Media Guidelines on the Reporting of Suicide

Framing Suicide - Investigating the News Media and Public's Use of the Problematic Suicide Referents Freitod and Selbstmord in German-Speaking Countries

BACKGROUND

In German-speaking countries, suicide experts recommend not using the suicide referents Freitod and Selbstmord, as their associative meanings relate to problematic concepts such as free will and crime.

AIMS

To investigate which terms - the neutral and recommended Suizid or Freitod and Selbstmord - have dominated news coverage and to reveal what terms the public actually used.

METHOD

A retrospective database study was undertaken on data from the period 2004-2016. First, we investigated how frequently the terms were used in news coverage via an automated content analysis. Second, we investigated how often individuals used the terms for information-seeking via Google's search engine, since it can be used as an indicator of the popularity of a given term within a given period.

RESULTS

Analyses revealed that Selbstmord was the most frequently used term in the news and by the public. Importantly, the use of Suizid increased in both datasets, nearly approaching the Selbstmord level in the later years. Although on a low level, the highly problematic term Freitod has also been in regular use.

CONCLUSION

Media interventions should continue trying to increase journalists' awareness so that they use appropriate terms when reporting on suicide.

The role of media in preventing student suicides: A Hong Kong experience

INTRODUCTION

In view of the surge of student suicides in March 2016, a large-scale media involvement was engaged to minimize copycat effects and to extensively spread more preventive information.

METHODS

Trend differences between student suicides in overall as well as youth suicides between 2003 and 2016 were examined. Impacts of media involvement were examined as to the changes of their intensities in reporting student suicides in different manners. Local polynomial smoothing method was used to estimate the intensities throughout the study period.

RESULTS

The intensity of students' suicides has been slowly increasing since 2006, which was in contrast to the decreasing trend of overall suicide intensity. After our engagement with the media, acute descriptive-reporting in student suicide news has sharply dropped and remained low since then, whereas preventive-reporting has increased sharply in March and April 2016, but dropped back to normal afterwards. The higher intensity of preventive-reporting seemed to have a protective effect on student suicide.

LIMITATIONS

Data of student suicides in 2016 were substantially extracted from the local news, which may not contain complete information. The analyses suggested, but could not confirm, a causal relationship between the changes of student suicide news-reporting and the incidents of suicides themselves.

CONCLUSIONS

The recent surge of student suicides in Hong Kong was statistically abnormal. Media engagement has changed local suicide news-reporting to become more preventive, which could have contributed to the drop of student suicides. It is essential to sustain the media's coverage of preventive reporting to maintain its enduring effect.

Developing Social Media-Based Suicide Prevention Messages in Partnership With Young People: Exploratory Study

BACKGROUND

Social media is increasingly being used by young people for health-related issues, including communicating about suicide. Due to the concerns about causing distress or inducing suicidal thoughts or behaviors, to date young people neither have been engaged in the development of social media-based suicide prevention interventions nor have interventions focused on educating young people about safe ways to communicate about suicide online. Given the potential that social media holds to deliver messages to vast numbers of people across space and time and the fact that young people often prefer to seek help from their friends and peers, safely educating and engaging young people to develop suicide prevention messages that can be delivered via social media is an obvious next step.

OBJECTIVES

The objectives of this study were to (1) provide education to a small number of secondary school students about safe ways to communicate about suicide via social media; (2) engage the same young people in the development of a suite of social media-based suicide prevention multimedia messages; (3) assess the impact of this on participants; and (4) assess the acceptability and safety of the messages developed.

METHODS

This study involved two phases. In phase 1, 20 participants recruited from two schools took part in an 8- to 10-week program during which they were provided with psychoeducation about mental health and suicide, including how to talk safely about suicide online, and they were then supported to design and develop their own media messages. These participants completed an evaluation questionnaire at the conclusion of the program. In phase 2, a larger group of participants (n=69), recruited via an opt-in process, viewed the media messages and completed a short questionnaire about each one.

RESULTS

Participants in phase 1 enjoyed the program and reported that they learned new skills, such as how to talk safely about suicide online, and felt more able to provide emotional support to others (16/20, 80%). No participants reported that the program made them feel suicidal. Participants in phase 2 generally rated the media messages as safe and acceptable, although some messages were rated more highly than others.

CONCLUSIONS

This study suggests that young people can be safely engaged in developing suicide prevention messages, which can be disseminated via social media. Engaging young people in this process may improve the traction that such campaigns will have with other young people. The study also suggests that educating young people regarding how to talk safely about suicide online has multiple benefits and is not associated with distress. Overall, these findings pave the way for new approaches to prevent suicide among young people.

Supporting Reporting: On the Positive Effects of Text- and Video-Based Awareness Material on Responsible Journalistic Suicide News Writing

Suicide is a global public health problem. Media impact on suicide is well confirmed and there are several recommendations on how media should and should not report on suicide to minimize the risk of copycat behavior. Those media guidelines have been developed to improve responsible reporting on suicide (RRS). Although such guidelines are used in several countries, we lack empirical evidence on their causal effect on actual journalistic news writing. We conducted an experiment with journalism students (N = 78) in Germany in which we tested whether exposure to awareness material promoting RRS influences news writing. As a supplement to the widely used text-based material, we tested the impact of a video in which a suicide expert presents the guidelines. A video was used as a supplement to text partly due to its potential benefit for prevention efforts over the Internet. We chose a low-budget production process allowing easy reproduction in different countries by local suicide experts. In the experiment, participants were either exposed to written, audio-visual, or no awareness material. Afterwards, participants read numerous facts of an ostensible suicide event and were asked to write a factual suicide news story based on these facts. Analyses indicate that awareness material exposure helped to improve RRS with the awareness video showing the strongest effects. We recommend that suicide prevention should use instructive awareness videos about RRS complementary to text-based awareness material.

