Media roles in suicide prevention: a systematic review

Suicide prevention: reflections on progress over the past decade

Interest in preventing suicides has increased greatly in recent years. In this Personal View, we consider the general global developments related to suicide prevention that have occurred in the decade since The Lancet Psychiatry was first published in 2014. We then review specific advances during this period, first, in relation to public health initiatives, and second, with regard to clinical developments. Finally, we examine some of the challenges that currently confront individuals and organisations responsible for designing and implementing suicide prevention measures.

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.

Predicting Sensationalism in Suicide Story Headlines

Objective: Suicide is a leading cause of death in the United States, and media publicity plays a role in suicide rates. The United States offers guidelines for the reporting of suicide. This study evaluated guideline adherence in newspaper and newswire publications covering celebrity suicide deaths. The research also assessed whether the sensationalism of article headlines could be predicted by variables reflecting nonadherent reporting. Method: Publications from 2013 to 2018 reporting on nine celebrity suicides were evaluated via content analysis. Adherence was assessed in a two-step hierarchical linear regression to determine which variables predicted sensationalism in headlines. Results: Overall adherence to reporting guidelines was moderate. Newspaper disclosure of suicide method only, suicide method and location, and note contents significantly predicted headline sensationalism in the first regression model, R2 = 22%. The sensationalism in the body of the article and other variables additionally predicted headline sensationalism in the second regression model, R2 = 55%. Limitations: This study is limited to celebrity suicide reporting and may not reflect media reporting trends of noncelebrity suicide deaths. Conclusion: Findings reveal that sensationalism in the body of the article and other variables uniquely contributed to sensationalism in newspaper headlines. This suggests that the public could be at risk for reading harmful content not consistent with reporting recommendations about suicide because of the initial attraction to sensational headlines.

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.

Suicidal Behavior in Nepali motion pictures of three decades (1990-2020): A content analysis

BACKGROUND

Assessment of the depiction of suicidal behavior in motion pictures would reveal the social representation of suicide that would foster suicide prevention in a country.

OBJECTIVES

We aimed to assess how suicidality has been depicted in Nepali movies by scrutinizing their contents against the sociodemographic checklist and WHO media guidelines for suicidal reporting.

METHODS

This is a narrative quantitative analysis of suicidal behavior portrayals in the Nepali motion pictures that are publicly and freely accessible.

RESULTS

Overall, out of the 573 scrutinized movies, we found ten movies consisting of 11 characters (i.e., the prevalence is 1.75%) showing suicidal behavior. The majority of suicidal behavior was seen in males 6 (54.5%), and the majority of attempters were students 3 (27.3%) or homemakers 2 (18.2%). Suicidal behavior was mostly observed in unmarried people 6 (54.5%). Hanging was the most prevalent method (45.5%), and home (36.4%) and public places (36.4%) were equally the most frequent places of attempt. The consequential risk factors for the attempts were found to be marital problems/premarital affairs (50%), followed by unfulfilled demand/conflict (30%). While all 11 items depicted the method and place of the attempt, two also depicted the complete scene of the attempt. One item used language that normalized suicide as a constructive solution to the problem. None of the pictures publicized any mental health messages or educated the public about suicide prevention.

CONCLUSIONS

The minimal adherence of the Nepali motion pictures on the depictions of suicidality with WHO media guidelines indicates urgent need to create awareness among the Nepali film fraternity.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Media Exposure of Suicidal Behaviour: An Umbrella Review

AIM

To analyse recommended interventions for the safe and responsible dissemination of suicidal behaviour in the media for preventive purposes.

BACKGROUND

Suicide is a serious public health problem that leads to more than 700,000 deaths per year, which translates into one death every forty seconds. The media play a significant role in shaping public perceptions and reflecting societal issues. Because of its active role in the construction of reality, the way in which the media report and expose suicidal behaviour has the capacity to influence the population in either a preventive or harmful way.

DESIGN

An umbrella review was carried out and a report was written according to the Preferred Reporting Items for Overviews of Reviews.

METHODS

We systematically searched for reviews published from inception to February 2023 in MEDLINE (PubMed), CINAHL and PsycInfo (via EBSCOhost), Web of Science, Embase, Cochrane Library of Systematic Reviews, Scopus, and Google Scholar. A narrative synthesis of the results was conducted.

RESULTS

Six systematic reviews with a moderate to high quality level were selected. Among the recommended interventions were the inclusion of positive messages of hope, resilience, or of overcoming the event, narratives with information on available resources or the promotion of support-seeking attitudes as an effective prevention mechanism, as well as the avoidance of repetitive reporting of the same suicide. The appropriate and responsible dissemination of information on suicidal behaviour in the media with complete and up-to-date information on available centres, organisations, institutions, and resources has proven to be effective, especially in vulnerable populations.

CONCLUSION

Educating and training the media in an appropriate approach to disseminating suicidal behaviour helps to reduce the number of suicidal behaviours. Knowing what information is advisable to include in the news item as well as what information to avoid is a strong point. Guidelines to promote responsible media reporting are a key component of suicide prevention strategies. This study was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 23 April 2022 with the registration number CRD42022320393.

Trends in Newspaper Coverage of Suicide in Israel: An 8-Year Longitudinal Study

BACKGROUND

The nature of newspaper coverage of suicide events can impact suicide risk. Thus, the World Health Organization published recommendations for reporting suicide in the media. To date, Israel has no data regarding adherence to these media guidelines and no indication of the influence of the Israeli National Suicide Prevention Program (NSPP) on adherence. Aiming to fill these gaps, the current study examined (1) Israeli newspapers' adherence to the guidelines for suicide coverage and (2) the impact of the NSPP on the adherence level of media reporting.

