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

The impact of media reporting of suicides on subsequent suicides in Asia: A systematic review

Introduction

This systematic review is aimed at (1) evaluating the association between media portrayals of suicides and subsequent copycat suicides or attempts among the general public in Asia, (2) understanding the factors associated with copycat suicides and (3) determining the positive impacts of the media reporting of suicides (e.g. increased help-seeking, coping).

Method

A systematic review and narrative synthesis of English and Chinese articles from 8 electronic databases (i.e. PsycINFO, MEDLINE, Embase, CINAHL, Web of Science, Ariti, China National Knowledge Infrastructure and OpenGrey) from January 2000 to May 2023 was conducted. Observational studies were included, and the data were analysed through narrative synthesis. The protocol was registered with PROSPERO (CRD42021281535).

Results

Among the 32 studies included (n=29 for evidence synthesis) in the review, there is good-quality evidence to show that copycat suicides and suicide attempts increase after media reports of a suicide, regardless of country, celebrity status, study design, type of media, mode of suicide or follow-up period. Females, younger age groups and those sharing similar characteristics as the deceased in publicised suicides (age, gender) were more susceptible to negative impact. Reporting of the mode of death of the deceased increased suicides by the same method among the public.

Conclusion

Media portrayals of suicide appear to have a negative impact on copycat suicides at the population level in Asia. Thus, in addition to tighter media control, healthcare systems, professional medical bodies and community outreach services should work collaboratively to promote early help-seeking in those with psychological distress.

Exploring the link between the increase in high-rise buildings and youth jumping suicide in Taiwan: A longitudinal study

INTRODUCTION

From 2010 to 2021, suicide rates in 15-24 age group in Taiwan increased by 70%, with jumping being the most common method in 2021. We examined the link between the rise in youth suicides and the increase in high-rise buildings during this period.

METHODS

Spearman's correlation coefficients and negative binomial mixed-effects models were employed to assess the association between the increase in high-rise buildings and jumping suicides over time.

RESULTS

Spearman's correlation coefficients of high-rise buildings and jumping suicide rates in youth decreased from 0.692 (p < 0.001) in 2010 to 0.354 (p = 0.11) in 2021. Negative binomial mixed-effects models showed that although jumping suicide rates in youths increased over time, the increase in numbers of high-rise buildings was not related to rates of youth suicide by jumping. Conversely, in older age groups, the correlations were still prominent.

CONCLUSION

Despite the rising trend in youth suicides by jumping over the past 11 years, our study refutes the intuitive notion that the increase in high-rise buildings contributes to this trend. It is imperative to identify and address other potential factors, such as academic stress and/or family disruptions, for effective prevention of youth suicide.

Werther or Papageno? Examining the effects of news reports of celebrity suicide versus non-celebrity peer suicide on intentions to seek help among vulnerable young adults

INTRODUCTION

A large body of literature has examined the Werther effect following news reports of suicide, yet much less attention has been paid to the protective Papageno effect. This research explored the causal relationships between news reports of real celebrity suicides (e.g., pop-rock star Chester Bennington) and real non-celebrity "peer" suicides (e.g., college student Madison Holleran) and intentions to seek help.

METHODS

Two survey experiments confirmed successful experimental manipulation (N = 280) and tested behavioral theory, clinical indicators, and intentions to seek help (N = 641) in samples of college students (18-25).

RESULTS

Participants were motivated to seek help if they believed it could lead to positive outcomes, yet this was less likely among participants with depression. Exposure to news reports of non-celebrity suicides had a small positive effect on help-seeking intentions. Among participants with depression, news reports of celebrity suicides had a small positive effect on intentions.

CONCLUSIONS

This research could not establish Werther effects for either of the news reports. Exposure to news reports of non-celebrity suicides had a small positive effect on intentions overall, but young adults with higher levels of depression were slightly more motivated to seek help after viewing news reports of celebrity suicides.

The Werther effect following the suicides of three korean celebrities (2017-2018): an ecological time-series study

BACKGROUND

The suicide rate in Korea was the highest among the member countries of the Organization for Economic Cooperation and Development(OECD) for 2013-2016 and 2018-2020. In korea, suicide was the leading cause of death among individuals aged 10-39, and the second leading cause of death for aged 40-59. Thus, this study aimed to examine the Werther effect of the suicides of three Korean idol singers (Jonghyun: December 18, 2017, Sulli: October 14, 2019, and Hara Gu: November 24, 2019).

METHODS

The study conducted Poisson regression and used the cause-of-death statistics microdata from 2016 to 2020 provided by Statistics Korea. The case periods ranged from the day of the suicide of each celebrity to 10 weeks after. The control periods were all weeks from 2016 to 2020, excluding the case periods.

RESULTS

The suicide rates in Korea significantly increased by 1.21, 1.30, and 1.28 times after the deaths of Jonghyun, Sulli, and Hara Gu, respectively. The Werther effect was more evident in women than men. Suicide rate among individuals aged 10-29 years was greater than those for other age groups.

CONCLUSIONS

This study confirmed that the rate of copycat suicides increased after three celebrity singers in Korea died by suicide. Nevertheless, the rate of suicide after the suicide of the three celebrity singers was lower than those in previous studies in Korea.

Effects of catastrophic financial loss on suicide risk: evidence from Korean stock market crash in October 2008

PURPOSE

The negative effect of catastrophic financial loss on suicide risk is widely perceived but hardly studied in-depth because of various difficulties in designing studies. We empirically investigated the effect utilizing the stock market crash event in October 2008 in South Korea.

METHODS

We extracted stock market investor data from Korea Exchanges, and mortality data from Microdata Integrated Service of individuals aged 30-60 years. We calculated age-standardized monthly suicide rate per 100,000 persons according to sex and age, and developed intervention analysis with multiplicative seasonal ARIMA model to isolate the effect of the stock market crash on suicide rate.

