The impact of media-based mental health campaigns on male help-seeking: a systematic review

More than half of all men do not seek professional help for depression, suicide and anxiety. Although media-based campaigns represent a promising health promotion intervention to improve male help-seeking, it is unclear what communication strategies in extant mental health media-based campaigns are effective for men. The aim of this systematic review was to synthesize information about the effectiveness of these campaigns on male help-seeking outcomes. A search was conducted of electronic databases and gray literature. Studies were eligible if they examined the effectiveness of a media-based campaign targeting male help-seeking attitudes, beliefs, intentions or behaviors in relation to mental disorders, distress, suicide or self-harm. Twenty-two studies of varying quality met the eligibility criteria. Most studies targeting mental health or depression were found to positively influence male help-seeking. There were mixed results for suicide prevention campaigns. Some evidence suggests that overall, brochure-based campaigns impact help-seeking. The use of male or mixed-gender campaign imagery produced similar results. The choice of message framing appeared to influence help-seeking outcomes. Despite substantial heterogeneity in campaign approaches and difficulties isolating the effects of campaign delivery from messaging, the review indicates that media-based campaigns can play a role in improving male help-seeking for mental health difficulties. Mounting evidence suggests that messaging and delivery should align with male communication preferences. However, high-quality, targeted research is required to evaluate the circumstances in which various campaign delivery and messaging components are effective in improving male help-seeking for poor mental health and suicidality.

Population- and Community-Based Interventions to Prevent Suicide

Background: Suicide is estimated to account for 1.4% of deaths worldwide, making it among the leading causes of premature death. Public health approaches to reduce suicide have the potential to reach individuals across the spectrum of suicide risk. Aims: To review the effectiveness of newer community-based or population-level suicide prevention strategies. Methods: We conducted a systematic review of literature published from January 2010 to November 2020 to evaluate the effectiveness of community- and population-level interventions. The US Center for Disease Control framework was used for grouping studies by strategy. Results: We included 56 publications that described 47 unique studies. Interventions that reduce access to lethal means, implement organizational policies and culture in police workplace settings, and involve community screening for depression may reduce suicide deaths. It is unclear if other interventions such as public awareness and education campaigns, crisis lines, and gatekeeper training prevent suicide. Evidence was inconsistent for community-based, multistrategy interventions. The most promising multistrategy intervention was the European Alliance Against Depression. Limitations: Most eligible studies were observational and many lacked concurrent control groups or adjustment for confounding variables. Conclusions: Community-based interventions that may reduce suicide deaths include reducing access to lethal means, implementing organizational policies in workplace settings, screening for depression, and the multistrategy European Alliance Against Depression Program. Evidence was unclear, inconsistent, or lacking regarding the impact of many other single- or multistrategy interventions on suicide deaths.

Public Service Announcements to Change Attitudes about Youth Suicide: A Randomized Controlled Trial

BACKGROUND

Youth suicide is a major public health concern worldwide. Public service announcements (PSAs) may have a role in suicide prevention, as part of broader suicide prevention campaigns.

METHOD

We conducted a double-blind four arm randomized controlled trial in which 18 to 24 year olds were allocated to watch one of three suicide prevention PSAs intervention PSAs or a control PSA. Participants provided data prior to viewing their allocated PSA and again four weeks after viewing it. Our primary outcome was a change in participants' attitudes toward the preventability of suicide, and analysis was conducted on an intention-to-treat basis.

RESULTS

A total of 349 participants were randomized to one of four groups and 266 participants provided pre and post viewing data. Across the four groups, no significant change was observed in our primary outcome: attitudes toward the preventability of suicide (p = .455). There were also no differences between groups on secondary outcomes, namely other attitudes toward suicide (permissiveness, incomprehensibility, avoidance and loneliness), risk taking behavior, levels of distress, suicidal ideation, and likelihood of help-seeking and actual help-seeking.

