Media roles in suicide prevention: a systematic review

Suicide and the agent-host-environment triad: leveraging surveillance sources to inform prevention

Suicide in the US has increased in the last decade, across virtually every age and demographic group. Parallel increases have occurred in non-fatal self-harm as well. Research on suicide across the world has consistently demonstrated that suicide shares many properties with a communicable disease, including person-to-person transmission and point-source outbreaks. This essay illustrates the communicable nature of suicide through analogy to basic infectious disease principles, including evidence for transmission and vulnerability through the agent-host-environment triad. We describe how mathematical modeling, a suite of epidemiological methods, which the COVID-19 pandemic has brought into renewed focus, can and should be applied to suicide in order to understand the dynamics of transmission and to forecast emerging risk areas. We describe how new and innovative sources of data, including social media and search engine data, can be used to augment traditional suicide surveillance, as well as the opportunities and challenges for modeling suicide as a communicable disease process in an effort to guide clinical and public health suicide prevention efforts.

The Werther Effect, the Papageno Effect or No Effect? A Literature Review

This paper examines the association between media reporting on suicides and the subsequent suicides. Scientific papers from two online bibliographic sources Medline (PubMed) and PsycINFO were searched. The sample included 108 research papers examining the impact of different types of media stories on suicides. The review revealed that although the media can be a double-edged sword and serve both as a risk and a protective factor, the vast majority of research suggests that the relationship between the media reporting and the actual suicide rates is causal and real. Moreover, both the quantity and the quality of media reporting may trigger additional suicides in society. Simultaneously, research suggests that especially non-fictional presentations of celebrities' suicides in newspapers and on television news have the biggest influence on the subsequent suicides. Additionally, a strong modelling effect of media reporting on suicide is based on nationality, age, and gender. However, research shows that because a negative reporting style can be modifiable and improved, the media can also have an educative or preventive effect and can reduce the risk of contagion. Consequently, it is important to monitor the implementation of media recommendations for the reporting of suicide, and continuous education of reporters is needed.

TV News and COVID-19: Media Influence on Healthy Behavior in Public Spaces

The COVID-19 outbreak has dramatically changed our life. Despite the rapid growth of scientific publications about medical aspects of the pandemic, less has been explored about the effects of media communication regarding COVID-19 on healthy behaviors. Yet, the scientific literature has widely debated on how media can influence people's health-related evaluations, emotions, and behaviors. To fill this gap, the aim of this study was to investigate the relationships between media exposure, people's attitudes and emotions toward media contents, and healthy behaviors related to the use of public spaces, such as avoiding crowded places, wearing face masks, and maintaining social distance. A questionnaire referring to these variables was administered to an opportunistic sample of 174 participants in Italy during the off-peak period of the COVID-19 outbreak and before restrictions to mobility were extended to the whole country. Results showed that media exposure, the perception of social initiatives of prevention, and moderate levels of fear increase healthier behaviors in the use of public spaces. Perceiving alarming information did not significantly predict healthy behaviors in the use of public spaces. Results are discussed with reference to the previous literature. Suggestions to media communication to increase preventive behaviors during emergencies are also provided.

Exposure to and experience of self-harm and self-harm related content: An exploratory network analysis

Exposure to the self-harm behaviour of others plays a role in individuals' own self-harm thoughts and behaviours, but there has been little consideration of the broader range of mediums through which exposure to self-harm related content may occur. N = 477 participants completed an online study, including questions regarding lifetime history of self-harm thoughts and behaviours and the frequency with which they had been exposed to self-harm via various mediums. Gaussian Markov random field network models were estimated using graphical LASSO and extended Bayesian information criterion. Bootstrapping revealed that exposure mediums with a direct connection to self-harm thoughts and behaviours were the internet (rrp = .34, 95% CI [.26, .42]) and in-passing 'miscellaneous' exposure (rrp = .14, 95% CI [.00, .23]). However, stability of the network centrality was low (expected influence stability = 0.52). The node with the greatest increase in expected influence within the network was miscellaneous "in-passing" exposure. In-passing exposure is an understudied exposure medium. Our results may suggest new types of exposure mediums for future research. Data were cross-sectional, so temporal relationships between exposure and behaviour could not be determined. Low stability of the networks suggests that future similar studies would benefit from larger sample sizes.

Emerging Adults' Attitudes and Beliefs About Suicide and Technology/Social Media

Suicide in emerging adults (18-29 years) is increasing in the United States, especially amidst coronavirus disease 2019. How the use of technology/social media affects suicidal behaviors is unclear. The purpose of this study was to examine attitudes and beliefs of emerging adults about suicide and identify whether relationships exist with technology/social media use. A total of 297 participants completed an online survey examining attitudes about suicide and technology use. Results indicate a normalization of suicide. Significant relationships were found with technology/social media, including a positive relationship between YouTube and glorification/normalization of suicide. Recommendations for primary and secondary suicide prevention are made for nurse practitioners in various settings.

Patterns of suicide mortality in England and Wales before and after the suicide of the actor Robin Williams

PURPOSE

There is international evidence supporting an association between sensational reporting of suicide and a subsequent increase in local suicide rates, particularly where reporting the death of a celebrity. We aimed to explore whether the observed increase in suicides in the United States, Canada and Australia in the 5 months following the 2014 suicide of the popular actor Robin Williams was also observed in England and Wales.

METHOD

We used interrupted time-series analysis and a seasonal autoregressive integrated moving averages (SARIMA) model to estimate the expected number of suicides during the 5 months following Williams' death using monthly suicide count data for England and Wales from the UK Office for National Statistics (ONS) 2013-2014.

RESULTS

Compared with the observed 2051 suicide deaths in all age groups from August to December 2014, we estimated that we would have expected 1949 suicides over the same period, representing no statistically significant excess.

CONCLUSIONS

This finding is an outlier among previous studies and contrasts with the approximately 10% increase in suicides found in similar analyses conducted in other high-income English-speaking countries with established media reporting guidelines.

Examining Adherence to Suicide Reporting Guidelines in Initial Reports on High-Profile Celebrity Suicides

Background: Research has found varying adherence by media professionals to recommendations for reporting on suicide. Aims: We compared adherence to recommendations for what to do and what not to do when reporting on suicide in initial reports of high-profile celebrity suicides in major media outlets. Method: A total of 100 articles published in news outlets during 2004-2018 and reporting on celebrity suicides were examined for adherence to reporting guidelines using content analysis. Results: Articles frequently adhered to guidelines for what not to do when reporting on suicide (83%), but rarely adhered to guidelines for what to do (26%). Limitations: This study was a single cross-sectional analysis and may not generalize to different outlets, guidelines, or countries. Conclusion: While news articles frequently do not include harmful information, they also do not include potentially protective content.

