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Calvo S, Carrasco JP, Conde-Pumpido C, Esteve J, Aguilar EJ. Does suicide contagion (Werther effect) take place in response to social media? A systematic review. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2024:S2950-2853(24)00032-2. [PMID: 38848950 DOI: 10.1016/j.sjpmh.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/10/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION The Werther, Copycat or contagion effect of suicidal behaviour is a complex phenomenon that can arise due to exposure to media stories in which identifiable people take their lives. On the contrary, the Papageno effect prevents people from suicide by promoting positives examples of suicidal crisis management. Impact of both effects has been widely studied in different types of situations, but its existence in social media is a source of much debate. METHODS A systematic search following the PRISMA guidelines of PubMed, Scopus, Embase, PsycInfo, Web of Science and the references of prior reviews yielded 25 eligible studies. RESULTS Most of the studies found were observational, with very different methodologies and generally with low risk of bias. In these, the results suggest the existence of the Werther effect in response to social media stories about suicide. This is mediated by multiple factors, including the characteristic of the users, the type of interaction and the content of the publications. At the same time, the Papageno effect is also described. Evidence found by type of social media and future implications are discussed. CONCLUSION Suicidal content on social media can be both contagious and protective. It is confirmed that the Werther and Papageno effects may occur in response to social media, so they could be an interesting target for preventive interventions.
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Affiliation(s)
- Serena Calvo
- Pediatrics Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan Pablo Carrasco
- Psychiatry Deparment, Consorcio Hospitalario Provincial de Castellón, Castellón, Spain.
| | - Celia Conde-Pumpido
- Psychiatry Deparment, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Jose Esteve
- Psychiatry Deparment, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Eduardo Jesús Aguilar
- Psychiatry Deparment, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain; CIBERSAM Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; University of Valencia, Department of Medicine, Valencia, Spain
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Keyes KM, Platt JM. Annual Research Review: Sex, gender, and internalizing conditions among adolescents in the 21st century - trends, causes, consequences. J Child Psychol Psychiatry 2024; 65:384-407. [PMID: 37458091 DOI: 10.1111/jcpp.13864] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/18/2023]
Abstract
Internalizing conditions of psychopathology include depressive and anxiety disorders; they most often onset in adolescence, are relatively common, and contribute to significant population morbidity and mortality. In this research review, we present the evidence that internalizing conditions, including depression and anxiety, as well as psychological distress, suicidal thoughts and self-harm, and fatal suicide, are considerably increasing in adolescent populations across many countries. Evidence indicates that increases are currently greatest in female adolescents. We present an epidemiological framework for evaluating the causes of these increases, and synthesize research on whether several established risk factors (e.g., age of pubertal transition and stressful life events) and novel risk factors (e.g., digital technology and social media) meet conditions necessary to be plausible causes of increases in adolescent internalizing conditions. We conclude that there are a multitude of potential causes of increases in adolescent internalizing conditions, outline evidence gaps including the lack of research on nonbinary and gender nonconforming populations, and recommend necessary prevention and intervention foci from a clinical and public health perspective.
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Affiliation(s)
- Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jonathan M Platt
- College of Public Health, University of Iowa, Iowa City, IA, USA
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Huang H, Yu H, Li W. Assessing the Importance of Content Versus Design for Successful Crowdfunding of Health Education Games: Online Survey Study. JMIR Serious Games 2024; 12:e39587. [PMID: 38456198 PMCID: PMC11004519 DOI: 10.2196/39587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 03/09/2024] Open
Abstract
Background Health education games make health-related tasks enjoyable and interactive, thereby encouraging user participation. Entrepreneurs and health educators can leverage online crowdfunding platforms, such as Kickstarter, to transform their innovative ideas into funded projects. Objective This research focuses on health education game initiatives on Kickstarter. Through an online user survey, it aims to understand user perceptions and evaluate the significance of 8 distinct components that may influence the success of such crowdfunding initiatives. Methods A total of 75 participants evaluated games using 8 dimensions: game rules, learning objectives, narrative, content organization, motivation, interactivity, skill building, and assessment and feedback. The survey data were analyzed using descriptive statistical analysis, exploratory factor analysis, the Wilcoxon-Mann-Whitney test, and multivariate analysis. Results Exploratory data analysis showed that, among the 8 dimensions, skill building, content organization, and interactivity were the top-ranking dimensions most closely associated with crowdfunding health education game. The 8 dimensions can be grouped into 3 categories from the exploratory factor analysis: game content-, instruction-, and game design-related components. Further statistical analysis confirmed the correlation between these dimensions with the successful crowdfunding of health education games. Conclusions This empirical analysis identified critical factors for game proposal design that can increase the likelihood of securing crowdfunding support.