CONCLUSION

Our study has highlighted that attitudes and help-seeking intentions in young adults are difficult to change with low intensity one-off exposure to PSA messages. Further research is required to understand the factors that contribute to safe and effective messaging about suicide prevention.

Gender Differences in Risk Factors Related to Suicidal Ideation Among Callers to Telephone Helplines in Spain

The main goals of this study were to determine the prevalence rate of suicidal ideation among callers to a Spanish telephone general crisis helpline (Teléfono de la Esperanza) and to identify gender-based characteristics and risk factors related to suicidal ideation. A sample of 10,765 (6,868 men and 3,897 women) callers to this telephone helpline was assessed. ATENSIS, an assessment tool designed to collect information related to suicidal ideation among callers to telephone helplines, was used. Comparisons between men and women with suicidal ideation were carried out in all variables studied: sociodemographics, telephone call timing, risk factors, and suicidality. Of the total sample, 1.87% (n = 201) presented suicidal ideation, with a higher prevalence in women (2.80%) than in men (1.34%). Moreover, significant gender-based differences among callers with suicidal ideations were observed in some variables: women were older than men and showed a greater prevalence of chronic disease with pain; men showed a greater prevalence of depression, alcohol/drug abuse, helplessness, and lack of hope for the future. This study showed that telephone helplines can be used to identify suicidal ideation among callers. Moreover, gender-based differential characteristics among suicide ideators have been found. The implications for further research are discussed.

Australian R U OK?Day campaign: improving helping beliefs, intentions and behaviours

Background

Suicide is a major public health concern and has been recognised as a public health priority. R U OK?Day aims to prevent suicide by encouraging and empowering Australians to reach out to friends and family who might be experiencing personal difficulties. This study aims to update the evaluation of the public awareness campaign ‘R U OK?Day’ that was conducted using 2014 data.

Methods

Data from 2013 participants were collected via an online survey following the R U OK?Day campaign implemented in 2017. Outcome measures included campaign awareness and participation, past 12-month help-seeking, helping beliefs, helping intentions and helping behaviours. Data were analysed using z-tests, Chi square and regression analyses in SPSS.

Results

Both campaign awareness and participation have increased since 2014, from 66% and 19% to 78% and 32%. Campaign exposure was associated with stronger beliefs in the importance and the ease of asking “Are you okay?”, and increased the likelihood of intentions to use recommended helping actions by two to three times compared to those not exposed to the campaign. Participants who were exposed to the R U OK?Day campaign were up to six times more likely to reach out to someone who might be experiencing personal difficulties compared to those not exposed to the campaign. Interestingly, those who had sought help from a mental health professional in the past 12 months were more likely to be aware of, and participate in, the campaign, suggesting people experiencing mental health issues recognise the value of seeking—and giving—social support.

Conclusions

The R U OK?Day campaign continues to be relevant and effective in spreading key messages about the importance of reaching out to others and empowering members of the community to have conversations about life problems. The campaign’s impact is increasing over time through increased campaign awareness and participation, and improving helping beliefs, intentions and behaviours. Ongoing monitoring and evaluation of the campaign’s impact is vital and may inform potential changes needed to further enhance its impact.

Suicide Prevention Media Campaigns: A Systematic Literature Review

Suicide prevention media campaigns are gaining traction as a means of combatting suicide. The current review set out to synthesize information about the effectiveness of these campaigns. We searched four electronic databases for studies that provided evidence on the effectiveness of media campaigns. We focused on studies that described an evaluation of the effectiveness of an entire campaign or a public service announcement explicitly aimed at suicide prevention. We identified 20 studies of varying quality. Studies that looked at whether campaign exposure leads to improved knowledge and awareness of suicide found support for this. Most studies that considered whether campaign materials can achieve improvements in attitudes toward suicide also found this to be the case, although there were some exceptions. Some studies found that media campaigns could boost help-seeking, whereas others suggested that they made no difference or only had an impact when particular sources of help or particular types of help-seeking were considered. Relatively few studies had sufficient statistical power to examine whether media campaigns had an impact on the ultimate behavioral outcome of suicides, but those that did demonstrated significant reductions. Our review indicates that media campaigns should be considered in the suite of interventions that might be used to prevent suicide. Evidence for their effectiveness is still amassing, but there are strong suggestions that they can achieve positive results in terms of certain suicide-related outcomes. Care should be taken to ensure that campaign developers get the messaging of campaigns right, and further work is needed to determine which messages work and which ones do not, and how effective messages should be disseminated. There is an onus on those developing and delivering campaigns to evaluate them carefully and to share the findings with others. There is a need for evaluations that employ rigorous designs assessing the most pertinent outcomes. These evaluations should explore the nature of given campaigns in detail - in particular the messaging contained within them - in order to tease out which messages work well and which do not. They should also take into account the reach of the campaign, in order to determine whether it would be reasonable to expect that they might have their desired effect.