Calls to helplines in Australia following media reports of Robin Williams' suicide

OBJECTIVE

In the United States, there was an increase in calls to helplines following media reporting of Robin Williams' suicide. We aimed to determine whether this was the case in Australia.

METHOD

The helpline services Lifeline and Beyond Blue provided us with weekly data on calls received for 2013-2015. We conducted interrupted time series regression analyses to determine whether there was an increase in the average weekly number of calls received by each helpline in two periods after the story about Williams' suicide broke (1 week and 4 weeks).

RESULTS

We found strong evidence of an increase in calls to Lifeline (incidence rate ratio [IRR] =1.13; 95% confidence interval [CI] =1.02-1.25; p = 0.016) and Beyond Blue (IRR = 1.32; 95% CI = 1.09-1.59; p = 0.004) in the week after Williams' suicide was first reported. We found no evidence of higher than normal call volumes for Lifeline (IRR = 1.04; 95% CI = 0.99-1.10; p = 0.104) or Beyond Blue (IRR = 1.10; 95% CI = 1.00-1.22; p = 0.058) over the four weeks following Williams' death, however, suggesting that calls leveled out over this period.

CONCLUSION

Suicide prevention experts and media professionals must work together to minimize the negative impacts of reports on suicide and maximize their positive ones. In cases where the story is likely to receive extensive international coverage, it may be important for local media to encourage help-seeking.

Effects of suicide awareness materials on individuals with recent suicidal ideation or attempt: online randomised controlled trial

BACKGROUND

Awareness materials featuring ways of coping with suicidal ideation can reduce suicidal ideation, the so-called Papageno effect. All of the previous experimental studies on this subject have been conducted with individuals not at risk of suicide.

AIMS

To assess effects of suicide awareness materials in a sample of individuals with recent suicidal ideation. Trial registration: German Clinical Trial Registry ID number DRKS00013613.

METHOD

Adults (n = 266) with recent self-reported suicidal ideation or attempt were randomised to read an educative article featuring a lay individual with personal experience of suicidality (n = 86), a similar article featuring a mental health expert (n = 90), or an unrelated article (n = 90) in a double-blind online randomised controlled trial. Questionnaire data were collected before (T1) and immediately after exposure (T2) as well as 1 week later (study end-point, T3) and analysed with linear mixed models. The primary outcome was suicide risk as assessed using the Survival and Coping Beliefs subscale of the Reasons for Living Inventory (RFLI); secondary outcomes were suicide-prevention knowledge and mood.

RESULTS

There was an immediate beneficial effect on suicide risk in the intervention group exposed to the message delivered by the individual with personal experience (group 1) as compared with the control group that was maintained until the study end-point (study end-point: RFLI score mean difference from baseline within group 1 MD = -0.36 (95% CI -0.66 to -0.06), mean difference compared with control group MD = -0.71 (95% CI -1.27 to -0.14); d = -0.18). The effect was particularly pronounced for individuals with recent suicide attempt (RFLI score at T3, compared with control group: MD = -1.55 (95% CI -2.52 to -0.57); d = -0.23). Participants in this group also showed increased prevention-related knowledge compared with the control group.

CONCLUSIONS

Individuals with a recent suicide attempt appear to benefit from a printed narrative of positive coping with suicidal ideation. The intervention materials do not increase short-term suicide risk.

Celebrity Suicide

Background: Increased suicides following media coverage of celebrities' suicide deaths have been documented in several countries. Recommendations for Reporting on Suicide were published to provide guidance for media professionals when covering suicide. Research indicates guidelines have been poorly followed. Aim: We aimed to determine whether the recommendations were similarly observed when studying two online news organizations' coverage of a celebrity's suicide. Method: In the 3 days following a high-profile celebrity's death, two US cable networks' news websites were studied to compare how the death was reported. Online articles were reviewed using a coding rubric organized by six themes and 21 coding categories. Results: Between the two organizations, 34 articles were published. Regarding the recommendations, neither source followed all of the recommendations, as measured in this study. Source A fared better in providing help-seeking information. Limitations: Only two news organizations were studied for a 3-day period. Online videos, print articles, and social media were excluded. Conclusion: The suicide of a celebrity received repetitive media coverage with little emphasis on prevention or help-seeking. The recommendations were not consistently followed by the two news websites included in this review.

Suicide Coverage in the Digital Press Media: Adherence to World Health Organization Guidelines and Effectiveness of Different Interventions Aimed at Media Professionals

This study evaluated the characteristics of suicide news articles in the digital press, their adherence to World Health Organization (WHO) recommendations, and the effectiveness of interventions. We assessed adherence, avoidability, frequency and typology of suicide news over a six-month period in the four main digital media outlets of the Canary Islands (Spain). A brief training and information package intervention to the Canary Islands media outlets was carried out. We compared the quality of media reporting at both the pre-intervention and post-intervention timepoints, and compared the quality of reporting at the post-intervention timepoint in Victoria (Australia), where media interventions have been well-resourced and running for several years. We evaluated 339 suicide news articles: 38 from the pre-intervention period, 64 from the post-intervention period, and 237 from Victoria. News articles showed a very low degree of adherence to WHO recommendations, especially to those recommendations thought to have a protective effect. Post-intervention news articles showed better adherence than pre-intervention ones, but lower than those of Victoria, where constant interventions have been developed for years. We conclude that adherence to WHO recommendations is low. Simple interventions aimed at media professionals can improve adherence. However, constant and complex interventions seem to be more effective.

Adaptation of evidence-based suicide prevention strategies during and after the COVID-19 pandemic

Suicide is preventable. Nevertheless, each year 800,000 people die of suicide in the world. While there is evidence indicating that suicide rates de-crease during times of crises, they are expected to increase once the immediate crisis has passed. The COVID-19 pandemic affects risk and pro-tective factors for suicide at each level of the socio-ecological model. Economic downturn, augmented barriers to accessing health care, increased access to suicidal means, inappropriate media reporting at the societal level; deprioritization of mental health and preventive activities at the community level; interpersonal conflicts, neglect and violence at the relationship level; unemployment, poverty, loneliness and hopelessness at the individual level: all these variables contribute to an increase of depression, anxiety, post-traumatic stress disorder, harmful use of alcohol, substance abuse, and ultimately suicide risk. Suicide should be prevented by strengthening universal strategies directed to the entire population, including mitigation of unemployment, poverty and inequalities; prioritization of access to mental health care; responsible media reporting, with information about available support; prevention of increased alcohol intake; and restriction of access to lethal means of suicide. Selective interventions should continue to target known vulnerable groups who are socio-economically disadvantaged, but also new ones such as first responders and health care staff, and the bereaved by COVID-19 who have been deprived of the final contact with loved ones and funerals. Indicated preventive strategies targeting individuals who display suicidal behaviour should focus on available pharmacological and psychological treatments of mental disorders, ensuring proper follow-up and chain of care by increased use of telemedicine and other digital means. The scientific community, health care professionals, politicians and decision-makers will find in this paper a systematic description of the effects of the pandemic on suicide risk at the society, community, family and individual levels, and an overview of how evidence-based suicide preventive interventions should be adapted. Research is needed to investigate which adaptations are effective and in which con-texts.