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Affiliation(s)
- Hong Huang
- School of Information, University of South Florida, Tampa, FL, United States
| | - Han Yu
- Department of Applied Statistics and Research Methods, University of Northern Colorado, Greeley, CO, United States
| | - Wanwan Li
- Tandy School of Computer Science, University of Tulsa, Tulsa, OK, United States
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Lindsay BL, Szeto ACH. The Influence of Media on the Stigma of Suicide when a Postsecondary Student Dies by Suicide. Arch Suicide Res 2023; 27:1278-1295. [PMID: 36106828 DOI: 10.1080/13811118.2022.2121672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This study investigated whether media articles from a postsecondary institution could influence students' stigma toward suicide after a student dies by suicide. Undergraduate participants (N = 425) read a fictitious scenario about a student suicide and were randomly assigned to a control article (no mention of the suicide) or one of three intervention articles that acknowledged the suicide and included a discussion with a psychologist, a friend of the decedent, or a suicide survivor. The stigma toward suicide survivors, particularly stereotypes, was significantly less after the three intervention articles compared to the control. No differences were found between the intervention articles or regarding the stigma toward suicide decedents. Reduced stigma toward survivors indicates that acknowledging a suicide, when possible, should be considered.
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Valinciute A, Gerbutaviciene RJ, Paukstaitiene R, Kubiliene L. Pharmacovigilance and Adverse Drug Reaction Reporting among the General Public in Lithuania: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11081133. [PMID: 37107967 PMCID: PMC10138446 DOI: 10.3390/healthcare11081133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Background: Despite the fact that for over ten years, Lithuanian consumers have been able to report adverse drug reactions (ADR) directly to the competent authority, reporting rates remain low. A comprehensive understanding of consumer perceptions and experiences regarding ADRs is needed to ascertain further factors impacting their engagement in ADR reporting. This study aimed to assess consumer knowledge of, attitude toward, and practice of reporting ADRs. Methods: A questionnaire-guided cross-sectional survey among 404 consumers between October 2021 and June 2022 was conducted. The semi-structured questionnaire comprised open-ended and closed-ended questions to explore the sociodemographic characteristics and general knowledge of ADRs and pharmacovigilance. Other question items evaluated attitudes toward ADR reporting and ADR reporting practice. The data were summarised using descriptive statistics, while the chi-square test was used to assess categorical variables at p < 0.05. The overall percent score in the knowledge and attitude domains was divided into groups of "poor", "moderate", and "good" knowledge, as well as "positive" and "negative" attitudes. Results: While having a generally poor understanding, this study demonstrates that Lithuanian consumers have a favourable attitude toward pharmacovigilance, particularly regarding issues involving the requirement for reporting. The data also revealed the justifications for reporting and not reporting ADRs. Conclusions: The current study provided the first understanding of consumer awareness and ADR reporting intentions, which can help to develop educational campaigns and interventions addressing pharmacovigilance and ADR reporting.
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Affiliation(s)
- Agne Valinciute
- Department of Drug Technology and Social Pharmacy, Lithuanian University of Health Sciences, Sukileliu Ave. 13, LT-50166 Kaunas, Lithuania
| | - Rima Jurate Gerbutaviciene
- Department of Drug Technology and Social Pharmacy, Lithuanian University of Health Sciences, Sukileliu Ave. 13, LT-50166 Kaunas, Lithuania
| | - Renata Paukstaitiene
- Department of Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences, Eiveniu Str. 4, LT-50161 Kaunas, Lithuania
| | - Loreta Kubiliene
- Department of Drug Technology and Social Pharmacy, Lithuanian University of Health Sciences, Sukileliu Ave. 13, LT-50166 Kaunas, Lithuania
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Guinovart M, Cobo J, González-Rodríguez A, Parra-Uribe I, Palao D. Towards the Influence of Media on Suicidality: A Systematic Review of Netflix's 'Thirteen Reasons Why'. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5270. [PMID: 37047886 PMCID: PMC10094075 DOI: 10.3390/ijerph20075270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
Online streaming series 'Thirteen Reasons Why' (13RW), released in March 2017, was criticized for its sensationalist portrayal of the main character's suicide, leading some people to voice fears of a global contagion of self-harm behaviors. The current investigation provides a systematic review of original studies analyzing the role of 13RW as an influencing factor for suicide. Articles were identified through a systematic search of Medline, Web of Science, Scopus, PsycInfo, and a manual search of reference lists from inception until the 16 January 2023. Twenty-seven published articles were identified from an initial search of 496 studies. The positive effects of watching 13RW included a reduction in suicide stigma and a greater likelihood to discuss mental health concerns and seek for help. However, several studies reported negative outcomes, including significant increases in the rate of deaths by suicide in adolescents, the number of admissions for suicidal reasons, and the prevalence and severity of suicidal ideation and self-harm behaviors in vulnerable viewers. Still, due to methodological limitations, no causal relationship could be established. Preventive measures are required to alert of the risk and should be particularly addressed to susceptible subjects. Psychoeducational programs should be focused on this kind of phenomena in vulnerable populations.
