Long-term impact of celebrity suicide on suicidal ideation: results from a population-based study

Suicidal Ideation During the COVID-19 Pandemic: Investigating Mental Health, COVID-19 Health Beliefs, and News Media Consumption in the United States Population in the Year 2020

This study examines the role of general news media consumption during COVID-19 in aggravating mental health and suicide risk in the US population. In a sample of U.S. adults (N = 5,010), we investigated how mental health, COVID-19 health beliefs, and general news consumption influenced the odds of suicidal ideation using hierarchical logistic regression models. Both worsening mental health overall and specifically in regard to COVID-19 increased suicidal ideation. Perceived susceptibility to COVID-19 infection did not increase suicidal ideation, yet higher levels of COVID-19 self-efficacy reduced suicidal ideation. Overall news consumption did not affect suicidal ideation, but media-specific post-hoc analyses revealed that TV news watching decreased suicidal ideation as much as high levels of COVID-19 self-efficacy decreased suicidal ideation. Furthermore, online news consumption increased suicidal ideation as much as worsening mental health overall increased suicidal ideation. Further implications are discussed.

Changing trends in quality of media reporting of suicide in the community following a celebrity suicide in India

OBJECTIVE

Little is known about changes in quality of media reporting of suicide in the community following a celebrity suicide. Our objective was to compare trends in quality of media reporting of suicide, before and after the suicide of an Indian entertainment celebrity, against the World Health Organization suicide reporting guidelines.

METHOD

Online news portals of English and local language newspapers, as well as television channels, were searched to identify relevant suicide-related news articles. Comparison of reporting characteristics before and after the celebrity suicide was performed using chi-square test or Fisher's exact test.

RESULTS

A total of 3867 eligible news reports were retrieved. There was a significant increase in harmful reporting characteristics, such as reporting the name, age and gender of the deceased (p < 0.001 for all comparisons), mentioning the location (p < 0.001) and reason for suicide (p = 0.04) and including photos of the deceased (p = 0.002) following the celebrity suicide. Helpful reporting practices were less affected; there was a significant rise in inclusion of expert opinion (p = 0.04) and mention of suicide-related warning signs (p = 0.02).

CONCLUSION

Following a celebrity suicide, significant changes in the quality of media reporting of suicide were noted with an increase in several potentially harmful reporting characteristics.

Factors associated with psychological impact of celebrity suicide media coverage: An online survey study

BACKGROUND

We investigated factors associated with vulnerability to the psychological impact of celebrity suicide news reporting after the suicide of an emerging Taiwanese novelist, Ms Yi-Han Lin.

METHODS

We conducted a cross-sectional online survey. Participants completed a questionnaire which asked whether they were affected by the media coverage of Lin's suicide and whether they would seek help if affected. Logistic regression was used to identify factors associated with being affected by the celebrity suicide media reporting and, among those affected, factors associated with feeling suicidal or not seeking help.

RESULTS

A total of 1258 respondents (81% females) completed the survey. Affected individuals (n=907; 70%) were more likely to be females, younger (age < 40 years), have past psychiatric treatment, and show increased interest in the incident (e.g., spending more time on reading the celebrity suicide news) than non-affected individuals. Among those affected, negative views of the media reporting impact, pessimistic attitude toward both depression treatment and suicide prevention, and having a history of past psychiatric treatment were associated with feeling suicidal, while low education attainment, increased interest in the celebrity suicide, and permissive attitude toward inappropriate media reporting were additionally associated with not seeking help.

LIMITATIONS

Selection bias of participants through internet-based surveying should be considered.

CONCLUSION

Individuals affected by the media coverage of celebrity suicide showed similar demographic and mental health characteristics as those of the deceased celebrity. Poor mental health and suicide prevention literacy may increase the risk of psychological impact and not seeking help. Future interventions could target at enhancing mental health literacy and help seeking intention in vulnerable individuals.

