Blue Whale ” : blog posts about the suicide game “ Baleia Azul ” : postagens em blogs sobre jogo suicida

| This study analyzed blog posts linked to the “Blue Whale” game in blogs. A Qualitative study was conducted on Tumblr Posts in Portuguese by searching for the string “baleia azul” (“blue whale”), and were submitted to thematic analysis. The main themes were: “Understanding and support”, “Opposition to the game or the players”, “Blue Whale game information”, “(Family) Relationship” and “Vulnerability”. Bloggers expressed warm, understanding or derogatory attitudes towards people prone or who identified themselves to the game. Games related to suicidal behavior may raise diverse interest level and diverse attitudes and behaviors in a young audience, being a risk for vulnerable individuals; it needs to be addressed in preventive strategies.


Introduction
Despite being considered a preventable death, suicide is the second leading cause of death among people aged 15 to 29 years old, this fact drawing attention to this phenomenon, which affects the young population 1 .The suicide has become easily accessible through the Internet.It has facilitated searching, as well as transmitting and sharing thoughts and feelings among individuals about the subject 2,3 .
Social media are used at different stages of life.Over the last decade, the Internet has influenced people's life, has influenced young people, and mainly teenagers, who are potentially susceptible to intimidation, victimization and social exclusion 4,5 Social media have different contents and an ambiguous relationship with suicide; they can make up a support and welfare net for suffering individuals or disseminate pro-suicide content 6 .
Blogs are commonly used as a virtual diary or as means of communication to express opinions, feelings, thoughts and experiences.They can reach a large audience and influence many people 7 .The literature shows that people with higher risk of suicide are more likely to talk about suicide in blogs 8 .Studies focusing on posts about suicide in blogs are scarce, despite the relevance of this virtual environment 8,9 .Furthermore, studies focusing on suicidal behavior in bogs have to take into account the inherent sociocultural aspect, and no studies on suicidal posts in Portuguese have been found.Finally, research about how suicide-vulnerable people interact in blogs is necessary for the planning of effective prevention and support strategies 9 .
Although some countries have a control and restriction policy for contents published on the Internet, there is no worldwide regulation on the access to content of a suicide-promotion nature.The Blue Whale encompasses stages and challenges proposed to participants, and has turned into a phenomenon that has gained visibility and awareness in Brazil and worldwide.Despite this alarming context, we have found no scientific research aimed to assess the impact of the Blue Whale game on the population, and especially on the Internet audience, where it runs and is disseminated.Research on this topic in the Internet is needed for the planning of effective prevention and support strategies and professionals should update themselves about the dangerous online challenges 10 .Thus, in view of the relevance of the issue and the gaps found in the scientific literature, this study aimed to analyze those themes related to the "Blue Whale" suicide game, found in blog posts in Portuguese.

Type of study
This is a cross-sectional qualitative study.The qualitative approach was adopted because it involves a nonmathematical process of interpretation which was suitable to the objective of this study.Qualitative research can not be misused to measure the "quality" of an object, but rather in the understanding of the individual or collective meaning in people's lives mainly applied to health.
In the qualitative analysis the main verbs are to understand and to interpret, taking into account the individuality and subjectivity of each one.From these principles it is necessary to value the narratives to elaborate coherent hypotheses to guide the work and to construct the instruments that will help with the discoveries and relevancies, to organize, to categorize, to contextualize and to construct the final report, fruit of the analysis 11 .

Source of data collection
The TUMBLR blogging platform was chosen as the source for data collection because it hosts a large amount of blogs (about 289 million, according to information available at the site).
The platform was created in 2007, headquartered in New York, USA.Its homepage states network's purpose "We made it really, really simple for people to make a blog and put whatever they want on it".(Retrieved Apr 22, 2016, from: <https:// www.tumblr.com>).Tumblr's Privacy Policy does not rule what the users do in their blogs, the platform provides flexibility in blogs' construction and features an anonymity option in users' account setup.

Post search strategy
The string "baleia azul", which means "blue whale" in Portuguese, was typed in the search field of website's homepage.Then, the retrieved posts were classified by popularity, in descending order, using the "most popular" tool.