Systematic comparison of recommendations for safe messaging about suicide in public communications

BACKGROUND

The diversity of guidelines for safe public messaging about suicide and the heterogeneous scientific research on the topic warrants comparisons of guidelines and analysis of the relevance of research findings to determine best practices.

METHODS

We searched databases and websites for organizations' guidelines concerning safe public messaging on suicide, and relevant research articles.

RESULTS

We identified 24 public messaging guidelines, 11 terminology guidelines and 44 research papers. No recommendations were in all guidelines, with more agreement on what not to do than on what to do. Recommendations in over half of guidelines are: avoid glorifying suicide, do not describe suicide methods, don't say suicide in inexplicable or explain simplistically, do not state that suicide is frequent in specific circumstances, encourage help seeking. There were disagreements on including personal details about people who died by suicide, and agreement to avoid: "committed suicide," "completed suicide," "successful suicide," "failed suicide/attempt" "unsuccessful suicide/attempt". Only "died by suicide" was recommended by a majority. Some recommended and some said to avoid: "Suicide attempt," "attempt to end his life," "attempted suicide," "non-fatal attempt at suicide," "unintentional (death)," "intentional self-harm," "suicidal ideation," "completed suicide," "survivor," "suicide loss survivor." Research papers had a wide range of objectives, methodologies, media studied and target populations. None provided empirical data that could help support or refute any recommendations.

LIMITATIONS

Lack of justifications for guidelines and scarce relevant research makes validation of recommendations challenging.

CONCLUSIONS

Research is needed to validate recommendations and terminology and develop consensus on guidelines for public messages, and determine if media guidelines for reporting on suicide are relevant for public messaging who's goal is to inform and educate rather than report news.

Crafting safe and effective suicide prevention media messages: outcomes from a workshop in Australia

Background

Suicide and suicide-related behaviours are major public health concerns in Australia and worldwide. One universal intervention that has received an increased focus as a means of preventing suicide is the use of media campaigns. There is, however, a lack of understanding of the kinds of campaign messages that are safe and effective. The current paper aims to expand on this knowledge. The study objectives were to: (1) explore what suicide prevention experts consider to be essential characteristics of effective and safe suicide media campaigns; (2) develop suicide prevention media messages; and (3) explore the impact that these messages might have on different audiences.

Methods

We conducted a workshop in July 2015 which was attended by 21 experts (professionals with knowledge about suicide prevention and/or media campaigns, and people with a lived experience of suicide). The experts were split into three groups, and each group developed a suicide prevention message for one of the following target audiences: people at risk of suicide; family and peers of people at risk of suicide; and people bereaved by suicide.

Results

The three groups generally agreed that these messages had to include two key characteristics: (1) validate or reflect the target group’s issues and needs; and (2) promote help-seeking behaviours. They noted, however, that messages that might have a positive impact for one target audience might inadvertently have a negative impact for other target audiences. In particular, they were concerned that messages designed for family and peers about being supportive and looking for warning signs might leave those who had been bereaved by suicide feeling isolated, guilty or traumatised. Workshop participants highlighted that gaps exist in relation to the use of appropriate language, were unsure of how to create destigmatising messages without normalising or sensationalising suicide and commented on the lack of evaluative evidence for the efficacy of media campaigns.