Suicide Prevention Public Service Announcements (PSAs): Examples from Around the World

Media campaigns have received increased attention as an intervention for combating suicide. Suicide prevention campaigns involving public service announcements (PSAs) have not been well described and have been subject to minimal evaluation. This study aimed to identify suicide prevention PSAs from around the world and analyze and describe their content. We searched the Internet for short, English-language PSAs that had been screened as part of suicide prevention campaigns and identified 35. Most commonly, these PSAs focused on the general population and/or people who might be at risk of suicide, and had a particular emphasis on young people. Almost 60% promoted open discussion about suicide, around 50% indicated that the life of a suicidal person was important, about 40% acknowledged the suffering associated with suicidal thoughts and feelings, about 25% stressed that suicide is preventable, and about 20% focused on the devastating impact of suicide for those left behind. Most PSAs promoted some sort of support for people at risk of suicide, usually a helpline or website. Although these messages appeared appropriate and practical there is a lack of research on the impact that they may have on people with varying degrees of suicide risk. Further work is needed to ensure that they are consistent with theories of behavior change, and that they are having their desired impacts.

Online media reporting of suicides: analysis of adherence to existing guidelines

Aims and method To assess the compliance of contemporary online media output with guidelines for the responsible reporting of suicidal acts. A search engine was used to identify online media reports of suicide from UK sources over the course of 1 month. Each article was assessed against guidelines for the responsible reporting of suicide produced by the Samaritans, a UK mental health charity. Results We identified 229 articles, of which 199 failed to comply with at least one of the Samaritans' guidelines. Failure to mention support sources, excessive detail about the method used and undue speculation about the trigger for suicide were the most commonly breached guidelines. Significant differences were found between the quality of local and national media sources, with local media sources being broadly more compliant with guidelines. Clinical implications This study highlights the urgent need for the implementation of responsible reporting guidelines in online media articles as a component of suicide prevention efforts.

Comparing Different Suicide Prevention Measures at Bridges and Buildings: Lessons We Have Learned from a National Survey in Switzerland

The goal of the study was to compare the effectiveness of different suicide prevention measures implemented on bridges and other high structures in Switzerland. A national survey identified all jumping hotspots that have been secured in Switzerland; of the 15 that could be included in this study, 11 were secured by vertical barriers and 4 were secured by low-hanging horizontal safety nets. The study made an overall and individual pre-post analysis by using Mantel-Haenszel Tests, regression methods and calculating rate ratios. Barriers and safety nets were both effective, with mean suicide reduction of 68.7% (barriers) and 77.1% (safety nets), respectively. Measures that do not secure the whole hotspot and still allow jumps of 15 meters or more were less effective. Further, the analyses revealed that barriers of at least 2.3 m in height and safety-nets fixed significantly below pedestrian level deterred suicidal jumps. Secured bridgeheads and inbound angle barriers seemed to enhance the effectiveness of the measure. Findings can help to plan and improve the effectiveness of future suicide prevention measures on high structures.

Towards a shared understanding: Perspectives from Toronto's first media forum for suicide prevention

Media reporting on suicide may have harmful and/or protective effects on deaths by suicide, depending on the nature of the coverage. Canada's first forum on this important issue was held in Toronto on November 6, 2015. Participating in the forum were public health policy-makers, mental health and suicide prevention experts and senior media representatives. This commentary summarizes the content of the forum and highlights the need for ongoing collaboration between suicide prevention experts and media professionals aimed at safe and respectful reporting that maintains the public's need to be informed.

Military suicide coverage: AP news wire & suicide guidelines

The authors evaluated how well Associated Press News Wire stories adhered to the Recommendations for Reporting on Suicide™ during 2012, a peak year of military suicide. They included individual suicide stories (N = 167) from randomly selected days. They also evaluated differences in the military versus civilian coverage. Military and civilian stories typically had about five negative practices, and less than one positive practice, with military stories significantly more likely to miss valuable opportunities to promote help-seeking. The findings, combined with previous evidence, suggest the need for the development of specific military suicide reporting guidelines.

Celebrity suicide and its effect on further media reporting and portrayal of suicide: An exploratory study

BACKGROUND

Suicide is a grave mental health problem in India, and suicide rates in India have risen over the past decades. Suicide reporting by the media is a common cause for spurts of suicides that may occur from time to time. The aim of the present study was to assess the change in trends in media reporting of suicide after a celebrity suicide.

METHODOLOGY

Suicide by the renowned actor Robin Williams was selected as the reference case. The top three Indian daily newspapers published in English having the highest circulation as per the Registrar of Newspapers, Government of India report were selected to be scanned in the study. These were the Times of India - Mumbai edition, Mumbai Mirror, and the Daily News Analysis - Mumbai edition. The authors screened all news stories in the three newspapers within a 6-month period (3 months prior and 3 months post the date of the reference suicide case), and these news reports were evaluated as per the suicide reporting guidelines for media laid down by the Indian Psychiatric Society. The data were analyzed using Chi-square test and descriptive statistics where appropriate.

RESULTS

A total of 708 newspaper articles were identified on the basis of the guidelines mentioned above. Nearly 88% (n = 623) of the articles directly covered suicide while 4.09% (n = 29) focused on suicidal threats and 7.91% (n = 56) focused on parasuicide behavior. There was a significantly greater increase in the total number of articles printed after the celebrity suicide (n = 409) for all article types except teasers as compared to that before the celebrity suicide (n = 299). There was a significantly greater increase in front page news on suicide after the celebrity suicide (P = 0.0016), description of the method of suicide (P = 0.0221), and the mention of the suicide notes (P = 0.0002). Most articles after the celebrity suicide placed the blame on someone or the environment for the act (P = 0.0001).