RESULTS

More than 11% of people aged 30-60 years were directly investing in stocks during stock market crash. In October 2008, both KOSPI and KOSDAQ indexes dropped by 22.67% and 30.14%, respectively. In November 2008, the suicide rate in males 30-60 years increased by > 40% compared to the expected levels if there had been no market crash, and in females aged 30-40 and 40-50 years, it increased by 101.84% and 74.81%, respectively. The effect appeared to persist in males, whereas it degenerated with time in females during our sampling period. Suicide was more pronounced in younger age groups and females.

CONCLUSION

In this first in-depth study, the effect of catastrophic financial loss negatively affects suicide risk for an extended period, indicating health and financial authorities should provide a long-term financial and psychological support for people with extreme financial loss.

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.

Appropriate Strategies for Reducing the Negative Impact of Online Reports of Suicide and Public Opinion From Social Media in China

Suicide events may have a negative impact on all of society. The media plays a significant role in suicide prevention. Therefore, the aims of this study are (a) to understand the association between characteristics of suicide events and characteristics of who committed suicide, and event impact indexes (EIIs) of suicide reported on the internet; (b) to analyze violation of recommendations for reporting suicide by Weibo, and (c) to investigate the effect of online reports of suicide on public opinion. We carried out a content analysis of online reports of suicide. This study analyzed 113 suicide events, 300 news reports of suicide, and 2,654 Weibo comments about suicide collected from the WeiboReach between 2015 and 2020. We used a t-test and analysis of variance (ANOVA) to explore the potential factors associated with the EIIs of suicide events. The results found that (a) The suicide events reported on the internet during COVID-19 and those related to celebrities and students tend to have higher EIIs; (b) suicide reports on Weibo frequently violated WHO recommendations for suicide reporting in the media; and (c) public opinion of suicide reporting in the online media was mostly emotional and irrational, which is not beneficial for public mental health and suicide prevention. In conclusion, first, the situation of many people working from home or studying from home and spreading more time online during COVID-19 may lead to suicide events obtain more public attention. Online media could further improve public responsible reporting and daily media-content surveillance, especially taking particular care in those suicide events during COVID-19, and related to celebrities and students, which may have a higher event impact on the internet. Second, health managers should regular assessment of observance of the WHO recommendations for suicide reporting by online social media to prevent suicide. Third, health communication managers should use big data to identify, assess, and manage harmful information about suicide; and track anyone affected by suicide-related reports on social media to reduce the negative impact of public opinion to intervene suicide in the early stage of suicide.

The Werther effect of celebrity suicides: Evidence from South Korea

Since 2003 Korea has experienced the highest suicide rate among OECD countries. One of the societal risk factors that triggers suicide is the contagious nature of suicide. This paper empirically examines the effect of celebrity suicide reports on subsequent copycat suicides, using daily suicide data and information of highly publicized suicide stories in Korea from 2005 to 2018. The findings from the Poisson regression model suggest that the number of public suicides soars after media reports on celebrity suicides. On average, the number of suicides in the population increased by 16.4% within just one day after the reports. Further analysis reveals that female and younger subgroups are more likely to be affected by celebrity suicides. Moreover, the public reacts more strongly to suicide incidents of celebrities of the same gender and even imitates the methods of suicide used by celebrities. This paper highlights the significance of careful and responsible media coverage of suicide stories to prevent copycat suicide. For policymakers, it is crucial to implement regulations not only for traditional media but also for new media where younger people can freely access unfiltered information.

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

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

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

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

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.

Quantifying the contributions of age, sex, methods, and urbanicity to the changing suicide rate trends in South Korea, 2001-2016

PURPOSE

Suicide rates in South Korea have been one of the highest in the world. The aim of this study is to quantify the contributions of age, sex, method, and place of residence to the trends of the suicide rates between 2001 and 2016 in South Korea.

METHODS

Using the suicide data obtained from the South Korean National Death Registration data set for the years 2001-2016, a Joinpoint regression analysis was conducted to determine if there was a significant change in the trend of suicide rates. Next, a decomposition analysis method was used to quantify the contributions of age, sex, method, and places of residence to the changes in the suicide rates.

RESULTS

Suicide rates increased between 2001 and 2010, and decreased between 2010 and 2016. Among all the age groups, the 65-79 age group contributed most to the rise (18% in men and 7% in women) and fall (- 15% in men and - 14% in women) of suicide rates. Men contributed much more than women to the increasing trend of suicide rate (63.0% vs. 37.0%). Hanging was the key method of suicide, dominating the ups and downs of the suicide rates. The rates of suicide by pesticide poisoning have been decreasing since 2005 and suicide by charcoal burning continued to increase against a decreasing trend of suicide rate during the period of 2010-2016. The gap of the metropolitan-city-rural suicide rates was narrowing during the period under study, although the rural areas remained to have the highest suicide rates.

CONCLUSION

The ups and downs of suicide rates in South Korea were not uniform across different sociodemographic groups. Age, sex, method, and place of residence contributed differently to the changes in suicide rates. Suicide prevention measures can be more focused on certain age-sex-method-region subgroups.

Attitudes towards suicide and risk factors for suicide attempts among university students in South Korea

BACKGROUND

In the new global socioeconomic development, suicidal deaths have increased which is progressively gaining more attention in the field of psychiatry, social work, psychology, and public health research. The present study aimed at examining the evidence for the attitudes towards suicide and risk factors for suicide attempts among university students in South Korea and suggested significant recommendations for future prevention programs and research.

METHOD

A study was conducted by reviewing recent publications and significant research journals published since 2000 related to the study objective, themes, and drawn broader perspectives and implications. The recent journal articles from PubMed, Global Health journal database, Google Scholar, MEDLINE, Academic Journals Database, WHO, and PsychInfo data sources were included. The study key terms were "suicide", "attitudes", "risk factors", "university students", & "South Korea".

RESULTS

The negative attitudes towards self, confusion of meaning in life, anxiety and stress about academic achievement, family problems, hopelessness, depression, and bipolar disorder were the main factors.