Depression and Suicide Ideation: The Role of Self-Acceptance for Black Young Adults

Suicide is a leading cause of death for Black young adults. Though depression is commonly linked to increased risk for suicide, empirical literature examining the depression–suicide association and intrinsic buffers for this association remains limited among Black young adults. This study sought to address this gap in the literature by examining the relationship between depression and suicide ideation among Black young adults. Importantly, this study assessed the moderating role of self-acceptance, an index of how content one is with oneself. Study participants included 123 Black young adults (63.5% female, Mage = 20.91 years, SD = 2.45 years) who completed measures evaluating symptoms of depression, suicide ideation, and psychological well-being. Multivariate regression analyses revealed that self-acceptance moderated the association between depressive symptomatology and suicide ideation ( β = −0.05, p < .01, 95% CI [-1.01, −0.11]), such that the depression–suicide ideation association was not significant for individuals who reported high levels of self-acceptance. These findings suggest that self-acceptance may be an important treatment target for interventions aimed specifically at reducing suicide vulnerability among Black young adults.

Capability for suicide: Discrimination as a painful and provocative event

OBJECTIVE

Developing the capability to die by suicide, and overcoming one's natural instinct of self-preservation, is thought to occur as a result of habituation to the fear and pain surrounding suicide. However, investigations of suicide capability have yet to examine whether perceived discrimination serves as a painful and provocative event that contributes to capability for suicide. The purpose of the current study was to examine the association of perceived discrimination and suicide capability for Black and White adults.

METHOD

The study sample included 173 Black adults (67.6% female; M_age  = 23.18, SD = 5.74) and 272 White adults (60.7% female; M_age  = 22.80, SD = 5.90). Participants completed a questionnaire battery that included measures of perceived discrimination, depression, and suicide ideation.

RESULTS

Regression analyses revealed for Black adults (but not White adults), perceived discrimination was associated with an increased capability for suicide after accounting for depressive symptomatology, suicide ideation, non-discriminatory painful and provocative events experienced, age, and gender (β = .226, t = 3.154, p = .002).

CONCLUSIONS

These findings provide preliminary evidence that perceived discrimination may play a role in suicide capability for Black adults and highlight the importance of considering contextual experiences when examining suicidality in underserved groups.

A lethal imitation game? Exploring links among psychoactive substance use, self-harming behaviors and celebrity worship

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Higher celebrity worship predict self-injury and suicide attempts.

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Higher celebrity worship predict drunkenness and illicit substance use among males.

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The contribution of celebrity worship to psychoactive substance use is limited.

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Celebrity worshipers are more likely to encounter severe excesses.

Recently, psychoactive substance use and suicidal behaviors have become general themes in popular culture, raising concerns that celebrity admirers may have become more affected in such health-risk behaviors. This study aimed to provide a more nuanced understanding of the role of celebrity worship in psychoactive substance use and self-harming behaviors. An online questionnaire was used recruiting 1,763 Hungarian adult participants (66.42% male, M_age = 37.2 years, SD = 11.4). Linear and binary logistic regressions were performed to investigate the contribution of celebrity worship to psychoactive substance use and self-harming behaviors for males and females. It was found that higher celebrity worship levels consistently predicted intentional self-injury and suicide attempts for both genders. Generally high levels of celebrity worship also predicted drunkenness and the use of illicit drugs and sedatives or tranquilizers for nonmedical purpose among males, while these behaviors were predicted only by excessive levels of celebrity worship among females. However, the explanatory power of celebrity worship for psychoactive substance use and self-harming behaviors was small for both genders (below 5%), indicating that these health-risk behaviors are largely independent of celebrity admiration. The present findings also suggest that individuals with excessive celebrity worship are more likely to encounter severe, potentially life-threatening excesses than more benign forms of maladaptive behaviors relating to substance use.

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.

Association between suicide reporting in the media and suicide: systematic review and meta-analysis

OBJECTIVE

To examine the association between reporting on suicides, especially deaths of celebrities by suicide, and subsequent suicides in the general population.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed/Medline, PsychInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to September 2019.

REVIEW METHODS

Studies were included if they compared at least one time point before and one time point after media reports on suicide; follow-up was two months or less; the outcome was death by suicide; and the media reports were about non-fictional suicides. Data from studies adopting an interrupted time series design, or single or multiple arm before and after comparisons, were reviewed.

