Ethical approval was granted by the ethics committee of the Medical Faculty of Leipzig University (365/21-ek). Participants in the short film study were informed at the outset about the study content, procedures, voluntariness, and data protection, and provided informed consent. Participants received compensation of €8.00 for their participation. The individuals appearing in the videos on the website have given their consent for the videos to be published.

Matomo [33], a web behavior analysis tool, was installed to study the website usage by collecting data on user behavior. Specifically, it records, among other things, when a visitor accesses the site, which subpages are visited, how much time is spent on each subpage, and from which subpage the visitor exits the website. For both practical use and data protection reasons, it was important to ensure the anonymity of website visitors. Therefore, Matomo was used as the data collection method, as it prevents the unique identification of individuals and removes the requirement for a cookie banner. This study examines the number of visits and how visitors used individual subpages from March 1, 2023, to December 31, 2024.

The website includes a feedback form on 13 out of 21 subpages. The form contains the following introductory text: “Please answer the following questions. Your response will help us further develop this website. Your responses will be stored anonymously. Thank you!”. This is followed by 3 questions (“Is this website helpful to you?”, “Can this website motivate you to use support services?”, and “Do you need further information? If yes, what kind?”), each of which can be answered with “Yes,” “No,” or “Maybe.” After the last question, there is a free-text field with the note “Add ideas.”

This study analyzes feedback received via the form from March 1, 2023, to December 31, 2024. The responses to the 3 questions were analyzed quantitatively, and the responses from the free-text field were evaluated using thematic analysis [34]. Thematic analysis is a method for identifying, analyzing, and reporting patterns (themes) within qualitative data. As a first step, text segments containing substantive feedback on the website were coded. MAXQDA [35] was used for the coding process, and initial coding was conducted by CS. Subsequently, the coded texts and codes were discussed and refined through peer debriefing with HG and LS, as well as with other colleagues experienced in qualitative research. Then, they were clustered into higher-order themes. These were elaborated and substantiated based on the underlying text segments.

The 3 short films are documentary-style interviews without a visible or audible interviewer (“talking head”). They are testimonies. Some men describe their experiences, while other experiential accounts are fictionalized narratives drawing on experiences reported by men in interviews [27]. The protagonists are either actors or men with lived experience. They included elements recommended by Sagar-Ouriaghli et al [24] for interventions in men’s suicide prevention. One of these 3 short films, featuring a young male protagonist (approximately 25‐30 years old), was tested in an online survey to determine its effect on the male participants’ intention to seek help.

The short film, lasting 6 minutes and 47 seconds, features an actor portraying a man who recounts how high-performance pressure and overwhelming work demands led to social withdrawal and depressive symptoms. After a breakup with his partner, he attempted suicide. He then describes seeking professional help and engaging in a recovery process marked by experiences of empathy, the rediscovery of personal strengths, and the development of new coping strategies. His narrative is accompanied by brief informational inserts on male suicidality and help-seeking behavior. The film concludes with contact details for professional support services.

G*Power software (version 3.1 [36]) was used to calculate the required sample size for the online survey seeking feedback on the film. Based on previous findings, we expected a moderate effect of the film on help-seeking intentions [37,38]. The calculation was conducted for a repeated-measures ANOVA using an effect size d. A correlation of 0.5 between the pre-, post-, and follow-up measurements was assumed. Statistical power was set at 0.95, and the significance level at .05. To detect the hypothesized effect, an initial sample of 43 participants was required. Considering an expected dropout rate of 25%, we aimed to recruit at least 54 participants.

Male-identified participants were recruited among students and academic networks at the University of Magdeburg between June and August 2023. A total of 64 people started the online survey on their intention to seek help. Of these, 57 completed the first phase. In the follow-up survey, 47 participants took part and were therefore included in the data analysis. Another 7 individuals were excluded from the analysis because the recorded time spent watching the short film indicated that they had not watched it, or because they did not identify as male.

The study was conducted using the online tool Social Science Survey [39]. Sociodemographic data were collected from the participants who also answered the General Help-Seeking Questionnaire (GHSQ [40,41]) before watching the short film, immediately afterward, and again 14 days later.

