ABSTRACT
The use of the internet has increased among adolescents in recent years. Although internet offers many opportunities such as socializing, obtaining information, it also has the potential to affect vulnerable individuals negatively. Recently the blue whale game, known as the blue whale challenge has attracted the attention of the public with numerous reports that young people from all over the world have harmed themselves due to the commands requested in the game. This and similar dangers should be recognized, and families should be warned and the necessary actions should be taken to protect children and adolescents in society. We describe a suicide case followed in the pediatric intensive care unit in order to raise awareness that computer games such as the blue whale game that adolescents can easily access via the internet can have fatal consequences
Keywords: Adolescent, blue whale, computer game, suicide
Introduction
In recent years, the use of the internet has increased among adolescents as the internet has become necessary for schoolwork, information gathering, and socialization. Social media networks such as Facebook, Instagram, Twitter, and YouTube, where they can develop public accounts or profiles to connect with other individuals, have become increasingly popular and common among adolescents.1 Although social media offers many opportunities such as socializing, obtaining information, it also has the potential to affect vulnerable individuals negatively.2
Computer-based online games have become part of popular culture these days. Online games create an environment where many people can interact with each other using graphics and sound technologies at the same time.3 Recently the blue whale game, known as the blue whale challenge has attracted the attention of the public with numerous reports that young people from all over the world have harmed themselves due to the commands requested in the game. The first step of the game is to carve F57 on the hand or the arm with a razor and to prove this by taking its photo. This duty is followed by 50 violent containing tasks based on self-harming such as self-pricking, carve a whale on the arm, and at the end game commit suicide by hanging themselves or jumping off a high building.4
Herein, we describe a suicide case followed in the pediatric intensive care unit in order to raise awareness that computer games such as the Blue Whale game that adolescents can easily access via the internet can have fatal consequences
Case Report
A 15-years-old girl presented to the emergency room with a loss of consciousness as a result of the suicide attempt. Her father was working at the consulate. She has lived in America since childhood. However, she has moved to Turkey two years ago and she has been living in Turkey for the last two years and started to private college school in Turkey. She took videos of her singing and uploaded them to social media. She was spending too much time on the internet.
When the history of the patient was detailed; her mother reported that she heard voices from her room at 4 am. She was watching a horror movie, but she told her mother that she had set her alarm wrong. Her parents stated that she had carved a whale on his arm a year ago, but they could not understand why she did it. She told her friends that she would die soon, get rid of her troubles, and be born again. Her father could not closely follow her daughter, because he was working abroad, and her parents could not understand that she was playing the blue whale game. After the questions and explanations regarding the steps of the blue whale game, her parents were noticed that their daughter had been playing the game and moving forward to the end of the game step by step.
She hung herself on a natural gas pipe in the kitchen with her music headset. Unfortunately, it was determined that the patient set up her tablet for a video shoot before hanging herself and broadcasted her suicide live to her friends and all social media. The patient was brought to the hospital after cardiopulmonary resuscitation. At admission, physical examination revealed Glasgow Coma scale was 3. There were hanging traces in her neck and a wound scar carved with a razor. She developed generalized tonic-clonic seizures. The patient who had no brainstem reflexes and spontaneous breathing underwent cranial magnetic resonance imaging which revealed signal changes compatible with diffuse hypoxic involvement. At the follow-up, the patient was diagnosed with brain death. The patient died on day 18. Informed consent was received from the family.
Discussion
Suicide is a serious public health problem. Suicides can be prevented by knowing risk factors and recognizing warning signs and timely intervention. The World Health Organization reports that approximately 800,000 people die each year from suicide, and suicide is the second leading cause of death among 15-29-year-olds worldwide. The link between suicide and mental disorders (especially depression and alcohol use disorders) is well established. Other risk factors that increase suicidality include the experience of loss, loneliness, a relationship break-up, discrimination, financial problems, chronic pain and illness, violence, abuse, and conflict.5
Computer-based online games have emerged in recent years that are thought to encourage adolescents through online challenges and assignments to violence, self-harm, and even suicide.4,6,7 It has been shown that adolescents who play many hours of action category video games, which tend to be more violent, have more lethal self-harm behavior and a tendency to commit suicide.6 Longitudinal data indicated that self-cutting is a significant risk factor for suicide among young people.7 The “blue whale challenge” encourages the player to repeatedly cut herself/himself and complete other dangerous missions. These repetitive self-harming behaviors and other dangerous missions gradually increase the risk of suicide by reducing and normalizing the fear of the player.
Computer-based online games can lead to self-harm and suicide, but cannot be seen as the only cause of suicide. These challenges can be considered as triggering factors for suicide. Strategies to protect adolescents with risk factors for problematic Internet use such as depression, emotional difficulties, and social isolation or peer problems are important.8 Parental monitoring might affect internet addiction and violent video gaming of adolescents. A study has shown that leisure boredom and involvement in internet and social activities increase the probability of internet addiction and might create a tendency to play violent video games; however, family and outdoor activities along with participative and supportive parental monitoring decrease these tendencies.9
The most important professional recommendations on this issue were declared by India United Nations Children’s Fund. Internet access sites must be controlled and should be provided to the adolescents in common usage areas of the family. Parents need to know new trends on the internet. Vigilance is recommended in the cases of unexpected changes such as changed mood, decreased communication, and unwillingness for studying, and decreased school marks. If such changes are recognized, internet activities of adolescents should be closely monitored, school authorities should be met, or a psychologist should be consulted. The Blue Whale game is a lethal reality, which enters up our homes with the virtual world. This and similar dangers should be recognized, and families should be warned and the necessary actions should be taken to protect children and adolescents in society.10
Ethics
Informed Consent: Informed consent was received from the family.
Peer-review: Externally peer-reviewed.
Authorship Contributions
Concept: M.U.Y., Design: M.U.Y., Data Collection or Processing: M.U.Y., E.G.T., Analysis or Interpretation: M.U.Y., Z.Ö., M.Ç., B.B., Literature Search: M.U.Y., E.G.T., Posted by: M.U.Y., E.G.T.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study received no financial support.
