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

Suicide on the Toronto Transit Commission subway system in Canada (1998-2021): a time-series analysis

Background

The Toronto Transit Commission (TTC) operates the public transit system in Toronto, Canada. From 1954 to 1980, there were 430 suicide deaths/attempts on the TTC subway system. In 2011, TTC implemented Crisis Link, a suicide helpline to connect subway passengers with counsellors. Upstream factors such as media reporting about suicide incidents may also influence suicidal behaviour. Our objectives were to investigate how Crisis Link and media reports about TTC suicide incidents influenced suicide rates.

Methods

Suicide data were obtained from the TTC and Coroner, with Crisis Link data provided by Distress Centres of Greater Toronto (1998-2021). Media articles were identified through a database search of Toronto media publications. Interrupted time-series analysis investigated the association between Crisis Link calls, media articles, and quarterly suicide rates on the subway system.

Findings

There were 302 suicides on TTC's subway system from 1998 to 2021. The introduction of Crisis Link was associated with a large but non-significant decrease in TTC-related suicide rate in the same quarter (IRR = 0.64, 95% CI = 0.36-1.12). Each subsequent post-Crisis-Link quarter experienced an average 2% increase in suicide rate (IRR = 1.02, 95% CI = 1.004-1.04). Furthermore, for each TTC-related media article in the previous quarter, the suicide rate on the TTC increased by 2% (IRR = 1.02, 95% CI = 1.004-1.04).

Interpretation

The Crisis Link helpline was associated with a large but non-significant short-term decrease in suicide rates. However, this outcome was not sustained; this may, in part, be attributable to media reporting which was associated with increased suicides. This should inform suicide prevention policies in Canada and worldwide.

Funding

No funding.

A machine learning approach to detect potentially harmful and protective suicide-related content in broadcast media

Suicide-related media content has preventive or harmful effects depending on the specific content. Proactive media screening for suicide prevention is hampered by the scarcity of machine learning approaches to detect specific characteristics in news reports. This study applied machine learning to label large quantities of broadcast (TV and radio) media data according to media recommendations reporting suicide. We manually labeled 2519 English transcripts from 44 broadcast sources in Oregon and Washington, USA, published between April 2019 and March 2020. We conducted a content analysis of media reports regarding content characteristics. We trained a benchmark of machine learning models including a majority classifier, approaches based on word frequency (TF-IDF with a linear SVM) and a deep learning model (BERT). We applied these models to a selection of more simple (e.g., focus on a suicide death), and subsequently to putatively more complex tasks (e.g., determining the main focus of a text from 14 categories). Tf-idf with SVM and BERT were clearly better than the naive majority classifier for all characteristics. In a test dataset not used during model training, F1-scores (i.e., the harmonic mean of precision and recall) ranged from 0.90 for celebrity suicide down to 0.58 for the identification of the main focus of the media item. Model performance depended strongly on the number of training samples available, and much less on assumed difficulty of the classification task. This study demonstrates that machine learning models can achieve very satisfactory results for classifying suicide-related broadcast media content, including multi-class characteristics, as long as enough training samples are available. The developed models enable future large-scale screening and investigations of broadcast media.

Changes in Media Reporting Quality and Suicides Following National Media Engagement on Responsible Reporting of Suicide in Canada: Changements de la Qualité des reportages dans les médias sur les suicides suite à l'engagement des médias nationaux à la déclaration responsable du suicide au Canada

OBJECTIVE

Responsible media reporting is an accepted strategy for preventing suicide. In 2015, suicide prevention experts launched a media engagement initiative aimed at improving suicide-related reporting in Canada; its impact on media reporting quality and suicide deaths is unknown.

METHOD

This pre-post observational study examined changes in reporting characteristics in a random sample of suicide-related articles from major publications in the Greater Toronto Area (GTA) media market. Articles (n = 900) included 450 from the 6-year periods prior to and after the initiative began. We also examined changes in suicide counts in the GTA between these epochs. We used chi-square tests to analyse changes in reporting characteristics and time-series analyses to identify changes in suicide counts. Secondary outcomes focused on guidelines developed by media professionals in Canada and how they may have influenced media reporting quality as well as on the overarching narrative of media articles during the most recent years of available data.

RESULTS

Across-the-board improvement was observed in suicide-related reporting with substantial reductions in many elements of putatively harmful content and substantial increases in all aspects of putatively protective content. However, overarching article narratives remained potentially harmful with 55.2% of articles telling the story of someone's death and 20.8% presenting an other negative message. Only 3.6% of articles told a story of survival. After controlling for potential confounders, a nonsignificant numeric decrease in suicide counts was identified after initiative implementation (ω = -5.41, SE  =  3.43, t  =  1.58, p  =  0.12).

CONCLUSIONS

We found evidence that a strategy to engage media in Canada changed the content of reporting, but there was only a nonsignificant trend towards fewer suicides. A more fundamental change in media narratives to focus on survival rather than death appears warranted.

Suicide-Related Media Reporting With a Focus on Sexual and Gender Minority Identities

Background: Little is known about the quality of media reports on suicide and prevention targeting persons with sexual or gender minority identities (LGBTQ+). Aims: To assess the quality of suicide-related media reporting of LGBTQ+ people and its consistency with media guidelines. Method: We conducted a content analysis of 5,652 media items in two US states (Washington and Oregon) published within 1 year. Results: There were only few differences in the reporting about suicide in LGBTQ+ as compared to non-LGBTQ+ reports. LGBTQ+ media items more often portrayed suicide as monocausal [Oregon: OR = 1.75, 95% CI (1.03-2.98), p = .038; Washington: OR = 3.00, 95% CI (1.81-4.97), p < .001] and linked them to adverse life experiences [OR = 2.16, 95% CI (1.38-3.38), p < .001; OR = 2.09, 95% CI (1.30-3.38), p = .002] than non-LGBTQ+ items. They also more often featured mental health experts [OR = 1.79, 95% CI (1.04-3.10), p = .034; OR = 2.12, 95% CI (1.23-3.67), p = .006] and contacts to support services [OR = 2.22, 95% CI (1.41-3.48), p < .001; OR = 2.70, 95% CI (1.64-4.45), p < .001]. Limitations: Aspects possibly influencing the portrayal of LGBTQ+ suicide and prevention beyond the characteristics listed were not investigated. Conclusion: Suicide-related media reporting related to LGBTQ+ issues features potentially beneficial aspects but tends to overlook multifactorial causes of suicide. Diverse factors contributing to LGBTQ+ suicide and prevention warrant greater attention.