CONCLUSIONS

A change in media trend toward reporting suicide was noted post a celebrity suicide, and it is important that media follow guidelines stringently when reporting a serious problem like suicide.

The adaptation and implementation of guidelines for responsible media reporting on suicide in Slovenia

Introduction

The existing literature provides evidence of the link between media reporting and suicide in terms of either preventive or provocative effects. Hence, working with media representatives on responsible reporting on suicide is of great importance. Until recently in Slovenia, there has been an obvious lack of communication between media representatives and suicidologists. The aims of the present study were twofold; firstly, to introduce the adaptation and dissemination of intervention on responsible media reporting, and secondly, to evaluate the effectiveness of the implemented intervention on suicide reporting.

Methods

We used a pre-post research design. Newspaper articles were retrieved over two 12-month periods: the baseline period and the follow-up period. In between, we had a year of implementation of our intervention program (launching and disseminating the Guidelines via workshops). Each retrieved article was rated qualitatively with respect to its adherence to the Guidelines.

Results

The comparison of baseline and follow-up periods revealed some significant differences. Reporting in the follow-up period was less sensationalistic, there was less reporting about specific cases of suicides and more about causes of suicide and pathways out of mental distress. Furthermore, in the follow-up period, there was a significant improvement related to headlines of media articles. Contact information about where to seek help was more often included in the articles.

Conclusion

The findings are promising, but working with the media needs to be continuous and ongoing if sustainable results are to be achieved.

Spatial and temporal evolution of the epidemic of charcoal-burning suicide in Japan

PURPOSE

An epidemic of carbon monoxide poisoning suicide by burning charcoal occurred in Hong Kong and Taiwan. An epidemic also emerged in Japan from February 2003 and resulted in an increase of 10-20 % in overall suicide rates in younger adults (aged <45 years) in the mid-2000s. We investigated the spatial and temporal evolution of the epidemic to assess its impact on the epidemiology of suicide in Japan.

METHODS

Mortality data were obtained from the official vital statistics of Japan. Smoothed standardized mortality ratios of charcoal-burning and non-charcoal-burning suicide were estimated for the period 2003-2013 using Bayesian hierarchical models. Joinpoint regression analysis was performed to analyze secular trends in suicide rates by gender, method used and geographic location between 1999 and 2013.

RESULTS

Suicide by burning charcoal rose sharply in the mid-2000s and was not accompanied by a simultaneous decline in alternative methods. The epidemic of charcoal-burning suicide in Japan showed a pronounced spatial pattern, being concentrated in rural prefectures particularly among males. For men but not women, the epidemic contributed to the widening of urban-rural disparities in suicide rates (higher rates in rural areas).

CONCLUSIONS

Our results differ from previous research in other Asian countries (e.g., Taiwan), where the epidemic of charcoal-burning suicide emerged more prominently in urban areas. In Japan, the introduction and diffusion of charcoal burning contributed to a real excess in suicide rates, as well as a widening of the urban/rural disparity in suicide.

Effects of Suicide Awareness Material on Implicit Suicide Cognition: A Laboratory Experiment

In spite of the increasing adoption of suicide awareness campaigns to prevent suicide, little is known about the effective construction of awareness messages used and on their impact on suicidal cognition. We hypothesized that media reporting on an individual overcoming a suicidal crisis increases the automatic association between "life" and self. University students (N = 112) were randomly allocated to one of three groups in a laboratory experiment. Participants allocated to treatment group 1 or group 2 read awareness material about a person coping with suicidal ideation by getting professional help. The only difference between the two groups was the amount of social similarity (low vs. high) between the protagonist and the participants. The control group read an article unrelated to suicide. Awareness material increased implicit cognition in terms of a strengthening of self-life associations. This effect was restricted to participants scoring low on wishful identification with the suicidal protagonist. This finding suggests that only individuals who do not wishfully identify with a protagonist going through difficult life circumstances benefit from the awareness material in terms of suicidal cognition. These findings provide a rich basis for further research and have potentially high relevance to the construction of suicide-awareness messages.

Suicide-related Internet use: A review

OBJECTIVE

To systematically review research on how people use the Internet for suicide-related reasons and its influence on users. This review summarises the main findings and conclusions of existing work, the nature of studies that have been conducted, their strengths and limitations, and directions for future research.

METHOD

An online search was conducted through PsycINFO, PubMed, Ovid MEDLINE and CINAHL databases for papers published between 1991 and 2014. Papers were included if they examined how the Internet was used for suicide-related reasons, the influence of suicide-related Internet use, and if they presented primary data, including case studies of Internet-related suicide attempts and completions.

RESULTS

Findings of significant relationships between suicide-related search trends and rates of suicide suggest that search trends may be useful in monitoring suicide risk in a population. Studies that examine online communications between people who are suicidal can further our understanding of individuals' suicidal experiences. While engaging in suicide-related Internet use was associated with higher levels of suicidal ideation, evidence of its influence on suicidal ideation over time was mixed. There is a lack of studies directly recruiting suicidal Internet users. Only case studies examined the influence of suicide-related Internet use on suicidal behaviours, while no studies assessed the influence of pro-suicide or suicide prevention websites. Online professional services can be useful to suicide prevention and intervention efforts, but require more work in order to demonstrate their efficacy.

CONCLUSIONS

Research has shown that individuals use the Internet to search for suicide-related information and to discuss suicide-related problems with one another. However, the causal link between suicide-related Internet use and suicidal thoughts and behaviours is still unclear. More research is needed, particularly involving direct contact with Internet users, in order to understand the impact of both informal and professionally moderated suicide-related Internet use.

Is Case Management Effective for Long-Lasting Suicide Prevention?

BACKGROUND

Case management services have been implemented in suicide prevention programs.