The 20-item GHSQ assesses self-reported intentions to seek help. It includes two 10-item scales addressing personal or emotional problems and suicidal ideation. Eight of the 20 items refer to private sources of help and 6 to professional sources. Thus, across problem types (personal or emotional problems, suicidal ideation), two subscales can be constructed for private and professional sources of help. The remaining items cannot be clearly assigned to either category (eg, “spiritual support”). Participants rated the likelihood of seeking help (eg, from a friend, doctor, or psychologist) on a 7-point Likert scale (1=extremely unlikely to 7=extremely likely). Item 10 (free-text) was excluded. Mean scores were calculated for each scale, with higher scores indicating stronger help-seeking intentions. The GHSQ demonstrates good psychometric properties. Internal consistency and test-retest reliability for the 2 problem scales were acceptable (α=.83/.70; r=0.88/0.86 [41]). Convergent validity has been shown with actual help-seeking and perceived quality of prior care. In our sample, internal consistency was α=.73 (suicidal ideation), α=.76 (private), and α=.79 (professional). The GHSQ was originally developed in English and was therefore translated for the German-speaking participants using a forward-backward translation procedure.

Before watching the film, the participants completed the Suicidal Ideation and Behavior Scale (SIBS [42]) and the 9-item Patient Health Questionnaire (PHQ-9 [43]). The SIBS comprises 6 items assessing the frequency of suicidal thoughts, intentions, reparation, and planning, rated from 1 (never) to 6 (many times every day). Two additional dichotomous (yes or no) items assess suicide attempts in the past 4 weeks and lifetime. One item on the frequency of past attempts was excluded. A sum score was calculated from items 1‐6; suicide attempt items were reported separately. The SIBS shows excellent internal consistency (α=.92) and strong test-retest reliability (r=0.83) [42]. In our sample, internal consistency was good (α=.77). The PHQ-9 is a 9-item self-report instrument for screening and assessing depressive symptoms over the past 2 weeks. The validated German version was used [44]. Items (eg, “little interest or pleasure in doing things”) are rated on a 4-point scale from 1 (not at all) to 4 (nearly every day). Total scores above 9 indicate minor and above 14 moderate-to-severe depression. The PHQ-9 is a reliable and valid instrument [43,44], with good internal consistency (α=.88). In our sample, internal consistency was α=.83.

Data analyses were conducted with the software R (version 4.3.0; R Core Team) [45] in the RStudio environment using the R package “rstatix” (version 0.7.2 [46]). To test for significant differences between measurement time points, a 1-way repeated-measures ANOVA was performed for each target variable. As a total of 4 tests were carried out, a Bonferroni correction was made by multiplying the P values by the number of comparisons. The reported P values reflect this adjustment. Prior to the analysis, the model assumptions for each ANOVA were checked. Post hoc analyses were performed using 2-tailed paired t tests comparing the 3 time points pairwise; here, too, P values were adjusted with the Bonferroni correction.

A total of 29,279 unique visits (single user session) were registered on the website via the Matomo analysis tool. Due to the degree of anonymization of visitors in the analysis tool (shortening of the IP address by the last 3 digits), it is not possible to determine how many visitors accessed the website repeatedly. For this reason, the number of visits is provided here. A visit may also involve viewing multiple subpages. The visits lasted an average of 1 minute and 35 seconds. On average, 2.1 actions were performed per visit on the website (page views, downloads, outbound links, and internal searches). Table 1 shows the most frequently visited subpages; the average time spent on the respective subpages; the bounce rate, which describes the proportion of visits that included only that subpage (without visiting any other subpages before or after); and the exit rate. This describes how often the subpage was the last subpage visited on the website.

During the study period, a total of 291 completed feedback forms were analyzed. There were no indications that any of these forms were completed for advertising purposes or any similar purpose. As the feedback form was completed anonymously, it is not possible to provide any information about the individuals who completed it. However, the thematic feedback in the free-text field allows cautious conclusions to be drawn about the respondents. The feedback was analyzed using quantitative descriptive statistics and qualitative thematic analysis. The number of yes-no-maybe responses to the 3 questions is shown in Table 2.

A total of 69.1% (n=201) report that the website was helpful to them, and 59.8% (n=174) confirm that the website could motivate them to seek help. In total, 14.4% (n=42) answered “no” to both questions. The free-text field after the last question was used by 75 (25.8%) of the respondents to provide thematic feedback. Of these 75 thematic responses, 57 (76%) referred to a positive assessment of the website (answering either “yes” or “maybe” to questions 1 and 2) and 18 (24%) referred to a negative assessment of the website (answering “no” to questions 1 and/or 2). This means that 42.9% of the negative responses to questions 1 and/or 2 also provided thematic feedback. The thematic analysis of the feedback indicates that it was primarily provided by men affected by suicidality, relatives, and professionals working in psychosocial care. To maintain clarity, only an overview of the themes identified through the thematic analysis is presented below. The positive feedback (at least one of the first two questions was answered affirmatively; n=38, 50.7%) relates in particular to the importance and need for suicide prevention services specifically aimed at men. This feedback was provided by affected individuals, as well as by relatives and professionals.