"Breaking the Silence" Suicide Prevention Media Campaign in Oregon, April 7-14, 2019

Background: Between April 7 and 14, 2019, the "Breaking the Silence" media engagement campaign was launched in Oregon. Aims: We aimed to assess the consistency of media content related to the campaign with media guidelines and the quantitative footprint on Twitter (now X) over time. Method: Media items related to the campaign were analyzed regarding focus and consistency with media guidelines for suicide reporting and compared with other suicide-related reports published in the same time frame, as well as with reporting in Washington, the control region. Tweets related to the campaign were retrieved to assess the social media footprint. Results: There were n = 104 media items in the campaign month, mainly in the campaign week. Items typically used a narrative featuring suicide advocacy or policy/prevention programs. As compared to other items with a similar focus, they scored better on several protective characteristics listed in media recommendations. Stories of coping with adversity, however, were scarce. The social media footprint on Twitter was small. Limitations: Inability to make causal claims about campaign impact. Conclusion: Media items from the Breaking the Silence campaign appeared mainly consistent with media guidelines, but some aspects, such as stories of recovery, were under-represented.

Background and Rationale - CDC Guidance for Communities Assessing, Investigating, and Responding to Suicide Clusters, United States, 2024

To assist community leaders in public health, mental health, education, and other fields with developing a community response plan for suicide clusters or for situations that might develop into suicide clusters, in 1988, CDC published Recommendations for a Community Plan for the Prevention and Containment of Suicide Clusters (MMWR Suppl 1988;37[No. Suppl 6]:1-12). Since that time, the reporting and investigation of suicide cluster events has increased, and more is known about cluster risk factors, assessment, and identification. This supplement updates and expands CDC guidance for assessing, investigating, and responding to suicide clusters based on current science and public health practice. This report is the first of three in the MMWR supplement that describes an overview of suicide clusters, information about the other reports in this supplement, methods used to develop the supplement guidance, and the intended use of the supplement reports. The second report, CDC Guidance for Community Assessment and Investigation of Suspected Suicide Clusters - United States 2024, describes the potential methods, data sources and analysis that communities can use to identify and confirm suspected suicide clusters, and better understand the relevant issues. The final report, CDC Guidance for Community Response to Suicide Clusters - United States, 2024, describes how local public health and community leaders can develop a response plan for suicide clusters. The guidance in this supplement is intended as a conceptual framework that can be used by public health practitioners and state and local health departments to develop response plans for assessing and investigating suspected clusters that are tailored to the needs, resources, and cultural characteristics of their communities.

Best practice for integrating digital interventions into clinical care for young people at risk of suicide: a Delphi study

BACKGROUND

Digital tools have the capacity to complement and enhance clinical care for young people at risk of suicide. Despite the rapid rise of digital tools, their rate of integration into clinical practice remains low. The poor uptake of digital tools may be in part due to the lack of best-practice guidelines for clinicians and services to safely apply them with this population.

METHODS

A Delphi study was conducted to produce a set of best-practice guidelines for clinicians and services on integrating digital tools into clinical care for young people at risk of suicide. First, a questionnaire was developed incorporating action items derived from peer-reviewed and grey literature, and stakeholder interviews with 17 participants. Next, two independent expert panels comprising professionals (academics and clinical staff; n = 20) and young people with lived experience of using digital technology for support with suicidal thoughts and behaviours (n = 29) rated items across two consensus rounds. Items reaching consensus (rated as "essential" or "important" by at least 80% of panel members) at the end of round two were collated into a set of guidelines.

RESULTS

Out of 326 individual items rated by the panels, 188 (57.7%) reached consensus for inclusion in the guidelines. The endorsed items provide guidance on important topics when working with young people, including when and for whom digital tools should be used, how to select a digital tool and identify potentially harmful content, and identifying and managing suicide risk conveyed via digital tools. Several items directed at services (rather than individual clinicians) were also endorsed.

CONCLUSIONS

This study offers world-first evidence-informed guidelines for clinicians and services to integrate digital tools into clinical care for young people at risk of suicide. Implementation of the guidelines is an important next step and will hopefully lead to improved uptake of potentially helpful digital tools in clinical practice.

The role of monocausal versus multicausal explanations of suicide in suicide reporting: A randomized controlled trial

BACKGROUND

Media guidelines for reporting on suicide recommend that journalists should avoid monocausal explanations of suicide, but it is unclear if media items with monocausal explanations elicit different effects as compared to multicausal portrayals.

METHOD

Using a web-based randomized controlled trial (n = 969), we tested five versions of a news article about the suicide of a teenage girl with varying portrayals of reasons for the suicide: (1) bullying as the sole (external) factor (i.e., monocausal), (2) several external social factors, (3) a combination of internal and external factors, (4) a combination of internal and external factors along with a focus on suicide prevention, or (5) no reason for the suicide (control group). We measured perceptions about the cause of suicide, attitudes toward suicide and suicide prevention, and identification with the suicidal protagonist with questionnaires.

RESULTS

Readers of articles that portrayed suicide as being caused by one specific reason or exclusively social factors tended to adopt these misconceptions. Identification with the suicidal protagonist did not vary between interventions groups, but was lower in the control group.

CONCLUSION

Highlighting the multifactorial etiology of suicide in news articles may help to avoid the misconception that suicide is a monocausal issue.

The realities of Medical Assistance in Dying in Canada

OBJECTIVES

To examine the impact of the Canadian MAiD program and analyze its safeguards.

METHODS

A working group of physicians from diverse practice backgrounds and a legal expert, several with bioethics expertise, reviewed Canadian MAiD data and case reports. Grey literature was also considered, including fact-checked and reliable Canadian mainstream newspapers and parliamentary committee hearings considering the expansion of MAiD.

RESULTS

Several scientific studies and reviews, provincial and correctional system authorities have identified issues with MAiD practice. As well, there is a growing accumulation of narrative accounts detailing people getting MAiD due to suffering associated with a lack of access to medical, disability, and social support.

SIGNIFICANCE OF RESULTS

The Canadian MAiD regime is lacking the safeguards, data collection, and oversight necessary to protect Canadians against premature death. The authors have identified these policy gaps and used MAiD cases to illustrate these findings.

Suicide mortality in Portugal after 4 mediatized suicides from 1996 to 2020

Many international studies describe a relation between prominent and sensational suicide reporting and subsequent rises in suicide rates - the Werther effect -, especially when involving celebrities, but that relation has never been investigated in Portugal. In this article, we intend to examine whether there were increases in suicides in Portugal in the 3 and 5 months following four national mediatized suicides, including a triple youth suicide and the suicides of two famous entertainment celebrities and a well-known journalist. We used monthly suicide count data for Portugal from the National Institute of Statistics (INE) for the period of January 1990 to December 2020, stratified by sex, method, and age group. We conducted a Poisson regression model to determine if there were changes in suicide mortality in the 3 and 5 months after the selected suicides. We found statistically significant increases in total, male, and same age group suicides after the death of actor Pedro Lima and a rise in total, female, same age group, and poisoning suicides following the death of singer Cândida Branca Flor. However, in the latter case, the rises coincide with a major change in the suicide counting system. No such statistically significant increases in suicides were found in the months following the other two suicide cases, either by method, sex, or age group. Our findings show that the Werther Effect appears to occur in some, but not all, cases of mediatized suicides in Portugal, but these results should be considered amid several contextual factors. They provide an opportunity to alert media professionals to the importance of making suicide reporting in Portugal more responsible.