RESULTS

31 studies were identified and analysed, and 20 studies at moderate risk of bias were included in the main analyses. The risk of suicide increased by 13% in the period after the media reported a death of a celebrity by suicide (rate ratio 1.13, 95% confidence interval 1.08 to 1.18; 14 studies; median follow-up 28 days, range 7-60 days). When the suicide method used by the celebrity was reported, there was an associated 30% increase in deaths by the same method (rate ratio 1.30, 95% confidence interval 1.18 to 1.44; 11 studies; median follow-up 28 days, range 14-60 days). For general reporting of suicide, the rate ratio was 1.002 (0.997 to 1.008; five studies; median follow-up 1 day, range 1-8 days) for a one article increase in the number of reports on suicide. Heterogeneity was large and partially explained by celebrity and methodological factors. Enhanced funnel plots suggested some publication bias in the literature.

CONCLUSIONS

Reporting of deaths of celebrities by suicide appears to have made a meaningful impact on total suicides in the general population. The effect was larger for increases by the same method as used by the celebrity. General reporting of suicide did not appear to be associated with suicide although associations for certain types of reporting cannot be excluded. The best available intervention at the population level to deal with the harmful effects of media reports is guidelines for responsible reporting. These guidelines should be more widely implemented and promoted, especially when reporting on deaths of celebrities by suicide.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019086559.

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.

The association between suicide deaths and putatively harmful and protective factors in media reports

BACKGROUND

Exposure to media reporting on suicide can lead to suicide contagion and, in some circumstances, may also lead to help-seeking behaviour. There is limited evidence for which specific characteristics of media reports mediate these phenomena.

METHODS

This observational study examined associations between putatively harmful and protective elements of media reports about suicide in 13 major publications in the Toronto media market and subsequent suicide deaths in Toronto (2011-2014). We used multivariable logistic regression to determine whether specific article characteristics were associated with increases or decreases in suicide deaths in the 7 days after publication, compared with a control window.

RESULTS

From 2011 to 2014, there were 6367 articles with suicide as the major focus and 947 suicide deaths. Elements most strongly and independently associated with increased suicides were a statement about the inevitability of suicide (odds ratio [OR] 1.97, confidence interval [CI] 1.07-3.62), about asphyxia by a method other than car exhaust (OR 1.72, CI 1.36-2.18), about suicide by jumping from a building (OR 1.70, CI 1.28-2.26) or about suicide pacts (OR 1.63, CI 1.14-2.35), or a headline that included the suicide method (OR 1.41, CI 1.07-1.86). Elements most strongly and independently associated with decreased suicides were unfavourable characteristics (negative judgments about the deceased; OR 1.85, CI 1.20-2.84), or mentions of railway (OR 1.61, CI 1.10-2.36) and cutting or stabbing (OR 1.59, CI 1.19-2.13) deaths, and individual murder-suicide (OR 1.50, CI 1.23-1.84).

INTERPRETATION

This large study identified significant associations between several specific elements of media reports and suicide deaths. It suggests that reporting on suicide can have a meaningful impact on suicide deaths and that journalists and media outlets and organizations should carefully consider the specific content of reports before publication.

Perceived Discrimination and Suicide Ideation: Moderating Roles of Anxiety Symptoms and Ethnic Identity among Asian American, African American, and Hispanic Emerging Adults

Suicide is a leading cause of death for vulnerable ethnic minority emerging adults in the United States (Web-based injury statistics query and reporting system [WISQARS], 2015). Perceived discrimination (Journal of Youth and Adolescence, 40, 2011, 1465) and anxiety symptoms (Asian American Journal of Psychology, 1, 2010, 18) are two predictors that are theoretically and conceptually related, but have yet to be examined in a simultaneous model for suicide ideation. Existing theory and research suggest that these variables activate similar pathways (American Behavioral Scientist, 51, 2007, 551). This study sought to address this gap in the literature by examining the simultaneous relationship between perceived discrimination and anxiety symptoms as predictors of suicide ideation. The moderating effect of anxiety symptoms on the relationship between perceived discrimination and suicide ideation was examined in a multiethnic sample of emerging adults. Results indicated that anxiety symptoms moderated the perceived discrimination-suicide ideation relationship for Hispanic emerging adults, but not for their Asian American and African American counterparts. Furthermore, ethnic identity has been shown to mitigate suicide risk in the face of other stressors (Cultural Diversity and Ethnic Minority Psychology, 14, 2008, 75). Ethnic identity emerged as a protective factor for Hispanic emerging adults by further interacting with perceived discrimination and anxiety symptoms to negatively predict suicide ideation. The implications of these findings are discussed.