LIMITATIONS

We mainly included peer review journals in our study, but address the few relevant books and reports also.

CONCLUSIONS

The authors discussed important implications for future actions, including conducting relevant studies and regular collaborative discussions among responsible stakeholders.

The Relationship Between Suicide-Related Twitter Events and Suicides in Ontario From 2015 to 2016

Background: Many studies have demonstrated suicide contagion through mainstream journalism; however, few have explored suicide-related social media events and their potential relationship to suicide deaths. Aims: To determine whether Twitter events were associated with changes in subsequent suicides. Methods: Suicide-related Twitter events that garnered at least 100 tweets originating in Ontario, Canada (July 1, 2015 to June 30, 2016) were identified and characterized as putatively "harmful" or "innocuous" based on recommendations for responsible media reporting. The number of suicides in Ontario during the peak of each Twitter event and the subsequent 6 days ("exposure window") was compared with suicides occurring during a pre-event period of the same length ("control window"). Results: There were 17 suicide-related Twitter events during the period of study (12 putatively harmful and five putatively innocuous). The number of tweets per event ranged from 121 for "physician-assisted suicide law in Quebec" to 6,202 for the "Attawapiskat suicide crisis." No significant relationship was detected between Twitter events and actual suicides. Notably, a comprehensive examination of the details of Twitter events showed that even the putatively harmful events lacked many of the characteristics commonly associated with contagion. Limitations: This was an uncontrolled experiment in only one epoch and a single Canadian province. Discussion: This study found no evidence of suicide contagion associated with Twitter events. This finding must be interpreted with caution given the relatively innocuous content of suicide-related Tweets in Ontario during 2015-2016.

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

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

Age and sex subgroups vulnerable to copycat suicide: evaluation of nationwide data in South Korea

Media reports of a celebrity's suicide may be followed by copycat suicides, and the impact may vary in different age and sex subgroups. We proposed a quantitative framework to assess the vulnerability of age and sex subgroups to copycat suicide and used this method to investigate copycat suicides in relation to the suicides of 10 celebrities in South Korea from 1993 to 2013. By applying a detrending model to control for annual and seasonal fluctuations, we estimated the expected number of suicides within a copycat suicide period. The copycat effect was assessed in two ways: the magnitude of copycat suicide by dividing the observed by the expected number of suicides, and the mortality rate by subtracting the expected from the observed number of suicides. Females aged 20-29 years were the most vulnerable subgroup according to both the magnitude of the copycat effect (2.31-fold increase over baseline) and the mortality rate from copycat suicide (22.7-increase). Males aged 50-59 years were the second most vulnerable subgroup according to the copycat suicide mortality rate (20.5- increase). We hope that the proposed quantitative framework will be used to identify vulnerable subgroups to copycat effect, thereby helping devise strategies for prevention.

Design and Methods of the Korean National Investigations of 70,000 Suicide Victims Through Police Records (The KNIGHTS Study)

OBJECTIVE

The suicide rate in South Korea was the second highest among the Organization for Economic Cooperation and Development countries in 2017. The purpose of this study is to understand the characteristics of people who died by suicide in Korea from 2013-2017 and to better prevent suicide.

METHODS

This study was performed by the Korea Psychological Autopsy Center (KPAC), an affiliate of the Korea Ministry of Health and Welfare. According to the Korea National Statistical Office, the number of suicide victims nationwide was estimated to reach about 70,000 from 2013 to 2017. Comprehensive suicide records from all 254 police stations in South Korea were evaluated by 32 investigators who completed a 14-day didactic training program. Then, we evaluated the characteristics of suicide victims in association with disease data from the National Health Insurance Database (NHID), which is anonymously linked to personal information of suicide victims.

RESULTS

Thirty-one of 254 police stations in the Seoul metropolitan area were analyzed by August 10, 2018. Findings showed that the characteristics of suicide victims differed according to the nature of the region.

CONCLUSION

Our results suggest that different strategies and methods are needed to prevent suicide by regional groups.

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.

Seasonal changes in suicide in South Korea, 1991 to 2015

Seasonality of suicidal behavior has been widely reported in many epidemiological studies with a well replicated suicide peak in spring followed by a trough in winter season. Research from some regions over the past few decades has shown a diminishing seasonal pattern of suicides and this introduced a new perspective on the suicide study. Data on all suicide deaths from the period 1991 to 2015 was extracted from the South Korean National Death Registration data set which was made available by Statistics Korea. Our findings confirmed a strong seasonal effect of suicides in South Korea throughout the study period and a marked diminishing pattern was observed since the period of 2006–2010. The rhythm of suicides kept changing across the time intervals with a spring peak followed by a second peak in late summer/autumn. The seasonality varied across age groups and the seasonal effect among the Korean elderly suicides was still found to be significant though a diminishing pattern was observed recently.

Assessing the Quality of Media Reporting of Suicide Deaths in Bangladesh Against World Health Organization Guidelines

Background: Media reporting of suicide events has thus far gone without sufficient scrutiny in Bangladesh. Aim: The purpose of this study was to assess the quality of newspaper reporting of suicides in Bangladesh against international guidelines. Methods: We used content analysis to assess the quality of suicide reporting in six daily newspapers in Bangladesh. The newspapers were hand-searched between November 2016 and April 2017 and 327 articles reporting on suicide deaths were retrieved. Results: The mean number of suicide articles per day per newspaper was 0.3 (range across newspapers 0.11-0.70) and the mean length was 11.3 sentences. Harmful reporting practices were very common (for example, a detailed suicide method was reported in 75.5% of articles) while almost no potentially helpful reporting practices were observed (for example, no articles gave contact details for a suicide support service). Limitations: The findings are limited to print mass media. Conclusions: We observed that explicit and simplistic reports of suicide deaths were frequently observed in newspapers in Bangladesh. Attempts should be made to understand the perspectives of media professionals in relation to suicide reporting, and to devise strategies to boost the positive contribution that media can make to suicide prevention in this context.