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Affiliation(s)
- Martí Guinovart
- Department of Mental Health, Hospital Universitari Parc Taulí, 1 Parc Taulí, 08208 Sabadell, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 3-5 Calle Monforte de Lemos, Pabellón 11, Planta 0, 28029 Madrid, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Spain
| | - Jesús Cobo
- Department of Mental Health, Hospital Universitari Parc Taulí, 1 Parc Taulí, 08208 Sabadell, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 3-5 Calle Monforte de Lemos, Pabellón 11, Planta 0, 28029 Madrid, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Spain
| | - Alexandre González-Rodríguez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 3-5 Calle Monforte de Lemos, Pabellón 11, Planta 0, 28029 Madrid, Spain
- Department of Mental Health, Hospital Universitari Mútua de Terrassa, 5 Plaça del Doctor Robert, 08221 Terrassa, Spain
- Department of Psychiatry, University of Barcelona, 585 Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
| | - Isabel Parra-Uribe
- Department of Mental Health, Hospital Universitari Parc Taulí, 1 Parc Taulí, 08208 Sabadell, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 3-5 Calle Monforte de Lemos, Pabellón 11, Planta 0, 28029 Madrid, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Spain
| | - Diego Palao
- Department of Mental Health, Hospital Universitari Parc Taulí, 1 Parc Taulí, 08208 Sabadell, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 3-5 Calle Monforte de Lemos, Pabellón 11, Planta 0, 28029 Madrid, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Spain
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Groves S, Hawley M, Lascelles KM, Hawton K. News reporting of suicide in nurses: A content analysis study. Int J Ment Health Nurs 2022; 31:1513-1522. [PMID: 36008915 PMCID: PMC9804535 DOI: 10.1111/inm.13057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2022] [Indexed: 01/05/2023]
Abstract
Media impact on suicide is well-established. Groups at heightened risk of suicide, such as nurses, may be particularly influenced by poor news reporting. This study aimed to examine UK newspaper reporting of suicide of nurses and student nurses, including during the COVID-19 pandemic. Print and online newspaper reports about suicide in nurses (including students) published in the UK between January 2018 and August 2021 were obtained and data extracted for analysis in collaboration with Samaritans' media advisory team. Content and quality of newspaper reports were examined using a content analysis approach. The study was compliant with the STROBE checklist. Nurse or student nurse suicides were reported in 134 articles, including 50 individual suicides. Most articles were acceptable against Samaritans' media guidelines. However, common problems included absence of signposting to support organizations and lack of suicide prevention messages. A minority of articles included methods of suicide within article headlines (18, 13.4%) and sensationalist or romanticizing language (14, 10.7%). Most contained occupation-related content. Many named the individual's specific hospital or university and a substantial proportion included occupation-related images. Working on the frontline was the most reported link between COVID-19 and nurse suicide. While reporting on suicide among nurses and students was largely acceptable, quality of reporting was variable. Occupation was often discussed, and most articles published during COVID-19 linked suicide to the pandemic. The research findings can help shape guidance on reporting of suicide in specific professions and occupations, including nursing, to encourage responsible reporting and reduce inadvertent promotion of suicide.
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Affiliation(s)
- Samantha Groves
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | | | | | - Keith Hawton
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.,Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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8
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Dullur P, Joseph J, Diaz AM, Lin PI, Jairam R, Davies R, Masi A, Shulruf B, Eapen V. Screening for media use in the ED among young Australians: a cross-sectional study (Preprint). JMIR Form Res 2022; 7:e42986. [PMID: 37184914 DOI: 10.2196/42986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Research on problematic internet use has largely adhered to addiction paradigms, possibly impeding the identification of specific internet behaviors related to psychopathology. This study presents a novel approach to screening for specific problematic internet behaviors by using a new measure, the emergency department media use screener (EDMUS). OBJECTIVE The purpose of this study was to identify patterns of internet use in young people presenting with mental health concerns to the emergency department (ED), ascertain associations with their mental health, and evaluate whether the EDMUS can be used to predict subsequent ED presentations within 3 months. METHODS This cross-sectional retrospective study of Australian young people (N=149, aged 11-25 years; female: n=92, 61.7%) sought to use the EDMUS, a 24-item questionnaire, to identify problematic internet behaviors, including accessing or posting prosuicidal or proeating disorder content, cyberbullying, and inappropriate digital content. Data on each person's mental health were extracted from electronic medical records to look for associations with EDMUS responses and ED re-presentation over 3 months. EDMUS items were grouped into clusters for analysis using chi-square tests, binary logistic regression, and path analyses. RESULTS Sharing suicidal digital content was the most common problematic internet use pattern identified by the EDMUS. However, this did not correlate with having a prior mental health diagnosis or predict readmission. Most participants had families with a concern for their internet use; however, this was less likely in participants with a diagnosis of personality disorder. Diagnoses of personality disorder or posttraumatic stress disorder were independent predictors of readmission (P=.003; P=.048). CONCLUSIONS Although a history of complex psychopathology increases the likelihood of subsequent ED presentations, its links to internet use-related behaviors are still unclear. The EDMUS has potential for identifying young people who are most vulnerable to problematic internet behaviors and offers the opportunity for early intervention and potential prevention of more entrenched difficulties.