Systematic Review and Meta-analysis: International Prevalence of Suicidal Ideation and Attempt in Youth

OBJECTIVE

Globally, rates of youth suicide vary considerably. Suicidal thoughts and behaviors (STB) are consistently associated with risk of death by suicide. However, international trends in STB have not yet been compared. To address this gap, an international meta-analysis of epidemiological and school-based studies that report on STB in youth was conducted.

METHOD

Systematic searches were conducted in PubMed and PsycINFO through April 2022. Eligible studies included prevalence of active suicidal ideation (SI) or suicide attempts (SA) in community youth younger than age 22. All studies were coded by 2 authors. Mixed models accounting for shared methods and including hypothesized moderators were conducted using the metafor package in R.

RESULTS

There were 371 effect sizes for SI, 94 for SI with a plan, and 316 for SA, representing 149 regions. Year of data collection ranged from 1981 to 2021. Participants were 6 to 21 years old. The prevalence of SI ranged across regions from 14.3% to 22.6%; the prevalence of SA ranged from 4.6% to 15.8%. Year was not associated with increasing STB prevalence except for studies from the United States, which showed increasing rates of SI and SA since 2007.

CONCLUSION

This is the most comprehensive meta-analysis of STB in youth, providing valuable data about how risk factors most commonly associated with suicide vary internationally and over time. International rates of STB among youth are not improving and may be getting worse in the United States, despite efforts to reduce suicide risk. Most studies did not report rates of SI or SA separately for LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others) youth and youth of color. A better understanding of proximal risk at the individual level will be important to informing future prevention efforts, especially for high-risk groups.

Association of 7 million+ tweets featuring suicide-related content with daily calls to the Suicide Prevention Lifeline and with suicides, United States, 2016-2018

OBJECTIVE

The aim of this study was to assess associations of various content areas of Twitter posts with help-seeking from the US National Suicide Prevention Lifeline (Lifeline) and with suicides.

METHODS

We retrieved 7,150,610 suicide-related tweets geolocated to the United States and posted between 1 January 2016 and 31 December 2018. Using a specially devised machine-learning approach, we categorized posts into content about prevention, suicide awareness, personal suicidal ideation without coping, personal coping and recovery, suicide cases and other. We then applied seasonal autoregressive integrated moving average analyses to assess associations of tweet categories with daily calls to the US National Suicide Prevention Lifeline (Lifeline) and suicides on the same day. We hypothesized that coping-related and prevention-related tweets are associated with greater help-seeking and potentially fewer suicides.

RESULTS

The percentage of posts per category was 15.4% (standard deviation: 7.6%) for awareness, 13.8% (standard deviation: 9.4%) for prevention, 12.3% (standard deviation: 9.1%) for suicide cases, 2.4% (standard deviation: 2.1%) for suicidal ideation without coping and 0.8% (standard deviation: 1.7%) for coping posts. Tweets about prevention were positively associated with Lifeline calls (B = 1.94, SE = 0.73, p = 0.008) and negatively associated with suicides (B = -0.11, standard error = 0.05, p = 0.038). Total number of tweets were negatively associated with calls (B = -0.01, standard error  = 0.0003, p = 0.007) and positively associated with suicide, (B = 6.4 × 10-5, standard error  = 2.6 × 10-5, p = 0.015).

CONCLUSION

This is the first large-scale study to suggest that daily volume of specific suicide-prevention-related social media content on Twitter corresponds to higher daily levels of help-seeking behaviour and lower daily number of suicide deaths.

PREREGISTRATION

As Predicted, #66922, 26 May 2021.

Is the narrative the message? The relationship between suicide-related narratives in media reports and subsequent suicides

OBJECTIVES

When journalists report on the details of a suicide, the way that they contextualize the meaning of the event (i.e. the 'narrative') can have significant consequences for readers. The 'Werther' and 'Papageno' narrative effects refer to increases and decreases in suicides across populations following media reports on suicidal acts or mastery of crises, respectively. The goal of this study was to investigate the impact of these different narrative constructs on subsequent suicides.

METHODS

This study examined the change in suicide counts over time in Toronto, Canada. It used latent difference score analysis, examining suicide-related print media reports in the Toronto media market (2011-2014). Articles (N = 6367) were coded as having a potentially harmful narrative if they described suicide in a celebrity or described a suicide death in a non-celebrity and included the suicide method. Articles were coded as having potentially protective narratives if they included at least one element of protective content (e.g. alternatives to suicide) without including any information about suicidal behaviour (i.e. suicide attempts or death).

RESULTS

Latent difference score longitudinal multigroup analyses identified a dose-response relationship in which the trajectory of suicides following harmful 'Werther' narrative reports increased over time, while protective 'Papageno' narrative reports declined. The latent difference score model demonstrated significant goodness of fit and parameter estimates, with each group demonstrating different trajectories of change in reported suicides over time: (χ2[6], N = 6367) = 13.16; χ2/df = 2.19; Akaike information criterion = 97.16, comparative fit index = 0.96, root mean square error of approximation = 0.03.

CONCLUSION

Our findings support the notion that the 'narrative' matters when reporting on suicide. Specifically, 'Werther' narratives of suicides in celebrities and suicides in non-celebrities where the methods were described were associated with more subsequent suicides while 'Papageno' narratives of survival and crisis mastery without depictions of suicidal behaviours were associated with fewer subsequent suicides. These results may inform efforts to prevent imitation suicides.

Nigerian newspapers coverage of suicide: Assessment of adherence to WHO suicide reporting guidelines

Context

Despite an increase in research evidence on media compliance with suicide reporting guidelines globally, evidence from Nigeria seems to be relatively limited.

Aim

This study assessed the prevalence of World Health Organization (WHO) helpful/harmful suicide reporting cues in suicide stories reported by Nigerian newspapers in 2021.

Setting and Design

The setting is the entire Nigeria and the design is descriptive.

Method

Quantitative content analysis method was adopted and 205 online suicide-related stories from news portals of 10 purposefully selected newspapers were analyzed. The newspapers selected were among the top 20 in Nigeria and had higher circulation/coverage and considerable online presence. Evaluation framework was designed following moderated WHO guidelines.

Statistical Analysis Used

Descriptive statistics (frequencies and percentages) were used for the analysis.

Results

The study suggested high prevalence of harmful reporting and near absence of helpful suicide reporting cues among Nigerian newspapers. Majority of the stories, 95.6% mentioned suicide in the headline; 79.5% provided details on the suicide methods employed; 66.3% offered mono-causal explanation to suicide; and 59% featured images of suicide victims and/or suicide-related graphics. Helpful reporting cues were almost nonexistence as only less than 4% of the stories traced warning signs, reported mental health experts/professionals' opinions, featured research findings/population level statistics, and provided details on the identity/contact of suicide prevention programs/support services.