Trends in pesticide suicide in South Korea, 1983-2014

AIMS

Self-poisoning using pesticides is among the major methods of suicide worldwide, and accounts for one-fifth of suicides in 2006-2010 in South Korea. We investigated long-term trends in pesticide suicide rates in South Korea and factors related to these trends.

METHODS

We calculated age-standardised rates of pesticide suicide in South Korea (1983-2014) using registered death data. We used graphical approach and joinpoint regression analysis to examine secular trends in pesticide suicide by sex, age and area, and a time-series analysis to investigate association of pesticide suicide rate with socioeconomic and agriculture-related factors. Age, period and cohort effects were examined using the intrinsic estimator method.

RESULTS

Age-standardised rate of pesticide suicide fluctuated between 1983 and 2000 before it markedly increased in 2000-2003 (annual percent change 29.7%), followed by a gradual fall (annual percent change -6.3%) in 2003-2011. Following the paraquat ban (2011-2012), there was a marked reduction (annual percent change -28.2%) in 2011-2014. Trend in pesticide suicide was associated with divorce rate but not with other factors studied. Declines in pesticide suicide in 2003-2011 were most noticeable in younger groups and metropolises; by contrast, elderly adults aged 70+ living in rural areas showed an upward trend until after the 2011-2012 paraquat ban, when it turned downward. In the age-period-cohort modelling, having been born between 1938 and 1947 was associated with higher pesticide suicide rates.

CONCLUSIONS

Pesticide suicide trend changed substantially in South Korea over the last three decades. Effective prevention should include close monitoring of trends and strong regulations of toxic pesticides.

Mining social networks to improve suicide prevention: A scoping review

Attention about the risks of online social networks (SNs) has been called upon reports describing their use to express emotional distress and suicidal ideation or plans. On the Internet, cyberbullying, suicide pacts, Internet addiction, and "extreme" communities seem to increase suicidal behavior (SB). In this study, the scientific literature about SBs and SNs was narratively reviewed. Some authors focus on detecting at-risk populations through data mining, identification of risks factors, and web activity patterns. Others describe prevention practices on the Internet, such as websites, screening, and applications. Targeted interventions through SNs are also contemplated when suicidal ideation is present. Multiple predictive models should be defined, implemented, tested, and combined in order to deal with the risk of SB through an effective decision support system. This endeavor might require a reorganization of care for SNs users presenting suicidal ideation.

Celebrity suicide on Twitter: Activity, content and network analysis related to the death of Swedish DJ Tim Bergling alias Avicii

BACKGROUND

Media recommendations for suicide reporting are recommended to prevent imitative suicide but little is known about social media reactions to different revelations about celebrity suicide.

METHODS

Using the Twitter Application Programming Interface (API), we recorded public tweets mentioning Avicii from the day when his death was reported (N = 2,865,292). We compared that data with a dataset of random tweets. Furthermore, we recorded tweets including suicide in 124 languages before Avicii's death (N = 5,939,107). We processed English tweets mentioning Avicii with the Linguistic Inquiry and Word Count (LIWC) to quantify the frequency of affects and related linguistic signals. We also processed the text of tweets to detect tweets mentioning the suicide method, and we retrieved the list of followers of users who tweeted about the method. We constructed reply networks from the dataset, analysing three networks corresponding to the major news events about Avicii's death.

RESULTS

Avicii's suicide sparked immediate strong interest with both positive (χ² = 781.06, p < 10^-6) and negative emotional expressions (χ² = 1518.5, p < 10^-6) in comparison to baseline levels. Subsequent revelations were associated with smaller peaks with mainly negative emotional content after Avicii's death was revealed as a suicide (χ² = 33.2, p < 10^-6 and after news about the suicide method (χ² = 274.93, p < 10^-6). Tweeting about the suicide method was infrequent, but twitter users who covered the method had more followers that users who did not (D = 0.1675, p < 10^-6; t = 19.87, p < 10^-6), and a noteworthy number of users had considerable exposure to the suicide method.

LIMITATIONS

This was a descriptive analysis.

CONCLUSIONS

Twitter users showed strong interest in news about Avicii's death and Avicii's suicide, but less so in the suicide method, and showed distinct tweeting behaviours based on the different revelations.

Media coverage of celebrity suicide caused by depression and increase in the number of people who seek depression treatment

We examined how media coverage of a celebrity who died by suicide due to depression was associated with the change in the number of people who visited a psychiatrist for depression. For this, of all news articles published in South Korea between 2010 and 2017, we identified all cases in which a celebrity died by suicide due to depression. Further, from the Korean health big data system, we collected monthly data on the number of people who visited a psychiatrist for depression. Regression analyses showed that, when there was media coverage of celebrity suicide due to depression in a particular month, more people visited a psychiatrist for depression-not in the same month but in the following month. We also found that, when there was media coverage of celebrity suicide due to depression, more news articles provided information about depression treatment or prevention. But, the increase in the number of such news articles did not play mediating roles between the media coverage of celebrity suicide, of which depression was known to be the main cause, and the increase in the number of visits to a psychiatrist.

Suicidal behaviours among Chinese adolescents exposed to suicide attempt or death

AIMS

Suicidal behaviours in adolescents are prevalent and multifactorial. This study was conducted to examine the associations between exposure to suicide attempt (ESA) or suicide death (ESD) and suicidal behaviours in a large sample of Chinese adolescents.

METHODS

Participants included for the analysis were 11 831 adolescent students who participated in the baseline survey of the Shandong Adolescent Behavior and Health Cohort (SABHC). Participants were sampled from five middle and three high schools in three counties of Shandong province, China. A self-administered structured questionnaire was used to collect data on demographics, behavioural and emotional problems, family environment, suicidal behaviours (suicidal thought, plan and attempt), and history of ESA or death of a family member, relative, friend or close acquaintance. Based on the sources of exposure, the participants were divided into four groups: non-exposure, exposure from relatives only, exposure from friends/close acquaintances only (EFO) and exposure from both relatives and friends (ERF). Logistic regressions were used to examine the associations between ESA or ESD and suicidal behaviours.