Conclusions

Developing suicide prevention messages is complex and target and non-target audiences may interpret these messages differently to the way they were intended and the impact of such messaging may be detrimental. Caution needs to be applied when developing suicide prevention messages.

A Systematic Review of Mass Media Campaigns for Suicide Prevention: Understanding Their Efficacy and the Mechanisms Needed for Successful Behavioral and Literacy Change

Mass media campaigns are increasingly seen as an important part of suicide prevention; however, despite their popularity, their efficacy is not well understood. The current review aimed to address key knowledge gaps regarding how mass media campaigns can be optimized to prevent suicide, by looking at their global efficacy, and mechanisms related to successful outcomes. A systematic review of the international literature examined studies which evaluated mass media campaigns targeted at suicide prevention, where suicide behaviors (mortality, attempts) or suicide literacy (knowledge, attitudes, help-seeking) was identified as a primary outcome. Thirteen articles describing 12 unique campaigns met eligibility criteria. For behavioral outcomes, mass media campaigns appear to be most effective when delivered as part of a multicomponent suicide prevention strategy, while "standalone campaigns" were modestly useful for increasing suicide literacy. Level of exposure, repeat exposure, and community engagement appeared to be fundamental to the success of these campaigns; however, these constructs were poorly adhered to in the development and implementation of campaigns. Overall, the mixed quality of the included studies highlights a need for increased quantity, consistency, and quality of evaluations to advance the evidence base.

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

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

Does a TV Public Service Advertisement Campaign for Suicide Prevention Really Work?

Abstract. Background: One of the critical measures in suicide prevention is promoting public awareness of crisis hotline numbers so that individuals can more readily seek help in a time of crisis. Although public service advertisements (PSA) may be effective in raising the rates of both awareness and use of a suicide hotline, few investigations have been performed regarding their effectiveness in South Korea, where the suicide rate is the highest among OECD countries. Aims: The goal of this study was to evaluate the effectiveness of a television PSA campaign. Method: We analyzed a database of crisis phone calls compiled by the Korean Ministry of Health and Welfare to track changes in call volume to a crisis hotline that was promoted in a TV campaign. We compared daily call counts for three periods of equal length: before, during, and after the campaign. Results: The number of crisis calls during the campaign was about 1.6 times greater than the number before or after the campaign. Relative to the number of suicide-related calls in the previous year, the number of calls during the campaign period surged, displaying a noticeable increase. Conclusion: The findings confirmed that this campaign had a positive impact on call volume to the suicide hotline.

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

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

Improving Suicide Prevention in Dutch Regions by Creating Local Suicide Prevention Action Networks (SUPRANET): A Study Protocol

The European Alliance against Depression (EAAD) program is to be introduced in The Netherlands from 2017 onwards. This program to combat suicide consists of interventions on four levels: (1) increasing the awareness of suicide by local media campaigns; (2) training local gatekeepers, such as teachers or police officers; (3) targeting high-risk persons in the community; and (4) training and support of professionals in primary care settings. The implementation starts in seven Dutch pilot regions. Each region is designated as a Suicide Prevention Action NETwork (SUPRANET). This paper describes the SUPRANET program components and the evaluation of its feasibility and impact. The findings will be used to facilitate the national implementation of EAAD in The Netherlands and to add new findings to the existing literature on EAAD.

Best Practices for Suicide Prevention Messaging and Evaluating California's "Know the Signs" Media Campaign

BACKGROUND

Although communication is a key component of US strategies to prevent suicide and there are a number of marketing campaigns promoting messages that suicide is a preventable public health problem, there has been little evaluation of these campaigns.

AIMS

The study describes the development of a checklist of best practices for suicide prevention communication campaigns and the use of the checklist to evaluate California's investment in "Know the Signs" (KTS-M), a suicide prevention mass media campaign.