AIMS

To investigate whether case management is an effective strategy for reducing the risks of repeated suicide attempts and completed suicides in a city with high suicide rates in northern Taiwan.

METHOD

The Suicide Prevention Center of Keelung City (KSPC) was established in April 2005. Subjects included a consecutive sample of individuals (N = 2,496) registered in KSPC databases between January 1, 2006, and December 31, 2011, with at least one episode of nonfatal self-harm. Subjects were tracked for the duration of the study.

RESULTS

Of all the subjects, 1,013 (40.6%) received case management services; 416 (16.7%) had at least one other deliberate self-harm episode and 52 (2.1%) eventually died by suicide. No significant differences were found in the risks of repeated self-harm and completed suicides between suicide survivors who received case management and those who refused the services. However, a significant reduction in suicide rates was found after KSPC was established.

CONCLUSION

Findings suggest that case management services might not reduce the risks of suicide repetition among suicide survivors during long-term follow-up. Future investigation is warranted to determine factors impacting the downward trend of suicide rates.

Suicide Reporting Within British Newspapers’ Arts Coverage

Background: Many suicide prevention strategies promote media guidelines on suicide reporting, given evidence that irresponsible reporting of suicide can influence imitative suicidal behavior. Due to limited resources, monitoring of guideline adherence has tended to focus on news outputs, with a risk of neglecting other journalistic content. Aims: To determine whether British newspapers’ arts coverage adheres to media guidelines on suicide reporting. Method: Purposive sampling was used to capture current national practice on suicide reporting within newspapers’ arts coverage of exhibitions. Recent major UK exhibitions by artists who had died by suicide were identified: Kirchner, Rothko, Gorky, and Van Gogh. Content analysis of all UK national newspaper coverage of these exhibitions was performed to measure the articles’ adherence to widely accepted media guidelines. Results: In all, 68 newspaper reviews satisfied inclusion criteria, with 100% failing to show full adherence to media guidelines: 21% used inappropriate language; 38% provided explicit descriptions of the suicide; 7% employed simplistic explanations for suicide triggers; 27% romanticized the suicide; and 100% omitted information on sources of support. Conclusion: British newspapers’ arts coverage of exhibitions deviates considerably from media guidelines on the reporting of suicide. The findings suggest scope to improve journalists’ awareness of the importance of this component of suicide prevention strategies.

The Press Coverage of Celebrity Suicide and the Development of Suicide Frequencies in Germany

The existence of the so-called "Werther effect" is well confirmed, and there are several recommendations on how the media should (not) report suicide to minimize the risk of copycat behavior. Unfortunately, very little is known about how suicide is actually reported. The article examines the German press coverage of six celebrity suicides with respect to compliance with guidelines on suicide reporting and analyzes changes in suicides in the wake of the reporting. It concludes that German media do not respect the recommendations in a substantial number of their articles. In addition, a significant increase in suicides and similar suicides is found.

Do newspaper reports of suicides comply with standard suicide reporting guidelines? A study from Bangalore, India

BACKGROUND

Several countries have prescribed standard guidelines for media professionals on suicide reporting. However, the implementation of these guidelines has been varied. Suicide rates in South Asia are one of the highest in the world, and it is known that media guidelines for suicide reporting are not followed adequately. However, there are no published reports available from this region.

AIM

This study aimed at assessing newspaper reports of suicide for quality of reporting based on standard reporting guidelines and to study differences between English and vernacular (Kannada) newspapers in Bangalore, South India.

METHODS

A total of 341 newspaper reports of suicide from 550 newspapers (3 English and 3 Kannada) over 3 months were systematically assessed for compliance with reporting guidelines. Each report was evaluated on 2 domains and 36 parameters. Data were analyzed for frequency of inappropriate reporting and patterns compared between vernacular and English newspapers.

RESULTS

In all, 87% of the reports were those of completed suicide. Non-compliant reporting - method of suicide was reported in 89% and 32% of reports were in prominent pages of the newspaper, 95% mentioned gender, 90% reported the name, 80% reported age and suicide location, 75% reported life events related to suicide, 70% reported occupation, 69% had headline explicity on suicide and 61% reported monocausality. Only 16% reported mental disorder related to suicide, and less than 3% included information on suicide prevention and helplines. Vernacular papers showed significantly better compliance in 16 of the 20 areas. However, protective characteristics were better reported in English newspapers.

CONCLUSION

Majority of reports on suicides in newspapers from Bangalore did not comply with standard guidelines of reporting. There is a strong need to evolve local guidelines and mechanisms for ensuring responsible reporting which have important implications in prevention of suicide.

Which suicides are reported in the media - and what makes them "newsworthy"?

BACKGROUND

Media reporting of suicide has attracted public health attention because of its potential to trigger "copycat" acts.

AIMS

To determine the factors associated with an individual suicide featuring in the media.

METHOD

We identified from the National Coroners Information System (NCIS) all suicides that occurred in Australia over a 1-year period and established those that were reported in the Australian media using data from our earlier Media Monitoring Project. Available variables were used to examine factors associated with a suicide being reported in the media.

RESULTS

Of the 2,161 suicides, 29 were reported in the media. Suicides by younger individuals were particularly likely to be reported, as were suicides by gunshot and other violent methods, suicides in commercial areas (e.g., office buildings and hotels) and medical/residential facilities and other institutions (e.g., detention centers), and suicides that occurred in the context of multiple fatality events (e.g., homicide-suicides and suicide pacts).

CONCLUSIONS

Striking the right balance in terms of media reporting of suicide is crucial. The current study suggests that the reported suicides tend to be those that may either heighten the risk of lethal imitative behaviors or serve to distort public perceptions about suicide.