RESULTS

Mean age of the participants was 14.97 ± 1.46 years and 50.9% were boys. Of the participants, 9.4% reported having ESA, and 6.6% reported having ESD. The prevalence rates of suicidal behaviours were significantly higher in adolescents who had been exposed to suicide attempt or death than those who had not. Multivariate logistic regressions showed that ESA and ESD were both significantly associated with increased risks of suicidal thought (ESA: OR = 1.96, 95% CI = 1.66-2.31; ESD: OR = 1.59, 95% CI = 1.31-1.94), plan (ESA: OR = 2.37, 95% CI = 1.84-3.05; ESD: OR = 1.62, 95% CI = 1.18-2.23) and attempt (ESA: OR = 2.73, 95% CI = 1.92-3.89; ESD: OR = 1.82, 95% CI = 1.18-2.82), respectively. When participants were exposed to suicide attempt, ERF and EFO groups had significantly higher risks of suicidal thought (ERF: OR = 2.61, 95% CI = 1.28-1.64; EFO: OR = 1.96, 95% CI = 1.64-2.36), plan (ERF: OR = 3.72, 95% CI = 2.04-6.78; EFO: OR = 2.31, 95% CI = 1.74-3.01) and attempt (ERF: OR = 4.83, 95% CI = 2.30-10.17; EFO: OR = 2.57, 95% CI = 1.73-3.81), respectively.

CONCLUSIONS

ESA or ESD was associated with increased risks of suicidal behaviours in adolescents. Exposure to suicidal behaviours of relatives and friends/close acquaintances appeared to have different influence on adolescent suicidal behaviours. Further research is warranted to examine the biological and psychosocial mechanisms between suicidal exposure and subsequent suicidal behaviours in adolescents.

Changing trends in suicide rates in South Korea from 1993 to 2016: a descriptive study

OBJECTIVES

The South Korean government has recently implemented policies to prevent suicide. However, there were few studies examining the recent changing trends in suicide rates. This study aims to examine the changing trends in suicide rates by time and age group.

DESIGN

A descriptive study using nationwide mortality rates.

SETTING

Data on the nationwide cause of death from 1993 to 2016 were obtained from Statistics Korea.

PARTICIPANTS

People living in South Korea.

INTERVENTIONS

Implementation of national suicide prevention policies (first: year 2004, second: year 2009).

PRIMARY OUTCOME MEASURES

Suicide was defined as 'X60-X84' code according to the ICD-10 code. Age-standardised suicide rates were estimated, and a Joinpoint regression model was applied to describe the trends in suicide rate.

RESULTS

From 2010 to 2016, the suicide rates in South Korea have been decreasing by 5.5% (95% CI -10.3% to -0.5%) annually. In terms of sex, the suicide rate for men had increased by 5.0% (95% CI 3.6% to 6.4%) annually from 1993 to 2010. However, there has been no statistically significant change from 2010 to 2016. For women, the suicide rate had increased by 7.5% (95% CI 6.3% to 8.7%) annually from 1993 to 2009, but since 2009, the suicide rate has been significantly decreasing by 6.1% (95% CI -9.1% to -3.0%) annually until 2016. In terms of the age group, the suicide rates among women of almost all age groups have been decreasing since 2010; however, the suicide rates of men aged between 30 and 49 years showed continuously increasing trends.

CONCLUSION

Our results showed that there were differences in the changing trends in suicide rate by sex and age groups. Our finding suggests that there was a possible relationship between implementation of second national suicide prevention policies and a decline in suicide rate.

Assessing the quality of media reporting of suicide news in India against World Health Organization guidelines: A content analysis study of nine major newspapers in Tamil Nadu

OBJECTIVES

Suicide rates in India are among the highest in the world, resulting in an estimated 250,000 suicide deaths annually. How the media communicates with the Indian public on the topic of suicide has thus far gone without sufficient scrutiny. The objective of our study was to assess the quality of newspaper reporting of suicide-related news in India against World Health Organization suicide reporting guidelines.

METHODS

We used content analysis to assess the quality of suicide reporting against World Health Organization guidelines in nine of the most highly read daily newspapers in the southern state of Tamil Nadu between June and December 2016. Five of the nine newspapers under review were in the top 20 most circulated daily newspapers in the country.

RESULTS

A total of 1681 suicide articles were retrieved. The mean number of suicide articles per day per newspaper was 0.9%, and 54.5% of articles were 10 sentences or less. The vast majority (95.9%) of articles primarily focused on reporting specific suicide incidents. Harmful reporting practices were very common (e.g. a detailed suicide method was reported in 43.3% of articles), while helpful reporting practices were rare (e.g. just 2.5% gave contact details for a suicide support service).

CONCLUSIONS

We observed that a daily diet of short and explicit suicide-related news was served up to readers of newspapers. Attempts should be made to understand the perspectives of media professionals in relation to suicide reporting, and to devise strategies to boost the positive contribution that media can make to suicide prevention.

Age, Period, and Cohort Effects on Suicide Mortality in South Korea, 1992⁻2015

Although the effects of age, period, and cohort (APC) on suicide are important, previous work in this area may have been invalid because of an identification problem. We analyzed these effects under three different scenarios to identify vulnerable groups and thus overcame the identification problem. We extracted the annual numbers of suicides from the National Death Register of Korea (1992⁻2015) and estimated the APC effects. The annual average suicide rates in 1992⁻2015 were 31.5 and 14.7 per 100,000 males and females, respectively. The APC effects on suicide were similar in both sexes. The age effect was clearly higher in older subjects, in contrast to the minimal changes apparent during earlier adulthood. The birth cohort effect showed an inverted U shape; a higher cohort effect was evident in females born in the early 1980s when period drift was larger than 3.7%/year. Period effect increased sharply during the early 1990s and 2000s. We found that elderly and young females may be at a particularly high risk of suicide in Korea.