METHOD

We conducted a literature review and solicited expert feedback to identify best practices and then used the RAND/UCLA appropriateness method to assess whether KTS-M was consistent with the identified best practices.

RESULTS

Overall, experts agreed that KTS-M adhered to most of the 46 checklist items and suggested that the campaign was among the best suicide prevention media campaigns they had observed.

LIMITATIONS

The checklist was developed through expert input and literature review and focuses only on media campaigns.

CONCLUSION

Given the nascent state of the evidence about what makes an effective suicide prevention message and the growing number of campaigns, the checklist of best practices reflects one way of promoting quality in this evolving field. The consistency between the experts' comments and their ratings of KTS-M suggests that the checklist may provide important guidance to inform the development of future campaigns and the evaluation of ongoing campaigns.

Abyss or Shelter? On the Relevance of Web Search Engines' Search Results When People Google for Suicide

Despite evidence that suicide rates can increase after suicides are widely reported in the media, appropriate depictions of suicide in the media can help people to overcome suicidal crises and can thus elicit preventive effects. We argue on the level of individual media users that a similar ambivalence can be postulated for search results on online suicide-related search queries. Importantly, the filter bubble hypothesis (Pariser, 2011) states that search results are biased by algorithms based on a person's previous search behavior. In this study, we investigated whether suicide-related search queries, including either potentially suicide-preventive or -facilitative terms, influence subsequent search results. This might thus protect or harm suicidal Internet users. We utilized a 3 (search history: suicide-related harmful, suicide-related helpful, and suicide-unrelated) × 2 (reactive: clicking the top-most result link and no clicking) experimental design applying agent-based testing. While findings show no influences either of search histories or of reactivity on search results in a subsequent situation, the presentation of a helpline offer raises concerns about possible detrimental algorithmic decision-making: Algorithms "decided" whether or not to present a helpline, and this automated decision, then, followed the agent throughout the rest of the observation period. Implications for policy-making and search providers are discussed.

Impact of a mass media mental health campaign on psychiatric emergency department visits

OBJECTIVE

Despite the high prevalence of mental illnesses and addictions, treatment rates remain low. In April 2010, a regional mass media campaign was implemented to increase awareness of mental health services in central Toronto, Canada. We studied the impact of this campaign on rates of psychiatric emergency department (PED) visits among all hospital emergency departments (EDs) located in Toronto.

DESIGN

Monthly PED visit totals were obtained for all Toronto EDs from April 1, 2007 to March 31, 2012 (n = 148,704). The campaign's impact on visit rates was measured using interrupted time series analysis and a difference-in-difference estimator. We conducted pre- and post-campaign analyses to examine whether volume increases were explained by specific diagnostic categories and/or new presentations (new patients with no prior PED visits), and to examine geographic trends.

RESULTS

The campaign was associated with an increased volume of PED visits at downtown hospitals (Centre for Addiction and Mental Health, an increase of 7.6 visits/month [p < 0.0001]; University Health Network, 5.8 visits/month [p < 0.0001]; St. Michael's Hospital, 4.2 visits/month [p < 0.0001]; and Mount Sinai Hospital, 3.2 visits/month [p < 0.0001]) but not in hospitals located outside of the downtown area. Neither new patient visits nor specific diagnostic categories disproportionately accounted for the overall observed increases. Following the campaign, patients travelled greater distances to receive ED services.

CONCLUSIONS

Mass media campaigns promoting mental health and psychiatric services can affect health care-seeking behaviour and utilization. Our findings have implications for system-level service planning, which should anticipate volume increases when public mental health campaigns are being considered.

Promoting Help Seeking to Veterans

BACKGROUND

Few studies have considered different messaging strategies that may augment campaign efficacy to generate help-seeking behaviors among populations at increased risk for suicide, mainly US military veterans.

AIMS

Findings are presented from the pilot evaluation of the It's Your Call campaign implemented by the Department of Veterans Affairs (VA). Three messaging strategies (with varying intensity and mix of messages) were compared to explore which best promote use of the Veterans Crisis Line (VCL) among veteran populations.