Conclusion

Prevalence of harmful suicide-reporting practice among Nigerian Newspaper presented a gloomy future for suicide prevention in the country. There be training and motivation programs for health/crime reporters/editors on responsive media coverage of suicide following (a domesticated) WHO guidelines.

Canadian news media coverage of suicide during the COVID-19 pandemic

PURPOSE

The COVID-19 pandemic led to concerns about increases in suicidal behaviour. Research indicates that certain types of media coverage of suicide may help reduce suicidality (the Papageno effect), while other types may increase suicidality (the Werther effect). This study aimed to examine the tone and content of Canadian news articles about suicide during the first year of the pandemic.

METHODS

Articles about suicide from Canadian news sources were collected and coded for adherence to responsible reporting of suicide guidelines. Articles which directly discussed suicidal behaviour in the COVID-19 context were identified and compared to other suicide articles in the same period. Lastly, a thematic analysis was conducted on the sub-sample of articles discussing suicide in the COVID-19 context.

RESULTS

The sub-set of articles about suicide in the COVID-19 context (n = 103) contained significantly more putatively helpful content compared to non-COVID-19 articles (n = 457), such as including help information (56.3% Vs 23.6%), quoting an expert (68.0% Vs 16.8%) and educating about suicide (73.8% Vs 24.9%). This lower adherence among non-COVID-19 articles is concerning as they comprised over 80% of the sample. On the plus side, fewer than 10% of all articles provided monocausal, glamourized or sensational accounts of suicide. Qualitative analysis revealed the following three themes: (i) describing the epidemiology of suicidal behaviour; (ii) discussing self and communal care; and (iii) bringing attention to gaps in mental health care.

CONCLUSION

Media articles about suicide during the first year of the pandemic showed partial adherence to responsible reporting of suicide guidelines, with room for improvement.

Associations of suicide-related media reporting characteristics with help-seeking and suicide in Oregon and Washington

OBJECTIVE

Specific content characteristics of suicide media reporting might differentially impact suicides in the population, but studies have not considered the overarching theme of the respective media stories and other relevant outcomes besides suicide, such as help-seeking behaviours.

METHODS

We obtained 5652 media reports related to suicide from 6 print, 44 broadcast and 251 online sources in Oregon and Washington states, published between April 2019 and March 2020. We conducted a content analysis of stories regarding their overarching focus and specific content characteristics based on media recommendations for suicide reporting. We applied logistic regression analyses to assess how focus and content characteristics were associated with subsequent calls to the US National Suicide Prevention Lifeline (Lifeline) and suicides in these two states in the week after publication compared to a control time period.

RESULTS

Compared to a focus on suicide death, a focus on suicidal ideation, suicide prevention, healing stories, community suicide crises/suicide clusters and homicide suicide was associated with more calls. As compared to a focus on suicide death, stories on suicide prevention and stories on community suicide crises/suicide clusters were also associated with no increase in suicides. Regarding specific content characteristics, there were associations that were largely consistent with previous work in the area, for example, an association of celebrity suicide reporting with increases in suicide.

CONCLUSION

The overall focus of a media story may influence help-seeking and suicides, and several story characteristics appear to be related to both outcomes. More research is needed to investigate possible causal effects and pathways.

Trends in suicide methods in Switzerland from 1969 to 2018: an observational study

BACKGROUND

Suicide is a serious societal and health problem. We examined changes in rates of completed suicides in Switzerland between 1969-2018 with particular regard to different methods of suicide used in different subgroups of the resident population.

METHODS

We used data of the Swiss cause of death statistics and Poisson regression models to analyse annual incidence rates and calendar time trends of specific suicide methods used in population subgroups by sex (men vs women), age (10-29, 30-64, >64 years), and nationality (Swiss vs other citizenship).

RESULTS

There were 64,996 registered suicides between 1969 and 2018. Across these 5 decades, the overall suicide rate was higher in men than in women (incidence rate ratio [IRR] 2.62, 95% confidence interval [CI] 2.58-2.67), in Swiss citizens than in foreigners (IRR 2.02; 95% CI 1.97-2.07), and in older residents (>64 years) than in the age groups 30-64 years (IRR 1.35, 95% CI 1.32-1.37) and 10-29 years (IRR 2.37, 95% CI 2.32-2.43). After peaking in the 1980s, the overall suicide rate had declined in all of these population subgroups, with flattening trends over most recent years. The most common specific methods of suicide were hanging (accounting for 26.7% of all suicides) and firearms (23.6%). The rates of the specific suicide methods were usually higher in men, in Swiss citizens and in older residents, and they had typically declined over most recent decades in the population subgroups examined. However, some methods diverged from this general pattern, at least in some population subgroups. For instance, railway suicides most recently increased in younger and in male residents whereas suicides by gas and by drowning were only at a low level after rapid declines in the last millennium.

CONCLUSIONS

Restricting access to lethal means (e.g., detoxification of domestic gas), improvements in health care and media guidelines for responsible reporting of suicides are possible explanations for the generally declining suicide rates in Switzerland. Whereas some methods (e.g., poisoning by gases or drowning) had become rare, others continue to account for many suicides every year, at least in some population subgroups (e.g., firearms in older Swiss men or railway suicides in younger and in male residents). As different methods of suicide are chosen by different people or subgroups of the population, preventive efforts should include differentiated strategies and targeted measures to further reduce suicides in Switzerland and elsewhere.

News reporting of suicide in nurses: A content analysis study

Media impact on suicide is well-established. Groups at heightened risk of suicide, such as nurses, may be particularly influenced by poor news reporting. This study aimed to examine UK newspaper reporting of suicide of nurses and student nurses, including during the COVID-19 pandemic. Print and online newspaper reports about suicide in nurses (including students) published in the UK between January 2018 and August 2021 were obtained and data extracted for analysis in collaboration with Samaritans' media advisory team. Content and quality of newspaper reports were examined using a content analysis approach. The study was compliant with the STROBE checklist. Nurse or student nurse suicides were reported in 134 articles, including 50 individual suicides. Most articles were acceptable against Samaritans' media guidelines. However, common problems included absence of signposting to support organizations and lack of suicide prevention messages. A minority of articles included methods of suicide within article headlines (18, 13.4%) and sensationalist or romanticizing language (14, 10.7%). Most contained occupation-related content. Many named the individual's specific hospital or university and a substantial proportion included occupation-related images. Working on the frontline was the most reported link between COVID-19 and nurse suicide. While reporting on suicide among nurses and students was largely acceptable, quality of reporting was variable. Occupation was often discussed, and most articles published during COVID-19 linked suicide to the pandemic. The research findings can help shape guidance on reporting of suicide in specific professions and occupations, including nursing, to encourage responsible reporting and reduce inadvertent promotion of suicide.