The werther effect of two celebrity suicides: an entertainer and a politician

Purpose

Suicide is a major health problem in Korea. Extensive media exposure of celebrity suicide may induce imitative suicide, a phenomenon called the Werther effect. We examined the increased suicide risk following the suicides of an entertainer and a politician, and identified the relative suicide risks.

Methods

News articles about the celebrity suicides were obtained from three major newspapers and analysed for quantitative and qualitative features. Imitative suicide risk was investigated by applying a Poisson time series autoregression model with suicide mortality data from the National Statistics Office for 1.5 years before and 1.5 years after each celebrity’s suicide. The period with a significantly increased number of suicides immediately after the celebrity’s suicide determined the Werther effect band. The relative risk during this period was examined for different ages, genders, and suicide methods.

Results

News reports were more numerous and they contained more positive definitions about the entertainer’s suicide. The risk of suicide deaths rose markedly after both celebrity suicides. However, the Werther effect band was longer for the entertainer (6 weeks) than for the politician (4 weeks). The relative suicide risk was significant for almost all ages and both genders during that of both individuals. Use of the same suicide method was a prominent risk factor after both celebrity suicides.

Conclusions

Our results confirm the existence of imitative suicide behaviours, suggesting a facilitation effect of media reports. Guidelines for responsible media reporting need to be implemented to enhance public mental health in Korea.

How people bereaved by suicide perceive newspaper reporting: qualitative study

BACKGROUND

People bereaved by suicide are often reported to be distressed by media reporting. Current media guidelines for reporting suicide focus especially on prevention of copycat behaviour.

AIMS

To explore bereaved individuals' experiences of media reporting after suicide and to examine their priorities in relation to media guidelines.

METHOD

In-depth interviews with 40 people bereaved by suicide, with qualitative analysis. Review of four guidelines.

RESULTS

There is a difference of emphasis between guidance for the press that aims to prevent copycat suicides (especially avoidance of details such as method used) and the perspectives of bereaved people (who prioritise sympathetic and accurate reporting, sometimes including details of the death and images of the person who died). We found that bereaved relatives were sometimes keen to talk to the press. Those who were upset by the press focused on careless reporting, misquoting and speculation that gave an inaccurate impression of the death.

CONCLUSIONS

The Leveson Inquiry has drawn attention to the damage that can be caused by irresponsible journalism. Guidelines written to prevent 'copycat' suicides are important, but so are the needs of bereaved relatives. Because accuracy matters greatly to the bereaved, families should be able to work with an intermediary such as a police press officer to prepare a statement for the press to minimise the risk of misrepresentation.

Differing perspectives on what is important in media reporting of suicide

There is a substantial literature which demonstrates that irresponsible reporting of suicide can lead to copycat acts and, as a result, many countries have developed guidelines for media professionals. Some of the recommendations in these guidelines draw directly on the evidence and describe how reporting can be done in a measured fashion that minimises any likely negative influence. Other recommendations relate more to good journalistic practice and are about showing respect for the bereaved in their time of grieving. The study by Chapple et al, in this issue, indicates that there may sometimes be tensions between what media guidelines recommend and what those bereaved by suicide believe is important. We would argue that in such cases common ground can be reached.

One followed by many?-Long-term effects of a celebrity suicide on the number of suicidal acts on the German railway net

BACKGROUND

Following the railway suicide of Robert Enke, a famous German football goal keeper, short-term copycat effects have been found. Main aims of the present study were to analyze long-term effects of this incidence and to compare them with overall national suicide data, as well as to investigate possible "anniversary effects".

METHODS

For long-term effects, the number of railway suicidal acts in the two years before and after Robert Enke's suicide (10th November 2009) were compared. For anniversary effects, the corresponding 2-week-periods in 2009, 2010 and 2011 were analyzed. Incidence ratios with 95% confidence intervals were computed.

RESULTS

Compared to the two years before Enke's suicide the incidence ratio of the number of railway suicidal acts in the 2-year-period following this event increased by 18.8% (95% confidence interval (CI)=11.0-27.1%; p<0.001). The median number of suicidal acts per day increased from 2 to 3 (p<0.001). This effect remains significant after excluding short-term 2-week effects of Enke's suicide. An anniversary effect was not present. The increase of fatal railway suicides between 2007 and 2010 (25%) was significantly different from that for the total number of suicides in Germany (6.6%) (p<0.0001).

LIMITATIONS

Due to missing data, analyses regarding gender were limited and regarding age not feasible.

CONCLUSIONS

Long-term effects of Enke's suicide on railway suicidal acts in Germany in the sense of copycat behavior are probable as this increase cannot be explained by corresponding changes of the total number of suicides in Germany.

Using science to improve communications about suicide among military and veteran populations: looking for a few good messages

Concern about suicide in US military and veteran populations has prompted efforts to identify more effective prevention measures. Recent expert panel reports have recommended public communications as one component of a comprehensive effort. Messaging about military and veteran suicide originates from many sources and often does not support suicide prevention goals or adhere to principles for developing effective communications. There is an urgent need for strategic, science-based, consistent messaging guidance in this area. Although literature on the effectiveness of suicide prevention communications for these populations is lacking, this article summarizes key findings from several bodies of research that offer lessons for creating safe and effective messages that support and enhance military and veteran suicide prevention efforts.

[Characterization of News on Suicide in the Printed Press in Colombia]

INTRODUCTION

Suicide is a major public health problem. It is believed that the media plays an important role in the onset of suicidal behavior. Certain sub-groups of the population (for instance, young people or those suffering from depression) can be especially vulnerable to engage in imitative suicidal behaviors.

OBJECTIVES

To characterize news reports on suicide published in the printed press in Bogotá. To identify strategies, models or structures used in the print media (newspapers) to report suicide cases. To establish whether the way of reporting suicide cases is appropriate according to the recommendations of the World Health Organization (WHO).