METHOD

Daily VCL call data were obtained for 10 US cities during 2011-2012 where the campaign was active, and modeled using Poisson regression to identify changes in utilization patterns associated with the implementation of different messaging strategies.

RESULTS

Significant increases in call rates were only evident during the campaign in communities where mixed messages were disseminated. Further, use of mixed messages yielded greater increases in call rates when compared with the other tested strategies. This was an observational study where identification of causal relationships between variables was limited.

CONCLUSION

Findings are encouraging as messaging was associated with help seeking, and they provide insights into strategies that may rapidly promote crisis line use. Results also underscore the need for further research on suicide prevention campaigns and dissemination practices.

Suicide prevention strategies revisited: 10-year systematic review

BACKGROUND

Many countries are developing suicide prevention strategies for which up-to-date, high-quality evidence is required. We present updated evidence for the effectiveness of suicide prevention interventions since 2005.

METHODS

We searched PubMed and the Cochrane Library using multiple terms related to suicide prevention for studies published between Jan 1, 2005, and Dec 31, 2014. We assessed seven interventions: public and physician education, media strategies, screening, restricting access to suicide means, treatments, and internet or hotline support. Data were extracted on primary outcomes of interest, namely suicidal behaviour (suicide, attempt, or ideation), and intermediate or secondary outcomes (treatment-seeking, identification of at-risk individuals, antidepressant prescription or use rates, or referrals). 18 suicide prevention experts from 13 European countries reviewed all articles and rated the strength of evidence using the Oxford criteria. Because the heterogeneity of populations and methodology did not permit formal meta-analysis, we present a narrative analysis.

FINDINGS

We identified 1797 studies, including 23 systematic reviews, 12 meta-analyses, 40 randomised controlled trials (RCTs), 67 cohort trials, and 22 ecological or population-based investigations. Evidence for restricting access to lethal means in prevention of suicide has strengthened since 2005, especially with regard to control of analgesics (overall decrease of 43% since 2005) and hot-spots for suicide by jumping (reduction of 86% since 2005, 79% to 91%). School-based awareness programmes have been shown to reduce suicide attempts (odds ratio [OR] 0·45, 95% CI 0·24-0·85; p=0·014) and suicidal ideation (0·5, 0·27-0·92; p=0·025). The anti-suicidal effects of clozapine and lithium have been substantiated, but might be less specific than previously thought. Effective pharmacological and psychological treatments of depression are important in prevention. Insufficient evidence exists to assess the possible benefits for suicide prevention of screening in primary care, in general public education and media guidelines. Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support. The paucity of RCTs is a major limitation in the evaluation of preventive interventions.

INTERPRETATION

In the quest for effective suicide prevention initiatives, no single strategy clearly stands above the others. Combinations of evidence-based strategies at the individual level and the population level should be assessed with robust research designs.

FUNDING

The Expert Platform on Mental Health, Focus on Depression, and the European College of Neuropsychopharmacology.

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

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

Predicting Intentions to Read Suicide Awareness Stories

Abstract. Background: Research on factors that influence the intention to read suicide awareness material is lacking. Aims: To identify how social and state similarities between the featured protagonist of a suicide awareness story and the audience impact on the intent to read similar stories. Method: Laboratory experiment with n = 104 students. Participants were randomly assigned to study groups. In the first group, the role model provided his personal story of crisis and was a student. In the second group, the content was identical but the model was socially dissimilar. The third group read about a topic unrelated to suicide. Depression, identification, and exposure intent were measured after the experiment. Conditional process analysis was carried out. Results: In the group featuring a once-suicidal role model with high social similarity, depression in the audience increased the intention to read similar material in the future via identification with the role model; 82% of individuals wanted to read similar material in the future, but only 50% wanted to do so in the group featuring a dissimilar person. Conclusion: Exposure intention increases via identification when role model and audience characteristics align regarding social traits and the experience of depression. These factors are relevant when developing campaigns targeting individuals with stories of recovery.