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Chen SS, Lam TP, Lam KF, Lo TL, Chao DVK, Mak KY, Lam EWW, Tang WS, Chan HY, Yip PSF. Youths' attitudes toward open discussion of suicide, preferred contexts, and the impact of Internet use: An exploratory sequential mixed-methods study in Hong Kong. Int J Soc Psychiatry 2022; 69:575-586. [PMID: 36120996 DOI: 10.1177/00207640221123394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the necessity and benefits of having the open and public discussion about suicide have been recognized, youths' opinions regarding such discussion remain unknown. AIMS To explore youths' attitudes toward open suicide discussion, particularly concerning their preference of discussion contexts and impacts of Internet use. METHOD This exploratory sequential mixed-methods study targeted Hong Kong youths aged 15 to 19. A total of six focus groups and 12 individual interviews were held (N = 40). Topics included adolescents' views of open suicide discussion, concerns, perceived benefits, and preferred contexts. The questionnaire survey (N = 1,676) was conducted subsequently to investigate the prevalence of youths' perspectives on public discussion of suicide and relationships with discussion contexts, use of social media platforms, and motivations of online expression. RESULTS Qualitative findings revealed three types of attitudes toward open suicide discussion: reluctance, support, and indifference. Major barriers included cultural norms, topic sensitivity, privacy concerns, contagion effect, fear of embarrassment, and unpleasant experiences in school programs. Results of quantitative analyses showed that reluctance was the dominant attitude among adolescents, and taboo was the top concern. Variations in youths' attitudes were related to gender, school academic banding, and suicide-related experiences. Notably, adolescents who had been exposed to suicide messages in contexts of peer networks and online platforms were more likely to endorse open suicide discussion. In addition, an increased likelihood of engaging in public suicide discussion was associated with the use of Instagram, WhatsApp, and Snapchat, and the motive of 'expressing emotions and opinions' online. CONCLUSIONS Our results indicated a prevalent rejection among adolescents toward open suicide discussion, suggesting the issue of stigma, the need for tailored programs, the value of appropriate contexts, and the impact of Internet use. These findings may facilitate the development of school-based suicide prevention initiatives and the efficacy of online services for suicide-related communication.
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Affiliation(s)
- Sikky Shiqi Chen
- Department of Family Medicine and Primary Care, School of Clinical Medicine, the University of Hong Kong, Hong Kong, China
| | - Tai Pong Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, the University of Hong Kong, Hong Kong, China
| | - Kwok Fai Lam
- Department of Statistics and Actuarial Science, the University of Hong Kong, Hong Kong, China.,Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Tak Lam Lo
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - David Vai Kiong Chao
- Department of Family Medicine and Primary Health Care, Hospital Authority Kowloon East Cluster, Hong Kong, China
| | - Ki Yan Mak
- Department of Family Medicine and Primary Care, School of Clinical Medicine, the University of Hong Kong, Hong Kong, China
| | - Edmund Wing Wo Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, the University of Hong Kong, Hong Kong, China
| | - Wai Sin Tang
- Department of Family Medicine and Primary Care, School of Clinical Medicine, the University of Hong Kong, Hong Kong, China
| | - Hoi Yan Chan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, the University of Hong Kong, Hong Kong, China
| | - Paul Siu Fai Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, the University of Hong Kong, Hong Kong, China.,Department of Social Work and Social Administration, the University of Hong Kong, Hong Kong, China
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Dhungel B, Thapa A, Martínez-Rives NL, Takagi K, Martín P, Wada K, Gilmour S. Method-specific suicide trends from 1979 to 2016 among Japanese adolescents. J Affect Disord 2022; 310:129-134. [PMID: 35537541 DOI: 10.1016/j.jad.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/16/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND In 2015 the Japanese government set a target of a 30% reduction in the total suicide rate by 2025, but deaths among adolescents have been rising since. In 2018 the overall suicide rate increased by 33% among Japanese students, as a part of a continued trend of rising suicide among adolescents. This study analysed the trends in method-specific suicide among Japanese adolescents from 1979 to 2016. METHODS We conducted a cross-sectional study using data obtained from the vital statistics registration of the Ministry of Health, Labour and Welfare Japan. Poisson regression analysis was performed among 10-20-year-olds separately by sex, with year, age category, suicide method and a 1998 step variable as covariates. RESULTS There was a sharp increase in suicide rates among boys (Incidence Rate Ratio (IRR), 1.68; 95% CI, 1.58-1.77) and girls (IRR, 1.69; 95% CI, 1.56-1.84) aged 10-20 years in 1998 when the overall suicide rate in Japan was at its peak. The commonly used method of suicide, hanging, has increased rapidly among high school and university-level aged adolescents since 1998. LIMITATIONS The computed mortality rates may have been affected by the shift in mortality coding from ICD-9 to ICD-10 in 1995. CONCLUSIONS Suicide among adolescents has been rising since the early 1990s. Several cultural factors such as notoriety of internet suicide and detergent suicide could have influenced the increase in suicide among adolescents. There is an urgent need to address suicide by hanging and gas among high school and university-aged adolescents.