Retired National Football League Players are Not at Greater Risk for Suicide

Objective

Some researchers have claimed that former National Football League (NFL) players are at increased risk for suicide as a clinical feature of chronic traumatic encephalopathy (CTE). This review examines the literature on risk for suicide in former professional football players, and the association between suicide and CTE.

Method

A narrative review of the literature published between 1928 and 2018.

Results

Between 1928 and 2009, suicide was not considered to be a clinical feature of CTE in the literature. The best available evidence from epidemiological studies suggests that former NFL football players are at lesser risk for suicide, not greater risk, compared to men in the general population. However, surveys have revealed that a substantial minority of former NFL players have depression and other mental health problems, chronic pain and opioid use is relatively common, and those with depression and chronic pain also have greater life stress and financial difficulties. That minority would be at increased risk for suicidal thoughts and behaviors.

Conclusions

Researchers and clinicians are encouraged to be cautious and circumspect when considering the clinical presentation of former athletes, and to not assume that depression and suicidality are caused by specific types of neuropathology. This represents a reductionistic and Procrustean view. Some former football players have mental health problems, but it should not be assumed uncritically that the underlying cause is an inexorably progressive neurodegenerative disease. Providing evidence-informed and evidence-supported treatments for depression and suicidality might reduce suffering and improve their functioning.

A Content Analysis and Comparison of Two Peaks of Newspaper Reporting During a Suicide Cluster to Examine Implications for Imitation, Suggestion, and Prevention

Abstract. Background: During 2007–2008, media attention focused on a cluster of youth suicides in the UK. There were two peaks (P1, P2) in the volume of newspaper reporting of the deaths. The number of possible suicides was greater than expected at the time of the first peak but not at the time of the second. Aims: To explore any differences in the content of the reporting peaks and to consider implications for imitation and prevention. Method: A content analysis of two peaks of newspaper reporting was conducted. Results: There were 204 articles in P1 (December 27, 2007 to February 19, 2008) and 157 in P2 (February 20, 2008 to March 15, 2008). Four main themes were identified: individual stories; possible causes; features of reporting of the cluster; and educating and informing the public. P1 articles more frequently contained: explicit details of method; photographs of the deceased, and contained more characterization of individuals. Limitations: The focus was on print media, future studies should incorporate online and social media content. Conclusion: The findings provide some support for the hypothesis of a process of suggestion initiated by sensationalist reporting in P1. This contributes to the evidence base of the role of the press in suicide imitation and prevention, highlighting the importance of care when reporting suicides.

An integrated community mental healthcare program to reduce suicidal ideation and improve maternal mental health during the postnatal period: the findings from the Nagano trial

BACKGROUND

During the perinatal period, suicides are more likely to occur in those with depression and who are not receiving active treatment at the time of death. Suicide is a common outcome in people with suicide ideation. We developed an intervention program taking care of comprehensive perinatal maternal mental healthcare to prevent suicide ideation. We hypothesized that our intervention program could reduce postnatal suicide ideation and improve maternal mental health.

METHODS

We performed a controlled trial to examine the usual postnatal care plus a maternal suicide prevention program (the intervention group) compared with usual postnatal care alone, which comprised home visits by public health nurses without mental health screening (the control group) in Nagano city, Japan. In total, 464 women were included; 230 were allocated to the control group and 234 to the intervention group. The intervention had three components: 1) all the women received postnatal mental health screening by public health nurses who completed home visits during the neonatal period, 2) the intervention was administered by a multidisciplinary clinical network, and 3) systematic follow-up sheets were used to better understand bio-psycho-social characteristics of both the mothers and their infants and develop responsive care plans. We measured the participants' mental health at 3-4 months postpartum (T1) and 7-8 months postpartum (T2) using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

Suicidal ideation was significantly lower in the intervention group compared with the control group at T1 (p = 0.014); however, this significant between-group difference did not continue to T2 (p = 0.111). We measured the intervention effects on maternal mental health using the total score of the EPDS, which was significantly improved in the intervention group compared with the control group at T1. Here, the significant difference continued to T2 (p = 0.049).

CONCLUSIONS

Our results indicate that our program may reduce maternal suicidal ideation at 3-4 months postnatally and improve women's mental health during the postnatal periods of 3-4 to 7-8 months. Postnatal maternal mental healthcare, including services to reduce suicide ideation, should be included as an important component of general postnatal care.

TRIAL REGISTRATION

Name of registry: A multidisciplinary intervention program for maternal mental health in perinatal periods. UMIN Clinical Trials Registry number: UMIN000033396 . Registration URL: https://upload.umin.ac.jp/cgibin/ctr/ctr_view_reg.cgi?recptno=R000038076 Registration date: July 15, 2018. Registration timing: retrospective.

Adherence to suicide reporting guidelines by news shared on a social networking platform

Rates of suicide in the United States are at a more than 20-y high. Suicide contagion, or spread of suicide-related thoughts and behaviors through exposure to sensationalized and harmful content is a well-recognized phenomenon. Health authorities have published guidelines for news media reporting on suicide to help prevent contagion; however, uptake of recommendations remains limited. A key barrier to widespread voluntary uptake of suicide-reporting guidelines is that more sensational content is perceived to be more engaging to readers and thus enhances publisher visibility and engagement; however, no empirical information exists on the actual influence of adherence to safe-reporting practices on reader engagement. Hence, we conducted a study to analyze adherence to suicide-reporting guidelines on news shared on social media and to assess how adherence affects reader engagement. Our analysis of Facebook data revealed that harmful elements were prevalent in news articles about suicide shared on social media while the presence of protective elements was generally rare. Contrary to popular perception, closer adherence to safe-reporting practices was associated with a greater likelihood of an article being reshared (adjusted odds ratio [AOR] = 1.19, 95% confidence interval [CI] = 1.10 to 1.27) and receiving positive engagement ("love" reactions) (AOR = 1.20, 95% CI = 1.13 to 1.26). Mean safe-reporting scores were lower in the US than other English-speaking nations and variation existed by publisher characteristics. Our results provide empirical evidence that improved adherence to suicide-reporting guidelines may benefit not only the health of individuals, but also support publisher goals of reach and engagement.

