Bridging Online Behavior and Clinical Insight: A Longitudinal LLM-based Study of Suicidality on YouTube Reveals Novel Digital Markers

Suicide remains a leading cause of death in Western countries, underscoring the need for new research approaches. As social media becomes central to daily life, digital footprints offer valuable insight into suicidal behavior. Focusing on individuals who attempted suicide while uploading videos to their channels, we investigate: How do suicidal behaviors manifest on YouTube, and how do they differ from expert knowledge? We applied complementary approaches: computational bottom-up, hybrid, and expert-driven top-down, on a novel longitudinal dataset of 181 YouTube channels from individuals with life-threatening attempts, alongside 134 control channels. In the bottom-up approach, we applied LLM-based topic modeling to identify behavioral indicators. Of 166 topics, five were associated with suicide-attempt, with two also showing temporal attempt-related changes ($p<.01$) - Mental Health Struggles ($+0.08$)* and YouTube Engagement ($+0.1$)*. In the hybrid approach, a clinical expert reviewed LLM-derived topics and flagged 19 as suicide-related. However, none showed significant attempt-related temporal effects beyond those identified bottom-up. Notably, YouTube Engagement, a platform-specific indicator, was not flagged by the expert, underscoring the value of bottom-up discovery. In the top-down approach, psychological assessment of suicide attempt narratives revealed that the only significant difference between individuals who attempted before and those attempted during their upload period was the motivation to share this experience: the former aimed to Help Others ($\beta=-1.69$, $p<.01$), while the latter framed it as part of their Personal Recovery ($\beta=1.08$, $p<.01$). By integrating these approaches, we offer a nuanced understanding of suicidality, bridging digital behavior and clinical insights. * Within-group changes in relation to the suicide attempt.