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Affiliation(s)
- Bibha Dhungel
- Graduate School of Public Health, St. Luke's International University, Tokyo 104-0045, Japan; Department of Health Policy, National Centre for Child Health and Development, Tokyo 157-0074, Japan.
| | - Anushka Thapa
- Department of Public Health, Nobel College, Pokhara University, Kathmandu 44604, Nepal
| | | | - Kuniyasu Takagi
- Graduate School of Public Health, International University of Health and Welfare, 107-8402 Tokyo, Japan.
| | - Pilar Martín
- Department of Psychiatry and Social Psychology, University of Murcia, 30100 Murcia, Spain.
| | - Koji Wada
- Graduate School of Public Health, International University of Health and Welfare, 107-8402 Tokyo, Japan.
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University, Tokyo 104-0045, Japan.
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Perry A, Lamont-Mills A, du Preez J, du Plessis C. "I Want to Be Stepping in More" - Professional Online Forum Moderators' Experiences of Supporting Individuals in a Suicide Crisis. Front Psychiatry 2022; 13:863509. [PMID: 35774095 PMCID: PMC9238438 DOI: 10.3389/fpsyt.2022.863509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Individuals experiencing suicidal crises increasingly turn to online mental health forums for support. Support can come from peers but also from online moderators, many of whom are trained health professionals. Much is known about users' forum experiences; however, the experiences of professional moderators who work to keep users safe has been overlooked. The beneficial nature of online forums cannot be fully realized until there is a clearer understanding of both parties' participation. This study explored the experiences of professional online forum moderators engaged in suicide prevention. MATERIALS AND METHODS A purposive sample of professionally qualified moderators was recruited from three online mental health organizations. In-depth semi-structured, video-recorded interviews were conducted with 15 moderators (3 male, 12 female), to explore their experiences and perceptions of working in online suicide prevention spaces. Data was analyzed using inductive thematic analysis. RESULTS Five themes were identified related to the experiences and challenges for moderators. These were the sense of the unknown, the scope of the role, limitations of the written word, volume of tasks, and balancing individual vs. community needs. DISCUSSION Findings indicate that the professionally qualified moderator role is complex and multifaceted, with organizations failing to recognize these aspects. Organizations restrict moderators from using their full therapeutic skill set, limiting them to only identifying and re-directing at-risk users to crisis services. The benefits of moderated online forums could be enhanced by allowing moderators to use more of their skills. To facilitate this, in-situ research is needed that examines how moderators use their skills to identify at-risk users.
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Affiliation(s)
- Amanda Perry
- School of Psychology and Wellbeing, University of Southern Queensland, Toowoomba, QLD, Australia.,Laidlaw College, Social of Social Practice, Auckland, New Zealand
| | - Andrea Lamont-Mills
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia.,Centre for Health, Institute of Resilient Regions, University of Southern Queensland, Springfield, QLD, Australia
| | - Jan du Preez
- School of Psychology and Wellbeing, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Carol du Plessis
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
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12
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Huang CY, Tsai CW, Chi YC, Wu KCC, Chen YY. Changes in accessibility of suicide-related information on websites in Taiwan during 2016 and 2019. J Formos Med Assoc 2021; 121:335-341. [PMID: 34024719 DOI: 10.1016/j.jfma.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/20/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/PURPOSE To the best of our knowledge, no studies have examined longitudinal changes in the accessibility of suicide-related content on Chinese-language websites. We investigated changes between 2016 and 2019 in suicide-related materials likely to be accessed by individuals through websites in Taiwan. METHODS In March 2019, we searched the Taiwanese versions of Google and Yahoo! using six suicide-related terms and compared the results to a search performed in 2016. Website characteristics (e.g., pro- or anti-suicide) generated by various keywords were calculated and compared in 2016 and 2019. RESULTS The number of anti-suicide websites exceeded that of pro-suicide websites in 2016 and 2019. Between 2016 and 2019, the proportion of pro-suicide sites decreased slightly from 16.3% (61 out of 375 sites) to 12.3% (51 out of 417 sites) (p = 0.10). User-generated webpages constituted the primary source of pro-suicide content at both time points. Over the same period, the proportion of pro-suicide information on internet forums decreased from 59.1% to 17.8% (p < 0.001); by contrast, pro-suicide content on news websites increased significantly, from 1.9% to 11.3% (p = 0.005). Searches with the term "painless suicide" were more likely to yield pro-suicide websites and less likely to generate anti-suicide ones than searches with "suicide" in both 2016 and 2019. CONCLUSIONS Harmful suicide-related information circulating on websites remained easily accessible to internet users in Taiwan, particularly through user-generated and news websites. Proper site moderation and implementation of online suicide reporting guidelines are still warranted.
