Search engine ads for suicide prevention: Analysis of engagement and costs from Australia, Indonesia and the US

Importance: Despite suicide being a global issue and 75% of suicides occurring in low and middle-income countries (LMICs), resources for suicide prevention in LMICs are often scarce and inadequate; thus, there is an imperative to reach individuals in crisis and develop tools outside of traditional healthcare systems. One such approach is using online ads to reach individuals searching for suicide-related keywords, presenting an ad and landing page to encourage help-seeking. Objective: To determine the difference in engagement and costs between suicide-related campaigns previously conducted in Australia, the US and Indonesia. Design: Primary and secondary analysis of engagement and cost data from three international studies. Setting: The study was conducted online in the US, Australia, and Indonesia.Participants: Participants were individuals searching for suicide-related information (e.g. suicide methods) and presented with a study ad during the relevant study periods (2019-2023).Intervention: People searching for relevant keywords were presented with an ad during their information-searching process, which linked to a landing page designed to de-escalate the crisis and promote help-seeking.Main Outcomes and Measures: We measured total engagement rate (engagements/impressions) and effective cost per engagement (cost adjusted for purchasing parity and inflation). Results: The total engagement rate was 18 and 15 times higher in the Indonesian study (11.04%) compared with the US and Australian studies (0.61% and 0.72%, respectively), at approximately one-fifth the effective cost per engagement. The total engagement rate was higher in all three studies compared the health and medical industry benchmarks. Conclusions and Relevance: Search engine ads may be a rapid, cost-effective, and easily scalable way to reach individuals in LMICs where resources can be scarce. Our results also indicate a substantial demand for online resources in Indonesia, where stigma is prevalent, and highlight the need for LMIC-based research, as research from high income countries may have underestimated the benefit and overestimated the cost of this intervention.