Association of Logic's hip hop song "1-800-273-8255" with Lifeline calls and suicides in the United States: interrupted time series analysis

"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.

Associations of Suicide Referents With Different Moral Connotation With Actual Suicides

Background: Different words used for suicide (so-called suicide referents) have different moral connotations, and neutral referents are recommended in media reporting guidelines. Aims: To assess how different referents in media reports are related to actual suicides. Method: Austrian news articles for each month between 2000 and 2021 (n = 276 months) were obtained from the Austrian Press Agency. Time series were modeled for media items referring to suicide as a crime [Selbstmord], an act of freedom [Freitod], or neutral connotation [Suizid]. Temporal associations with suicides in the month before, during, and after the reporting were examined. Results: Terminology referring to suicide as an act of free will [Freitod] was weakly associated with increases in total, male, and female suicides and with suicides in up to 64-year-olds in the same month. No other statistically significant associations were found. Limitations: No detailed content analysis of media reports was done. Conclusion: During times of prevalent use of referents suggesting suicide to be an act of freedom, there are small-sized increases in suicides. The simultaneous occurrence of this referent and suicides might reflect effects of a societal framing present in both the media and the community rather than a sheer media effect.

Leveraging Digital Media to Promote Youth Mental Health: Flipping the Script on Social Media-Related Risk

Purpose of Review

Despite growing public concern about the negative impact of digital media for mental health problems, there are key ways in which digital media can be leveraged to prevent such outcomes. This article reviews research exploring the ways that digital media, particularly social media, can be used to prevent negative mental health outcomes and promote youth mental health and well-being.

Recent findings

Research indicates that media can be protective against mental health problems and promote mental health by enabling social support and destigmatizing mental illness, especially for youth with limited resources. Media also can be leveraged to identify those at risk, to educate, provide resources, and promote well-being, and to track symptoms and intervene to prevent or mitigate negative mental health outcomes. There is limited research on interventions designed to reduce the negative effects of digital media on mental health, especially those that harness media itself, a critical area of future research.

Summary

This article provides a summary of the current evidence on this topic, highlights key directions for future research, and provides evidence-based recommendations for adolescents, families, educators, clinicians, industry, and policy-makers to prevent mental health problems related to media.

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.

The 988 suicide hotline-Lifeline or letdown? A pre-post policy analysis

Suicide has emerged as an urgent threat in recent years as COVID-19 impaired the health and economic wellbeing of millions of Americans. According to the Centers for Disease Control and Prevention, the impact of COVID-19 and the ongoing opioid epidemic has "taken a mental, emotional, physical, and economic toll on individuals, families, and communities," increasing the need for innovative solutions to prevent suicide on a national scale. The National Suicide Hotline Designation Act of 2020 established 988 as the universal telephone number for suicide prevention and represents a key federal intervention to address this crisis. However, research on 9-8-8's effectiveness is limited, given the Act's recent enactment and implementation at the federal and state levels. This policy analysis investigates how and to what extent the mental health crisis system in Georgia has improved since the implementation of the 2020 Act as well as the implications of state law on population-level mental health outcomes. Georgia is used as a nationally representative case study for two reasons: (1) Georgia had a robust statewide suicide hotline prior to 2020, providing solid infrastructure on which federal expansion of a suicide hotline number could be built, and (2) the conflicting characteristics of Georgia's mental health system represent several different pockets of the U.S., allowing this analysis to apply to a broad range of states and locales. The paper draws on takeaways from Georgia to propose state and national policy recommendations for equitable interventions to prevent and respond to this form of violence.

Third Molar Comparison in Class I and II Extraction and Non-extraction Orthodontic Treatment: A Retrospective Longitudinal Study

Objective

This study compared third molar angulation and eruption status in Class I and II malocclusions after orthodontic treatment with and without first premolar extractions.

Methods

The sample comprised 93 patients divided into four groups: Group 1, Class I malocclusion treated with first premolar extractions; Group 2, Class I malocclusion treated without extractions; Group 3, Class II malocclusion treated with first premolar extractions; and Group 4, Class II malocclusion treated without extractions. Panoramic radiographs were used to evaluate the third molar mesiodistal angulations at T1 (pretreatment), T2 (posttreatment), and T3 (long-term posttreatment). Third molar eruption status was assessed in dental casts. Intergroup angulations and eruption status comparisons were performed using one-way analysis of variance (ANOVA), followed by Tukey's test and Kruskal-Wallis test, respectively.

Results

Significantly greater mesial angulation and percentage of erupted right maxillary third molars were observed in the Class I extraction group. Significantly greater eruption status of the right mandibular third molars was observed in the Class I and Class II malocclusion extraction groups.