MATERIALS AND METHODS

A detailed search was performed to find news on suicide or suicide attempts published in three Colombian newspapers -2 of them with national circulation (El Espectador and El Tiempo), and one with local circulation (El Espacio)-, during the period between August 2009 and August 2011. Compliance with WHO recommendations by the 3 newspapers was compared using Fisher tests; the frequency of news release was assessed using statistical control charts, and headlines were evaluated by lexicometric analysis.

RESULTS

During the study period, a total of 135 items of news relating to cases occurring in Colombia were found. Although there were differences between the newspapers, none of them fully met the WHO recommendations. There was no clear trend in the way of presenting the news. Three styles were found in the presentation of news (suggestive, sensationalist, and revealing impact on survivors), which could be associated with each of the 3 newspapers evaluated.

Suicide news reporting accuracy and stereotyping in Hong Kong

BACKGROUND

The mass media are often criticized for oversimplifying the causes of suicide and overlooking some of the risk factors. However, there is a lack of empirical evidence to support this assertion. The study aims to examine the accuracy of news reports in Hong Kong (HK) and in particular whether or not such reports stereotype victims according to gender and suicide method.

METHODS

Data from a case-control psychological autopsy (PA) study of 150 HK suicides were utilized. The reports of the PA cases from five major HK newspapers were collected and reviewed to identify whether or not there was a match in terms of the cases' profile and risk factors.

RESULTS

The age, gender, and method of the suicides were largely reported correctly (>70%) but accounts of risk factors were seldom accurate (<46%). No significant difference was found between tabloid- and non-tabloid-type newspapers' accuracy. Media stereotyping of gender-specific suicide and charcoal-burning suicide was identified.

LIMITATIONS

The study was based on a HK sample so the findings are not necessarily applicable elsewhere.

CONCLUSIONS

The HK mass media generally demonstrated poor accuracy in reporting suicide risk factors. Their reporting was also problematic in terms of stereotyping gender- and method-specific suicides. Clinical practitioners should be alerted to these findings when working with the media. They can also adopt this novel usage of PA data to extract further information from other PA studies and thereby broaden the investigation of reporting accuracy and stereotyping of suicide to more diverse social contexts.

Belief in the dangerousness of people with mental disorders: a review

BACKGROUND

The scientific literature on stigma has been confused because there are multiple components of stigma with different correlates. In order to help make sense of this confusion, the present review focuses on research on one of the most commonly measured components - belief in dangerousness.

METHOD AND RESULTS

The review examines: measurement of belief in dangerousness; prevalence of belief in dangerousness; characteristics of people who believe in dangerousness; experiences associated with belief in dangerousness; characteristics of people that elicit belief in dangerousness; the effects of psychiatric labelling; the effects of causal explanations; interventions to reduce belief in dangerousness; and effects on help-seeking.

CONCLUSION

It is concluded that future research needs to focus on rigorous evaluation of interventions to reduce belief in dangerousness and the impact of this belief on people affected by mental disorders.

Post-suicide intervention programs: a systematic review

OBJECTIVE

The purposes of this study were: 1) to determine the effectiveness of suicide postvention programs on suicide attempts and suicide as well as grief symptoms, mental distress, and mental health broadly defined; and 2) to investigate their cost-effectiveness.

METHODS

Computerized database searches (PubMed, PsycINFO, Cinahl, Cochrane Database, Crisis and Suicide & Life-Threatening Behavior) were performed in September 2009 to obtain evaluations of suicide postvention programs and in February 2010 (Centre for Research and Dissemination Database, Cochrane Database of Systematic Reviews, PubMed, PsycINFO, and Cinahl) to obtain cost-effectiveness analyses of bereavement programs. Hand searches of relevant articles and reviews were also conducted. Publications were included in the analysis if they described an evaluation/cost-effectiveness analysis of a suicide postvention program, provided data, and were published in English-language peer-reviewed journals. There was no restriction on publication date. Studies were excluded if they were narrative systematic reviews or dissertations or if they described a postvention program but provided no evaluation. Because very few cost-effectiveness analyses were identified, articles describing "costs" of bereavement programs were also included. Studies were evaluated for quality using Centres for Evidence-Based Medicine Levels of Evidence, and for program effectiveness using Office of Justice Programs "What Works Repository" Analytic Framework.

RESULTS

Of the 49 studies of suicide postvention programs retrieved, 16 met inclusion criteria for evaluation of study quality and evidence of effectiveness. Three target populations for postvention programs were identified: school-based, family-focused, and community-based. No protective effect of any postvention program could be determined for number of suicide deaths or suicide attempts from the available studies. Few positive effects of school-based postvention programs were found. One study reported negative effects of a suicide postvention. Gatekeeper training for proactive postvention was effective in increasing knowledge pertaining to crisis intervention among school personnel. Outreach at the scene of suicide was found to be helpful in encouraging survivors to attend a support group at a crisis centre and seek help in dealing with their loss. Contact with a counseling postvention for familial survivors (spouses, parents, children) of suicide generally helped reduce psychological distress in the short term. There was no statistical analysis of community-based suicide postvention programs; however media guidelines for reporting of suicide and suicide attempts have been adopted by mental health organizations in numerous countries. No analyses of cost-effectiveness of suicide postvention programs were found.

CONCLUSION

Recommendations to provide guidance to policy-makers, administrators and clinicians are presented and directions for future research are outlined.

