Examining Suicide in 'Pro-Choice Suicide' Forums: A Cyclical Model.

OBJECTIVES:This study examined real-time, unobtrusive accounts of suicidal distress shared by online forum users and developed a process framework to advance understanding and inform prevention efforts. DESIGN:A large pro-choice suicide discussion forum (150,000+ users) was selected to capture and analyse contemporaneous accounts of the suicide process, offering real-time, anonymous and minimally filtered disclosures less influenced by recall bias than retrospective interviews. METHODS:A directed qualitative content analysis was conducted on publicly available posts (N = 526) describing suicidal distress or behaviour, categorizing content into current states (e.g. ideation, action), associated emotions and motivations. RESULTS:The Cyclical Model of Suicide (CMS) emerged as a non-linear, bidirectional framework characterized by non-sequential state transitions and recurrent movement. The model includes six states (non-suicidal distress, suicidal ideation, ambivalence, resolution, suicide in progress and recovery), a Reversal mechanism (regression to prior states) and 'incident drivers' (triggering shifts to higher-distress states and contributing to recurrence and state-bypassing). CONCLUSIONS:This study offers four insights. First, it uses in-the-moment accounts to propose a process-oriented framework rather than relying on retrospective reports. Second, it highlights recurrence language, with users describing experiences as cyclical. Third, it captures Reversal as a short-term shift away from action. Finally, it emphasizes the use of anonymous pro-choice suicide online spaces for venting and support before suicidal desire crystallizes into intent, highlighting that many users may be turning to these platforms instead of traditional therapeutic settings.