METHOD

Adherence to newspapers coverage guidelines was examined in two leading Israeli newspapers at three time points: T1 (2012, two years before the NSPP's establishment), T2 (2016-2017, 2-3 years after its establishment), and T3 (2018-2019, 4-5 years after NSPP's establishment). All articles reporting on suicide or suicidal behavior were analyzed at each time point regarding their adherence to the media guidelines.

RESULTS

Two hundred articles were assessed and analyzed. The adherence level was 49.35% across all time points. We found improved adherence at T2 (after the initiation of the NSPP) in most of the guidelines but a slight decline at T3. Adherence to guidelines regarding prevention (Do guidelines) showed no significant improvement over time.

CONCLUSIONS

General adherence to guidelines was relatively low. However, steps can be taken to improve media coverage of suicide stories. The NSPP should make greater efforts to promote changes in media coverage of suicide events in Israel, such as providing information about risk factors, prevention, and intervention. HIGHLIGHTSA longitudinal study examined Israeli newspapers over three time points in the last decade.General adherence level to the suicide coverage guidelines was 49.35% across all time points.The National Suicide Prevention Program was linked to improvement in adherence to most guidelines.

Suicide Scripts in Italian Newspapers

Background: There is substantial variability, by culture, in suicide rates, and also in suicide beliefs and attitudes. Suicide beliefs and attitudes predict actual suicidality. They also are elements of cultural scripts of suicide. Most suicide-scripts research has been conducted in Anglophone countries. Aims: This study investigates women's and men's suicide scripts in Italy. Methods: Italy's suicide scripts, including beliefs about what causes suicide, were explored via analyses of newspaper stories (N = 923) of women's and men's suicides. Results: Italian newspapers mostly featured men's suicide stories, consistent with Italian men's higher suicide mortality. Women's suicide was narrated as an unexpected act signaling personal (e.g., emotional and private-relationship) problems. By contrast, men's suicide was framed as relatively understandable response to serious public-life/social adversities (e.g., an economic downturn), and as a death of legitimate despair. Limitations: Social media suicide stories were not included in this study. Conclusion: In Italy, as in several countries with higher male suicide mortality, female suicide is psychologized and considered irrational while male suicide is viewed as a symptom of serious public-life/social problems, and therefore as deserving respect and empathy. The preference for social explanations of male suicide, together with the empathic attitudes, may contribute to male suicide being relatively more permissible and less stigmatized, and therefore also to men's higher suicide mortality.

Assessing Vulnerability to Surges in Suicide-Related Tweets Using Japan Census Data: Case-Only Study

BACKGROUND

As the use of social media becomes more widespread, its impact on health cannot be ignored. However, limited research has been conducted on the relationship between social media and suicide. Little is known about individuals' vulnerable to suicide, especially when social media suicide information is extremely prevalent.

OBJECTIVE

This study aims to identify the characteristics underlying individuals' vulnerability to suicide brought about by an increase in suicide-related tweets, thereby contributing to public health.

METHODS

A case-only design was used to investigate vulnerability to suicide using individual data of people who died by suicide and tweet data from January 1, 2011, through December 31, 2014. Mortality data were obtained from Japanese government statistics, and tweet data were provided by a commercial service. Tweet data identified the days when suicide-related tweets surged, and the date-keyed merging was performed by considering 3 and 7 lag days. For the merged data set for analysis, the logistic regression model was fitted with one of the personal characteristics of interest as a dependent variable and the dichotomous exposure variable. This analysis was performed to estimate the interaction between the surges in suicide-related tweets and personal characteristics of the suicide victims as case-only odds ratios (ORs) with 95% CIs. For the sensitivity analysis, unexpected deaths other than suicide were considered.

RESULTS

During the study period, there were 159,490 suicides and 115,072 unexpected deaths, and the number of suicide-related tweets was 2,804,999. Following the 3-day lag of a highly tweeted day, there were significant interactions for those who were aged 40 years or younger (OR 1.09, 95% CI 1.03-1.15), male (OR 1.12, 95% CI 1.07-1.18), divorced (OR 1.11, 95% CI 1.03 1.19), unemployed (OR 1.12, 95% CI 1.02-1.22), and living in urban areas (OR 1.26, 95% CI 1.17 1.35). By contrast, widowed individuals had significantly lower interactions (OR 0.83, 95% CI 0.77-0.89). Except for unemployment, significant relationships were also observed for the 7-day lag. For the sensitivity analysis, no significant interactions were observed for other unexpected deaths in the 3-day lag, and only the widowed had a significantly larger interaction than those who were married (OR 1.08, 95% CI 1.02-1.15) in the 7-day lag.

CONCLUSIONS

This study revealed the interactions of personal characteristics associated with susceptibility to suicide-related tweets. In addition, a few significant relationships were observed in the sensitivity analysis, suggesting that such an interaction is specific to suicide deaths. In other words, individuals with these characteristics, such as being young, male, unemployed, and divorced, may be vulnerable to surges in suicide-related tweets. Thus, minimizing public health strain by identifying people who are vulnerable and susceptible to a surge in suicide-related information on the internet is necessary.

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.

County-level estimates of suicide mortality in the USA: a modelling study

BACKGROUND

Suicide is one of the leading causes of death in the USA and population risk prediction models can inform decisions on the type, location, and timing of public health interventions. We aimed to develop a prediction model to estimate county-level suicide risk in the USA using population characteristics.

METHODS

We obtained data on all deaths by suicide reported to the National Vital Statistics System between Jan 1, 2005, and Dec 31, 2019, and age, sex, race, and county of residence of the decedents were extracted to calculate baseline risk. We also obtained county-level annual measures of socioeconomic predictors of suicide risk (unemployment, weekly wage, poverty prevalence, median household income, and population density) and state-level prevalence of major depressive disorder and firearm ownership from US public sources. We applied conditional autoregressive models, which account for spatiotemporal autocorrelation in response and predictors, to estimate county-level suicide risk.