Conclusion

Class I and II malocclusion extraction treatment exhibited more favorable angulations and a greater number of erupted third molars than non-extraction treatment. The non-extraction groups exhibited a greater percentage of unerupted third molars.

Suicide in Song: A Thematic Analysis of 674 Songs Referencing Suicide

Music is a ubiquitous form of entertainment, engaging millions and providing emotional release for both musicians and listeners. Songs referencing suicide - a generally taboo subject - are common in U.S. culture, appearing in every genre of music from country to hip hop, punk rock to blues. Suicide songs prompt concern among the lay public (e.g., lawmakers, parents) and also researchers, whose work has documented statistically significant relationships between musical preference and suicidality. Still, suicide songs could also carry positive effects for listeners through behavioral modeling by illustrating alternatives to suicide. The outcomes are likely dependent, in part, on lyrical content. To understand lyrical content about suicide, the present study used thematic analysis to identify common threads in modern English-language songs referencing suicide. The lyrics of 674 songs were examined. The analysis identified 5 themes in which musicians illustrated: (1) support and empathy for people struggling with suicide, (2) personal experience with suicidal thoughts, (3) endorsement of suicide, (4) suicide as rebellion or revenge, and (5) self-medication. The study provides the foundation for future research on the relationship between song exposure and listener beliefs, attitudes, and behavior related to suicide.

CDC Guidance for Community Response to Suicide Clusters, United States, 2024

This is the third of three reports in the MMWR supplement that updates and expands CDC's guidance for assessing, investigating, and responding to suicide clusters based on current science and public health practice. The first report, Background and Rationale - CDC Guidance for Communities Assessing, Investigating, and Responding to Suicide Clusters, United States, 2024, describes an overview of suicide clusters, methods used to develop the supplement guidance, and 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. This report describes how local public health and community leaders can develop a response plan for suicide clusters. Specifically, the steps for responding to a suicide cluster include preparation, direct response, and action for prevention. These steps are not intended to be explicitly adopted but rather adapted into the local context, culture, capacity, circumstances, and needs for each suicide cluster.

Suicide in the press: an analysis of newspaper coverage of adolescent versus adult suicides in Italy

BACKGROUND

An association between sensationalized media reporting and subsequent increase in suicidal behavior has been documented, and adolescents are especially vulnerable to imitative influences. The aims of this study were to examine the characteristics of the articles reporting adult and adolescent (under age 18) suicides in the Italian press and to assess adherence to the World Health Organization (WHO) guidelines for responsible reporting. Methods: The print versions of the three newspapers with the widest national distribution in Italy were searched for all the articles on incident suicides printed over a 7-month period (July 2022 to February 2023). Articles were examined for adherence to the WHO guidelines. Results: Overall, 213 articles were identified, reporting on 122 individual suicide cases (88.5% adults and 11.5% adolescents). Of the articles, 78.9% were on adults and 21.1% on adolescents, with a ratio articles/suicide cases of 1.6 for adults and 3.2 for adolescents (p < 0.0001). Adolescent suicide articles had more words (mean 612.5 ± SD 275.6) than adult ones (462.1 ± 267.7, p = 0.001). Potentially harmful reporting features were present in both the adult and adolescent articles (12-82%). Few articles (0-15%) included protective features. Articles on adolescents were more adherent to the WHO guidelines for omitting specific information of suicide method and location. Conclusions: Significant differences were found in the press reporting of adolescent versus adult suicides, with adolescent suicides receiving more attention in terms of the number of articles and article length. Suicide press reporting can be improved. A close collaboration between journalists and suicide prevention experts may be beneficial.

Experiences of suicide survivors of sharing their stories about suicidality and overcoming a crisis in media and public talks: a qualitative study

BACKGROUND

Media stories of hope and recovery from suicidal ideation have been found to have a positive impact on the audience, but little is known about how individuals who share their own experiences perceive the effects of their storytelling. This study aimed to assess qualitatively, through focus groups, how individuals who shared their personal story of hope and recovery in the media and public talks experienced the process, and which aspects they perceived as important in sharing their coping story.

METHODS

Three focus groups were conducted with a total of n = 12 individuals. These included n = 5 participants with experience of suicidal ideation or a suicide attempt, n = 4 individuals who had been bereaved through suicide, and n = 3 participants who experienced both. Participants were recruited from the American organisation "Suicide Survivors United". Thematic analysis was used to assess the participants' perception and experiences of sharing their story.

RESULTS

Participants shared that the intention to help others was the main motivation to share their story of hope and recovery. Participants noted many positive effects of their storytelling on themselves and also received positive feedback from the audience, such as improved help-seeking attitudes. The participants offered recommendations for those who want to share their story of hope and recovery, including careful personal preparation and media training before going public. They also discussed media recommendations for talking about suicide in the media.

