-related internet forums where he posed as a suicidal female nurse. He would offer people step-by-step instructions on how to kill themselves (usually by hanging), and in ten cases, he entered into suicide pacts with other forum members. He believes five of those people went through with the suicides. In some cases, he may have watched people commit suicide over a webcam.

And while Melchert-Dinkel certainly represents the worst of what people might encounter online, it turns out that the Internet is not a reliable source of support for people who are depressed or suicidal.

Research published in April shows that when people consult the Internet for help with issues of suicide or mental health, they have significantly increased suicidal ideation as well as hopelessness, depression, , and [1].

Over 5,000 people participated in the study, half of whom had consulted the web for help with depression or suicide issues. Participants took standard psychological tests to measure their levels of suicidal ideation, loneliness, depression, and hopelessness at the start, one week later, and seven weeks later.

Researchers compared the scores within groups between the tests taken at week 1 and week 7. Over those six weeks, the group of subjects who sought out information about suicide or mental health online saw significant increases in all the areas mentioned above.

This study was unique because of its size and methodology, but the results are not surprising. They echo what was found in a meta-survey published last year. Across 225 papers on young adults, suicide, and Internet use, there were consistent results: when people go online looking for help regarding suicide or , their suicidal ideation, depression, and risk for self-harm increases [2].

There are three big unanswered questions that arise from these results.

First, why are people having such consistently negative outcomes? It is especially perplexing given that a lot of other research shows that for other conditions (e. . cancer), online support groups are very effective at helping people who come to them.

Second, these studies do not look at which sites people visit, so it is hard to know what kinds of interactions people are having and how those affect them. Perhaps some sites are successful but many others are harmful.

And finally, given that the overall online environment is not helpful to depressed and suicidal users, what can be done to get them the support they are looking for?

More research will be needed to definitively answer these questions, though research covered in [2] offers some theories that speak particularly to the first question about why we may be seeing these negative impacts. There is some evidence that suggests online communities might be a place that treats self-harm and suicide as something routine and that it discussed in a way that normalizes it. Some online forums also tend to support suicide by offering instructions or helping people find suicide "partners". might also be a factor.

And though we don't know which sites help or hurt, we can look to one community online as an example of how a group might develop a culture and structure that helps people contemplating suicide by providing them with encouragement, resources, and hope: the PostSecret community.

PostSecret is a community art project where people make artistic postcards that share a personal secret. They mail their secrets to Frank Warren, creator and curator of the project. He selects cards to post online each week at postsecret.com.

Suicide is a frequent theme among the postcards, and since its beginning 10 years ago, the PostSecret website has included links to suicide prevention hotlines and resources. In 2011, the community of PostSecret readers launched the International Suicide Prevention Wiki. It's the web's largest collection of suicide hotlines, textlines, and resources.

I talked to Frank Warren about the experiences he has had, both as someone who handles secrets from people contemplating suicide and as someone involved in directing people to suicide prevention help online. He has seen very positive interactions within the PostSecret community.

"The people who have shared their stories with me overwhelming have been more positive than negative. That's from my sampling from 10 years of sharing secrets and hearing how people have reacted to them."

He mentions that the way suicide is presented in the media and online can have a profound impact on how people react and respond.

"Talk in general might not always lead to a solution but educated, researched conversation and websites that create that kind of structured interaction can lead to more positive results."

Observing the interactions within the PostSecret community as well as the breadth of resources available on the International Suicide Prevention Wiki certainly makes it seem like this is a place online that is, in fact, helping people who come there for help. Are there guiding principles or structures in place that help it succeed? Frank Warren says he is a firm believer in three things that he sees as important to their success.

"The first is always offering people help and letting them know through stories with a positive outcome that hope is real and hope is true and help is available. So offering the idea of help through storytelling is very useful.

"Secondly, I think that destigmatizing these issues is another important step for people. Understanding that it's ok to have these feelings, it’s ok to talk about them, to know they're not alone with those feelings. I think that’s another important part.

"And lastly, is offering resources. Resources that are all over the web but sometimes not always easy to access."

Hope is a core theme in his comments. While researchers need to probe all of these questions more deeply, PostSecret may well serve as an exemplar of an online community that is successfully guiding people to the resources and support they need.

[1] Sueki, Hajime, et al. "The impact of -related internet use: a prospective large cohort study with young and middle-aged internet users." PloS one 9.4 (2014): e94841.

[2] Daine, Kate, et al. "The power of the Web: a systematic review of studies of the influence of the Internet on self-harm and suicide in young people." PloS one 8.10 (2013): e77555.