Detecting Potentially Harmful and Protective Suicide-Related Content on Twitter: Machine Learning Approach

Background

Research has repeatedly shown that exposure to suicide-related news media content is associated with suicide rates, with some content characteristics likely having harmful and others potentially protective effects. Although good evidence exists for a few selected characteristics, systematic and large-scale investigations are lacking. Moreover, the growing importance of social media, particularly among young adults, calls for studies on the effects of the content posted on these platforms.

Objective

This study applies natural language processing and machine learning methods to classify large quantities of social media data according to characteristics identified as potentially harmful or beneficial in media effects research on suicide and prevention.

Methods

We manually labeled 3202 English tweets using a novel annotation scheme that classifies suicide-related tweets into 12 categories. Based on these categories, we trained a benchmark of machine learning models for a multiclass and a binary classification task. As models, we included a majority classifier, an approach based on word frequency (term frequency-inverse document frequency with a linear support vector machine) and 2 state-of-the-art deep learning models (Bidirectional Encoder Representations from Transformers [BERT] and XLNet). The first task classified posts into 6 main content categories, which are particularly relevant for suicide prevention based on previous evidence. These included personal stories of either suicidal ideation and attempts or coping and recovery, calls for action intending to spread either problem awareness or prevention-related information, reporting of suicide cases, and other tweets irrelevant to these 5 categories. The second classification task was binary and separated posts in the 11 categories referring to actual suicide from posts in the off-topic category, which use suicide-related terms in another meaning or context.

Results

In both tasks, the performance of the 2 deep learning models was very similar and better than that of the majority or the word frequency classifier. BERT and XLNet reached accuracy scores above 73% on average across the 6 main categories in the test set and F₁-scores between 0.69 and 0.85 for all but the suicidal ideation and attempts category (F₁=0.55). In the binary classification task, they correctly labeled around 88% of the tweets as about suicide versus off-topic, with BERT achieving F₁-scores of 0.93 and 0.74, respectively. These classification performances were similar to human performance in most cases and were comparable with state-of-the-art models on similar tasks.

Conclusions

The achieved performance scores highlight machine learning as a useful tool for media effects research on suicide. The clear advantage of BERT and XLNet suggests that there is crucial information about meaning in the context of words beyond mere word frequencies in tweets about suicide. By making data labeling more efficient, this work has enabled large-scale investigations on harmful and protective associations of social media content with suicide rates and help-seeking behavior.

The Association Between Suicide-Related Media Coverage and Suicide: A Cross-Sectional Observational Study

OBJECTIVE

To examine the association between the publication and content of suicide-related media reports and actual suicide in Noord Brabant, a province of the Netherlands.

METHOD

Between April 2017 and March 2018, a retrospective cross-sectional observational study was conducted on suicide-related media reports and incident data regarding suicides. Linear regression, Mann-Whitney U and negative binomial regression analyses were conducted.

RESULTS

In Noord-Brabant, a total of 352 people died from suicide during the observation period and 440 reports were identified by using the search terms "suicide", "self-killing", and "self-murder". No associations between media reports and actual suicides were found for any of the analyses performed.

CONCLUSIONS

No indications were found for an association between media coverage of suicide and increases or decreases in actual suicides in Noord-Brabant. The descriptive statistics of this study reveal that the regional and national Dutch media are doing well with respect to not including elements in their reports that could encourage copycat behavior, such as simplifying, romanticizing or dramatizing. They could improve on including protective content, for example, providing supportive background information. A recommendation for further research is to evaluate causal relationships between media and actual suicide. A stepped wedge trial might be needed, as this provides an ethical research design to investigate this issue in a controlled setting. Also, in such a study, other variables influencing the decision to attempt suicide should be taken into account as much as possible.

Differences in Suicide-Related Twitter Content According to User Influence

Background: The content of suicide-specific social media posts may impact suicide rates, and putatively harmful and/or protective content may vary by the author's influence. Aims: This study sought to characterize how suicide-related Twitter content differs according to user influence. Method: Suicide-related tweets from July 1, 2015, to June 1, 2016, geolocated to Toronto, Canada, were collected and randomly selected for coding (n = 2,250) across low, medium, or high user influence levels (based on the number of followers, tweets, retweets, and posting frequency). Logistic regression was used to identify differences by user influence for various content variables. Results: Low- and medium-influence users typically tweeted about personal experiences with suicide and associations with mental health and shared morbid humor/flippant tweets. High-influence users tended to tweet about suicide clusters, suicide in youth, older adults, indigenous people, suicide attempts, and specific methods. Tweets across influence levels predominantly focused on suicide deaths, and few described suicidal ideation or included helpful content. Limitations: Social media data were from a single location and epoch. Conclusion: This study demonstrated more problematic content vis-à-vis safe suicide messaging in tweets by high-influence users and a paucity of protective content across all users. These results highlight the need for further research and potential intervention.

Media coverage of Canadian Veterans, with a focus on post traumatic stress disorder and suicide

BACKGROUND

A large corpus of research indicates that the media plays a key role in shaping public beliefs, opinions and attitudes towards social groups. Some research from the United States indicates that military Veterans are sometimes framed in a stereotypical and stigmatizing manner, however there is a lack of research on Canadian media coverage of Veterans. As such, the overarching aim of this study is to assess the tone and content of Canadian media coverage of military Veterans, with a focus on PTSD and suicide. The first objective is to document and analyze common themes, content and temporal patterns in Canadian media coverage of Veterans per se. The second objective is to examine common themes and content in the sub-set of articles having PTSD as a theme. The third objective is to assess adherence to responsible reporting of suicide guidelines in the sub-set of articles having suicide as a theme.

METHODS

We used validated and systematic methods including use of key words, retrieval software and inter-rater reliability tests to collect and code news articles (N = 915) about Veterans from over 50 media sources during a 12-month period, with specific coding of articles about PTSD (N = 93) and suicide (N = 61).

RESULTS

Analysis revealed that the most common theme is 'honour or commemoration of Veterans' which occurred in over half of the articles. In contrast 14% of articles focused on danger, violence or criminality. In the sub-set of articles with PTSD as a theme, over 60% focused on danger, violence or criminality, while only around 1 in 3 focused on recovery, rehabilitation, or health/social service intervention. In the sub-set of articles about suicide, there was generally strong adherence to responsible reporting guidelines, though less than 5% gave help-seeking information. Moreover, most reporting on PTSD and suicide focused on a single anomalous murder-suicide incident, with few articles about suicide prevention, helpful resources and modifiable risk factors.

CONCLUSIONS

The results reveal some encouraging findings as well as a need to diversify media coverage of Canadian Veterans. This could be achieved through targeted educational outreach to help Canadian journalists responsibly report on Veterans and their mental health issues.

Effect of suicide prevention law and media guidelines on copycat suicide of general population following celebrity suicides in South Korea, 2005-2017

OBJECTIVE

To prevent copycat suicides following media reporting of celebrity suicides, the South Korean government enacted a 'suicide prevention law' in 2012 and revised the media guidelines for suicide reporting in 2013. This study examined how these two regulatory measures affected suicide trends among the general population in South Korea.