Media Guidelines for Reporting on Suicide: 2017 Update of the Canadian Psychiatric Association Policy Paper

This paper has been substantially revised by the Canadian Psychiatric Association's Research Committee and approved for republication by the CPA's Board of Directors on May 3, 2017. The original policy paper¹ was developed by the Scientific and Research Affairs Standing Committee and approved by the Board of Directors on November 10, 2008.

Suicide in children and adolescents: a Tunisian perspective from 2009 to 2015

This study presents the characteristics of child and adolescent suicides which occurred in Kairouan, Tunisia. Data were collected from autopsy records of the Forensic Department of the University Hospital Ibn El Jazzar of Kairouan. General characteristics of suicides among children and adolescents (under the age of 18) between 2009 and 2015 were retrospectively reviewed. A total of 49 cases, with a female predominance (61.2%) and a mean age of 15.4 ± 2.1, were registered. Most of the victims were from rural areas (93.1%). In most cases, suicide occurred in the victim's home or the surrounding area (73.4%). The identified precipitating factors were family problems in 55.1%, and school issues in 12.2%. The most common suicide method was hanging (69.38%) for both genders, followed by self-immolation for males and poisoning for females, the majority using pesticides. This study offers useful information to understand the risk factors in Tunisian child and adolescent suicides and provides a basis for the development of urgently needed preventive strategies.

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

BACKGROUND

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

METHODOLOGY

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

RESULTS

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

CONCLUSIONS

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

Impact of the Tunisian Revolution on homicide and suicide rates in Tunisia

OBJECTIVES

To analyze the impact of the Tunisian Revolution on suicide and homicide patterns in Tunisia.

METHODS

It is a retrospective, cross-sectional study, including all the cases of homicides and suicides that occurred during an 8-year period (2007-2014) in Northern Tunisia. We compared data before and after the revolution.

RESULTS

After the revolution, the number of suicides rose 1.7 times, with a prevalence rising from 1.8 to 3.12 suicides per 100,000 persons per year. Homicides rose 1.3 times after the revolution. For both manner of death, victims were mostly males, aged between 20 and 39 years, living in urban areas. Hanging and self-immolation rose, respectively, 1.8 and 3 times after 2011. We observed suicide cases most frequently occurred in public places and in front of public administration after 2011. Homicide victims' profile and circumstances showed a single variation which is an increase in number of cases happening in rural areas.

CONCLUSIONS

Our results proved a short-term impact of the transition period on homicides and suicides. Urgent preventive measures are needed especially to decrease the suicide rates.

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.

Age-period-cohort analysis of the suicide rate in Korea

BACKGROUND

The suicide rate has been increasing in Korea, and the country now has the highest rank in the world. This study aimed to present the long-term trends in Korea's suicide rate using Joinpoint analysis and age-period-cohort (APC) modeling.

METHODS

The population and the number of suicides for each five-year age group were obtained from the National Statistical Office for the period 1984-2013 for Koreans aged 10 years and older. We determined the changes in the trends in age-standardized mortality rates using Joinpoint. APC modeling was performed to describe the trends in the suicide rate using the intrinsic estimator method.

RESULTS

The age-standardized suicide rate in men rapidly increased from 1989 to 2004, and slightly increased thereafter, whereas the suicide rate in women increased from 1989 to 2009 and then decreased thereafter. Within the same period, the suicide rate was higher among the older age groups than in the younger groups. Within the same birth cohort, the suicide rate of the older groups was also higher than that in the younger groups. Within the same age group, the suicide rate of the younger cohorts was higher than it was in the older cohorts. In the APC modeling, old age, recent period, and having been born before 1924 were associated with higher suicide rates.

LIMITATIONS

The accuracy and completeness of the suicide rate data may lead to bias.

CONCLUSIONS

This study showed an increasing trend in the suicide rates for men and women after 1989. These trends may be mainly attributed to cohort effects.

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.

Can Social Ties be Harmful? Examining the Spread of Suicide in Early Adulthood

Durkheim posited that social relationships protect individuals against suicide; however, substantial research demonstrates that suicide can spread through the very ties Durkheim theorized as protective. With this study, we use Waves I, III, and IV of the National Longitudinal Study of Adolescent Health, to investigate whether young adults' suicide attempts and thoughts are in part products of exposure to suicidal behaviors via their social relationships. We find that young adults who have had family members or friends attempt suicide are more likely to report suicide ideation or even suicide attempts, over both the short and long run. This finding is robust to many important controls for risk and protective factors for suicide. Our findings have implications for the sociology of suicide, not the least of which, is that social ties have the power to harm in addition to the power to protect.

Suicide from carbon monoxide poisoning in South Korea: 2006-2012

BACKGROUNDS

Suicide from carbon monoxide poisoning by burning coal briquette or barbecue charcoal increased rapidly in some East Asian countries in the recent decade. The purpose of this study was to examine trends in suicides from carbon monoxide poisoning in South Korea and their epidemiologic characteristics.

METHODS

We presented age-standardized mortality rates of carbon monoxide suicide and compared them with those of suicide by other methods using registered death data from Statistics Korea (South Korea) from 2006 to 2012. Logistic regression analysis was conducted to estimate odds ratios of carbon monoxide suicide by socio-demographic characteristics before and after the marked increase in carbon monoxide suicide in September 2008.

RESULTS

The number of carbon monoxide suicides in South Korea was only 34 in 2006 but rapidly increased to 267 in 2008 and was 1125 in 2012, with the age-standardized rates of 0.06 (2006), 0.48 (2008), and 1.97 (2012) per 100,000 population respectively (a striking 3,183% increase in 2006-2012). Suicide by carbon monoxide poisoning showed greater odds ratios among men, younger age groups, single or the divorced, and those with high education and non-manual jobs compared with suicides by other methods.