FINDINGS

Estimates derived from conditional autoregressive models were more accurate than from models not adjusted for spatiotemporal autocorrelation. Inclusion of suicide risk and protective covariates further reduced errors. Suicide risk was estimated to increase with each SD increase in firearm ownership (2·8% [95% credible interval (CrI) 1·8 to 3·9]), prevalence of major depressive episode (1·0% [0·4 to 1·5]), and unemployment rate (2·8% [1·9 to 3·8]). Conversely, risk was estimated to decrease by 4·3% (-5·1 to -3·2) for each SD increase in median household income and by 4·3% (-5·8 to -2·5) for each SD increase in population density. An increase in the heterogeneity in county-specific suicide risk was also observed during the study period.

INTERPRETATION

Area-level characteristics and the conditional autoregressive models can estimate population-level suicide risk. Availability of near real-time situational data are necessary for the translation of these models into a surveillance setting. Monitoring changes in population-level risk of suicide could help public health agencies select and deploy targeted interventions quickly.

FUNDING

US National Institute of Mental Health.

Using a television programme as a tool to increase perceived awareness of mental health and well-being - findings from 'Our Mental Health' survey

BACKGROUND

International research shows that media can increase knowledge, raise public awareness and reduce stigma relating to mental health.

METHODS

Following the broadcast of a documentary on national television featuring interviews with young people who had experienced mental health difficulties and suicidal behaviour, an anonymous online survey, aimed at examining public perceptions of the impact of a television documentary, was conducted, using a mixed methods approach.

RESULTS

2311 people completed the survey. Of those who watched the documentary and answered the closed questions (n = 854), 94% stated that the documentary will positively impact young people's mental health and well-being. The majority (91%) stated that the documentary will encourage young people to talk to someone if experiencing difficulties and 87% indicated it will help to reduce stigma associated with mental health. Viewers had a 5% higher level of intention to seek help than non-viewers. Participants indicated that the identifiable personal stories and discourse around stigma and shame, and the increased understanding and awareness gained, had the most profound impact on them.

CONCLUSIONS

These findings indicate that a documentary addressing mental health and suicidal behaviour, which incorporates real life identifiable stories of resilience and recovery, has the potential to impact positively on emotional well-being and general mood, to reduce stigma related to mental health and to encourage help-seeking behaviour. Documentaries including these concepts, with a public mental health focus and a consistent message, incorporating pre- and post-evaluations, and customisation for target audiences in compliance with current media recommendations, should be considered.

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.

Exposure to images showing (non)adherence to physical distancing rules: Effect on adherence behavior and perceived social norms

Introduction

Adherence to behavioral measures such as physical distancing are key to mitigating the effects of viral pandemics such as the COVID-19 pandemic. Adherence depends in part on people’s perception of what others do (descriptive norms) or approve of (injunctive norms). This study examines the effects that exposure to images depicting people following or breaking physical distancing rules have on perceptions of descriptive and injunctive norms and subsequent adherence behavior.

Methods

An online between-subjects experiment (n = 315) was conducted, in which participants were exposed to a set of five photographs of different public spaces in which people either did or did not adhere to physical distancing rules (pre-registration: https://www.osf.io/uek2p). Participants’ adherence behavior was measured using a triangulation of measures (incentivized online behavioral task, vignettes, intention measure). Perceptions of relevant social norms were also measured.

Results

Mann-Whitney tests showed no effects of condition on perceptions of descriptive and injunctive norms or on adherence behavior. Linear regressions showed that both component paths of the indirect effect (condition on norm perceptions, and norm perceptions on adherence behavior) were non-significant, hence mediation analyses were not conducted.

Conclusions

Exposure to images of people following (compared to breaking) physical distancing rules did not affect adherence to such rules or perceived norms. We surmise that a single exposure to such images, especially in the context of COVID-19, is insufficient to affect behavior. We therefore recommend performing a comparable experiment in which participants are exposed repeatedly to images showing people (non)adhering to a specific behavior in a particular context for a longer period.

Cost-effectiveness of media reporting guidelines for the prevention of suicide

INTRODUCTION

Media guidelines for the responsible reporting of suicide are a recognized universal suicide prevention intervention. While implemented in numerous countries, including Australia, little is known about whether they are cost-effective. We aimed to determine the cost-effectiveness of Mindframe, the national initiative implementing media guidelines in Australia.

METHOD

We conducted a modelled economic evaluation (5-year time-horizon) incorporating two types of economic analysis: (i) return-on-investment (ROI) comparing estimated cost savings from the intervention to the total intervention cost, and (ii) cost-effectiveness analysis comparing the net intervention costs to health outcomes: suicide deaths prevented and quality-adjusted life-years (QALYs). We also included uncertainty analyses to propagate parameter uncertainty and sensitivity analyses to test the robustness of the model outputs to changes in input parameters and assumptions.

RESULTS

The estimated ROI ratio for the main analysis was 94:1 (95% uncertainty interval [UI]: 37 to 170). The intervention was associated with cost savings of A$596M (95% UI: A$228M to A$1,081M), 139 (95% UI: 55 to 252) suicides prevented and 107 (95% UI: 42 to 192) QALYs gained. The intervention was dominant, or cost-saving, compared with no intervention with results being robust to sensitivity analysis but varying based on the conservativeness of the parameters entered.

CONCLUSION

Mindframe was found to be cost-saving, and therefore, worthy of investment and inclusion as part of national suicide prevention strategies.