METHODS

We analyzed the individual effect estimates for the general population within 30 days following the media report of 24 celebrity suicides using multivariate negative binomial regression. We performed a meta-analysis to compute the pooled rate ratios of the two regulations. We examined the trends in daily suicides by month during three time intervals before and after enactment using an autoregressive model and tested their significance using a piecewise linear regression.

RESULTS

Total suicides increased by 6.27 daily during the 30-day period after celebrity suicides. Compared with the 30 days prior to the reports on the suicide of 24 celebrities, the number of suicidal deaths in the general population increased by 13% during the 30 days after the reports were announced (pooled rate ratio 1.13, 95% confidence interval: 0.06-0.18; p < 0.001). There was a significant downward trend in the average daily suicide deaths, and no significant increase in suicide rates, after the enactment of the suicide prevention law (p < 0.001) and revision of the media guidelines (p = 0.014).

CONCLUSIONS

Suicide prevention and media guidelines were effective in reducing the effect of celebrity suicides. In addition to regulating media reporting of celebrity suicide, measures are needed to address viral republication on social media and to prevent suicide among entertainers.

The Tool for Evaluating Media Portrayals of Suicide (TEMPOS): Development and Application of a Novel Rating Scale to Reduce Suicide Contagion

Research suggests that media adherence to suicide reporting recommendations in the aftermath of a highly publicized suicide event can help reduce the risk of imitative behavior, yet there exists no standardized tool for assessing adherence to these standards. The Tool for Evaluating Media Portrayals of Suicide (TEMPOS) allows media professionals, researchers, and suicide prevention experts to assess adherence to the recommendations with a user-friendly, standardized rating scale. An interdisciplinary team of raters constructed operational definitions for three levels of adherence to each of the reporting recommendations and piloted the scale on a sample of articles to assess reliability and clarify scale definitions. TEMPOS was then used to evaluate 220 news articles published during a high-risk period following the suicide deaths of two public figures. Post-hoc analyses of the results demonstrated how data produced by TEMPOS can be used to inform research and public health efforts, and inter-rater reliability analyses revealed substantial agreement across raters and criteria. A novel, wide-reaching, and practical approach to suicide prevention, TEMPOS allows researchers, suicide prevention professionals, and media professionals to study how adherence varies across contexts and can be used to guide future efforts to decrease the risk of media-induced suicide contagion.

A Pilot Case-Control Study of the Social Media Activity Following Cluster and Non-Cluster Suicides in Australia

Social media may play a role in the "contagion" mechanism thought to underpin suicide clusters. Our pilot case-control study presented a novel methodological approach to examining whether Facebook activity following cluster and non-cluster suicides differed. We used a scan statistic to identify suicide cluster cases occurring in spatiotemporal clusters and matched each case to 10 non-cluster control suicides. We identified the Facebook accounts of 3/48 cluster cases and 20/480 non-cluster controls and their respective friends-lists and retrieved 48 posthumous posts and replies (text segments) referring to the deceased for the former and 606 for the latter. We examined text segments for "putatively harmful" and "putatively protective" content (e.g., discussion of the suicide method vs. messages discouraging suicidal acts). We also used concept mapping, word-emotion association, and sentiment analysis and gauged user reactions to posts using the reactions-to-posts ratio. We found no "putatively harmful" or "putatively protective" content following any suicides. However, "family" and "son" concepts were more common for cluster cases and "xx", "sorry" and "loss" concepts were more common for non-cluster controls, and there were twice as many surprise- and disgust-associated words for cluster cases. Posts pertaining to non-cluster controls were four times as receptive as those about cluster cases. We hope that the approach we have presented may help to guide future research to explain suicide clusters and social-media contagion.

Suicide Risk in Emerging Adulthood: Associations with Screen Time over 10 years

Suicide rates have increased over the past decade, and screen media (and social media in particular) are often blamed for this marked increase. However, there is little longitudinal research on this topic. The current study examined the link between various types of screen media use over a 10-year period (from adolescence to emerging adulthood) to suicide risk in emerging adulthood. Participants included 500 adolescents (51% female) who were first surveyed in 2009, when they were an average of 13.82 years old (range 12-15 years). For girls, a high level of social media or television use in early adolescence followed by a marked increase over time was most predictive of suicide risk in emerging adulthood. Additionally, video game use that increased over time was also associated with a higher risk for developing suicide risk for girls. A passive sensing measurement was also included at the final wave of data collection to obtain a more accurate and complete picture of phone use in particular. The use of entertainment apps was risky for girls while reading apps were risky for boys. Additionally, video game use (for boys) was associated with suicide risk when cyberbullying was also high. Identifying nonnormative patterns of media during adolescence may be instructive in terms of suicide prevention efforts.

Physician Suicide Prevention and the Ethics and Role of a Healing Community: an American College of Physicians Policy Paper

Suicide is a major global public health issue, and in recent years, there has been increasing recognition of the problem of physician suicide. This American College of Physicians policy paper examines, from the perspective of ethics, the issues that arise when individuals and institutions respond to physician suicides and when they engage in broader efforts aimed at physician suicide prevention. Emphasizing the medical profession as a unique moral community characterized by ethical and professional commitments of service to patients, each other, and society, this paper offers guidance regarding physician suicide and the role of a healing community. The response to an individual physician suicide should be characterized by respect and concern for those who are grieving, the creation of a supportive environment for suicide loss survivors, and careful communication about the event. Because suicide is a complex problem, actions aimed at preventing suicide must occur at the individual, interpersonal, community, and societal levels. The medical community has an obligation to foster a culture that supports education, screening, and access to mental health treatment, beginning at the earliest stages of medical training.

News reporting of suicidal behaviour in Nigeria: Adherence assessment to World Health Organization guidelines

BACKGROUND

Sensible media reporting has been considered an important suicide prevention strategy which is an under-researched issue in Nigeria. There is a dearth of research assessing how the media has been reporting suicidal news to the general population in Nigeria.

AIM

It was aimed to see the adherence of news reports to the World Health Organization (WHO) suicide reporting guidelines while reporting the events.

METHODS

We searched the published contents of 10 English newspapers of Nigeria and assessed the adherence to the WHO media guidelines for reporting suicide from January 2010 to December 2019.

RESULTS

Most of the reports (85.31%) mentioned completed suicides, 4.4% recorded suicides, and 9.5% recorded suicide-related homicides. The majority of the reports mentioned the name (85.6%) and profession (63.8%) of the person; the name of the method (92%) and life events (67.8%). The word 'suicide' was mentioned in the headline of 87.6% of the reports; the method was mentioned in the headline of 22.8% of the reports, and 31.7% of the reports referred to life events in the headline. Only 8.8% of reports had traced mental illness, 33.3% traced the warning signs, 2.8% mentioned evidence of substance abuse and very few reports mentioned educative materials.