Content analysis of suicide-related online portrayals: changes in contents retrieved with search engines in the United States and Austria from 2013 to 2018

BACKGROUND

In recent years, efforts in suicide prevention in the United States and Europe have been made to change the conversation on suicide to incorporate more preventive aspects. The majority of information-seeking occurs online. Structured analyses assessing qualitative changes in retrieved online material on suicide over time, however, are scarce. We replicated a content analysis of suicide-related websites retrieved with popular search engines in the United States and Austria aiming to assess how suicide-related online portrayals have changed in the past five years.

METHOD

We retrieved 396 websites using the search term suicide, method-related search terms (e.g., how to hang yourself), and help-related search terms (e.g., suicide help) in the United States and 286 websites from Austrian searches. We performed a content analysis based on media recommendations for suicide reporting and compared the findings to 335 websites in the United States and 396 websites in Austria retrieved in 2013 with the same procedure.

RESULTS

In both countries, the number of both protective (United States: p < .001, Austria: p < .001) and harmful characteristics (United States: p < .001, Austria: p < .001) increased. The ratio of protective to harmful characteristics improved to 3.3:1 in the United States and to 2.4:1 in Austria.

LIMITATIONS

No assumptions about the actual impact of the retrieved contents can be assumed.

CONCLUSION

There has been an increase in potentially protective aspects in online portrayals of suicidality, but also an increase in potentially harmful characteristics, which may suggest an increasing polarization of suicide-related contents. Future prevention efforts need to address this potential polarization.

Developing a Suicide Prevention Social Media Campaign With Young People (The #Chatsafe Project): Co-Design Approach

BACKGROUND

Young people commonly use social media platforms to communicate about suicide. Although research indicates that this communication may be helpful, the potential for harm still exists. To facilitate safe communication about suicide on social media, we developed the #chatsafe guidelines, which we sought to implement via a national social media campaign in Australia. Population-wide suicide prevention campaigns have been shown to improve knowledge, awareness, and attitudes toward suicide. However, suicide prevention campaigns will be ineffective if they do not reach and resonate with their target audience. Co-designing suicide prevention campaigns with young people can increase the engagement and usefulness of these youth interventions.

OBJECTIVE

This study aimed to document key elements of the co-design process; to evaluate young people's experiences of the co-design process; and to capture young people's recommendations for the #chatsafe suicide prevention social media campaign.

METHODS

In total, 11 co-design workshops were conducted, with a total of 134 young people aged between 17 and 25 years. The workshops employed commonly used co-design strategies; however, modifications were made to create a safe and comfortable environment, given the population and complexity and sensitivity of the subject matter. Young people's experiences of the workshops were evaluated through a short survey at the end of each workshop. Recommendations for the campaign strategy were captured through a thematic analysis of the postworkshop discussions with facilitators.

RESULTS

The majority of young people reported that the workshops were both safe (116/131, 88.5%) and enjoyable (126/131, 96.2%). They reported feeling better equipped to communicate safely about suicide on the web and feeling better able to identify and support others who may be at risk of suicide. Key recommendations for the campaign strategy were that young people wanted to see bite-sized sections of the guidelines come to life via shareable content such as short videos, animations, photographs, and images. They wanted to feel visible in campaign materials and wanted all materials to be fully inclusive and linked to resources and support services.

CONCLUSIONS

This is the first study internationally to co-design a suicide prevention social media campaign in partnership with young people. The study demonstrates that it is feasible to safely engage young people in co-designing a suicide prevention intervention and that this process produces recommendations, which can usefully inform suicide prevention campaigns aimed at youth. The fact that young people felt better able to safely communicate about suicide on the web as a result of participation in the study augurs well for youth engagement with the national campaign, which was rolled out across Australia. If effective, the campaign has the potential to better prepare many young people to communicate safely about suicide on the web.

Young People's Perspectives and Understanding of the Suicide Story in 13 Reasons Why

Background: The Netflix drama 13 Reasons Why (13RW) focusing on the suicide of an adolescent girl became a global phenomenon. It was accompanied by intense public debate about the risks of exposing youth to fictional portrayals of adolescent suicide. Aims: To explore adolescents' subjective perspectives and understanding of 13RW focusing on the portrayal of adolescent suicide. Method: We applied a thematic analysis to qualitative data from interviews with 25 New Zealand adolescents eliciting views on the show's portrayal of adolescent suicide. Results: Four themes were developed from the analysis: entertaining but not realistic; the unexpected shock factor; jumbled messages; and superficial conversations. Conclusion: This study contributes a youth perspective which has been missing from the debate on 13RW. This research highlights the way that youth, when given the opportunity, articulated a nuanced understanding of the representation of adolescent suicide in 13RW, viewing it as entertainment rather than a realistic depiction that added little in terms of suicide awareness and generated minimal opportunities for in-depth discussion.

Indonesian online newspaper reporting of suicidal behavior: Compliance with World Health Organization media guidelines

BACKGROUND

Despite the lack of attention, suicide is a major public and mental health problem in Indonesia. Research on how Indonesian newspapers portray suicide case has been lacking.

AIM

To assess the quality of Indonesian online newspaper reporting suicide news and its compliance with the World Health Organization (WHO) mass media reporting guidelines.

METHODS

The content of suicide news reported in online newspapers was searched and scrutinized against the WHO suicide reporting guidelines.

RESULTS

Within the duration of 6 months, there were 548 suicide news reported. This consisted of 16.8% attempted suicide and 83.2% completed suicide. Approximately 90.3% reported age, 97.3% reported gender and 64.3% reported the marital status of the victims. Furthermore, 68% reported the methods of suicide in headline or title, 40.5% shown the picture of the victims and 56.6% shown illustration only, and 67.2% reported life event related to suicide act.

CONCLUSION

The vast majority of online newspapers in Indonesia exaggerate suicide news. They rarely inform the readers that there is hope and help available. The majority also do not conform to the WHO media guidelines.

Effects of awareness material featuring individuals with experience of depression and suicidal thoughts on an audience with depressive symptoms: Randomized controlled trial

BACKGROUND AND OBJECTIVE

Suicide prevention plans support individuals with personal experience of mental disorders and suicidality to provide their narratives of coping in the media. The evidence how such portrayals impact on individuals with similar symptoms is limited and there are concerns about unwanted side effects.