LIMITATIONS

This study only used data for fatal self-poisoning by carbon monoxide (non-fatal cases not included) and had no information on the sources of carbon monoxide.

CONCLUSIONS

Carbon monoxide suicides substantially increased in South Korea over the relatively short study period and showed some distinct socio-demographic characteristics compared with suicides by other methods.

Celebrity suicides and their differential influence on suicides in the general population: a national population-based study in Korea

OBJECTIVE

Although evidence suggests that there is an increase in suicide rates in the general population following celebrity suicide, the rates are heterogeneous across celebrities and countries. It is unclear which is the more vulnerable population according to the effect sizes of celebrity suicides to general population.

METHODS

All suicide victims in the general population verified by the Korea National Statistical Office and suicides of celebrity in South Korea were included for 7 years from 2005 to 2011. Effect sizes were estimated by comparing rates of suicide in the population one month before and after each celebrity suicide. The associations between suicide victims and celebrities were examined.

RESULTS

Among 94,845 suicide victims, 17,209 completed suicide within one month after 13 celebrity suicides. Multivariate logistic regression analyses revealed that suicide victims who died after celebrity suicide were significantly likely to be of age 20-39, female, and to die by hanging. These qualities were more strongly associated among those who followed celebrity suicide with intermediate and high effect sizes than lower. Younger suicide victims were significantly associated with higher effect size, female gender, white collar employment, unmarried status, higher education, death by hanging, and night-time death. Characteristics of celebrities were significantly associated with those of general population in hanging method and gender.

CONCLUSION

Individuals who commit suicide after a celebrity suicide are likely to be younger, female, and prefer hanging as method of suicide, which are more strongly associated in higher effect sizes of celebrity suicide.

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.

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.

Reasons for desiring death: examining causative factors of suicide attempters treated in emergency rooms in Korea

BACKGROUND

Suicide attempters treated in emergency rooms were studied in order to understand the motives behind this behavior. Disparities between the etiological contributions to suicidal ideation, intention, and action were examined in order to characterize motives in these categories.

METHODS

Suicide attempters who visited the emergency departments of seven university hospitals were analyzed. Attempts leading to mortality were excluded from the analysis. Participants were assessed using semi-structured questionnaires, the results of which were noted on their medical records. These were analyzed retrospectively.

RESULTS

Attempter self-report assessment revealed that participants chose external sources of stress (75.4%) and psychiatric symptoms (19.1%) as their main reasons for attempting suicide. However, assessments by interviewers indicated that stressors contributed to suicide attempts to a lesser degree (52.8%) while psychiatric symptoms were more etiologically relevant (36.6%). Compared to those with stressors that was identified as causal in both self-report and clinician assessed evaluation, the participants-regardless of their self-report evaluation-who identified with causal psychiatric symptoms by psychiatrist had more severe and intense suicidal ideation and more determined suicidal intention.

LIMITATIONS

We collected samples from only university hospitals, resulting in selection bias. In addition, we did not use psychiatric scales to evaluate the participants׳ symptoms.

CONCLUSIONS

Stress was the greatest motive for attempting suicide, affirmed in both self-report and clinician assessed evaluation. A fair proportion of people were objectively identified as being motivated by psychiatric symptoms, yet were unaware of what they suffered from. Furthermore, suicide severity, intensity, and suicidal intention were stronger in psychiatrically driven cases.

Regional changes in charcoal-burning suicide rates in East/Southeast Asia from 1995 to 2011: a time trend analysis

BACKGROUND

Suicides by carbon monoxide poisoning resulting from burning barbecue charcoal reached epidemic levels in Hong Kong and Taiwan within 5 y of the first reported cases in the early 2000s. The objectives of this analysis were to investigate (i) time trends and regional patterns of charcoal-burning suicide throughout East/Southeast Asia during the time period 1995-2011 and (ii) whether any rises in use of this method were associated with increases in overall suicide rates. Sex- and age-specific trends over time were also examined to identify the demographic groups showing the greatest increases in charcoal-burning suicide rates across different countries.

METHODS AND FINDINGS

We used data on suicides by gases other than domestic gas for Hong Kong, Japan, the Republic of Korea, Taiwan, and Singapore in the years 1995/1996-2011. Similar data for Malaysia, the Philippines, and Thailand were also extracted but were incomplete. Graphical and joinpoint regression analyses were used to examine time trends in suicide, and negative binomial regression analysis to study sex- and age-specific patterns. In 1995/1996, charcoal-burning suicides accounted for <1% of all suicides in all study countries, except in Japan (5%), but they increased to account for 13%, 24%, 10%, 7%, and 5% of all suicides in Hong Kong, Taiwan, Japan, the Republic of Korea, and Singapore, respectively, in 2011. Rises were first seen in Hong Kong after 1998 (95% CI 1997-1999), followed by Singapore in 1999 (95% CI 1998-2001), Taiwan in 2000 (95% CI 1999-2001), Japan in 2002 (95% CI 1999-2003), and the Republic of Korea in 2007 (95% CI 2006-2008). No marked increases were seen in Malaysia, the Philippines, or Thailand. There was some evidence that charcoal-burning suicides were associated with an increase in overall suicide rates in Hong Kong, Taiwan, and Japan (for females), but not in Japan (for males), the Republic of Korea, and Singapore. Rates of change in charcoal-burning suicide rate did not differ by sex/age group in Taiwan and Hong Kong but appeared to be greatest in people aged 15-24 y in Japan and people aged 25-64 y in the Republic of Korea. The lack of specific codes for charcoal-burning suicide in the International Classification of Diseases and variations in coding practice in different countries are potential limitations of this study.