Inclusion and exclusion criteria
Posts in Portuguese, classified as "most popular", and being "text" or "quote" type, among those retrieved using the procedure above, were eligible.Videos, links, audios, chats and photos were excluded, as well as entries in any language other than Portuguese.

Data collection procedure
Screenshots of the posts that met the inclusion criteria were saved and named with a number corresponding to the order they were found.Each post was transcribed into an editable document and the transcriptions were reviewed for the correction of any errors.

Data analysis
An inductive data thematic analysis, as proposed by Braun and Clarke (2008), was used in this study to identify hidden themes or patterns and meanings in the data.The four initial steps (data familiarization, construction of initial codes, search by theme, and theme analysis) were conducted by two researchers and, later, compared, verified and judged by two different researchers.Then, the four researchers moved on to the final review steps: defining and naming the themes and producing the report 12 .Finally, discussions were held in order to reach consensus among researchers.

Ethical aspects
Tumblr posts are public, and free access is allowed.The study kept bloggers' anonymity and complied with all recommendations concerning research involving human beings, as proposed by the Brazilian law and the Declaration of Helsinki.

Results
Categories that represent the main themes addressed in the posts included in this study are presented below.

Understanding and support
This was the most frequent category found in the posts.It encompasses demonstrations of understanding and support to people who are undergoing difficult times, suffering, mental disorders and anxiety.It also calls on people to have empathic, welcoming and supportive behaviors.
The importance of empathy, tolerance, understanding, coming closer, dialogue, listening, openness, acceptance and recognition of needs was highlighted, as well as the proactive offering of help and advice, the solidarity and the need to avoid criticism, judgment and trivialization of the suffering of others.
My inbox is open for those who want to talk or just vent, or who want a shoulder to cry on (...) People need to be listened and I'm willing to listen.I do not know you, but you are important to me (...) Do not keep everything to yourself; balloons too inflated explode.
Folks, help whoever you can help, those having hard times, a friend or even people you don't know.Just help!Listen what they have to say, don't criticize them for entering in suicide challenges or watching things that make them even more depressed.Just listen to them.The scary thing is not just the game itself, but the lack of compassion (...) So, I make an appeal: let's love too much and not the opposite.

Opposition to the game or the players
Several posts expressed criticism and opposition towards the game or people who engaged in its proposal.It was observedpeople's concern to prevent the dissemination of the game, considered harmful, disruptive and potentially fatal.There are appeals for potential players not to engage and at the same time the development of games that are opposed to suicide game occur (related to the promotion of mental health or religiosity) stood out.Expressions of criticism, judgment or contempt for young people who engage as Blue Whale players were also clearly found.
"Spread out the pink whale (a game that promotes welfare)!Don't let the blue whale make more victims!Be good, do good.""Never let your life in someone else's hands, don't let yourself go or allow to be manipulated; cut the strings that make you puppet.

No matter what you are undergoing, playing Blue
Whale is not the answer.Please, don't fall into the "Blue whale game" trap, bro!" "Wow, who does those things must be a jerk" "Cutting oneself is stuff for stupid people" "If they were slapped, they would not do these things"

Information about the "Blue Whale" game
We identified uncertainty about the game, and expressions of interest to get information on it.We also found news about the origin of the game, its main objectives, dissemination, repercussion, playing stages and playing termination (being suicide the latter task), as well as reports of deaths allegedly linked to the game.
Information was permeated by personal impressions, shock reactions, doubts regarding the veracity of the game, concern, and the anticipation that more deaths will come.

Vulnerability
The content of some posts points out the vulnerability and the invitations to join the suicide game.It also highlights the desire (implicit or explicit) of dying through the Blue Whale game, being linked to the lack of motivation to live, suicidal thinking, intense emotional distress and the feeling to be misunderstood.The game represented a way to commit to a suicide plan, to arrange it and to assign new meanings and values to it.