Quality of Media Reporting of Suicide in Nepal

Objectives. Suicide is a major public health concern. Sensible media reporting of suicide is one of the important prevention strategies. There has been no report assessing the quality of media reporting of suicide in Nepal. We aimed to assess the quality of newspaper reporting of suicide in Nepal against the World Health Organization (WHO) reporting guidelines. Methods. We undertook a content analysis study of articles from the online archives on reporting of suicide deaths in six English language (daily or weekly) newspapers published in Nepal over the two-year duration from a period between January 1, 2019, and December 31, 2020. Also, we compared them with the World Health Organization (WHO) guidelines. Results. A total of 165 English newspaper articles reporting on suicide were analyzed. 163 (98.8%) of news were published in the main section of the newspaper, and the mean length was 17.6 sentences. The name and age of the person who died of suicide were mentioned in about 69.1% ( $n=114$ ) and 53.3% ( $n=88$ ) articles, respectively. The most common method of suicide reported in the news articles was hanging (45.5%, $n=75$ ), followed by poisoning (11.5%, $n=19$ ). About 97.6% ( $n=161$ ) of news articles violated the recommendation provided in the WHO guidelines. Conclusions. The adherence to the WHO guidelines for media reporting of suicide in Nepal was found to be poor, with a large majority of news reports having at least one potentially harmful media characteristic. Only a small minority of news reports included potentially helpful information to prevent suicide.

Perception of the criminality of attempted suicide in Nepal and its impact on suicide reporting

In 2018-2019, according to the official statistics, 5754 people died as a result of suicide in Nepal. This is a high number for a country with a population of 29 million people. Experts believe that the actual rate is considerably higher and that many suicides are not reported. This underreporting of suicide is frequently blamed on the stigma and the criminality of attempted suicide. Yet, there has never been a criminal liability for attempted suicide in Nepal. This article discusses the reasons for the perception of the criminality of attempted suicide in the country, its consequences, and the ways of addressing them. We found that the involvement of the police at the initial stages of suicide investigation confirms public perceptions that attempted suicide is a punishable offense and this may reinforce the stigma of suicide. Recent criminalization of the abetment of suicide has contributed to this perception as the public may not be clear about the distinction between abetment of suicide and attempted suicide. Criminalization of suicide not in the laws but in minds discourages reporting and help-seeking behaviour and victimizes people who need support and services. We argue that decriminalization is more than removing the outdated legal clauses from the legal statutes, but also public awareness raising about the reasons for police investigation of suspicious deaths, sensitivity training, and education of government officials, policymakers, and police about suicide and its prevention. These are needed to dispel the myth of criminalization of attempted suicide in Nepal. Our findings could be of wider interest to scholars working on reducing the stigma of suicide and decriminalization of suicide attempts.

Suicide Classification for News Media Using Convolutional Neural Networks

Currently, the process of evaluating suicide is highly subjective, which limits the efficacy and accuracy of prevention efforts. Artificial intelligence (AI) has emerged as a mean of investigating large datasets to identify patterns within 'big data' that can determine the factors on suicide outcomes. Here, we used AI tools to extract the topic from (press and social) media texts. However, news media articles lack of suicide tags. Using tweets with hashtags related to suicide, we trained a neuronal model that identifies if a given text has a suicide-related topic. Our results suggest a high level of impact of suicide cases in the media, and an intrinsic thematic relationship of suicide news. These results pave the way to build more interpretable suicide data from the media, which may help to better track, understand its origin, and improve prevention strategies.

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.

Have News Reports on Suicide and Attempted Suicide During the COVID-19 Pandemic Adhered to Guidance on Safer Reporting?

Background: Associations between sensational news coverage of suicide and increases in suicidal behavior have been well documented. Amid growing concern over the impact of the COVID-19 pandemic on suicide rates, it is especially important that news coverage adheres to recommended standards. Method: We analyzed the quality and content of print and online UK news reports of possible COVID-19-related suicides and suicide attempts in the first 4 months of the pandemic (N = 285). Results: The majority of reports made explicit links between suicidal behavior and the COVID-19 pandemic in the headline (65.5%), largely based on statements by family, friends, or acquaintances of the deceased (60%). The impact of the pandemic on suicidal behavior was most often attributed to feelings of isolation (27.4%), poor mental health (14.7%), and entrapment due to government-imposed restrictions (14.4%). Although rarely of poor overall quality, reporting was biased toward young people, frontline staff, and relatively unusual suicides and, to varying degrees, failed to meet recommended standards (e.g., 41.1% did not signpost readers to sources of support). Limitations: This analysis cannot account for the impact of reporting on suicide. Conclusion: Careful attention must be paid to the quality and content of reports, especially as longer-term consequences of the pandemic develop.

Suicide by hanging: A scoping review

Suicide by hanging is increasing in many countries around the world and whilst efforts are being made to influence the prevention agenda to reduce the incidence, little is known regarding the contributing factors for choosing this method. The purpose of this scoping review is to summate understandings about how the epidemiology and prevention of suicide by hanging is recognised, described, and discussed in the literature, and critically appraise the extent to which the lived-experiences of survivors of suicide attempts are included. A scoping review was conducted implementing the appropriate framework and in accord with the PRIMSA-ScR extension. Three databases (CINAHL, PubMed, and PsycINFO) were searched along with the reference lists of eligible sources in January and February 2021. Thirty-six articles with a primary focus on hanging as a method of suicide and/or its prevention are included in this review, with brief thematic analysis used to summarise the featured studies. Three distinct themes emerging from the literature include: (i) Hanging suicide deaths in the community environment or person's usual place of residence, (ii) Hanging suicide deaths in controlled environments (including police cells, prisons, and inpatient units), and (iii) Medical management of near-lethal hangings. This review highlights the necessity for improving education and policy regarding the controlled environments frequently associated with hanging suicides and the medical management of near-lethal hangings, as well as the ongoing need for policy to guide and govern the responsible media portrayal of known suicides as well as fictional hangings. Finally, this review highlights the necessity for including those with lived-experiences of a suicide attempt by hanging to advance the current prevention agenda.