METHODS

This was a double-blinded randomized controlled online trial conducted from August to November 2018. N = 158 young adults aged 18-24 with current depressive symptoms and suicidal thoughts were randomized to watch a short film featuring a young individual with personal experience of depression and suicidality (n = 81), or a thematically unrelated control film (n = 77) with similar stylistic elements. Questionnaire data were collected before and immediately after exposure and analysed with ANOVA. The primary outcome was suicidal ideation; secondary outcomes were depressed mood and help-seeking intentions. We also tested the moderating effects of the degree of depressive symptoms on the effects.

RESULTS

Depressed mood was significantly lower, with small-to medium effect size, in the intervention group compared to the control group (F(1,111) = 4.13, P < .05, η_p² = .036). There was no effect on suicidal ideation or help-seeking intentions in the total sample. Participants screening positive for moderately severe depression or higher experienced an increase in suicidal ideation in the control group.

LIMITATIONS

Self-reported variables in an online setting.

CONCLUSIONS

Videos featuring personal experience of coping with depression appear safe for young individuals with similar or higher symptoms of depression and suicidal ideation on the short run, and might have some benefits.

TRIAL REGISTRATION

German Clinical Trial Registry, DRKS00015095 (registration date: 2018-07-16).

The experiences of people bereaved by suicide regarding the press reporting of the death: qualitative study

Background

Media guidelines on suicide reporting of suicide have two purposes: to prevent further suicides, and to minimise distress to the bereaved, who are themselves at increased risk of suicide. We aimed to describe the subjective experiences of people bereaved by suicide regarding media reporting of the suicide of their friend or relative.

Methods

We conducted a cross-sectional study of staff and students aged 18–40 at 37 United Kingdom higher educational institutions in 2010 to recruit adults who had experienced bereavement by the suicide of a close contact. We analysed free-text responses to a question probing experiences of the press after the suicide, using thematic analysis to identify key themes.

Results

We analysed responses from 140 eligible respondents, and identified 3 main themes: value placed on respecting the privacy or wishes of the bereaved; respect accorded to the deceased; and the role of the press in promoting suicide prevention messages. Many respondents described negative experiences of the press, with sub-themes capturing distressing experiences relating to perceptions of journalists’ intrusive behaviour, failure to consult appropriately with the bereaved, journalists releasing private information, negatively misrepresenting the deceased, and breaching the anonymity of the deceased or bereaved. We identified considerable variation in people’s views over acceptable levels of detail reported in the press, and in some cases objections were in relation to journalists following media guidelines. These divergent views illustrate the tensions between the twin purposes of media guidelines: to prevent further suicides, and to protect the bereaved.

Conclusions

The findings from our British sample provide journalists with personal perspectives from bereaved relatives on the impact of media intrusion, speculation, and misrepresentation, and an insight into disparate views on the nature of information relatives feel comfortable disclosing. These findings suggest a need for journalists’ training to include exposure to such views, to heighten awareness of potentially distressing effects and the nuances of bereaved people’s preferences. This should aim to encourage journalists to consult with bereaved relatives more sensitively, whilst also remaining mindful of media guidelines on the reporting of suicide.

The uptake of evidence-informed guidelines for reporting suicide into media codes of practice and policies in Australia

ISSUE ADDRESSED

Despite different models and frameworks for effective suicide prevention, a universal intervention that is consistently highlighted is the need for responsible and safe media reporting of suicide. This is based on evidence of an association between media reporting of suicide and subsequent suicidal behaviour. This study examines the extent to which media-led policies and codes of practice in Australia have integrated and aligned with evidence-informed recommendations about reporting suicide.

METHODS

An online search of Australian media agency websites was used to identify codes of practice or similar guidance for news reporting. Content analysis was conducted on all identified documents, assessing alignment with 16 key recommendations from the Mindframe media guidelines for reporting on suicide.

RESULTS

A total of 17 documents across 12 media agencies were identified. Ten of the 12 agencies provided specific advice about the reporting of suicide, with all agencies that issue codes of practice or editorial policies including between two and 10 recommendations aligned with the Mindframe guidelines.

CONCLUSIONS

While the results of this study are positive, significant variation between media agencies shows that there are opportunities to enhance adoption and implementation of evidence-informed guidance for media professionals in Australia. SO WHAT?: With over 3000 people dying by suicide and over 60 000 people attempting suicide each year in Australia, the prevention of suicide remains a key public health priority requiring a multi-sector and health-in-all-policies approach. This study reveals that there is a strong platform for ongoing collaboration with the Australian media to ensure safe and sensitive coverage of suicide.

A suicide prevention initiative at a jumping site: A mixed-methods evaluation

BACKGROUND

Gap Park in Sydney, Australia has historically been recognised as a suicide jumping site. In 2010-2011 the Gap Park Masterplan initiative implemented a series of suicide prevention measures. This study applied a mixed-methods design to evaluate the effectiveness of the Masterplan in reducing suicides.

METHODS

Data from the Australian National Coronial Information System (NCIS) was examined to compare suicides at Gap Park before and after the Masterplan was implemented. This was complemented with qualitative data from interviews with police officers who respond to suicidal behaviours at Gap Park.

FINDINGS

Joinpoint analysis of NCIS data showed a non-significant upward trend in jumping suicides during the study period. A significant upward trend in suicides was seen for females before the implementation of the Masterplan (2000-2010), followed by a significant downward trend from the implementation period onwards (2010-2016) for females: however, a non-significant upward trend for males was observed. Qualitative analysis of police interviews identified six key themes: romanticism and attraction at hotspots, profiles and behavioural patterns of suicidal individuals, responding to a person in a suicidal crisis, repeat attempts, means restriction, and personal impacts on police officers.

INTERPRETATION

The mixed-method study provided important insights, suggesting the Gap Park Masterplan has contributed to a reduction in female, but not in male jumping suicides. Further qualitative information from police officers suggested that the safety barriers were not difficult to climb, and may be more of a visual or psychological barrier. However, the effectiveness of CCTV and alarms in the detection and location of suicide attempters was highlighted.

FUNDING

Lifeline Research Foundation.

Association Between the Release of Netflix's 13 Reasons Why and Suicide Rates in the United States: An Interrupted Time Series Analysis

OBJECTIVE

To estimate the association between the release of the Netflix series 13 Reasons Why and suicide rates in the United States.

METHOD

Using segmented quasi-Poisson regression and Holt-Winters forecasting models, we assessed monthly rates of suicide among individuals aged 10 to 64 years grouped into 3 age categories (10-17, 18-29, and 30-64 years) between January 1, 2013, and December 31, 2017, before and after the release of 13 Reasons Why on March 31, 2017. We also assessed the impact of the show's release on a control outcome, homicide deaths.