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Affiliation(s)
- Cho-Yin Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chi-Wei Tsai
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan; Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan
| | - Ying-Chen Chi
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan
| | - Kevin Chien-Chang Wu
- Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei City, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei City, Taiwan.
| | - Ying-Yeh Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei City, Taiwan.
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Silva Filho OCD, Minayo MCDS. Triple taboo: considerations about suicide among children and adolescents. CIENCIA & SAUDE COLETIVA 2021; 26:2693-2698. [PMID: 34231682 DOI: 10.1590/1413-81232021267.07302021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/31/2021] [Indexed: 11/22/2022] Open
Abstract
This article aims to understand the construction and repercussion of taboos involving suicides among children and adolescents, considering the discomfort, silence, and dread that the theme causes across society. Due to the recognition of a continuum of taboos (taboo of death < taboo of suicide < taboo of child suicide), the authors present, as an attempt to address this issue, the concept of a triple taboo, recognizing the incommensurability of self-inflicted deaths that have children and adolescents as protagonists. Developed from a qualitative study with paediatricians during their medical residence, this paper serves as a call to professionals who assist children and adolescents in the country. Paediatric training needs to recognise these taboos and the dimensions of suicidal behaviour as a manifestation of violence and as a threat to mental health. Their identification is a critical and urgent element in contemporary children and adolescents' care.
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Affiliation(s)
- Orli Carvalho da Silva Filho
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (Fiocruz). Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | - Maria Cecília de Souza Minayo
- Departamento Estudos sobre Violência e Saúde Jorge Careli, Escola Nacional de Saúde Pública Sergio Arouca, Fiocruz. Rio de Janeiro RJ Brasil
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Kim S, Yu YM, You M, Jeong KH, Lee E. A cross-sectional survey of knowledge, attitude, and willingness to engage in spontaneous reporting of adverse drug reactions by Korean consumers. BMC Public Health 2020; 20:1527. [PMID: 33032559 PMCID: PMC7545860 DOI: 10.1186/s12889-020-09635-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spontaneous reporting (SR) of adverse drug reactions (ADRs) from patients can be considered as a valuable activity providing both objective and subjective data. However, improving the rate of under-reporting has been a major challenge to ensure successful operation of the SR system. This study aimed to assess knowledge, attitude, and intent to report ADRs and explore the factors contributing to consumers' reporting intent in South Korea. METHODS Self-administered questionnaire was collected from a sex-, age-, and regionally stratified nationwide convenience sample of consumers using a commercial panel in December 2018. Univariate and multivariate logistic regression analyses were used to explore the factors contributing to the intent to report ADRs by consumers. RESULTS A total of 1000 respondents were enrolled in the survey; 50.9% were males and the mean age was 44.4 (standard deviation, 13.3) years. While less than 15% of the respondents were aware of the SR system and even fewer (3.4%) had actual experience of SR, however, 59.2% expressed their intent to report ADRs. The positive attitude (adjusted odds ratio [aOR] 3.972, p < 0.001), awareness of the SR system (aOR 2.102, p < 0.01), self-efficacy for SR (aOR 1.956, p < 0.001), and experiences related to ADR counselling with healthcare professionals (OR 2.318, p < 0.001) are the significant factors contributing to reporting intent. CONCLUSIONS Findings of this study highlight the need for increasing the awareness of the SR system among consumers and empowering them to report ADRs by themselves, which would ultimately improve the drug-safety environment.
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Affiliation(s)
- Seungyeon Kim
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Yun Mi Yu
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, 21983, Republic of Korea. .,Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, 21983, Republic of Korea.
| | - Myoungsoon You
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, 08826, Republic of Korea
| | - Kyeong Hye Jeong
- College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Euni Lee
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea.