Religious Coping Style and Cultural Worldview are Associated with Suicide Ideation Among African American Adults

The purpose of this study was to examine whether specific religious coping styles and cultural worldview would be associated with thoughts of suicide given higher levels of stress in a community-based sample of African American adults. African American men and women (n = 134) completed measures of religious coping, cultural worldview, stressful life events, depression symptoms, and suicide ideation. Higher ratings of suicide ideation were observed for African Americans who endorsed a more self-directing religious coping style. The self-directing religious coping was more frequently endorsed by participants who identified with a more Eurocentric cultural worldview that espouses an individualist philosophy. Together, these findings provide some insight to how religious coping and culture are related to suicide vulnerability for African Americans who are not in clinical care.

Media effects on suicide methods: A case study on Hong Kong 1998-2005

Background

Previous studies have suggested that mass media’s reports of new suicide methods will increase suicides using the same method. The same pattern seems not to apply to a conventional suicide method, unless it was used by a celebrity.

Objective

1) to examine media effects on both new and non-new suicide methods during 1998 and 2005 in Hong Kong (HK), when a new method by burning charcoal (CB suicide) was spreading in the region. 2) to examine how CB competed with non-CB methods in terms of media coverage and “recruiting” suicidal persons in the socio-economic context.

Methods

A self- and mutual- exciting process model was fitted to the data, adjusting for divorce rate, unemployment rate, and property price index. Breaking the whole period into onset, peak, and post-peak stages, the model was fitted again to examine the differences.

Results

Comparable copycat effects were found on both CB and non-CB suicide news. The only cross-method media effects were found in the onset stage when non-CB suicide news showed suppressing effect on CB suicides. CB suicides reported a significant self-excitation effect. A higher divorce rate and lower property price index were associated with significantly more suicides incidences and more suicide news.

Conclusions

The emerging of CB suicide method did not substitute media coverage of non-CB suicide in HK. Media effects in this case were not limited to new suicide method or celebrity suicide. The effects were further fueled by adverse socio-economic conditions.

Newspaper Reporting on a Cluster of Suicides in the UK

Abstract. Background: Media reporting may influence suicide clusters through imitation or contagion. In 2008 there was extensive national and international newspaper coverage of a cluster of suicides in young people in the Bridgend area of South Wales, UK. Aims: To explore the quantity and quality of newspaper reporting during the identified cluster. Method: Searches were conducted for articles on suicide in Bridgend for 6 months before and after the defined cluster (June 26, 2007, to September 16, 2008). Frequency, quality (using the PRINTQUAL instrument), and sensationalism were examined. Results: In all, 577 newspaper articles were identified. One in seven articles included the suicide method in the headline, 47.3% referred to earlier suicides, and 44% used phrases that guidelines suggest should be avoided. Only 13% included sources of information or advice. Conclusion: A high level of poor-quality and sensationalist reporting was found during an ongoing suicide cluster at the very time when good-quality reporting could be considered important. A broad awareness of media guidelines and expansion and adherence to press codes of practice are required by journalists to ensure ethical reporting.

The Impact of Celebrity Suicide on Subsequent Suicide Rates in the General Population of Korea from 1990 to 2010

The association between celebrity suicide and subsequent increase in suicide rates among the general population has been suggested. Previous studies primarily focused on celebrity suicides in the 2000s. To better understand the association, this study examined the impacts of celebrity suicides on subsequent suicide rates using the data of Korean celebrity suicides between 1990 and 2010. Nine celebrity suicides were selected by an investigation of media reports of suicide deaths published in three major newspapers in Korea between 1990 and 2010. Suicide mortality data were obtained from the National Statistical Office of Korea. Seasonal autoregressive integrated moving average models with intervention analysis were used to test the impacts of celebrity suicides, controlling for seasonality. Six of the 9 celebrity suicides had significant impacts on suicide rates both in the total population and in the same gender- or the same age-subgroups. The incident that occurred in the 1990s had no significant impact on the overall suicide rates, whereas the majority of the incidents in the 2000s had significant influences for 30 or 60 days following each incident. The influence of celebrity suicide was shown to reach its peak following the suicide death of a renowned actress in 2008. The findings may suggest a link between media coverage and the impact of celebrity suicide. Future studies should focus more on the underlying processes and confounding factors that may contribute to the impact of celebrity suicide on subsequent suicide rates.