Discussion
The main themes related to the "Blue Whale" suicide game were represented by the categories "Understanding and support", "Opposition to the game or the players", "Information about the Blue Whale game", "(Family) relationships" and "Vulnerability".Bloggers expressed warm, understanding or derogatory attitudes towards people prone to engage in the game or who identified themselves with the game.The "Blue Whale" suicide game aroused aversion, curiosity, and blaming of players' families.It is perceived as a strategy for engagement with suicidal plans.We could not compare many of these results to previous studies on virtual social media, because of the lack of research on the subject on virtual social networks.
The risk represented by the blue whale suicide game raised reflection on the importance of providing understanding and acceptance to vulnerable people, as well as developing support actions to this population.In this regard, studies show that technology and health virtual social networks are important sources of social support for people with health conditions 13 , as they can provide aid to the mental health of people facing difficult situations 14 .Therefore, it is important to carry out research on the way people participate and contribute to virtual social networks focused on health and wellness promotion 15 .
Some bloggers expressed criticism and opposition to the game or to people who engaged in its proposal.
Several studies show that an individual with suicidal behavior usually arouses negative 16,17 or moralist attitudes 18 , judgments 19 , and understanding and empathy difficulties 20 in others.Although it is not desirable taking suicide as an acceptable option, it is important to pay attention to extremist, judicious or little empathetic attitudes that can harm the support to vulnerable people and the prevention of suicide 21 .
We also identified alternative games with proposals opposing to suicide game, which emphasize the value life, health promotion or religiosity.Prevention specialists could benefit vulnerable individuals through a responsible use of the Internet 22,23 .This could be done by leveraging social connections between peers with similar experiences and developing programs, prevention lines, educational and support resources 24 .Referrals to support services from search engines could also be implemented.
Demonstrations of curiosity about the game were found, as well as dissemination of information on the same.The scientific literature suggests that the media may have an important influence in suicide contagion, a phenomenon apparently caused by the improper communication on the theme 25 .Thus, information about suicide, if not carefully conveyed, can favor the spread of pro-suicide content 6 .This is a major issue for public health, which needs to be carefully addressed worldwide.
Careless or conflictive interpersonal relationships were considered risk factors or "reasons" for the engagement of young people in the "Blue Whale" suicide game.Blaming the family for the initiation of young people into the game also stood out.
Helplessness, feelings of social inadequacy, conflictive interpersonal relationships and lack of acceptance, understanding and support may aggravate the psychological pain associated with suicidal behavior 26 .However, such behavior is a complex and multifactorial phenomenon 1 , and reducing it to the result of interpersonal relationships can be risky, especially when that judgment is accompanied by blaming people.
In this study, we identified posts in which vulnerability was the core subject.We also identified posts with invitations for the suicide game and posts expressing the desire (implicit or explicit) of dying by playing "Blue Whale", as a way to commit to a suicidal plan, to arrange it and to assign new meanings and values to it.The literature suggests that people with higher risk of suicide are more likely to talk about suicide on the Internet 8 .Thus, if no preventive actions are taken on virtual environments, these spaces probably will only leverage connections between individuals who are vulnerable to suicidal behavior, or people incapable to deal with demands related to this issue.
Suicide is a problem particularly concerning among young people, it is the second cause of death in the 15-29 age group 1 and prevention efforts have to address the needs of this audience 1 .Preventive actions should include virtual strategies, as they are promising due to the influence of the Internet among young people 4 .Furthermore, our study reveals the importance of health and education professionals being up to date on issues that arouse the interest of young people on the Internet.
This study provides new knowledge, relevant for planning strategies on suicidal behavior prevention.
Limitations of the study were the inclusion of publications in Portuguese, not explored in previous studies, and consequently not having been explored and compared with the posts in other languages.In the analyzed platform, postings are allowed through images, videos and music, which were not analyzed in this specific study because the inclusion were of text posts only, to enable a thematic analysis of material written by bloggers in a standardized manner.Its results show that it is necessary to evaluate and implement actions to prevent online and offline suicidal behavior, addressing the interests and new developments that pose a risk, especially for the young audience.