CONCLUSIONS

Sharing a personal story of hope and recovery may have a beneficial impact on the storytellers. Storytelling requires a careful preparation and training before going public and support and guidance is crucial in all stages of the storytelling, particularly to help unexperienced storytellers in going public and using their personal narratives to help prevent suicide.

Improving programme-led and focused interventions for eating disorders: An experts' consensus statement-A UK perspective

OBJECTIVE

Eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Greater use of programme-led and focused interventions that are less resource-intensive might be part of the solution to this demand-capacity mismatch.

METHOD

In October 2022, a group of predominantly UK-based clinical and academic researchers, charity representatives and people with lived experience convened to consider ways to improve access to, and efficacy of, programme-led and focused interventions for eating disorders in an attempt to bridge the demand-capacity gap.

RESULTS

Several key recommendations were made across areas of research, policy, and practice. Of particular importance is the view that programme-led and focused interventions are suitable for a range of different eating disorder presentations across all ages, providing medical and psychiatric risk are closely monitored. The terminology used for these interventions should be carefully considered, so as not to imply that the treatment is suboptimal.

CONCLUSIONS

Programme-led and focused interventions are a viable option to close the demand-capacity gap for eating disorder treatment and are particularly needed for children and young people. Work is urgently needed across sectors to evaluate and implement such interventions as a clinical and research priority.

Young people's mental and social distress in times of international crisis: evidence from helpline calls, 2019-2022

We document mental and social distress of children, adolescents and adults, using data on 3 million calls to German helplines between January 2019 and May 2022. High-frequency data from crisis helpline logs offer rich information on the evolution of "revealed distress" among the most vulnerable, unaffected by researchers' study design and framing. Distress of adults, measured by the volume of calls, rose significantly after both the outbreak of the pandemic and the Russian invasion of Ukraine. In contrast, the overall revealed distress of children and adolescents did not increase during those crises. The nature of young people's concerns, however, changed more strongly than for adults after the COVID-19 outbreak. Consistent with the effects of social distancing, call topics of young people shifted from problems with school and peers to problems with family and mental health. We find the share of severe mental health problems among young people to have increased with a delay, in the second and third year of the pandemic.

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.

Implementation of the 988 Suicide & Crisis Lifeline: Estimating State-Level Increases in Call Demand Costs and Financing

BACKGROUND

Per federal law, "988" became the new three-digit dialing code for the National Suicide & Crisis Lifeline on July 16, 2022 (previously reached by dialing "1-800-283-TALK").

AIMS OF THE STUDY

This study aimed to produce state-level estimates of: (i) annual increases in 988 Lifeline call volume following 988 implementation, (ii) the cost of these increases, and (iii) the extent to which state and federal funding earmarked for increases in 988 Lifeline call volume are sufficient to meet call demand.

METHOD

A 50 state pre-post policy implementation design was used. State-level Lifeline call volume data were obtained. For each state, we calculated the absolute difference in number of Lifeline calls in the four-month periods between August-November 2021 (pre-988 implementation) and August-November 2022 (post-988 implementation), and also expressed this difference as percent change and rate per 100,000 population. The difference call volume was multiplied by a published estimate of the cost of a single 988 Lifeline call (USD 82), and then by multiplied by three to produce annual, 12-month state-level cost increase estimates. These figures were then divided by each state's population size to generate cost estimates per state resident. State-level information on the amount of state (FY 2023) and federal SAMHSA (FY 2022) funding earmarked for 988 Lifeline centers in response to 988 implementation were obtained from legal databases and government websites and expressed as dollars per state resident. State-level differences between per state resident estimates of increased cost and funding were calculated to assess the extent to which state and federal funding earmarked for increases in 988 Lifeline call volume were sufficient to meet call demand.

RESULTS

988 Lifeline call volume increased in all states post-988 implementation (within-state mean percent change = +32.8%, SD = +20.5%). The total estimated cost needed annually to accommodate increases in 988 Lifeline call volume nationally was approximately USD 46 million. The within-state mean estimate of additional cost per state resident was +USD 0.16 (SD = +USD 0.11). The additional annual cost per state resident exceeded USD 0.40 in three states, was between USD 0.40- USD 0.30 in three states, and between USD 0.30 - USD 0.20 in seven states. Twenty-two states earmarked FY 2023 appropriations for 988 Lifeline centers in response to 988 (within-state mean per state resident = USD 1.51, SD = USD 1.52) and 49 states received SAMHSA 988 capacity building grants (within-state mean per state resident = USD 0.36, SD = USD 0.39). State funding increases exceeded the estimated cost increases in about half of states.