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.

Quantitative exponential modelling of copycat suicides: association with mass media effect in South Korea

BACKGROUND

There is ample evidence media reporting of celebrity suicides increases copycat suicides. This study had three aims: (a) to quantitatively examine copycat suicides with exponential modelling that predicts the copycat suicide effect of South Korean celebrity suicides; (b) to investigate the association between media effect and subsequent suicides following celebrity deaths; and (c) to investigate the extent in which media influences the increase and rate of decline of copycat suicides following a celebrity suicide.

METHODS

All suicides during 1991-2010 in South Korea were included in this study utilising a nationwide database. Fifteen celebrities were selected based on the frequency of media reports following 1 week after their suicide. The media effect was obtained through the Korean Integrated Newspaper Database System. Exponential curve fits and correlation analyses investigated the quantitative effect of copycat suicides.

RESULTS

After controlling for baseline number of average suicides, there was a marked increase in the number of suicides following each celebrity suicides, which followed an exponential model. There was a significant correlation between the total number of copycat suicides and number of media following the celebrity suicide (r = 0.74, p < 0.01). There were weak-to-moderate correlations between the amplitude of increase in suicides (r = 0.45, p = 0.09) and rate of decline (r = 0.38, p = 0.16) with the total number of media coverage.

CONCLUSIONS

Copycat suicides following celebrity suicides follow exponential modelling. Additionally, there is a strong media effect between the number of media reports following the days after celebrity suicides and subsequent copycat suicides. This may also be associated with the amplitude and rate of decline of copycat suicides. This suggests that improving media reporting and implementing preventative interventions for vulnerable populations may be important.

Suicide Reporting Within British Newspapers’ Arts Coverage

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

Detecting Changes in Suicide Content Manifested in Social Media Following Celebrity Suicides

The Werther effect describes the increased rate of completed or attempted suicides following the depiction of an individual's suicide in the media, typically a celebrity. We present findings on the prevalence of this effect in an online platform: r/SuicideWatch on Reddit. We examine both the posting activity and post content after the death of ten high-profile suicides. Posting activity increases following reports of celebrity suicides, and post content exhibits considerable changes that indicate increased suicidal ideation. Specifically, we observe that post-celebrity suicide content is more likely to be inward focused, manifest decreased social concerns, and laden with greater anxiety, anger, and negative emotion. Topic model analysis further reveals content in this period to switch to a more derogatory tone that bears evidence of self-harm and suicidal tendencies. We discuss the implications of our findings in enabling better community support to psychologically vulnerable populations, and the potential of building suicide prevention interventions following high-profile suicides.

PRINTQUAL – A Measure for Assessing the Quality of Newspaper Reporting of Suicide

Background: Many studies have demonstrated a relationship between newspaper reporting of actual or fictional suicides and subsequent suicidal behaviors. Previous measures of the quality of reporting lack consistency concerning which specific elements should be included and how they should be weighted. Aims: To develop an instrument, PRINTQUAL, comprising two scales of the quality (poor and good) of newspaper reporting of suicide that can be used in future studies of reporting. Method: A first draft of the PRINTQUAL instrument was compiled, comprising items indicative of poor- and good-quality newspaper reporting based on guidelines and key sources of evidence. This was refined by team members and then circulated to a group of international experts in the field for further opinion and weighting of individual items. Results: The final instrument comprised 19 items in the poor-quality scale and four in the good-quality scale. Following training, agreement between raters was acceptably high for most items (κ ≥ .75) except for three items for which agreement was still acceptable (κ ≥ .60). Conclusion: The PRINTQUAL instrument for assessing the quality of newspaper reporting of suicide appears appropriate for use in research and monitoring in future studies.

Perceived racism and suicide ideation: mediating role of depression but moderating role of religiosity among African American adults

Suicide is a public health problem for African Americans who are young and of working age. The purpose of this study was to examine mediated and moderated effects of perceived racism on suicide ideation in a community sample of 236 African American men and women. Measures of suicide ideation, depression symptoms, intrinsic/extrinsic religiosity, and perceived racism were administered. Perceived racial discrimination was directly and indirectly associated with suicide ideation. For participants who reported low levels of extrinsic religiosity, the mediated effect of perceived racism (via depression symptoms) was significant. These findings provide some insight into suicide vulnerability for specific subgroups of African Americans.