RESULTS

After accounting for seasonal effects and an underlying increasing trend in monthly suicide rates, the overall suicide rate among 10- to 17-year-olds increased significantly in the month immediately following the release of 13 Reasons Why (incidence rate ratio [IRR], 1.29; 95% CI, 1.09-1.53); Holt-Winters forecasting revealed elevated observed suicide rates in the month after release and in two subsequent months, relative to corresponding forecasted rates. Contrary to expectations, these associations were restricted to boys. Among 18- to 29-year-olds and 30- to 64-year-olds, we found no significant change in level or trend of suicide after the show's release, both overall and by sex. The show's release had no apparent impact in the control analyses of homicide deaths within any age group.

CONCLUSION

The release of 13 Reasons Why was associated with a significant increase in monthly suicide rates among US youth aged 10 to 17 years. Caution regarding the exposure of children and adolescents to the series is warranted.

Reanalysis of the Bridge et al. study of suicide following release of 13 Reasons Why

Bridge et al. recently presented a time series analysis of suicide rates in the US following the release of the 2017 Netflix series "13 Reasons Why." Their analysis found a powerful effect of the show on boys ages 10-17 for nine months after the show was released in April 2017. I questioned this finding on two grounds. First, contagion would be expected to be stronger for girls than boys for this story, and second their analysis did not take into account strong secular trends in suicide, especially in boys from 2016 to 2017. I reanalyzed their data using a simple auto-regression model that tested for changes in rates after removing auto-correlation and national trends in suicide. I found that the increase for boys observed by Bridge et al. in April was no greater than the increase observed during the prior month before the show was released. There were also no effects in later months of that year. For girls, I found a small but nonsignificant increase in suicide in April that was unique to that month, potentially consistent with a combined protective and harmful effect of the show. In total, I conclude that it is difficult to attribute harmful effects of the show using aggregate rates of monthly suicide rates. More fine-grained analyses at the weekly level may be more valid but only after controlling for secular changes in suicide that have been particularly strong since 2008 in the US.

Suicides in Australia following media reports of the death of Robin Williams

OBJECTIVE

This study assessed the extent to which local reporting of Robin Williams' suicide (on 11 August 2014) was associated with suicide in Australia. It followed several studies in the United States which showed that there were significant increases in suicide following media reports of Williams' death and that those media reports were less than optimal in terms of adherence to best-practice guidelines. In a previous study, we demonstrated that Australian media reports of Williams' suicide were largely adherent with our Mindframe guidelines on responsible reporting of suicide, so we speculated that there would be no increase in suicide following the reporting of Williams' suicide in Australia.

METHOD

We extracted data on Australian suicides from the National Coroners Information System for the period 2001 to 2016. We conducted interrupted time series regression analyses to determine whether there were changes in suicides in the 5-month period immediately following Williams' suicide.

RESULTS

Our hypothesis that there would be no increase in suicides in Australia following Williams' highly publicised suicide was not supported. There was an 11% increase in suicides in the 5-month period following Williams' death, largely accounted for by men aged 30-64 and by people who died by hanging (the method Williams used).

CONCLUSION

It may be that Australians were exposed to reports that contravened safe reporting recommendations, particularly via overseas media or social media, and/or that some Australian reports may have had unhelpful overarching narratives, despite largely adhering to the Mindframe guidelines. The Mindframe guidelines constitute international best practice but consideration should be given to whether certain recommendations within them should be further reinforced and whether more nuanced information about how stories should be framed could be provided. Future revision and augmentation of the Mindframe guidelines should, as always, involve media professionals.

Public Response to Suicide News Reports as Reflected in Computerized Text Analysis of Online Reader Comments

Previous research has documented the rise in rates of suicidal behaviors following media reports of celebrity suicide. Whereas most research has focused on documenting and analyzing suicide rates, little is known about more subtle psychological effects of celebrity suicide on the public, such as despair and feelings of abandonment. The Internet has revolutionized the responses to news reports, enabling immediate and anonymous responses potentially reflecting these psychological processes. Thus, the current study explored the unique psychological impact of a celebrity suicide on the public by analyzing the big data of readers' comments to suicide news reports, using computational linguistics methods. Readers' comments (N = 14,506) to suicide news reports were retrieved from 4 leading online news sites. The comments were posted in response to 1 of 1 types of reports: a celebrity suicide (Robin Williams), a non-celebrity suicide, and general reports of suicide as a social phenomenon. LIWC software for computerized linguistic analysis was used to calculate the frequency of the various types of words used. Comparison of the responses to the 3 types of suicide reports revealed higher frequency of first-person pronouns and for emotionally charged words on comments to a celebrity suicide, compared with comments to the other types of suicide reports. The findings suggest that celebrity suicide news reports evoke the expression of positive emotions, possibly related to the venerated celebrity, alongside negative, internalized emotions, and feelings of social isolation. Theoretical, practical, and methodological implications are discussed.

Why Are Suicide Rates Increasing in the United States? Towards a Multilevel Reimagination of Suicide Prevention

Suicide, a major public health concern, takes around 800,000 lives globally every year and is the second leading cause of death among adolescents and young adults. Despite substantial prevention efforts, between 1999 and 2017, suicide and nonfatal self-injury rates have experienced unprecedented increases across the United States - as well as in many other countries in the world. This chapter reviews the existing evidence on the causes behind increased suicide rates and critically evaluates the impact of a range of innovative approaches to suicide prevention. First, we briefly describe current trends in suicide and suicidal behaviors and relate them to recent time trends in relevant suicide risk markers. Then, we review the existing evidence in suicide prevention at the individual and the population levels, including new approaches that are currently under development. Finally, we advocate for a new generation of suicide research that examines causal factors beyond the proximal and clinical and fosters a socially conscious reimagining of suicidal prevention. To this end, we emphasize the need for the conceptualization of suicide and suicidal behaviors as complex phenomena with causes at several levels of organization. Future interdisciplinary research and interventions should be developed within a multilevel causal framework that can better capture the social, economic, and political settings where suicide, as a process, unfolds across the life course.