CONCLUSION

The study found that Nigeria's online newspapers are poorly adherent to the WHO media reporting guidelines. Explicit descriptions of the person, methods, life events, and mono-causal explanations were frequently published. Negligible initiatives have been found to educate the general people in the reports.

Online media reporting of suicidal behaviour in Ghana: Analysis of adherence to the WHO guidelines

BACKGROUND

Irresponsible media reporting of suicide is a potential risk for copycat suicide. There is a paucity of studies from sub-Saharan Africa on the quality of media reporting of suicide.

OBJECTIVES

We assessed the compliance of Ghanaian online media outlets with the World Health Organization (WHO) guidelines for media reporting of suicide.

METHODS

We searched 10 local media outlets with strong online presence in Ghana, to identify suicide-related news reports from 2000 through 2019. We applied summative content analysis and chi-square (χ2) test to the data.

RESULTS

We included 288 news reports, of which 261 (90.6%) were completed suicides, 7 (2.4%) were attempted suicides and 20 (6.9%) were homicide suicides. Most of the news reports failed to comply with the WHO guidelines: 92.7% mentioned the specific method of the suicide act, 82.6% included 'suicide' in the headline and 55.6% included photos of the victims. The χ2 tests indicated that privately owned media outlets were more likely than publicly owned to post a photo of the victim, χ2(1) = 17.37, p < .001, and report the incident location in the headline, χ2(1) = 15.00, p < .001. However, generally, there were no statistically significant relationships between the quality of reporting and media outlet ownership. Each of the 288 reports failed to mention any of the potentially helpful features recommended by the WHO guidelines.

CONCLUSION

Regardless of the ownership of the media outlet (whether private or publicly owned), mostly, the online reportage of suicidal behaviour in Ghana deviates sharply from the international recommended best practice by the WHO.

Suicide-related Twitter Content in Response to a National Mental Health Awareness Campaign and the Association between the Campaign and Suicide Rates in Ontario

OBJECTIVE

Mental health awareness (MHA) campaigns have been shown to be successful in improving mental health literacy, decreasing stigma, and generating public discussion. However, there is a dearth of evidence regarding the effects of these campaigns on behavioral outcomes such as suicides. Therefore, the objective of this article is to characterize the association between the event and suicide in Canada's most populous province and the content of suicide-related tweets referencing a Canadian MHA campaign (Bell Let's Talk Day [BLTD]).

METHODS

Suicide counts during the week of BTLD were compared to a control window (2011 to 2016) to test for associations between the BLTD event and suicide. Suicide tweets geolocated to Ontario, posted in 2016 with the BLTD hashtag were coded for specific putatively harmful and protective content.

RESULTS

There was no associated change in suicide counts. Tweets (n = 3,763) mainly included content related to general comments about suicide death (68%) and suicide being a problem (42.8%) with little putatively helpful content such as stories of resilience (0.6%) and messages of hope (2.2%).

CONCLUSIONS

In Ontario, this national mental health media campaign was associated with a high volume of suicide-related tweets but not necessarily including content expected to diminish suicide rates. Campaigns like BLTD should strongly consider greater attention to suicide-related messaging that promotes help-seeking and resilience. This may help to further decrease stigmatization, and potentially, reduce suicide rates.

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.

The association between Twitter content and suicide

OBJECTIVE

A growing body of research has established that specific elements of suicide-related news reporting can be associated with increased or decreased subsequent suicide rates. This has not been systematically investigated for social media. The aim of this study was to identify associations between specific social media content and suicide deaths.

METHODS

Suicide-related tweets (n = 787) geolocated to Toronto, Canada and originating from the highest level influencers over a 1-year period (July 2015 to June 2016) were coded for general, putatively harmful and putatively protective content. Multivariable logistic regression was used to examine whether tweet characteristics were associated with increases or decreases in suicide deaths in Toronto in the 7 days after posting, compared with a 7-day control window.

RESULTS

Elements independently associated with increased subsequent suicide counts were tweets about the suicide of a local newspaper reporter (OR = 5.27, 95% CI = [1.27, 21.99]), 'other' social causes of suicide (e.g. cultural, relational, legal problems; OR = 2.39, 95% CI = [1.17, 4.86]), advocacy efforts (OR = 2.34, 95% CI = [1.48, 3.70]) and suicide death (OR = 1.52, 95% CI = [1.07, 2.15]). Elements most strongly independently associated with decreased subsequent suicides were tweets about murder suicides (OR = 0.02, 95% CI = [0.002, 0.17]) and suicide in first responders (OR = 0.17, 95% CI = [0.05, 0.52]).

CONCLUSIONS

These findings largely comport with the theory of suicide contagion and associations observed with traditional news media. They specifically suggest that tweets describing suicide deaths and/or sensationalized news stories may be harmful while those that present suicide as undesirable, tragic and/or preventable may be helpful. These results suggest that social media is both an important exposure and potential avenue for intervention.

Quality of Newspaper Reporting of Suicide in Kashmir: Adherence to World Health Organization Guidelines

Background: Sensible media reporting of suicide is one of the important prevention strategies. However, there has been no report assessing the quality of media reporting of suicide in Kashmir, India.Aim: We aimed to assess the quality of newspaper reporting of suicide in Kashmir, India against the World Health Organization (WHO) reporting guidelines.Methods: We searched the available contents in four English and two Urdu newspapers of Jammu Kashmir and assessed the adherence to the WHO media guidelines. We collected the reports between 25 January 2016 and 18 September 2020.Results: A total of 152 reports were scrutinized. Almost all the reports mentioned the name of the person and the method of suicide (99.34%), occupation (85.53%) of the person. The life events were mentioned in 35.53% of the reports. Among the reports, 38.82% explained suicide on the basis of the mono-causality, and 3.95% mentioned suicide notes. Only 3.29% of reports had traced mental illness, and none of the reports mentioned evidence of substance abuse. Only three reports mentioned expert opinion, and none of the reports mentioned any research findings, statistics, prevention programs, educational information, and contact information for help.Conclusion: The study revealed that news reports of suicide in Kashmir adhere poorly to the WHO media reporting guidelines. Identifying information of the deceased was explicitly mentioned in almost every report while almost none of the reports mentioned educational information.

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

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

Coverage of Robin Williams' Suicide in Australian Newspapers

Background: Australia's Mindframe guidelines provide media professionals with advice on ways to safely report on suicide. Aims: We aimed to examine the extent to which Australian newspaper articles on Robin Williams' suicide conformed to the Mindframe recommendations. Method: We searched Factiva for relevant articles appearing in Australian newspapers during the 5 months following Williams' death on August 11, 2014. We retrieved the text of these articles from Factiva and, wherever possible, sourced scanned copies from the National Library of Australia. Trained coders rated the articles for quality, using a 10-item coding framework derived from the Mindframe guidelines. Results: Our search yielded 303 articles. In general, there were high levels of adherence to the Mindframe guidelines, with 67% of articles adhering to at least eight (80%) of the Mindframe guidelines. Limitations: We may have missed some articles and the coders' task involved some subjective judgments. Conclusion: Australian newspaper reporting of Robin Williams' suicide was largely consistent with the Mindframe guidelines. In particular, there was good adherence to recommendations designed to minimize the risk of imitative acts, which is positive. The poorer performance of articles in terms of recommendations to do with public education about suicide may be a missed opportunity.