Trends and risk factors of the epidemic of charcoal burning suicide in a recent decade among Korean people

The aims of this study were to analyze annual trends of charcoal burning (CB) suicide, 2000 to 2011, and to examine the risk factors of CB suicide in Korea. Data on suicides (n=138,938) were obtained from the Statistics Korea. The proportion of CB suicides among all suicide deaths reported was 0.7% (84 cases) in 2007, and since 2008 it has rapidly increased to 7.9% (1,251 cases) in 2011. Of significant risk factors of CB suicide, the presence of the media report of Ahn's suicide was the greatest risk factor (adjusted odds ratio, 11.69; 95% CI, 10.30-13.23) of the initial phase of the continuing CB suicides since 2008. Korean Government should urgently consider effective measures against CB suicide, including enforced media regulations on reporting such suicides.

Does a copycat effect exist in the emergency department?

OBJECTIVE

This study aimed to examine the copycat effect of a famous actress's suicide on suicide attempts visiting the emergency department (ED) in Korea.

METHOD

We retrospectively reviewed the medical records of suicide attempt cases which had visited the EDs of two general hospitals. during the 6 months before and after a celebrity suicide. We obtained data pertaining to demographics, history of psychiatric illnesses and suicide attempts, method of the suicide attempts, discharge status, and follow-up compliance.

RESULTS

We identified 319 cases during the study period, of which 158 cases occurred before the celebrity suicide, and 161 occurred after the event. Following the celebrity suicide, suicide attempts with the similar age and the same method as the celebrity's suicide (hanging), presence of psychiatric history, and use of intensive and multiple methods increased. We observed that suicide attempts with the similar age and the same method of hanging were consistent with a copycat effect. Despite a decrease of discharge against advice (DAA) after the celebrity's death from 67.7% to 59.6%, DAA was still high, and the follow-up compliance at outpatient clinics was less than 50%.

CONCLUSIONS

A copycat effect was found in ED-visiting suicide attempts. Prevention of re-attempts should be initiated in the ED. A specific action guide should be established for suicide attempts in the ED, including cooperation between other hospitals, the community, and the media.

Personal suicidality in reception and identification with suicidal film characters

The authors investigated the impact of suicidality on identity work during film exposure. Adults with low suicidality (n = 150) watched either It's My Party or The Fire Within, censored versions of these films not depicting the suicide, or the control film that concluded with a non-suicidal death. Baseline suicidality was measured with questionnaires before the movie. Identity work and identification with the protagonist were measured after the movie. Suicidality was directly associated with identity work during film dramas depicting suicide methods. The reception of suicide-related media content seems to partially depend on personal suicidality. Potential implications for suicide prevention are discussed.

A study of the impact of thirteen celebrity suicides on subsequent suicide rates in South Korea from 2005 to 2009

A number of ecological studies have found a pattern of increasing suicide rates after suicides of several Asian entertainment celebrities. However, the finding may be subject to positive outcome bias where cases with no perceived impact may be routinely excluded. In this study, we deploy interrupted time-series analysis using ARIMA transfer function models to investigate systematically the impact of thirteen celebrity suicides on subsequent suicide rates in South Korea. We find that three out of eleven cases were found to be followed by a significant increase in suicide rate, while controlling for seasonality, secular trends, and unemployment rates. Such significant increases could last for nine weeks. Non-significance cases may be attributable to the small amount of media coverage, the “displacement” effect of preceding case, and the negative connotation of celebrity deaths. We therefore conclude that whether or not the impacts were detected may be largely conditioned by various contextual factors. Current evidence based on ecological studies is insufficient to draw a firm conclusion. Further studies using multiple approaches should be developed.

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

INTRODUCTION

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

Suicide news reporting accuracy and stereotyping in Hong Kong

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

[Suicide reporting in German print and online media for adolescents in Austria and possible effects on suicide prevalence]

OBJECTIVE

We analyzed the quality of suicide reporting in youth magazines and assessed potential copycat effects following media reports on suicide.