The Portrayal of Suicidal Behavior in Police Television Series

Fictional suicidal behavior can affect the public as a risk or a protective factor, and it may reflect how suicide is perceived in a society. However, surprisingly little is known of how suicidal behavior is portrayed in television series. The aim of this study was to investigate the characteristics of televised fatal and non-fatal suicidal behavior, preventative interventions, and the portrayal of people bereaved by suicide. All episodes (N = 475) of four Belgian police series were screened against inclusion and exclusion criteria, and 87 episodes with a total of 54 suicides, 13 attempted suicides, 13 suicide threats, and 20 characters bereaved by suicide were included in a quantitative and qualitative analysis. Televised suicidal behavior was primarily motivated by external motives, such as social/relational issues or the death of a significant other, and to a lesser extent, by internal motives, such as mental or physical health related issues. Interventions were likely to prevent suicide. People bereaved by suicide were mostly portrayed as individuals seeking justice. Shame, revenge, and escape were the major qualitative themes associated with suicidal behavior. Two prototypes emerged: a ruthless, "psychopath" type criminal, who kills him/herself before being arrested, and a suicidal individual struggling with devastating life events. The study provided unique insights in how suicidal behavior is televised in Belgian police series. Though some characteristics were portrayed adequately, mental health related issues were overlooked, spectacular suicide methods were overrepresented, and the bereaved characters were mostly unidimensional revengers. Strategies for improving the accuracy of televised suicidal behavior should be studied.

Suicide reporting in mass media in the state of Magdalena, Colombia

In 2016 and 2017, the suicide rate in Colombia went up from 5.20 to 5.72, respectively. The same trend was observed for the State of Magdalena for the same period with an increase in the rates that went from 3.37 in 2016 and 4.27 per one hundred thousand inhabitants in 20171,2. The suicide rate in the State of Magdalena occupies third place among the departments of the Colombian Caribbean region1

The Impact of Widely Publicized Suicides on Search Trends: Using Google Trends to Test the Werther and Papageno Effects

The objective of this study was to examine the impact of widely publicized suicides on the Werther and Papageno Effects using internet search trends. A list of widely publicized suicides from 2010 through 2018 was compiled along with dates of death for each of these individuals. Google.com/trends data were then collected for searches for "how to suicide" and "suicide prevention" for 14 days prior to a widely publicized suicide/14 days after a widely publicized suicide and 7 days prior to a widely publicized suicide/7 days after a widely publicized suicide. Comparisons were then made between these time periods for "how to suicide" and "suicide prevention." Some celebrities, such as Robin Williams (2014) and Aaron Hernandez (2017) were associated with increased searches. However, for many there was no increase in search trends. Limited support was found for the impact of widely publicized suicides on internet search trends with one case supporting a Werther Effect and one case supporting a Papageno Effect. The finding that only some celebrities were associated with increased searches may be a byproduct of the impact of celebrity status on these effects, with more prominent celebrities having the greatest impact.

Biological bases of suicidal behaviours: A narrative review

Suicidal behaviour is a multifaceted phenomenon that concerns all human populations. It has been suggested that a complex interaction between the individual genetic profile and environmental factors throughout life underlies the pathophysiology of suicidal behaviour. Although epidemiological and genetic studies suggest the existence of a genetic component, exposure to biological and psychosocial adversities, especially during critical developmental periods, also contributes to altering the biological responses to threat and pleasure. This results in amplified maladaptive cognitive and behavioural traits and states associated with suicidal behaviours. Alterations in the cognitive inhibition and decision-making capacity have been implicated in suicidal behaviours. Structural and functional changes in key brain regions and networks, such as prefrontal cortex, insula and default mode network, may underlie this relationship. Furthermore, the shift from health to suicidal behaviour incorporates complex and dynamic changes in the immune and stress responses, monoaminergic system, gonadal system and neuroplasticity. In this review, we describe the major findings of epidemiological, genetic, neuroanatomical, neuropsychological, immunological and neuroendocrinological studies on suicide behaviours to provide a solid background for future research in this field. This broad overview of the biological bases of suicide should promote neuroscience research on suicidal behaviours. This might lead to improved biological models and to the identification of evidence-based biomarkers, treatment options and preventive strategies.

Fatal and Non-fatal Self-Injury in the USA: Critical Review of Current Trends and Innovations in Prevention

PURPOSE OF REVIEW

To examine current trends in suicide and self-injury in the USA, as well as potential contributors to their change over time, and to reflect on innovations in prevention and intervention that can guide policies and programs to reduce the burden of suicide and self-injury in the USA.

RECENT FINDINGS

Suicide and non-fatal self-injury are on the rise in the USA. Reasons for such trends over time remain speculative, although they seem linked to coincident increases in mood disorders and drug use and overdose. Promising innovative prevention and intervention programs that engage new technologies, such as machine learning-derived prediction tools and computerized ecologic momentary assessments, are currently in development and require additional evidence. Recent increases in fatal and non-fatal self-harm in the USA raise questions about the causes, interventions, and preventive measures that should be taken. Most innovative prevention efforts target individuals seeking to improve risk prediction and access to evidence-based care. However, as Durkheim pointed out over 100 years ago, suicide rates vary enormously between societal groups, suggesting that certain causal factors of suicide act and, hence, should be targeted at an ecological level. In the next generation of suicide research, it is critical to examine factors beyond the proximal and clinical to allow for a reimagining of prevention that is life course and socially focused.

Developing an early warning system of suicide using Google Trends and media reporting

BACKGROUND

Conventional surveillance systems for suicides typically suffer from a substantial time lag of six months to two years. This study aims to develop an early warning system of possible suicide outbreaks in Hong Kong using Google Trends and suicide-related media reporting.

METHODS

Data on 3,534 suicides from 2011 to 2015 were obtained from Hong Kong Census and Statistics Department, and the Coroner's Court. Using data from Google Trends and features extracted from media reporting on suicide news, we fitted Poisson regression models to predict the number and estimate the intensity of suicides on a weekly basis, for six subgroups, defined by gender and age. We adopted the cumulative sum (CUSUM) control chart-based method to identify outbreaks of suicide.

RESULTS

The proposed model was able to predict the number of suicides with reasonably low normalized root mean squared errors, ranging from 15.6% for young females to 24.16% for old females. The suicide intensity curves were well captured by the proposed models for young males and females, but not for other groups. The Sensitivity, Precision and F1 Score of the CUSUM-based method were 50%, 100% and 67% for young females, and 93%, 54% and 68% for young males.

LIMITATIONS

This study focused only on predicting the number of suicides in the current week, not in the future weeks. The model did not include social media, socioeconomic and climate data.

CONCLUSIONS

Our results indicate that Google Trends search terms and media reporting data may be valuable data sources for predicting possible outbreak of suicides in Hong Kong. The proposed system could support effective and targeted interventions.

Increases in Demand for Crisis and Other Suicide Prevention Services After a Celebrity Suicide

OBJECTIVE

This study examined data on acute (i.e., within 30 days) increases in suicides, help and information seeking, and service capacity after a celebrity suicide.