Media Guidelines for the Responsible Reporting of Suicide

Background: The media have a powerful influence on those at risk of suicide. Evidence linking sensational media reporting with imitative suicidal behavior continues to grow, prompting the widespread development of guidelines for media professionals on the reporting of suicide. While such guidelines have been widely implemented, only a small amount of research has addressed their use and effectiveness. Aims: To conduct a systematic literature review aimed at critically evaluating the evidence concerning the use and effectiveness of media guidelines for reporting on suicide. Methods: All research publications that addressed the effectiveness of media guidelines against a variety of outcome measures were examined. Results: The findings highlight cases in which guideline implementation has successfully mitigated imitative suicides. Significant variability in the effect of guidelines on the quality of suicide reporting was observed between studies, and research suggests journalist awareness, use, and opinion of guidelines is generally low. The critical positive effects of media collaboration and training on reporting are noted. Conclusions: Overall, the findings of this review suggest that the guidelines can change reporting style and prevent imitative suicide, but that approaches centered on consultation, collaboration, media ownership, and training are likely to achieve the greatest success.

Suicide announcement on Facebook

BACKGROUND

The media and the Internet may be having an influence on suicidal behavior. Online social networks such as Facebook represent a new facet of global information transfer. The impact of these online social networks on suicidal behavior has not yet been evaluated.

AIMS

To discuss potential effects of suicide notes on Facebook on suicide prevention and copycat suicides, and to create awareness among health care professionals.

METHODS

We present a case involving a suicide note on Facebook and discuss potential consequences of this phenomenon based on literature found searching PubMed and Google.

RESULTS

There are numerous reports of suicide notes on Facebook in the popular press, but none in the professional literature. Online social network users attempted to prevent planned suicides in several reported cases. To date there is no documented evidence of a copycat suicide, directly emulating a suicide announced on Facebook.

CONCLUSIONS

Suicide notes on online social networks may allow for suicide prevention via the immediate intervention of other network users. But it is not yet clear to what extent suicide notes on online social networks actually induce copycat suicides. These effects deserve future evaluation and research.

Suicide and deliberate self-harm in Oxford University students over a 30-year period

PURPOSE

To determine whether rates of suicide and self-harm in university students differ from those in other young people.

METHODS

We obtained information on Oxford University students who died by suicide or presented to hospital following deliberate self-harm (DSH) between 1976 and 2006 from official records and a General Hospital monitoring system in Oxford. Rates of suicide and self-harm in the students and in other young people in the general population were calculated from university, local and national population figures.

RESULTS

Forty-eight Oxford University students (32 males and 16 females) died by suicide. Most (N = 42) were aged 18-25 years. The suicide rate did not differ from that of other people in this age group in England and Wales (SMR 105.4; 95% CI 75.2, 143.4). There was evidence of clustering of methods of suicide over time. During the same period, 602 students (383 females and 219 males) presented to the General Hospital following DSH. Most (90.7%) were aged 15-24 years, in which age group rates of DSH (per 100,000) during term-time were lower than in other young people in Oxford City (females: 206.5 vs. 285.6, z = -5.03, p < 0.001; males: 75.9 vs. 111.2, z = -4.35; p < 0.001). There was an excess of student DSH episodes in the main exam term.

CONCLUSIONS

Contrary to earlier findings and popular belief, suicide rates in Oxford University students do not differ from those in other young people. Rates of DSH are significantly lower than in other young people. Risk of DSH may increase around the time of examinations.

The railway suicide death of a famous German football player: impact on the subsequent frequency of railway suicide acts in Germany

BACKGROUND

The railway suicide of Robert Enke, an internationally respected German football goal keeper, sent shockwaves throughout the world of football. We analyzed its impact on the frequency of subsequent railway suicide acts (RS).

METHODS

Two analytic approaches were performed applying German Railway Event database Safety (EDS) data: first, an inter-year approach comparing the incidence of RS during a predefined "index period" with identical time windows in 2006 to 2008; second, an intra-year approach comparing the number of RS 28 days before and after the incidence. To analyze a possible "compensatory deficit", the number of RS in the subsequent first quarter of 2010 was compared with the identical time windows in the preceding three years. Incidence ratios with 95% confidence intervals were estimated by Poisson regression. Findings were controlled for temperature.

FINDINGS

Compared to the preceding three years, the incidence ratio (IR) of the number of RS in the index period increased by 1.81 (1.48-2.21; p<0.001), leading to an overall percentage change of 81% (48-121%; p<0.001). Comparing the number of suicides 28 days before and after the incidence revealed an even more pronounced increase of IR (2.2; 1.6-3.0). No modifications of these associations were observed by daytime, by location of the suicide and fatality. No compensatory deficit occurred in the post-acute period.

INTERPRETATION

The substantial increase of RS in the aftermath of the footballer's suicide death brought about copycat behavior in an unforeseen amount, even though the media reporting was largely sensitive and preventive measures were taken.

The Foxconn suicides and their media prominence: is the Werther Effect applicable in China?

Background

Media reporting of suicide and its relationship with actual suicide has rarely been investigated in Mainland China. The "Foxconn suicides" is a description referring to a string of suicides/attempts during 2010, all of which were related to a giant electrical manufacturing company, Foxconn. This study aimed to examine the clustering and copycat effects of the Foxconn suicides, and to investigate temporal patterns in how they were reported by the media in Mainland China, Hong Kong (HK), and Taiwan (TW).

Methods

Relevant articles were collected from representative newspapers published in three big cities in Mainland China (Beijing (BJ), Shenzhen (SZ), and Guangzhou (GZ)), HK, and TW, together with searching intensity data on the topic conducted using the Baidu search engine in Mainland China. The temporal clustering effects of the Foxconn suicides and their media prominence were assessed using the Kolmogorov-Smirnov test. The media reports of the Foxconn suicides' temporal patterns were explored using a nonparametric curve estimation method (that is, the local linear method). The potential mutual interactions between the Foxconn suicides and their media prominence were also examined, using logistic and Poisson regression methods.