METHOD

We obtained suicide-related articles from five Austrian and German youth magazines published between 1996 and 2008. Reported sex, suicide (attempt) methods, suicide motives, the portrayal of suicide in a positive or negative light, accusations of blame and consistency with media recommendations for the reporting of suicide were analysed using qualitative content analysis. The suicide frequency among adolescents in Austria was compared 2 weeks before and after the publication of reports on suicide and suicide attempts.

RESULTS

59 articles were identified, most of which had been published in the magazine Bravo. There was an overrepresentation of suicide among girls and an underrepresentation of attempted suicide. The frequency of specific suicide and suicide attempt methods was consistent with epidemiological distributions of suicide methods. Fall from height was most frequently described for girls and hanging for boys. Regarding motives for suicide, factors like psychiatric diseases were underrepresented. Girls who died by suicide were often positively described in articles, but boys were more often negatively described. Parents were frequently blamed as being guilty of their child's suicidal behaviour, in particular when reporting on suicide attempts. Photos, suicide notes and details concerning method were frequently described. There was no indication of a Werther effect following reporting.

CONCLUSIONS

The identified discrepancies between epidemiologic data regarding suicidal behaviour in adolescents and media reporting in youth media constitutes an important basis for suicide prevention in the community.

Media roles in suicide prevention: a systematic review

The aim of the current systematic review was to monitor and provide an overview of the research performed about the roles of media in suicide prevention in order to find out possible effects media reporting on suicidal behaviours might have on actual suicidality (completed suicides, attempted suicides, suicidal ideation). The systematic review was performed following the principles of the PRISMA statement and includes 56 articles. Most of the studies support the idea that media reporting and suicidality are associated. However, there is a risk of reporting bias. More research is available about how irresponsible media reports can provoke suicidal behaviours (the 'Werther effect') and less about protective effect media can have (the 'Papageno effect'). Strong modelling effect of media coverage on suicide is based on age and gender. Media reports are not representative of official suicide data and tend to exaggerate sensational suicides, for example dramatic and highly lethal suicide methods, which are rare in real life. Future studies have to encounter the challenges the global medium Internet will offer in terms of research methods, as it is difficult to define the circulation of news in the Internet either spatially or in time. However, online media can provide valuable innovative qualitative research material.

Investigating the long-term effects of a psychiatric rehabilitation programme for persons with serious mental illness in the community: a follow-up study

AIMS AND OBJECTIVES

This is a follow-up study to investigate the long-term effects of a holistic care programme for the rehabilitation of persons with serious mental illness. Perception of help from the programme and factors relating to the outcomes of the programme will also be studied.

BACKGROUND

This psychiatric rehabilitation programme in Hong Kong adopts a self-help group (SHG) approach with holistic care emphasising on the physical, psychological, social and spiritual functioning of the programme participants.

DESIGN

A quantitative approach using a set of self-administered questionnaires was adopted.

METHOD

Data were compared with a quasi-experimental study conducted in 2003 by Luk and Shek involving an experimental group and a control group.

RESULTS

All the outcome measures of participants were similar to that of the experimental group found in last study. When compared with the control group, it was found that participants had more hope than the control subjects. Help perceived from the programme included support, encouragement, enhancement of self-confidence, spiritual assistance and reflection of values. Having a job is found to be a key factor relating to the outcomes of the programme participants.

CONCLUSIONS

The programme is effective to provide some positive changes to its participants. Help is perceived by most participants and the programme is also useful to provide mutual support to participants in maintaining a job in the community, which is a paramount factor for rehabilitation.

RELEVANCE TO CLINICAL PRACTICE

A partnership model in SHG seems to be successful in providing support for the rehabilitation of persons with serious mental illness. Spiritual element should be incorporated into psychiatric rehabilitation programme to instil hope and meaningfulness of life. Nurses should be better educated in providing holistic care to individual clients and to a group.

Suicides by jumping from iconic bridges in Hong Kong

BACKGROUND

Three bridges in Hong Kong have become iconic sites for suicide since their openings 11 years ago.

AIMS

This retrospective record-based study aimed to examine suicides by jumping from a group of three iconic bridges in Hong Kong, and to explore potential preventive strategies on these bridges to prevent future suicide.

METHODS

We examined the Coroner's files of 12 people who killed themselves by jumping from the bridges between 1997 and 2007. We also examined the Coroner's files of other suicides in 2003, and compared them with the bridge suicides.

