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

The Association Between Media Exposure to Non Suicidal Self-Injury and Emergency Department Visits for Self-Harm

OBJECTIVE

This study aimed to evaluate the association between media exposure to non suicidal self-injury (NSSI) and emergency department (ED) visits due to self-harm in Korea, specifically before and after the initial broadcast of the song Barcode, which has an explicit focus on NSSI.

METHOD

We used the national emergency department information system to obtain data related to ED visits due to self-harm between January 1, 2014, and December 31, 2018. Using interrupted time series regression analysis, we assessed the monthly ED visits due to self-harm before and after the media exposure to NSSI on March 30, 2018. In addition, self-harm methods were assessed.

RESULTS

A total of 35,928,834 visits to ED were identified, of which 115,647 were due to self-harm. ED visits due to self-harm showed a significant step increase in the 10- to 14-year-old (β = 0.883, p = .001), 15- to 19-year-old (β = 2.941, p < .001), 20- to 24-year-old (β = 1.997, p = 0.002), and 25- to 29-year-old (β = 1.438, p = .029) age groups, before and after the media exposure to NSSI. The most pronounced increase was observed in male participants aged 20 to 24 years (β = 1.790, p = .012) and female participants aged 15 to 19 years (β = 5.158, p < .001). Self-harm by cutting has increased significantly in participants aged 10 to 29 years, and self-harm by poisoning has also increased significantly in participants aged 10 to 19 and 25 to 29 years.

CONCLUSION

ED visits due to self-harm increased significantly, especially in adolescents and young adults, following the exposure to NSSI. Responsible media reporting on NSSI and appropriate guidelines would help prevent a further increase in self-harm.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Shifting attitudes toward suicide over time: A latent profile analysis using the Korea National Suicide Survey

Introduction

South Korea has a high suicide rate, and changes in sociodemographic factors can further increase the rate. This study aims to (1) classify participants using the Attitudes toward Suicide Scale (ATTS) through latent profile analysis (LPA), (2) identify and compare the associations between sociodemographic factors with the ATTS in two survey years (2013, 2018), and (3) determine the moderating effect of survey year.

Methods

Six sub-factors of the ATTS were used for LPA with a total of 2,973 participants. Sociodemographic characteristics were compared between groups, and multinomial logistic regression was conducted for each survey year. A moderation analysis was conducted with the survey year as moderator.

Results

LPA identified three groups of attitudes toward suicide: incomprehensible (10.3%), mixed (52.8%), and permissive (36.9%). The proportion of permissive attitudes increased from 2013 (32.3%) to 2018 (41.7%). Participants reporting suicidal behavior were more likely to be in the mixed and permissive groups than the incomprehensible group in both years. People reporting no religious beliefs were associated with the permissive group in the two survey years. The influence of education and income levels on groups differed by survey year.

Discussion

There were significant changes between 2013 and 2018 in attitudes toward suicide in the Korean population.

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 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.

Risks of suicide attempts after prescription of zolpidem in people with depression: a nationwide population study in South Korea

OBJECTIVES

To investigate the association between zolpidem prescription and suicide attempts in people with depression.

METHODS

A nationwide, population-based electronic medical records database from the Health Insurance Review & Assessment Service of South was used to investigate the incidence rate ratios (IRRs) of suicide attempts and probable suicide attempts in people with depression before and after zolpidem prescription using self-controlled case series design.

RESULTS

In a total of 445 people who attempted suicide and 23 141 people who attempted probable suicide attempt, the IRRs of suicidal behavior during the risk periods before and after zolpidem prescription increased compared with those at the baseline. The IRRs gradually increased and peaked immediately before the prescription of zolpidem. The IRR was 70.06 (95% CI: 25.58-191.90) on day 2 before zolpidem prescription and 63.35 (95% CI: 22.99-174.59) on day 1 after zolpidem prescription in the suicide attempt group. The IRR was 24.07 (95% CI: 20.50-28.26) on the day before zolpidem prescription and 14.96 (95% CI: 12.21-18.34) on the day after zolpidem prescription in the probable suicide attempt group. The ratios declined eventually after zolpidem was prescribed.

CONCLUSIONS

Although zolpidem prescription was associated with an increased risk of suicide attempts in people with depression, the risk increased and peaked immediately before zolpidem prescription. The risk declined gradually thereafter. This result indicates that the risk of suicide attempts increases at the time of zolpidem prescription. However, zolpidem prescription does not contribute to additional increase in the risk of suicide attempts.

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

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Higher celebrity worship predict self-injury and suicide attempts.

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

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

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Celebrity worshipers are more likely to encounter severe excesses.

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

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.

Suicide Mortality in Canada after the Death of Robin Williams, in the Context of High-Fidelity to Suicide Reporting Guidelines in the Canadian Media

BACKGROUND

Evidence suggests that suicide mortality increases after high-profile suicide deaths. Indeed, suicide in the United States increased disproportionately after the suicide by suffocation of well-known comedian Robin Williams in August 2014. Such increases are often attributed to irresponsible media coverage of the suicide contributing to "copycat suicides." However, recent research indicates that the mainstream Canadian media have significantly improved their suicide coverage, with high fidelity to suicide reporting guidelines after Williams' death. As such, the aim of the present study is to examine suicide mortality in Canada after Robin Williams' suicide.

METHODS

We obtained deidentified monthly suicide count data from January 1999 to December 2015 stratified by age, sex, and method of suicide from Statistics Canada. We used time-series analyses to estimate the expected number of suicides in the months following Robin Williams' death. This was done using a seasonal autoregressive integrated moving averages (SARIMA) method. Expected suicides were then compared with observed suicides.