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Biernesser C, Sewall CJ, Brent D, Bear T, Mair C, Trauth J. Social Media Use and Deliberate Self-Harm Among Youth: A Systematized Narrative Review. CHILDREN AND YOUTH SERVICES REVIEW 2020; 116:105054. [PMID: 32773916 PMCID: PMC7413131 DOI: 10.1016/j.childyouth.2020.105054] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Suicide is now the 2nd leading cause of death among adolescents and young adults. Social media's influence on youth suicidal risk or attenuation of risk is a novel and rapidly expanding topic of research that requires attention from a broad range of mental health services professionals. We aimed to provide an updated review of social media-related risk and protective factors to youth deliberate-self harm (DSH) to guide mental health services professionals in offering care and support to youth vulnerable to suicide. METHODS Studies on which primary research was conducted that evaluated young people's use of social media platforms related to DSH were systematically searched via Scopus and identified through expert recommendation and the Association for Computing Machinery's digital library of conference materials. The search focused on the timeframe June 2014 to September 2019, to offer an update since the time the most recent systematic reviews on this topic concluded their literatures searches. Quality was reviewed using the Mixed Methods Appraisal Tool (MMAT). RESULTS A total of 38 articles were eligible, and 24 articles rated as high quality were included in a narrative review. Of the included articles, 19 explored DSH risk and 8 explored DSH protection. Most articles reported on cross-sectional quantitative or qualitative studies. Opportunities for both risks and benefits were explored, and potential influences of social media use were considered for subgroups of youth who may be especially vulnerable to suicide. CONCLUSIONS In the relatively short period of review, the association between social media use and youth DSH was tested in population-based studies, offering preliminary evidence for suicide prevention and treatment efforts. Further research is needed to understand the contribution of social media use to youth DSH, particularly among youth most vulnerable to suicidal risk.
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Affiliation(s)
- Candice Biernesser
- Department of Psychiatry, School of Medicine, University of
Pittsburgh, 3811 O’Hara St., Pittsburgh, PA 15213
- Department of Behavioral and Community Health Sciences,
Graduate School of Public Health, University of Pittsburgh, 130 De Soto St.
6 Floor, Pittsburgh, PA 15261
| | - Craig J.R. Sewall
- School of Social Work, University of Pittsburgh, 2117
Cathedral of Learning, 4200 Fifth Ave., Pittsburgh, PA 15260
| | - David Brent
- Department of Psychiatry, School of Medicine, University of
Pittsburgh, 3811 O’Hara St., Pittsburgh, PA 15213
| | - Todd Bear
- Department of Behavioral and Community Health Sciences,
Graduate School of Public Health, University of Pittsburgh, 130 De Soto St.
6 Floor, Pittsburgh, PA 15261
| | - Christina Mair
- Department of Behavioral and Community Health Sciences,
Graduate School of Public Health, University of Pittsburgh, 130 De Soto St.
6 Floor, Pittsburgh, PA 15261
| | - Jeanette Trauth
- Department of Behavioral and Community Health Sciences,
Graduate School of Public Health, University of Pittsburgh, 130 De Soto St.
6 Floor, Pittsburgh, PA 15261
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Khasawneh A, Chalil Madathil K, Dixon E, Wiśniewski P, Zinzow H, Roth R. Examining the Self-Harm and Suicide Contagion Effects of the Blue Whale Challenge on YouTube and Twitter: Qualitative Study. JMIR Ment Health 2020; 7:e15973. [PMID: 32515741 PMCID: PMC7312265 DOI: 10.2196/15973] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/19/2019] [Accepted: 03/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Research suggests that direct exposure to suicidal behaviors and acts of self-harm through social media may increase suicidality through imitation and modeling, particularly in more vulnerable populations. One example of a social media phenomenon that demonstrates how self-harming behavior could potentially be propagated is the blue whale challenge. In this challenge, adolescents and young adults are encouraged to engage in self-harm and eventually kill themselves. OBJECTIVE This paper aimed to investigate the way individuals portray the blue whale challenge on social media, with an emphasis on factors that could pose a risk to vulnerable populations. METHODS We first used a thematic analysis approach to code 60 publicly posted YouTube videos, 1112 comments on those videos, and 150 Twitter posts that explicitly referenced the blue whale challenge. We then deductively coded the YouTube videos based on the Suicide Prevention Resource Center (SPRC) safe messaging guidelines as a metric for the contagion risk associated with each video. RESULTS The thematic analysis revealed that social media users post about the blue whale challenge to raise awareness and discourage participation, express sorrow for the participants, criticize the participants, or describe a relevant experience. The deductive coding of the YouTube videos showed that most of the videos violated at least 50% of the SPRC safe and effective messaging guidelines. CONCLUSIONS These posts might have the problematic effect of normalizing the blue whale challenge through repeated exposure, modeling, and reinforcement of self-harming and suicidal behaviors, especially among vulnerable populations such as adolescents. More effort is needed to educate social media users and content generators on safe messaging guidelines and factors that encourage versus discourage contagion effects.