RESULTS

The majority of the suicides were male, middle-age (40-59 years), married or cohabiting, not living alone, employed or self-employed, and in financial difficulty. None of these cases had a reported psychiatric diagnosis or psychiatric care history, and only one case had a history of suicidal attempt. Compared with other suicides in Hong Kong, the bridge jumpers were more likely to be younger, holding a job, indebted, free from a psychiatric and attempt history, and to leave a suicide note (p < .05). The bridge suicide cases in Hong Kong also appeared to be different from the profiles of bridge jumpers in other countries.

CONCLUSIONS

Erection of an effective safety barrier has been found to prevent bridge suicides in many countries. Given the different characteristics of bridge jumpers in Hong Kong and the technical difficulties, more innovative ways may be needed to prevent suicides by such means. Potential prevention measures are discussed and, hopefully, will better inform the future design and development of bridges of significance.

Suicidality in Chinese adolescents in Hong Kong: the role of family and cultural influences

BACKGROUND

Adolescent suicidal ideation has found to predict suicidal behaviors and psychopathology in adulthood. Previous studies focused solely on the medical and environmental risk factors, which were insufficient to give a holistic picture of adolescent suicidality.

OBJECTIVES

To assess the role of affective and cognitive attributes in the identification and prevention of adolescent suicidal ideation.

METHOD

A community sample of 511 participants (age 15-19 years) were asked to indicate their suicidality in the 12 months and in their lifetime. Generalized estimating equation regression models were used to examine the effect of psychosocial and socio-environmental correlates in relation to adolescent suicidal ideation.

RESULTS

The data show that perceived responsibilities for family was the only protective factor, while a coping mechanism by behavioral disengagement, severity of depressive symptoms, a history of deliberate self-harm, chronic physical illness or pain, media reporting of suicide news, and low household income were the risk factors for adolescent suicidal ideation.

CONCLUSIONS

The results suggest that a multilayer effort for preventing adolescent suicide is needed by providing support for children in deprived families; enhancing life skills in the teens; strengthening family relationship; improving mental and health services; and promoting responsible media reporting on suicide.

Deliberate self-harm in adolescents: comparison between those who receive help following self-harm and those who do not

This international comparative study addresses differences between adolescents who engage in deliberate self-harm (DSH) and who receive help following the DSH episode versus those who do not. A standardised self-report questionnaire was completed by pupils aged 14-17 in Australia, Belgium, England, Hungary, Ireland, The Netherlands, and Norway (n=30,532). An act of DSH in the year prior to the study was reported by 1660 participants. Nearly half (48.4%) had not received any help following DSH, 32.8% had received help from their social network only and 18.8% from health services. Except for Hungary, cross-national comparisons revealed remarkably similar findings. Adolescents who had been in contact with health services following DSH reported more often a wish to die, lethal methods, alcohol/drug problems and DSH in the family compared to those who had not. However, those who received no help or help from their social network only were also heavily burdened.

Changes in reporting of suicide news after the promotion of the WHO media recommendations

Media recommendations on suicide reporting are available in many countries and in different languages. Hong Kong newspapers have been found to be noncompliant with WHO recommendations. A booklet containing WHO media guidelines Preventing Suicide: A Resource for Media Professionals, and an awareness campaign were launched in November 2004 in Hong Kong. Content analysis was then conducted to compare the reporting of suicide news before and after the launch. Results indicate that certain reporting styles were changed in accordance with the recommendations; namely, lessened use of pictorial presentations and headlines mentioning suicides. Most of the changes were attributed to the tabloid-style newspapers. This study suggests that programs to promote media recommendations tailored for journalists appear to be efficacious in altering their way of reporting.

Charcoal-Burning Suicides and Strategies for Prevention

Abstract. This paper examines the emergence of a new method of suicide in Hong Kong by carbon monoxide poisoning generated by the burning of charcoal. In just 6 years, it has become the second most common means of suicide after jumping from heights. The profile of these charcoal-burning suicide victims is different from that of other suicide deaths. It seems that a significant proportion of the increase in the number of suicides for the period is attributable to the charcoal burning. The effect of mass media reporting and strategies on how to contain the contagious effect of charcoal-burning deaths are discussed.