Towards a shared understanding: Perspectives from Toronto's first media forum for suicide prevention

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.

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.

Assessing the quality of media reporting of suicide deaths in Pakistan against international guidelines

BACKGROUND

In Pakistan, there is lack of official suicide data due to associated stigma and socio-cultural factors. Although, suicide incidents are regularly reported in newspapers there are no official suicide reporting guidelines.

AIMS

The aim was to study the quality of suicide reporting in Pakistani newspapers and compare it to international media guidelines.

METHOD

Newspaper reports on suicide deaths were searched in four Pakistani national newspapers from 1st January 2019 to 31st December 2020. Data was extracted using templates based on World Health Organization and Reporting on Suicide media guidelines.

RESULTS

There were total 2,295 suicides reported in 2 years. The word 'suicide' was mentioned in title of 2,113 (92.06%) reports. In 70.37% news articles, motive for suicide was reduced to a single factor. Method was mentioned in 95.6% suicides. Pictures accompanied 103 (4.4%) news reports. Only 13 (0.57%) the news stories recognized the link between substance abuse and suicide. None of the reports provided education to public about suicide or mentioned resources to seek help.

CONCLUSIONS

The articles reporting on suicide deaths were regularly featured in Pakistani newspapers with strikingly low level of adherence to suicide reporting guidelines.

Development of Internet suicide message identification and the Monitoring-Tracking-Rescuing model in Taiwan

BACKGROUND

Suicide messages can be transmitted infinitely online; the Internet is influential in suicide prevention. Identifying suicide risks online via artificial technological advances may help predict suicide.

METHODS

We built a classifier that detects open messages containing suicidal ideation or behavior-related words in social media via text mining methods and developed the Monitoring-Tracking-Rescuing model, which links data monitoring and tracking to high-risk suicide rescues. Natural language processing (NLP) techniques such as Long Short-Term Memory and Bidirectional Encoder Representations from Transformers were applied to online posts of common social media sites in Taiwan. This model uses a two-step high-risk identification procedure: an automatic prediction process using NLP to classify suicide-risk levels, followed by professional validation by a senior psychiatrist and a nursing faculty specialized in suicidology.

RESULTS

From a dataset containing 404 high-risk and 2226 no- or low-risk articles, the sensitivity and specificity of our model reached 80 %.

LIMITATIONS

The model is limited to data platforms that can be "crawled" and excludes suicide-risk content from graphics, video and audio files. Additionally, machine learning does not provide the best recognition rate from complex online messages. Keywords for high-risk suicide in long articles are difficult to interpret using this model. Finally, the model lacks keywords for suicide-protective factors.

CONCLUSIONS

Artificial intelligence techniques may help detect and monitor high-risk suicide posts and inform mental health professionals of these posts. Periodic tracking plus manual validation to determine risk levels are recommended to enhance the reliability and effectiveness of Internet suicide-prevention tasks.

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.

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.

Developing a Suicide Prevention Social Media Campaign With Young People (The #Chatsafe Project): Co-Design Approach

BACKGROUND

Young people commonly use social media platforms to communicate about suicide. Although research indicates that this communication may be helpful, the potential for harm still exists. To facilitate safe communication about suicide on social media, we developed the #chatsafe guidelines, which we sought to implement via a national social media campaign in Australia. Population-wide suicide prevention campaigns have been shown to improve knowledge, awareness, and attitudes toward suicide. However, suicide prevention campaigns will be ineffective if they do not reach and resonate with their target audience. Co-designing suicide prevention campaigns with young people can increase the engagement and usefulness of these youth interventions.

OBJECTIVE

This study aimed to document key elements of the co-design process; to evaluate young people's experiences of the co-design process; and to capture young people's recommendations for the #chatsafe suicide prevention social media campaign.

METHODS

In total, 11 co-design workshops were conducted, with a total of 134 young people aged between 17 and 25 years. The workshops employed commonly used co-design strategies; however, modifications were made to create a safe and comfortable environment, given the population and complexity and sensitivity of the subject matter. Young people's experiences of the workshops were evaluated through a short survey at the end of each workshop. Recommendations for the campaign strategy were captured through a thematic analysis of the postworkshop discussions with facilitators.

RESULTS

The majority of young people reported that the workshops were both safe (116/131, 88.5%) and enjoyable (126/131, 96.2%). They reported feeling better equipped to communicate safely about suicide on the web and feeling better able to identify and support others who may be at risk of suicide. Key recommendations for the campaign strategy were that young people wanted to see bite-sized sections of the guidelines come to life via shareable content such as short videos, animations, photographs, and images. They wanted to feel visible in campaign materials and wanted all materials to be fully inclusive and linked to resources and support services.

CONCLUSIONS

This is the first study internationally to co-design a suicide prevention social media campaign in partnership with young people. The study demonstrates that it is feasible to safely engage young people in co-designing a suicide prevention intervention and that this process produces recommendations, which can usefully inform suicide prevention campaigns aimed at youth. The fact that young people felt better able to safely communicate about suicide on the web as a result of participation in the study augurs well for youth engagement with the national campaign, which was rolled out across Australia. If effective, the campaign has the potential to better prepare many young people to communicate safely about suicide on the web.

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

OBJECTIVE

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

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSIONS

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

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019086559.

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

BACKGROUND

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

METHODS

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

RESULTS

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

INTERPRETATION

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

Life course well-being framework for suicide prevention in Canadian Armed Forces Veterans

Introduction: The risks of suicidality (suicidal ideation or behaviour) are higher in Canadian Armed Forces (CAF) Veterans (former members) than in the Canadian general population (CGP). Suicide prevention is everyone’s responsibility, but it can be difficult for many to see how they can help. This article proposes an evidence-based theoretical framework for discussing suicide prevention. The framework informed the 2017 joint CAF – Veterans Affairs Canada (VAC) suicide prevention strategy. Methods: Evidence for the framework was derived from participation in expert panels conducted by the CAF in 2009 and 2016, a review of findings from epidemiological studies of suicidality in CAF Veterans released since 1976, suicide prevention literature reviews conducted at VAC since 2009, and published theories of suicide. Results: Common to all suicide theories is the understanding that suicide causation is multifactorial, complex, and varies individually such that factors interact rather than lie along linear causal chains. Discussion: The proposed framework has three core concepts: a composite well-being framework, the life course view, and opportunities for prevention along the suicide pathway from ideation to behaviour. Evidence indicates that Veterans are influenced onto, along, and off the pathway by variable combinations of mental illness, stressful well-being problems and life events, individual factors including suicidal diathesis vulnerability, barriers to well-being supports, acquired lethal capability, imitation, impulsivity, and access to lethal means. The proposed framework can inform discussions about both whole-community participation in prevention, intervention and postvention activities at the individual and population levels, and the development of hypotheses for the increased risk of suicidality in CAF Veterans.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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