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Affiliation(s)
- Amro Khasawneh
- Department of Anesthesiology and Critical Care, Johns Hopkins University, Baltimore, MD, United States
| | - Kapil Chalil Madathil
- Glenn Department of Civil Engineering, Clemson University, Clemson, SC, United States.,Department of Industrial Engineering, Clemson University, Clemson, SC, United States
| | - Emma Dixon
- College of Information Studies, University of Maryland, College Park, College Park, MD, United States
| | - Pamela Wiśniewski
- Department of Computer Science, University of Central Florida, Orlando, FL, United States
| | - Heidi Zinzow
- Department of Psychology, Clemson University, Clemson, SC, United States
| | - Rebecca Roth
- Department of Psychology, Clemson University, Clemson, SC, United States
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Bridge JA, Greenhouse JB, Ruch D, Stevens J, Ackerman J, Sheftall AH, Horowitz LM, Kelleher KJ, Campo JV. Association Between the Release of Netflix's 13 Reasons Why and Suicide Rates in the United States: An Interrupted Time Series Analysis. J Am Acad Child Adolesc Psychiatry 2020; 59:236-243. [PMID: 31042568 PMCID: PMC6817407 DOI: 10.1016/j.jaac.2019.04.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/26/2019] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Jeffrey A. Bridge
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH; The Ohio State University College of
Medicine, Columbus
| | | | - Donna Ruch
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Jack Stevens
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH; The Ohio State University College of
Medicine, Columbus, OH
| | - John Ackerman
- The Ohio State University College of Medicine, Columbus, OH; Nationwide Children’s Hospital Big Lots
Behavioral Health Services
| | - Arielle H. Sheftall
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH; The Ohio State University College of
Medicine, Columbus, OH
| | - Lisa M. Horowitz
- Intramural Research Program, National Institute of Mental Health, Bethesda, MD
| | - Kelly J. Kelleher
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH; The Ohio State University College of
Medicine, Columbus, OH
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Pisinger VS, Hawton K, Tolstrup JS. School- and class-level variation in self-harm, suicide ideation and suicide attempts in Danish high schools. Scand J Public Health 2018; 47:146-156. [DOI: 10.1177/1403494818799873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: Strong associations have been found between being exposed to self-harm in family and friends and own self-harm in adolescence. Therefore, self-harm and suicide behaviour might tend to cluster within school and school classes. The aim of this study was to describe the prevalence, frequency and type of self-harm, suicide ideation and suicide attempts within Danish high schools and to test whether self-harm and suicide behaviour cluster in schools and school classes. Methods: Data came from the Danish National Youth Study 2014, a national survey. The respective study included 66,284 high-school students nested in 117 schools and 3146 school classes. The prevalence and clustering of self-harm behaviour, ever and within the last year, type of self-harm (e.g. cutting, burning, scratching and hitting) and suicide ideation and suicide attempts were investigated. Multi-level logistic regression was applied to quantify clustering among participants within the same class and school. Results: In total, 12,960 (20%) reported self-harm ever and 5706 (8.6%) within the last year. Prevalence was higher among girls than boys. Among girls, cutting (15%) and scratching (13%) was the most common type of self-harm, whereas among boys, hitting (6.7%) was most prevalent. The degree of clustering of self-harm and suicide behaviour was low, with school-level intra-class correlation coefficients (ICC) ranging from 0.8–1.8% and school class level ICC’s from 4.3–6.8%. Conclusions: This study shows that self-harm was common, especially in girls. The degree of clustering of self-harm and suicide behaviour in school and school classes was low.
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Affiliation(s)
- Veronica S.C. Pisinger
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, Oxford University and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Janne S. Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Campo JV, Bridge JA. Exploring the Impact of 13 Reasons Why: Looking for Light Amidst the Heat . . J Am Acad Child Adolesc Psychiatry 2018; 57:547-549. [PMID: 30071975 DOI: 10.1016/j.jaac.2018.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/11/2018] [Indexed: 11/26/2022]
Abstract
A Letter to the Editor by Kieling and collegues1 in this month's Journal attempts to explore the impact of the Netflix series 13 Reasons Why (13RW) on the thinking and behavior of adolescent viewers. The series is an adaptation of a 2007 novel by Jay Asher, and tells the story of an adolescent girl who dies by suicide following a series of traumas and disappointments that she catalogues before her death on 13 audiotapes. The tapes are left behind with the expectation that each of the individuals presumably responsible for her suicide will listen and better understand their individual and collective failures. Since its release and airing in 2017, the show has generated considerable heated debate and controversy, largely due to concerns about its potential for suicide contagion.
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Affiliation(s)
- John V Campo
- West Virginia University and the Rockefeller Neuroscience Institute, Morgantown, WV.
| | - Jeffrey A Bridge
- Research Institute at Nationwide Children's Hospital, Columbus, OH, and The Ohio State University, Columbus
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