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.

Association of Media Coverage on Transgender Health With Referrals to Child and Adolescent Gender Identity Clinics in Sweden

IMPORTANCE

Increasing numbers of transgender and gender diverse children and adolescents have been referred to gender identity clinics in Sweden in the past decade, and previous studies have found an association between media attention and referral counts. Whether the tone of media stories is associated with referrals is not yet known.

OBJECTIVE

To investigate whether positive or negative media coverage on transgender and gender diverse issues is associated with referral counts to child and adolescent gender identity clinics.

DESIGN, SETTING, AND PARTICIPANTS

In this cross-sectional study, referrals counts were collected from all 6 specialized gender identity clinics in Sweden, along with information on referral date, sex assigned at birth, and birth year. Participants were all individuals younger than 19 years, referred to a gender identity clinic between January 1, 2017, and December 31, 2019. Data were analyzed from May 2020 to September 2021.

EXPOSURES

Exposures included 3 major media events related to transgender health care in 2019; 1 event was categorized as positive and 2 events were categorized as negative press coverage.

MAIN OUTCOMES AND MEASURES

Referral counts before and after each of the 3 major media events were assessed, and the moderating association of sex assigned at birth and age was examined with stratified analyses. Weekly referral counts and trends were assessed with interrupted time series analysis.

RESULTS

Among 1784 referrals (359 referrals [21.4%] among individuals aged <13 years; 1034 referrals [72.1%] among individuals assigned female at birth and 401 referrals [27.9%] among individuals assigned male at birth), a negative association between media coverage and referral counts was found for the first of the negative media events. In the 3 months following the event, referrals decreased by 25.4% (95% CI, -31.9% to -18.9%) overall, by 32.2% (95 CI, -41.8% to -22.8%) for individuals assigned female at birth, and by 25.3% (95 CI, -32.4% to -18.3%) for individuals aged 13 to 18 years. In the interrupted time series analysis, a mean weekly decrease of 3% in the referrals was observed in the extended time interval of 39 weeks (incidence rate ratio, 0.97; 95 CI, 0.95 to 0.99). For the other 2 media events, no changes in referral counts or time trends were observed.

CONCLUSIONS AND RELEVANCE

These findings suggest that an event of negative media coverage on transgender-specific health care was negatively associated with access to health care for transgender children and adolescents; therefore, nuanced and accurate media coverage, as well as increased awareness of these mechanisms among key stakeholders, is essential.

Revisiting evidence of primary prevention of suicide among adult populations: A systematic overview

BACKGROUNDS

Primary prevention of suicidal behaviors in the general population is required to interrupt the trend of self-inflicted deaths worldwide. We reviewed the evidence of the efficacy of primary prevention of suicide among the adult population.

METHODS

This is an overview of systematic reviews. We searched PubMed, EMBASE, Scopus, PsycINFO, and Cochrane databases to identify articles on suicide prevention strategies in non-clinical populations. For the purpose of overview, only systematic reviews were eligible. Primary outcomes: The outcomes of the present study were changes in the number of suicide death or suicide behaviors. Two reviewers assessed the methodological quality and the risk of bias of included studies.

RESULTS

From the initial 2,315 records, 32 articles met inclusion criteria. Evidence of reduction of suicide-related outcomes was detected, but of small magnitude. Most multicomponent prevention programs were delivered to specific populations, comprising strategies such as restriction to lethal means, educational programs, and gatekeeper training. Means restriction was the single intervention that showed some evidence of individual efficacy in reducing suicide. There is evidence that poor quality of media reporting is related with increasing suicide and better-quality reports could help suicide prevention. Most of the included SRs were of critically-low methodological quality.

LIMITATIONS

Publication bias, reporting bias, study designs, outcome definition and article overlap across studies are the main concerns.

CONCLUSIONS

Multicomponent programs and means restriction have indicated a reduction of suicide rates, mainly in specific populations. There is insufficient evidence to recommend a widespread implementation of suicide primary prevention in the general population.

Reasons for Suicide During the COVID-19 Pandemic in Japan

IMPORTANCE

Although the suicide rate in Japan increased during the COVID-19 pandemic, the reasons for suicide have yet to be comprehensively investigated.

OBJECTIVE

To assess which reasons for suicide had rates that exceeded the expected number of suicide deaths for that reason during the COVID-19 pandemic.

DESIGN, SETTING, AND PARTICIPANTS

This national, population-based cross-sectional study of data on suicides gathered by the Ministry of Health, Labor, and Welfare from January 2020 to May 2021 used a times-series analysis on the numbers of reason-identified suicides. Data of decedents were recorded by the National Police Agency and compiled by the Ministry of Health, Labor, and Welfare.

EXPOSURE

For category analysis, we compared data from January 2020 to May 2021 with data from December 2014 to June 2020. For subcategory analysis, data from January 2020 to May 2021 were compared with data from January 2019 to June 2020.

MAIN OUTCOMES AND MEASURES

The main outcome was the monthly excess suicide rate, ie, the difference between the observed number of monthly suicide deaths and the upper bound of the 1-sided 95% CI for the expected number of suicide deaths in that month. Reasons for suicide were categorized into family, health, economy, work, relationships, school, and others, which were further divided into 52 subcategories. A quasi-Poisson regression model was used to estimate the expected number of monthly suicides. Individual regression models were used for each of the 7 categories, 52 subcategories, men, women, and both genders.