Results

The results support a temporal clustering effect for the Foxconn suicides. The BJ-based newspapers' reporting and the occurrence of a Foxconn suicide/attempt are each found to be associated with an elevated chance of a further Foxconn suicide 3 days later. The occurrence of a Foxconn suicide also immediately influenced the intensity of both Baidu searching and newspaper reporting. Regional diversity in suicide reporting tempo-patterns within Mainland China, and similarities between HK and TW, are also demonstrated.

Conclusions

The Foxconn suicides were temporally clustered. Their occurrences were influenced by the reporting of BJ-based newspapers, and contagion within the company itself. Further suicide research and prevention work in China should consider its special media environment.

The development of a guideline and its impact on the media reporting of suicide

CONTEXT

A causal association between media reporting of suicides and the subsequent actual suicides has been observed. There are no studies from India regarding media reporting of suicide. This study examines whether educating media professionals about responsible reporting of suicides can change the quality of reporting.

AIMS

To study the impact of a guideline on the reporting style of suicides by journalists.

SETTINGS AND DESIGN

Newspaper reports in the local language examined by psychiatrists.

MATERIALS AND METHODS

The Department of Psychiatry of a Teaching Hospital conducted a workshop for journalists, with the collaboration of media and mental health professionals and came out with a guideline about responsible reporting of suicide. Using this, a proforma was designed for assessing newspaper reports of suicides. All the suicide reports in the leading newspapers in Kerala were analyzed for one year prior to the workshop, the immediate next year, the second year, and six years later, using the 15 item proforma and whether each report was concordant or discordant to each item in the proforma was noted.

RESULTS

The total concordant responses were 43.7% in the year prior to the workshop, 45.2% during the first year following the workshop, 46.2% in the next year, and 45.7% after six years. When the trend of each item was examined, the concordance rates were increasing in each item, except two. There was no statistical significance.

CONCLUSIONS

A workshop for journalists could bring about positive changes in the media reporting of suicides. The changes persisted over the years, although they did not reach statistical significance.

Self-immolation, suicide and self-harm in Buddhist and Western traditions

There are significant points of similarity between considerations of self-harm and suicide in Buddhist and non-Buddhist traditions, including qualified acceptance of certain forms of self-harm, altruism as a motivation for suicide, and self-immolation as a form of political protest. Differences include specific contexts in which certain forms of self-harm are accepted and the predominant frameworks used to interpret such acts. The integration of Buddhist concepts of dukkha (unsatisfactoriness or suffering) and sati (mindfulness) into Western psychotherapeutic paradigms represents a significant point of convergence between the two traditions, and suggests the possibility of greater dialogue and therapeutic benefit in the future.

Media awards for responsible reporting of suicide: Experiences from Australia, Belgium and Denmark

BACKGROUND

Media awards to encourage responsible reporting of suicide have been introduced in several countries, including Australia, Belgium and Denmark.

AIMS

This study aimed to examine the experiences of Australian, Belgian and Danish award recipients in preparing stories on suicide, and consider the impacts of the awards for these recipients and for media professionals more broadly.

METHOD

We conducted semi-structured telephone interviews with the majority (14 out of 15) of past recipients of the awards in the three countries of interest.

RESULTS

Media awards appear to show promise as a method of reinforcing national and international media guidelines on reporting suicide. The recipients of awards were proud to have had their achievements recognized in this way, and had developed a heightened awareness of the issues inherent in reporting suicide. Although relatively few had prepared subsequent stories on suicide, a number had been given opportunities to provide advice to other media professionals about how best to approach this sensitive topic. Recipients viewed the awards as an important means by which good quality reporting can be rewarded, and a springboard for raising community awareness about suicide.

CONCLUSION

The experience from Australia, Belgium and Denmark suggests that media awards which recognize responsible reporting of suicide are extremely worthwhile.

Suicide coverage in U.S. newspapers following the publication of the media guidelines

A nationally representative sample of 968 local and national newspapers was examined to determine whether the 2001 U.S. media guidelines were followed in articles published in 2002-2003, and featuring individual cases of suicidal behavior (N = 157). We found that, during this period of time, U.S. newspaper suicide coverage did not consistently reflect the influence of the media guidelines. On the positive side, only 19% of stories included inappropriate imagery. On the negative side, suicide stories often detailed suicide method (56% of stories) and location (58%), and rarely provided information about warning signs and risk factors (1%), the roles of depression (4%) and alcohol (2%), and prevention resources (6%). Our findings, together with previous evidence, suggest the need for sustained dialogue with the media about suicide reporting.

Role of media reports in completed and prevented suicide: Werther v. Papageno effects

BACKGROUND

Media reporting of suicide has repeatedly been shown to trigger suicidal behaviour. Few studies have investigated the associations between specific media content and suicide rates. Even less is known about the possible preventive effects of suicide-related media content.

AIMS

To test the hypotheses that certain media content is associated with an increase in suicide, suggesting a so-called Werther effect, and that other content is associated with a decrease in suicide, conceptualised as a Papageno effect. Further, to identify classes of media articles with similar reporting profiles and to test for associations between these classes and suicide.

METHOD

Content analysis and latent class analysis (LCA) of 497 suicide-related print media reports published in Austria between 1 January and 30 June 2005. Ecological study to identify associations between media item content and short-term changes in suicide rates.

RESULTS

Repetitive reporting of the same suicide and the reporting of suicide myths were positively associated with suicide rates. Coverage of individual suicidal ideation not accompanied by suicidal behaviour was negatively associated with suicide rates. The LCA yielded four classes of media reports, of which the mastery of crisis class (articles on individuals who adopted coping strategies other than suicidal behaviour in adverse circumstances) was negatively associated with suicide, whereas the expert opinion class and the epidemiological facts class were positively associated with suicide.

CONCLUSIONS

The impact of suicide reporting may not be restricted to harmful effects; rather, coverage of positive coping in adverse circumstances, as covered in media items about suicidal ideation, may have protective effects.