RESULTS

August 2014 was the month with the highest number of suicides from 2010 to 2015. The time-series model indicated a 16% increase in the expected number of suicides during the months from August to December 2014 inclusive. Moreover, males over 30 had the greatest number of excess suicides, and suicides by suffocation (the method used by Robin Williams) were also higher in August and the following months.

INTERPRETATION

Suicides increased in Canada after Robin Williams' death, despite the improved mainstream media coverage witnessed in other studies. Other factors (e.g., social and alternative media) may have contributed to the observed increase in suicide.

Multiple types of somatic pain increase suicide attempts and depression: A nationwide community sample of Korean adults

OBJECTIVE

Somatic pain is an important risk factor for suicide and suicidal behaviors. However, the association between the number of somatic pain conditions and lifetime suicide attempts (LSA) has not been well established yet. Therefore, the objective of this study was to examine associations between LSA and multiple somatic pain (MSP), singe pain, and no pain in a nationwide survey.

METHODS

A total of 12,532 adults were randomly selected from the population using the one-person-per-household method. Each participant completed a face-to-face interview using the Korean Composite International Diagnostic Interview (K-CIDI) with Suicide Module, and the Barratt Impulsiveness Scale 11 (BIS-11). The MSP was defined as pain in two or more parts of one's body, including abdominal pain, back pain, arthralgia, arm or leg pain, chest pain, headache, menstrual pain, dysuria, genital pain, and other pain.

RESULTS

Among 12,532 subjects, 858 (6.85%) had MSP. Among the three groups (MSP, single pain, and no pain) of subjects, the MSP group had higher percentages of females, those with lower education, and divorced/widowed/separated individuals. However, there were no significant differences in monthly income or residence among the three groups. The MSP group showed four times higher suicide attempts and six times higher multiple attempts than did the no pain group. The BIS total score of the MSP group was the highest among the three groups. Genital pain showed the highest odds ratio for LSA. The higher the number of somatic pain, the higher the odds ratios were for LSA, major depressive disorder (MDD), and anxiety disorders. Subjects having both MSP and MDD showed a significant association with LSA (AOR = 14.78, 95% CI 10.08-21.67, p < 0.001) compared to those having neither somatic pain nor MDD.

CONCLUSIONS

MSP was significantly associated with LSA. It had greater prevalence among individuals reporting a higher number of somatic pain conditions and comorbid MDD.

Risks of Completed Suicide of Community Individuals with ICD-10 Disorders Across Age Groups: A Nationwide Population-Based Nested Case-Control Study in South Korea

OBJECTIVE

Suicide is the leading cause of death in 10-39-year-olds in South Korea, and the second highest rate among the OECD countries. However, few studies have investigated the particularity of completed suicide in South Korea.

METHODS

Study subjects consisted of 2,838 suicide cases and 56,758 age and sex matched living controls from a national representative sample of 1,025,340 South Koreans. They were obtained from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) with follow-up up to 12 years. We obtained information on primary diagnosis of any ICD-10 disorder along with suicide cases during their lifetime.

RESULTS

Among ICD-10 disorders, depression was the most common disorder (19.10%, n=542), found in victims of completed suicides except for common medical disorders such as hypertensive crisis, respiratory tract infection or arthropathies. After adjusting for sex, age, economic status, disability, and disorders, schizophrenia showed the strongest association with suicide (AOR: 28.56, 95% CI: 19.58-41.66) among all ICD-10 disorders, followed by psoriasis, multiple body injury, epilepsy, sleep disorder, depression, and bipolar disorder. For age groups, ≤19 years was associated with anxiety disorder (AOR=80.65, 95% CI: 13.33-487.93), 20-34 years with epilepsy (AOR=134.92, 95% CI: 33.69-540.37), both 35-49 years (AOR=108.57, 95% CI: 37.17-317.09) and 50-65 years (AOR=189.41 95% CI: 26.59-1349.31), with schizophrenia, and >65 years (AOR=44.7, 95% CI: 8.93-223.63) with psoriasis.

CONCLUSION

Psychiatric and physical disorders carried greatly increased risks and numbers of suicides in South Korea. Schizophrenia was the strongest risk factor, especially 35-65 years, and depression was the most common in suicide victims among ICD-10 disorders in South Korea.

Copycat Suicide Induced by Entertainment Celebrity Suicides in South Korea

OBJECTIVE

Throughout the past several years, there have been a number of entertainment celebrity suicides in South Korea. The aim of this study was to investigate the clustering of suicides following celebrities' suicides in South Korea from 2005 to 2008, particularly according to certain characteristics.

METHODS

Seven celebrity suicides were examined and defined using the Korean Integrated Newspaper Database System (KINDS) and from these, we considered four affected periods occurring 28 days after each celebrity's suicide. A Poisson time-series autoregression model was used to estimate the relative risk of the total suicide number for each affected period from 2005 to 2008. Logistic regression analysis was performed to investigate whether there were specific increases in the numbers of suicides in subgroups matching each celebrity.

RESULTS

There were significant increases in the risk of suicide during the affected periods. Remarkable increases were found in the subgroups matching each celebrity, especially in the group in which all factors (sex, age, and method) were similar.

CONCLUSION

This study provides confirmation that a significant copycat effect was induced by these celebrities' suicides, especially among people who identified more with the celebrities. This implies that countermeasures for upright media coverage of celebrity suicides should be discussed and practiced properly in South Korea.