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

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

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Changes in Suicide Reporting Quality and Deaths in Ontario Following Publication of National Media Guidelines

Background: Media guidelines can influence suicide-related reporting quality and may impact suicide rates. Aim: Our study aimed to investigate the quality of suicide-related reporting after the release of the 2009 Canadian Psychiatric Association (CPA) guidelines and their impact on suicides. Method: A random sample of suicide-related articles (n = 988) were retrieved from 12 major Canadian print/online publications (2002-2015). Articles were coded for quality of content before and after guidelines release. Suicide mortality data were obtained from Ontario coroner records. Time series analyses were used to identify associations between guideline publication and subsequent suicides. Results: The CPA guidelines were associated with improvements in reporting quality with 10 putatively harmful elements being less frequent after their publication. These included less frequent front-page articles, monocausal (simplistic) explanations for suicide, and depictions of suicide methods. Two putatively protective factors, alternatives to suicide and messages of hope, were twice and four times as common, respectively, after the guidelines. The guidelines were not associated with a change in suicide counts. Limitations: This study could not prove exposure to suicide reporting. Conclusion: Publication of Canadian media guidelines was associated with significant, moderate-sized improvements in reporting quality but not with decreased suicides. The latter finding may reflect only modest dissemination and implementation of the guidelines.

Media guidelines and suicide: A critical review

By providing information on help-seeking resources (HSR), Google's Suicide Prevention Results (SPR) fill a void, because less than 30% of news reports provide such information. This article addresses larger issues on media guidelines and suicide prevention. First, studies on the effects of providing HSR provide little support for a reduction in suicide. Second, research on the effects of other media guidelines often does not report the anticipated reductions in suicide. Third, although research does tend to support an increase in suicide after publicized suicides of celebrities, it does not necessarily happen for all categories of celebrity suicides. Fourth, there has been a lack of integration of (a) research on imitative effects of publicized suicides and (b) content analysis of stories' adherence to guidelines. Fifth, an associated puzzle is that (a) most research findings (64.2%) show no increase in suicide rates after suicide stories, while (b) most content analyses document widespread violations of media guidelines. Apparently, stories often violate media guidelines, but there is often no anticipated increase in suicide deaths. Rigorous research is needed to fully evaluate which media guidelines matter, and to determine the efficacy of Google's SPR program.

13 Reasons Why: The Evidence Is in and Cannot Be Ignored

Decades of research overwhelmingly supports the public health necessity of safe, balanced, and responsible news media reporting on suicide.^1,2 When news media follow recommendations for safe reporting, the risk of copycat suicide decreases.³ The Recommendations for Media Reporting on Suicide were developed by leading experts in suicide prevention and in collaboration with several international suicide prevention and public health organizations, schools of journalism, media organizations, and key journalists, as well as Internet safety experts (www.reportingonsuicide.org). The recommendations are based on more than 100 international studies on suicide contagion. Furthermore, in recent years, Niederkrotenthaler and others have specifically examined suicide-related media portrayals focused on messages of hope, recovery, or mastery over a crisis. Research demonstrates that following such portrayals, those exposed experience a decrease in suicidal ideation, diminished distress, and an increased sense of hope.^4,5 Importantly, in some cases, fewer suicides are observed across the exposed population.¹ In other words, both suicide and resilience are contagious behaviors, and the content of suicide-related news media messaging can and does prevent tragic deaths.

Assessing Adherence to Responsible Reporting of Suicide Guidelines in the Canadian News Media: A 1-year Examination of Day-to-day Suicide Coverage: Évaluer la conformité au journalisme responsable en matière de directives sur le suicide dans les médias canadiens d'information: Un examen d'une année de la couverture quotidienne du suicide

OBJECTIVE

This study aims to examine routine day-to-day suicide reporting in the Canadian media, giving a descriptive overview of the tone and content of news articles. The primary objective is to assess adherence to responsible reporting of suicide recommendations in news articles about suicide. A secondary objective is to categorize these articles according to their focus. A tertiary objective is to compare guideline adherence across the different categories of articles.

METHODS

We collected news articles containing the keyword "suicide" from 47 Canadian news sources between April 1, 2019, and March 31, 2020. Articles were read and coded for their adherence to responsible reporting of suicide recommendations. Articles were also allotted into categories according to their focus and primary suicide discussed. Frequency counts and percentages of adherence were calculated for all key variables-both overall and by category of article. Chi-square tests were also conducted to assess for variations in adherence by category of article.

RESULTS

The procedures resulted in 1,330 coded articles. On the one hand, there was high overall adherence to several recommendations. For example, over 80% of articles did not give a monocausal explanation, glamourize the death, appear on the front page, include sensational language, or use discouraged words. On the other hand, there was low adherence to other recommendations, especially those related to putatively protective content. For example, less than 25% included help-seeking information, quoted an expert, or included educational content. Cross-category analysis indicated that articles about events/policies/research and Indigenous people had the highest proportions of adherence, while articles about murder-suicide and high-profile suicides had the lowest adherence.

CONCLUSIONS

While a substantial proportion of articles generally adhere to suicide reporting recommendations, several guidelines are frequently underapplied, especially those concerning putatively helpful content. This indicates room for improvement in the responsible reporting of suicide.

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

BACKGROUND

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

METHOD

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

RESULTS

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

LIMITATIONS

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

CONCLUSION

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

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.

Participatory model building for suicide prevention in Canada

Background

Suicide is a behaviour that results from a complex interplay of factors, including biological, psychological, social, cultural, and environmental factors, among others. A participatory model building workshop was conducted with fifteen employees working in suicide prevention at a federal public health organization to develop a conceptual model illustrating the interconnections between such factors. Through this process, knowledge emerged from participants and consensus building occurred, leading to the development of a conceptual model that is useful to organize and communicate the complex interrelationships between factors related to suicide.

Methods

A model building script was developed for the facilitators to lead the participants through a series of group and individual activities that were designed to elicit participants' implicit models of risk and protective factors for suicide in Canada. Participants were divided into three groups and tasked with drawing the relationships between factors associated with suicide over a simplified suicide process model. Participants were also tasked with listing prevention levers that are in use in Canada and/or described in the scientific literature.

Results

Through the workshop, risk and prevention factors and prevention levers were listed and a conceptual model was drafted. Several "lessons learned" which could improve future workshops were generated through reflection on the process.

Conclusions

This workshop yielded a helpful conceptual model contextualising upstream factors that can be used to better understand suicide prevention efforts in Canada.

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.