METHODS

Daily suicide data, call volume to the National Suicide Prevention Lifeline (NSPL), and visits to two suicide prevention Web sites before and after entertainer Robin Williams' death on August 11, 2014, were examined.

RESULTS

Before August 11 in 2012, 2013, and 2014, daily suicide deaths averaged between 113 and 117; in 2014, the count increased to 142, an increase not observed in 2012 and 2013. The number of calls to the NSPL rose by up to 300%, but answered calls decreased from an average of 71% to 57%. Visits to both Web sites also increased dramatically.

CONCLUSIONS

Dramatic increases in all three measured outcomes in the days after a celebrity suicide were noted, suggesting the need for contingency plans to meet immediate increased demand.

The Number and Characteristics of Newspaper and Twitter Reports on Suicides and Road Traffic Deaths in Young People

In the light of concern about the harmful effects of media reporting of suicides and a lack of comparative research, this study compares the number and characteristics of reports on suicides and road traffic accidents (RTAs) in young people (aged 11-18) in newspapers and Twitter during a 6-month period. Tweets about young people's suicides were more numerous than newspaper reports. Twitter and newspaper reports were more strongly correlated for suicides than for RTAs. Recent suicides were less likely to be reported in newspapers than recent deaths by RTA. Bullying-related suicides were especially newsworthy. Suicide prevention organizations should consider routinely monitoring social media reporting.

The Effects of Publicized Suicide Deaths on Subsequent Suicide Counts in Israel

This study investigated associations between indiscriminate media reporting of suicides and later inflated suicide counts among Israel's general population between the years 2008 and 2012. Self-inflicted deaths that received post-suicide media exposure (referred to as "publicized suicides") were selected via Google news search-hit appraisals. Distributions of suicides were inspected and risk ratios (RRs) estimated by comparing population suicide rates 4 weeks before and 4 weeks after each publicized suicide ("reference" vs. "affected" periods, respectively). Poisson time series regression was employed to account also for secular trends and seasonality. A total of 2,119 people died by suicide, 13 of whom received noticeable media attention throughout the study. No meaningful impact following the 13 deaths on subsequent suicide counts during the observation window (affected vs. reference phase) was found. Poisson regression confirmed that suicide counts following publicized suicides were independent of media coverage. Given the pronounced search hits following the publicized suicides developing regulation practices that constrain indiscreet media reporting should officially be included as part of suicide prevention practices. Future research should focus on imitation suicide effects as a function of post-suicide media exposure, while including both risk and protective factors.

Do Australian media apply recommendations when covering a suicide prevention campaign?

Purpose

Media reporting and portrayals of mental illness and suicide can play an important role in shaping and reinforcing community attitudes and perceptions. Depending on the content, a report about suicide can have either a negative (Werther-) or a positive (Papageno-) effect. Evidence-informed recommendations for the reporting of suicide in Australia are provided under the Mindframe initiative. The purpose of this paper is to assess the application of these recommendations in broadcasts associated with one of the largest national campaigns to promote suicide prevention, the R U OK? Day, a yearly campaign of the Australian suicide prevention charity R U OK?

Design/methodology/approach

The sample consisted of 112 (32 TV, 80 radio) Australian broadcasts discussing the R U OK? Day suicide prevention campaign during the month preceding the 2015 campaign and on the national R U OK? Day itself. Broadcasts were coded for medium (TV or radio), content (suicide focus, mental illness focus or both) and consistency with Mindframe recommendations.

Findings

Over 97 per cent of broadcasts used language consistent with Mindframe recommendations. None of the broadcasts used images that negatively portrayed mental illness or suicide; there were no instances of using mental illness to describe a person’s behaviour; and no sensationalizing or glamorising terminology was used in the broadcasts. However, less than 40 per cent of the broadcasts included help-seeking information (e.g. helplines) and some of the broadcasts used negative or outdated terminology (e.g. “commit” suicide; “suffering” from mental illness).

Originality/value

The present study is the first to examine consistency with reporting recommendations around a national suicide prevention campaign (R U OK? Day). The results can steer improvements in current reporting and inform strategies to optimise future reporting.

Self-Harm and Suicide Among Children and Adolescents in Hong Kong: A Review of Prevalence, Risk Factors, and Prevention Strategies

This paper reviews the prevalence, risk factors, and effectiveness of prevention programs for self-harm and suicide among children and adolescents in Hong Kong. Youth suicide rates declined gradually over the past two decades, but it is alarming to see that self-harm, suicidal thoughts, and attempts are quite common among junior secondary students. Local studies identify psychopathology (especially depression) and family relationship issues as the most common risk factors of suicide and self-harm, and impulsive control issues are an additional factor contributing to self-harm. In the second part, this paper reviews the evidence for six types of universal and selective prevention strategies identified from local and overseas literature: (1) restriction of access to means of suicide; (2) guidelines for responsible media reporting of suicides; (3) provision of quality mental healthcare to at-risk populations; (4) school-based screening and prevention programs; (5) online prevention, monitoring, and support programs; and (6) life skills training programs. Research evidence supports that the provision of high-quality mental health services to at-risk populations and some school-based prevention programs (awareness and screening, and gatekeeper training) are effective in suicide prevention. Further research efforts are needed to verify the impact of the other four strategies. Practitioners could make better use of new prevention programs through the internet and instant messaging platforms, which have the potential to alter attitude toward suicide and self-harm as well as promoting help seeking behavior among young people.

Problematic Internet Use in University Students Attending Three Superior Graduate Schools in Italy: Is Autism Spectrum Related to Suicide Risk?

Background: Over the past decades, problematic internet use (PIU) has dramatically increased, especially among young people. PIU has been recently associated with autism spectrum disorder (ASD) and autistic traits. Subjects with PIU report an increased suicidal risk and the same has been demonstrated among patients with ASD. The aim of this study was to investigate putative PIU rates among students and explore the correlation between autistic traits and suicide risk. Methods: A sample of 178 high achieving university students was assessed by means of the Adult Autism Subthreshold Spectrum (AdAS Spectrum), Autism Quotient questionnaire (AQ). Suicide risk was investigated by some specific items of the Trauma and Loss Spectrum-Self Report (TALS-SR) and putative PIU was identified on the basis of a specific AdAS Spectrum item. Results: 27.5% subjects reporting putative PIU. This subgroup showed higher scores in all domains of AdAS Spectrum and AQ compared with others. Students with putative PIU showed a significant correlation between suicide risk and the non-verbal communication domain of the AdAS Spectrum and the Social skills domain of the AQ. Conclusions: We found that students with PIU show higher levels of autistic traits compared to those without PIU. A significant correlation was found between autistic traits and suicide risk.