RESULTS

From the 29 938 suicides (9984 [33.3%] women; 1093 [3.7%] aged <20 years; 3147 [10.5%] aged >80 years), there were 21 027 reason-identified suicides (7415 [35.3%] women). For both genders, all categories indicated monthly excess suicide rates, except for school in men. October 2020 had the highest excess suicide rates for all cases (observed, 1577; upper bound of 95% CI for expected number of suicides, 1254; 25.8% greater). In men, the highest monthly excess suicide rate was 24.3% for the other category in August 2020 (observed, 87; upper bound of 95% CI for expected number, 70); in women, it was 85.7% for school in August 2020 (observed, 26; upper bound of 95% CI for expected number, 14).

CONCLUSIONS AND RELEVANCE

In this study, observed suicides corresponding to all 7 categories of reasons exceeded the monthly estimates (based on data from before or during the COVID-19 pandemic), except for school-related reasons in men. This study can be used as a basis for developing intervention programs for suicide prevention.

Effectiveness of a Malaysian Media Intervention Workshop: Safe Reporting on Suicide

Background: Suicide remains an important cause of premature deaths and draws much media attention. However, unsafe reporting and portrayal of suicides by the media have been associated with increased risk of suicidal behavior. Current evidence suggests that media capacity-building could potentially prevent suicide. However, there are still knowledge gaps in terms of a lack of data on effective strategies for improving awareness and safe reporting of suicide-related media content. This study aims to investigate the effectiveness of a workshop conducted with members of the media community on the safe reporting of suicide-related content.

Methods: An interventional single-arm pre and post pilot study was conducted on a sample of the Malaysian media community recruited through purposive and snowball sampling. The media safe reporting workshop was conducted by a suicide prevention expert with a media industry background. Thirty participants completed a self-reported evaluation questionnaire on their awareness and knowledge of reporting on suicide-related media content; before and after the interventional workshop.

Results: There was a significant difference between the total scores before and after the intervention, with a large effect size. Post-intervention scores were significantly improved in 8 items, namely those related to the reporting of: (i) the content of any suicide note; (ii) headlines with methods of suicide; (iii) headlines with the location of suicide; (iv) cases of suspected suicide despite the unconfirmed cause of death; (v) suicide news to cater to readers’ interests; (vi) cause of suicide; (vii) details of the location of suicide; and (viii) the negative impact to media community when reporting suicide stories. In particular, there was an improvement in the majority of items for people from the media community with no lived experience of suicidal behavior.

Conclusion: The media safe reporting workshop is a potentially effective intervention for improving awareness and knowledge measures relating to safe reporting on suicide among the media community, with a more pronounced effect in those without lived experience of suicidal behavior. Limitations in the sample size, generalizability, short-term evaluation, and lack of a control group warrant future larger, longer-term controlled, and more representative studies.

The Impact of Educative News Articles about Suicide Prevention: A Randomized Controlled Trial

Media stories featuring stories of personal experiences of coping with suicidal ideation have been shown to decrease suicide risk, but it is unclear whether more impersonal awareness materials have similar effects. This study aimed to test the impact of impersonal educative news articles featuring interviews with suicide prevention experts. Because the impact of news articles may be determined by the articles' pull quotes and headlines, we also aimed to compare the impact of two versions of the same suicide prevention news article. One version featured headlines and pull quotes highlighting the message that suicide is preventable, whereas the other version focused on the message that suicide is prevalent. In a web-based randomized controlled trial, n = 425 participants either read a news article featuring a prevention expert with one of the above versions of the same text or an article unrelated to suicide. Data on suicidal ideation, stigmatizing attitudes toward suicidal individuals, policy attitudes toward suicide prevention, help-seeking intentions, and assumptions on the prevalence of suicide-related behavior were measured with questionnaires. The assumed prevalence of suicide in the population was greater in both intervention groups than in the control group, but the articles did not have an impact on other outcomes, and there were no differences for variations in headlines and pull quotes. Impersonal suicide prevention articles appear safe to use and do not have an impact on suicide risk factors in general population samples.

Factors associated with psychological impact of celebrity suicide media coverage: An online survey study

BACKGROUND

We investigated factors associated with vulnerability to the psychological impact of celebrity suicide news reporting after the suicide of an emerging Taiwanese novelist, Ms Yi-Han Lin.

METHODS

We conducted a cross-sectional online survey. Participants completed a questionnaire which asked whether they were affected by the media coverage of Lin's suicide and whether they would seek help if affected. Logistic regression was used to identify factors associated with being affected by the celebrity suicide media reporting and, among those affected, factors associated with feeling suicidal or not seeking help.

RESULTS

A total of 1258 respondents (81% females) completed the survey. Affected individuals (n=907; 70%) were more likely to be females, younger (age < 40 years), have past psychiatric treatment, and show increased interest in the incident (e.g., spending more time on reading the celebrity suicide news) than non-affected individuals. Among those affected, negative views of the media reporting impact, pessimistic attitude toward both depression treatment and suicide prevention, and having a history of past psychiatric treatment were associated with feeling suicidal, while low education attainment, increased interest in the celebrity suicide, and permissive attitude toward inappropriate media reporting were additionally associated with not seeking help.

LIMITATIONS

Selection bias of participants through internet-based surveying should be considered.

CONCLUSION

Individuals affected by the media coverage of celebrity suicide showed similar demographic and mental health characteristics as those of the deceased celebrity. Poor mental health and suicide prevention literacy may increase the risk of psychological impact and not seeking help. Future interventions could target at enhancing mental health literacy and help seeking intention in vulnerable individuals.

Can we predict or prevent suicide?: An update

This article updates a 2006 review of empirical data concerning whether clinicians can predict whether patients will die by suicide, or whether fatality can be prevented. Based on further empirical data, a negative conclusion remains justified. There is good evidence that treatment programs, using psychotherapy and medication, can reduce suicide attempts. But people who die by suicide are a distinct population from attempters, and those at high risk do not necessarily present for treatment. Research on suicide prevention has not shown that fatalities among patients can be predicted, or that clinical interventions can reduce the risk. The strongest evidence for prevention derives from reducing access to means. Population-based strategies are more effective than high-risk strategies focusing on patients with suicidal ideas or attempts.