One example reads:

In addition, the following themes were identified in the data: description of personal experiences, offer to collaborate, provision of information on support services, expressions of gratitude, needs of relatives and professionals, lack of specialized support services, technical issues, and the expressed desire for more experiential reports. Example texts include: “I am experiencing a professional crisis. I have now sought help and hope to overcome this crisis soon” (description of personal experience) or “As an occupational therapist, I would need informational materials to display in the waiting room” (needs of professionals).

The focus of the negative feedback (at least one of the first 2 questions was answered negatively; n=18, 24%) was on anger and frustration or despair that individuals experience in connection with the psychosocial support system recommended on the website. In their feedback, respondents reported having negative experiences with the support system or described situations in which they did not receive support from the system despite being in need.

This is illustrated by the following example:

Some negative responses reflected differing expectations and needs among users regarding the website. While some found the amount of information overwhelming, others expressed a desire for more detailed content. The following themes were identified in the free-text responses: frustration regarding gender-inclusive language, no new information provided, unclear purpose, technical issues or requests for changes, lack of specialized support services or difficulty locating support services, and the desire for more experiential reports. Examples of text passages include the following: “Your support services do not provide any new information” (no new information) or “Please stop with the gender-inclusive language!” (frustration regarding gender-inclusive language).

Table 3 presents the sociodemographic characteristics of the sample (n=40). The sample is relatively young (mean age 24.53, SD 5.03 y) and shows elevated depression scores (PHQ-9), and more than one third report prior experiences with suicidal thoughts and behaviors.

The intention to seek help, in the case of suicidal ideation (F_1.49,58.16=10.51; P_adjusted=.002) as well as in the case of a personal problem (F_2,78=9.50; P_adjusted=.001), increased significantly. This significant increase in the intention to seek help was also evident at follow-up. The same applies to the intention to seek professional help (F_2,78=11.20; P_adjusted<.001). There was no significant increase in the intention to seek help from private sources directly after watching the film or at follow-up (F_1.74,67.93=4.56; P_adjusted=.72). The exact data of the analyses can be found in Figure 3 and Table 4.

Online services are extremely important in suicide prevention, especially for target groups that are hard to reach, like men [47-49]. Websites can be accessed anonymously, from any location and at any time. The website [17] is the first suicide prevention website for men in Germany. It was developed with consideration of the limited research on how to effectively address men in online settings to prevent suicide. In line with a participatory approach, men with lived experience were actively involved in the development process. This exploratory study combines quantitative web analytics and survey data with a qualitative analysis of free-text responses to examine the extent to which the website achieves its primary objectives: encouraging men at risk of suicide to seek help, providing information, and reducing stigma. This study builds upon the investigation by Reifegerste et al [22], who demonstrated through qualitative interviews that the videos on the website [17] were perceived by men as engaging, clear, and empathetic. However, they were also considered too lengthy for a brief introduction. The balance between emotional and informational content was regarded as appropriate and supportive. Furthermore, the health information provided was viewed as credible and trustworthy.

In the period under review, the website received almost 30,000 visits. The information from the feedback form indicates that the website’s target groups (affected men, relatives, and professionals working in psychosocial care) were reached. The number of visits is difficult to interpret, as very few studies report usage figures for prevention websites [50], and therefore, no comparative data are available. Moreover, no conclusions can be drawn about the number of unique visitors based on the number of visits. Due to data protection requirements and the protection of anonymity, individual visitors cannot be identified using the web analytics data. If it is assumed that some visitors accessed the website multiple times, the number of unique visitors is likely to be lower than 30,000. An analysis of the thematic subpages accessed shows that the help pages (short-term and medium-term support) were visited most frequently, as well as pages addressing gender-specific topics (warning signs in men and masculinity in the context of crises).

The 291 responses submitted via the form on the website show that the majority of those who completed the form rated the service as helpful, encouraging them to seek help. The thematic feedback clearly emphasizes the high demand for suicide prevention services specifically tailored to men, while also highlighting the lack of such services to date. In addition to the positive feedback, 15% (n=42) of the respondents indicated that they did not find the website helpful and did not feel motivated to seek help. This substantial proportion may reflect several factors. Certainly, a website that primarily serves as a first point of contact and provides only information, insights into others’ experiences, and links to support services may not be the right resource for some men in (suicidal) crises. These individuals may require other forms of support, counseling, or therapy, which can be tailored to their individual needs. It should also be considered that the website targets a highly heterogeneous group—“men”—without differentiating between specific subgroups, such as age groups, minority groups, or other demographic characteristics. Consequently, many diverse perspectives and needs may not be directly addressed on the website and are instead generalized for the “majority.” This could also contribute to some visitors feeling that the website does not adequately speak to them. In addition, the negative feedback provided through the feedback form points to issues of trust and frustration in dealing with the support system and its professionals, a concern also reflected in the literature [51]. Approximately 1 quarter (n=75, 25.8%) of the completed feedback forms contained entries in the free-text field. This high proportion of substantive contributions suggests that the website encouraged visitors to actively engage with the topic and share their perspectives. At the same time, it must be noted that, as described above, it is not possible to determine who completed the form or whether individuals may have submitted feedback more than once.