CONCLUSIONS

The Lifeline's transition to 988 increased 988 Lifeline call volume in all states, but the magnitude of the increase and associated cost was heterogenous across states. State funding earmarked for increases in 988 Lifeline center costs is sufficient in about half of states. Sustained federal funding, and/or increases in state funding, earmarked for 988 Lifeline centers is likely important to ensuring that 988 Lifeline centers have the capacity to meet call demand in the post-988 implementation environment.

Media coverage and speculation about the impact of the COVID-19 pandemic on suicide: a content analysis of UK news

OBJECTIVES

Since the start of the COVID-19 pandemic, there has been much concern and speculation about rises in suicide rates, despite evidence that suicides did not in fact increase in the first year of the pandemic in most countries with real-time suicide data. This public narrative is potentially harmful, as well as misleading, and is likely to be perpetuated by sensational news coverage.

METHOD

Using a bespoke database, we analysed the quality and content of print and online UK news (including opinion pieces) on the impact of COVID-19 on suicidality, based on adherence to international recommendations. χ² tests were conducted to examine variability in relation to key characteristics (eg, type of publication) and to four 'restriction phases' (based on UK government official lockdown measures) over the first 14 months of the pandemic.

RESULTS

We identified 372 stories about COVID-19 and suicidality in online and print news between the first UK lockdown (March 2020) and May 2021 (when restrictions were significantly eased in the UK). Throughout this period, over a third of articles (39.2%) and headlines (41.4%) claimed or predicted a rise in suicide, often attributed to feelings of entrapment and poor mental health (especially among young people) and fueled by expert commentary and speculation. Almost a third of reports were rated as being of negative quality (116, 31.2%), and at least half included no signposting to help and support. However, reporting improved in phases of less stringent COVID-19 restrictions and over time, with later articles and headlines including fewer negative statements and predictions about rises in suicides, and greater reliance on academic evidence.

CONCLUSIONS

As the longer-term consequences of the pandemic develop, and other national and global events unfold, it is increasingly important that the media, and the wider community of experts shaping its narratives, strive for a positive and evidence-informed approach to news coverage of suicide.

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.

[Suicide prevention in the context of assisted suicide]

The verdict of the German Federal Constitutional Court from 26 February 2020 made it clear that every person is granted the right to end his or her own life, provided it is the person's own free will. It is also within his or her rights to utilize assistance in doing so, if such assistance is offered. This freedom to end one's life and to utilize assistance is not limited to terminal illnesses or situations of unbearable suffering. However, the High Court has also demanded that lawmakers ensure the safety of vulnerable people by making certain that the decision for suicide is in fact made out of the person's own free will. This free decision-making capability can be substantially impaired by acute psychosocial stressors, by mental illnesses but also by third party influence. Therefore, a liberalization of assisted suicide must unconditionally be accompanied by a massive strengthening of suicide prevention measures, which clearly prioritize the help to live over the help to die. This article reviews the scientifically established methods for suicide prevention and makes demands to lawmakers to comprehensively implement such measures.

Mental Health Emergency Hotlines in the United States: A Scoping Review (2012-2021)

OBJECTIVE

Mental health emergency hotlines provide clinical supports and connection to services. This scoping review describes the current literature on hotlines in the United States, including which populations they do and do not reach, typical call volumes and engagement levels, barriers to and facilitators of implementation, and common call outcomes. The review also identifies gaps in the literature and presents recommendations.

METHODS

A systematic search of peer-reviewed articles on U.S.-based telephone, text, and chat hotlines published between January 2012 and December 2021 retrieved 1,049 articles. In total, 96 articles met criteria for full-text review, of which 53 met full inclusion criteria.

RESULTS

Approximately half of the included studies (N=25) focused on descriptive information of callers, most of whom were females, younger adults, and White; veteran hotlines typically reached older men. Common reasons for calling were suicidality, depression, and interpersonal problems. Of studies examining intervention effects (N=20), few assessed hotlines as interventions (N=6), and few evaluated caller behavioral outcomes (N=4), reporting reduced distress and suicidality among callers after hotline engagement. However, these studies also suggested areas for improvement, including reaching underrepresented high-risk populations. Six studies reported implementation needs, such as investments in data collection and evaluation, staff training, and sustainable funding.

CONCLUSIONS

Hotlines appear to be more effective at reaching some populations than others, indicating that more intensive outreach efforts may be necessary to engage underrepresented high-risk populations. The findings also indicated limited evidence on the relationship between use of hotlines-particularly local text and chat hotlines-and caller outcomes, highlighting an area for further investigation.