Mental health in Lebanon: Tomorrow's silent epidemic

Lebanon is a middle-income country that has been recently crippled by several tragedies including the economic collapse, COVID-19, and the fourth of August Beirut port explosion, the world’s most powerful non-nuclear explosion of the twenty-first century. Recent data on mental health from Lebanon is summarised, and other topics such as the psychological impact of cumulative adversities and the role of international support in Lebanon are examined. Data from Lebanon shows severe levels of distress among the people, in a country with minimal resources. Given current adversities in Lebanon, recent data in the country, and the literature on adversity and mental health outcomes of man-made disasters, Lebanon is most likely going to face an epidemic in poor mental health. A call is made for the wider scientific community and international organizations to support the mental health field in the country and help prevent further negative mental health outcomes. Understanding how to better navigate mental health in places with extreme adversity and emergencies can be beneficial to other communities which might face similar challenges.

An analysis of the impact of suicide prevention messages and memorials on motorway bridges

Recently, there has been activity at public locations where people have died by suicide, including the erection of suicide prevention messages and memorials (decorations). This research looks at the impact of these decorations and associated media coverage of the decorations on suicidal behaviour at bridges. Incidents (n = 160) of suicidal behaviour on 26 bridges across motorways in England were analysed. Overall, there was no significant difference in the proportion of incidents pre-decoration versus post-decoration (p-value = .55). The incident rates were not significantly different pre- and post-decoration (p = .46). Only one bridge had statistically significantly more incidents post-decoration and media reporting (p = .03). However, following correction for multiple testing there was no significant difference in pre- and post-incident rates at any of the bridges. In total, 58% of bridges had a greater frequency of incidents when decorations were absent; however, this proportion was not statistically significant (p = .41). Further research is required to establish how suicide prevention messages are perceived. There does not appear to be any benefit, but it often generates media coverage which has been shown to increase risk.

Effects of Exposure to Multiple, Graphic Suicide News Articles on Explicit and Implicit Measures of Suicide Risk

Research has examined suicide-related behaviors following exposure to suicide news articles, yet only a handful of studies utilized experimental designs. We aimed to address the limitations of these prior experimental studies by utilizing more realistic suicide articles and more empirically sound measures. 420 participants were randomly assigned to read a series of either suicide-related or neutral news articles, then complete a battery of questionnaires and the Death/Suicide Implicit Association Task. Overall, no significant differences between groups were observed, nor did we observe any moderation effect of individual vulnerabilities (e.g., lifetime suicidal ideation/behavior). We did not observe any immediate effects of exposure to suicide news articles. Further research examining potential mechanisms for imitative effects remains critically needed.

Time-series analyses of firearm-related Google searches and U.S. suicide rates 2004-2016

OBJECTIVE

The U.S. suicide rate has increased 35% since 1999. The role of the Internet has not been thoroughly investigated despite Internet use more than doubling from 1999 to present. The majority of U.S. suicide deaths are by firearm; however, there is no examination of the association between trends in firearm Internet searches and overall and firearm monthly suicide rates. We hypothesized that search strings related to firearm suicide would be significantly associated with monthly suicide rates (both all methods and firearm).

METHODS

Google Trends provides data on request frequencies of searches. Twenty-four search strings were examined representing possible searches by individuals considering firearm suicide and compared to U.S. suicide rates with time-series modeling.

RESULTS

In the time series with higher search volumes, consistent associations were found of negative cross-correlation at lag +1.

CONCLUSIONS

Several searches appeared at least sensitive enough to consistently show associations with overall and firearm suicide rates in the following month. This novel finding should be followed up as the potential exists to predict suicide trends.

Assessing Suicide Reporting in Top Newspaper Social Media Accounts in China: Content Analysis Study

BACKGROUND

Previous studies have shown that suicide reporting in mainstream media has a significant impact on suicidal behaviors (eg, irresponsible suicide reporting can trigger imitative suicide). Traditional mainstream media are increasingly using social media platforms to disseminate information on public-related topics, including health. However, there is little empirical research on how mainstream media portrays suicide on social media platforms and the quality of their coverage.

OBJECTIVE

This study aims to explore the characteristics and quality of suicide reporting by mainstream publishers via social media in China.

METHODS

Via the application programming interface of the social media accounts of the top 10 Chinese mainstream publishers (eg, People's Daily and Beijing News), we obtained 2366 social media posts reporting suicide. This study conducted content analysis to demonstrate the characteristics and quality of the suicide reporting. According to the World Health Organization (WHO) guidelines, we assessed the quality of suicide reporting by indicators of harmful information and helpful information.

RESULTS

Chinese mainstream publishers most frequently reported on suicides stated to be associated with conflict on their social media (eg, 24.47% [446/1823] of family conflicts and 16.18% [295/1823] of emotional frustration). Compared with the suicides of youth (730/1446, 50.48%) and urban populations (1454/1588, 91.56%), social media underreported suicides in older adults (118/1446, 8.16%) and rural residents (134/1588, 8.44%). Harmful reporting practices were common (eg, 54.61% [1292/2366] of the reports contained suicide-related words in the headline and 49.54% [1172/2366] disclosed images of people who died by suicide). Helpful reporting practices were very limited (eg, 0.08% [2/2366] of reports provided direct information about support programs).

CONCLUSIONS

The suicide reporting of mainstream publishers on social media in China broadly had low adherence to the WHO guidelines. Considering the tremendous information dissemination power of social media platforms, we suggest developing national suicide reporting guidelines that apply to social media. By effectively playing their separate roles, we believe that social media practitioners, health institutions, social organizations, and the general public can endeavor to promote responsible suicide reporting in the Chinese social media environment.