CONCLUSIONS

Charcoal-burning suicides increased markedly in some East/Southeast Asian countries (Hong Kong, Taiwan, Japan, the Republic of Korea, and Singapore) in the first decade of the 21st century, but such rises were not experienced by all countries in the region. In countries with a rise in charcoal-burning suicide rates, the timing, scale, and sex/age pattern of increases varied by country. Factors underlying these variations require further investigation, but may include differences in culture or in media portrayals of the method. Please see later in the article for the Editors' Summary.

Regional changes in charcoal-burning suicide rates in East/Southeast Asia from 1995 to 2011: a time trend analysis

BACKGROUND

Suicides by carbon monoxide poisoning resulting from burning barbecue charcoal reached epidemic levels in Hong Kong and Taiwan within 5 y of the first reported cases in the early 2000s. The objectives of this analysis were to investigate (i) time trends and regional patterns of charcoal-burning suicide throughout East/Southeast Asia during the time period 1995-2011 and (ii) whether any rises in use of this method were associated with increases in overall suicide rates. Sex- and age-specific trends over time were also examined to identify the demographic groups showing the greatest increases in charcoal-burning suicide rates across different countries.

METHODS AND FINDINGS

We used data on suicides by gases other than domestic gas for Hong Kong, Japan, the Republic of Korea, Taiwan, and Singapore in the years 1995/1996-2011. Similar data for Malaysia, the Philippines, and Thailand were also extracted but were incomplete. Graphical and joinpoint regression analyses were used to examine time trends in suicide, and negative binomial regression analysis to study sex- and age-specific patterns. In 1995/1996, charcoal-burning suicides accounted for <1% of all suicides in all study countries, except in Japan (5%), but they increased to account for 13%, 24%, 10%, 7%, and 5% of all suicides in Hong Kong, Taiwan, Japan, the Republic of Korea, and Singapore, respectively, in 2011. Rises were first seen in Hong Kong after 1998 (95% CI 1997-1999), followed by Singapore in 1999 (95% CI 1998-2001), Taiwan in 2000 (95% CI 1999-2001), Japan in 2002 (95% CI 1999-2003), and the Republic of Korea in 2007 (95% CI 2006-2008). No marked increases were seen in Malaysia, the Philippines, or Thailand. There was some evidence that charcoal-burning suicides were associated with an increase in overall suicide rates in Hong Kong, Taiwan, and Japan (for females), but not in Japan (for males), the Republic of Korea, and Singapore. Rates of change in charcoal-burning suicide rate did not differ by sex/age group in Taiwan and Hong Kong but appeared to be greatest in people aged 15-24 y in Japan and people aged 25-64 y in the Republic of Korea. The lack of specific codes for charcoal-burning suicide in the International Classification of Diseases and variations in coding practice in different countries are potential limitations of this study.

CONCLUSIONS

Charcoal-burning suicides increased markedly in some East/Southeast Asian countries (Hong Kong, Taiwan, Japan, the Republic of Korea, and Singapore) in the first decade of the 21st century, but such rises were not experienced by all countries in the region. In countries with a rise in charcoal-burning suicide rates, the timing, scale, and sex/age pattern of increases varied by country. Factors underlying these variations require further investigation, but may include differences in culture or in media portrayals of the method. Please see later in the article for the Editors' Summary.

The effects of media reports of suicides by well-known figures between 1989 and 2010 in Japan

BACKGROUND

Many studies have shown that media reporting of suicide incidents can trigger suicidal behaviours in viewers and readers. Yet little is known about the exact timing and duration of the imitative effects.

METHODS

We estimated the Poisson regression model using original data on 109 celebrity suicides and daily suicide counts (n = 8035) in Japan from 1989 through 2010. Various fixed effects were included in the model to control for the effects of seasonal variations and time-specific shocks.

RESULTS

The media reports on celebrity suicides were associated with an immediate increase in total suicides. The total number of suicides increased by 4.6% (95% confidence interval (CI): 2.4-6.7) on the day that media reports on celebrity suicides were published. The increase during the post-report period lasted for about 10 days after the publication of news reports. The average effect of celebrity suicides on total suicides over the 10-day post-reporting period was estimated to be highest when the suicide by nationally recognized politicians was reported (14.8%; CI: 10.9-18.7), whereas reports on the deaths of entertainment celebrities were followed by a 4.7% increase (CI: 2.9-6.5) in suicide counts.

CONCLUSIONS

This study presents evidence that media reports on celebrity suicides have an immediate impact on the number of suicides in the general population. Our findings also highlight the importance of responsible and cautious media reporting on suicide.

The impact of indiscriminate media coverage of a celebrity suicide on a society with a high suicide rate: epidemiological findings on copycat suicides from South Korea

BACKGROUND

This study examines the extent to which the indiscriminate media coverage of the famous young actress Lee Eun-ju's suicide in 2005 affected suicides overall and in specific subgroups (by age, gender, and suicide method) in a suicide-prone society, South Korea.

METHODS

South Korea's 2003-2005 suicide data (n=34,237) were obtained from death certificate records of the National Statistical Office (NSO). Data was analyzed with Poisson time series auto-regression models.

RESULTS

After adjusting for confounding factors (such as seasonal variation, calendar year, temperature, humidity, and unemployment rate), there was a significant increase in suicide (RR=1.40, 95%, CI=1.30-1.51, no. of excess mortalities=331; 95% CI=267-391) during the 4 weeks after Lee's suicide. This increase was more prominent in subgroups with similar characteristics to the celebrity. In particular, the relative risk of suicide during this period was the largest (5.24; 95% CI=3.31-8.29) in young women who used the same suicide method as the celebrity. Moreover, the incidence of these copycat suicides during the same time significantly increased in both genders and in all age subgroups among those who committed suicide using the same method as the celebrity (hanging).

LIMITATIONS

It is difficult to prove conclusively that the real motivation of the suicides was Lee's death.

CONCLUSIONS

The findings from this study imply that, if the media indiscreetly reports the suicide of a celebrity in a suicide-prone society, the copycat effect can be far-reaching and very strong, particularly for vulnerable people.