The investigation of the use of the website and the feedback via the form on the website are primarily descriptive in nature. On the one hand, they offer a high degree of realism (external validity), as they capture actual use and authentic feedback from real visitors. On the other hand, they do not take place under controlled conditions (low internal validity) and therefore do not permit reliable conclusions about the target group, impact, related factors, and so forth.

The study also examined the effect of a short suicide prevention film—also available on the website—on men’s intentions to seek help. The short film portrays a young man describing the positive outcomes of seeking help after a suicidal crisis. The results showed that immediately after watching the short film, the intention to seek help increased significantly, both for suicidal thoughts and for personal problems. The intention to seek help from professionals also increased. The short film on suicide prevention thus has the desired effect. It was also shown that this significant increase in the intention to seek help remained even 14 days later (follow-up). However, the study also shows that there was no increase in the intention to seek help from friends and family. Since the film explicitly focuses on professional support rather than help from friends and family, this effect appears consistent with the content of the film.

The results are in line with previous studies showing that media narratives about overcoming crises can positively influence help-seeking behavior [15,29,32,37,52]. In addition, our study contributes to the still limited but growing body of research indicating that gender-specific approaches—particularly those incorporating male role models and addressing gender-specific aspects of suicide—have the potential to increase men’s willingness to seek professional help [15]. Finally, it should be emphasized that this study measured only the intention to seek help, not actual help-seeking behavior. Although such intentions are regarded as reliable indicators of later behavior [41], the direct measurement of future help-seeking behavior was not part of the study design.

There are limitations to this study that need to be acknowledged. In particular, a potential selection bias may limit the generalizability of the findings and may also lead to an underestimation or overestimation of the effects. The sample for the film study was predominantly young, consisting mainly of university students (see Table 3). Studies indicate that age and education influence help-seeking intentions in the context of mental health crises in different ways. Zhao et al [53] demonstrated in their review that help-seeking intentions are relatively high among university students. Mackenzie et al [54] further found that older populations with higher levels of education exhibited stronger help-seeking intentions than younger individuals. In addition, the sample studied had a rather high load in terms of depression and suicidality, indicating that the topic of suicide prevention may be relevant to them. However, not all study participants exhibited such levels of burden, which may also have influenced the results. Stas et al [20] demonstrated that among men reporting mental health problems, a suicide prevention website led to increased openness to communication and emotional expression. Further studies should investigate whether the increase in help-seeking intentions can be observed independently of levels of psychological distress.

While even small increases (d=0.52-0.72; Table 4) in help-seeking intentions could be clinically and preventively significant, as they may lead to earlier engagement with professional support, the results must be interpreted with caution regarding their clinical and preventive relevance. On the one hand, no reliable cut-off exists to determine whether the intention to seek help is present or absent. On the other hand, the limitations described regarding the generalizability of the findings must also be taken into account. To confirm the effects found on the intention-enhancing effect of the film or to extend them to other films with a similar content structure, further large-scale studies with more diverse populations are required. In both the examination of the film and the analysis of the content-related feedback, the small sample sizes limit the generalizability of the findings. Another important limitation is the absence of a control group. Without a control group, causal conclusions cannot be drawn; the findings should be replicated in future randomized controlled trials.

In summary, the findings of this study suggest that the website has been well received by the target group and is effective with respect to its stated objectives. These findings complement existing evidence by Till et al [55], which demonstrates knowledge gains through suicide prevention websites and suggests a reduction in suicidal ideation among vulnerable groups. The short film, in particular, may serve as an easily disseminated and cost-effective approach to suicide prevention in men. Potential applications extend beyond the website, for example, through high-reach social media channels. As the qualitative interview results by Reifegerste et al [22] have shown, shortened versions of the film could also be used in this context. However, to examine the effectiveness of these gender-specific, suicide-preventive media and website content more closely, considerably more research—particularly randomized controlled trials studies—is needed. The website and this study provide starting points for further research and campaigns that specifically address the high suicide risk among men. The high number of men who die by suicide each year worldwide underscores the urgent need for such approaches to gender-specific suicide prevention.