Digital Data Sources and Their Impact on People's Health: A Systematic Review of Systematic Reviews

Background: Digital data sources have become ubiquitous in modern culture in the era of digital technology but often tend to be under-researched because of restricted access to data sources due to fragmentation, privacy issues, or industry ownership, and the methodological complexity of demonstrating their measurable impact on human health. Even though new big data sources have shown unprecedented potential for disease diagnosis and outbreak detection, we need to investigate results in the existing literature to gain a comprehensive understanding of their impact on and benefits to human health.

Objective: A systematic review of systematic reviews on identifying digital data sources and their impact area on people's health, including challenges, opportunities, and good practices.

Methods: A multidatabase search was performed. Peer-reviewed papers published between January 2010 and November 2020 relevant to digital data sources on health were extracted, assessed, and reviewed.

Results: The 64 reviews are covered by three domains, that is, universal health coverage (UHC), public health emergencies, and healthier populations, defined in WHO's General Programme of Work, 2019–2023, and the European Programme of Work, 2020–2025. In all three categories, social media platforms are the most popular digital data source, accounting for 47% (N = 8), 84% (N = 11), and 76% (N = 26) of studies, respectively. The second most utilized data source are electronic health records (EHRs) (N = 13), followed by websites (N = 7) and mass media (N = 5). In all three categories, the most studied impact of digital data sources is on prevention, management, and intervention of diseases (N = 40), and as a tool, there are also many studies (N = 10) on early warning systems for infectious diseases. However, they could also pose health hazards (N = 13), for instance, by exacerbating mental health issues and promoting smoking and drinking behavior among young people.

Conclusions: The digital data sources presented are essential for collecting and mining information about human health. The key impact of social media, electronic health records, and websites is in the area of infectious diseases and early warning systems, and in the area of personal health, that is, on mental health and smoking and drinking prevention. However, further research is required to address privacy, trust, transparency, and interoperability to leverage the potential of data held in multiple datastores and systems. This study also identified the apparent gap in systematic reviews investigating the novel big data streams, Internet of Things (IoT) data streams, and sensor, mobile, and GPS data researched using artificial intelligence, complex network, and other computer science methods, as in this domain systematic reviews are not common.

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.

Annual Research Review: Youth firearm violence disparities in the United States and implications for prevention

OBJECTIVE

Research has identified the United States (U.S.) as a global outlier in its firearm ownership rates, with a correspondingly higher risk of youth firearm violence compared to other countries. The relative extent of disparities in youth firearm violence within the U.S. has been less clear. Little is known about factors in the social ecology driving these disparities and whether current firearm violence prevention approaches sufficiently address them.

METHOD

Applying a health disparities framework, we synthesized epidemiological, sociological, and prevention science literatures, emphasizing structural inequalities in youth sociocultural positionality in life course developmental context. We also highlighted findings from national injury data and other studies regarding the magnitude and impacts of youth firearm violence disparities.

RESULTS

The burden of firearm violence varied markedly at intersections of gender, race, place, developmental stage, and homicidal or suicidal intent. Firearm homicide among Black boys and young men (ages 15-24) was at outlier levels - many times greater than the rates of any other demographic group, developmental stage, or violence intent, particularly in urban settings. Recent research has operationalized structural racism and implicated historically racialized spaces as a root cause of this disparity. In contrast, elevated firearm suicide rates were found among Native and White boys and young men in rural settings; firearm-related cultural attitudes and gender socialization were points of consideration to explain these disparities. We highlighted research-based youth firearm violence preventive interventions, and emphasized gaps in efforts focused on structural and sociocultural factors.

CONCLUSIONS

More explicit attention to reducing firearm homicide among Black boys and young men and firearm suicide among Native and rural White boys and young men is urgently needed and has potential to substantially lower overall rates of firearm violence in the U.S.

Suicidal behaviour and the coronavirus (COVID-19) pandemic: Insights from Durkheim's sociology of suicide

Whilst suicide is well established as a critical global public health burden causing around 800,000 deaths annually along with many more attempts, there is a concern that the impact of the coronavirus (COVID-19) pandemic might intensify suicidality. The purpose of this study is to draw attention to the budding correlation between the COVID-19 pandemic and suicidality from the theoretical perspective of Emile Durkheim's sociology of suicide. A review of online newspaper databases (1 January to 30 April 2020) that reported suicide cases and attempts triggered as a result of the disruptions caused by the COVID-19 pandemic were included and analysed. Out of the 28 identified cases, there were three suicide attempts, one homicide-suicide/pact-suicide, and 24 suicides spanning 10 countries. Durkheim explained the social causation of suicide and provided a four-fold suicide typology. The cases were analysed according to their appropriate typology, and classified as egoistic (9), altruistic (3), anomic (8), and fatalistic (8). Durkheim suggests that the rise and fall of suicide rates will depend on the nature of social change. As society is undergoing massive social disruption resulting from the COVID-19 pandemic, suicide rates may increase unless suicide prevention measures align with the current social reconstruction process.

Trends and patterns of suicidal behaviour in Nigeria: Mixed-methods analysis of media reports from 2016 to 2019

BACKGROUND

Media coverage of suicides in Nigeria appears to be explicitly descriptive and deviates from the recommended best practice. Despite these shortcomings, verifiable information provided by these media outlets could arguably, at the minimum, mirror the reality of the trends and patterns of suicidal behaviour in Nigeria.

AIM

This study aimed to analyse the trends and patterns of suicidal behaviour in Nigeria using media reports from 2016 to 2019. We examined the effect of gender and age groups on these trends and patterns of suicidal behaviour.

SETTING

The study was carried out in Nigeria.

METHODS

Qualitative content analysis was used to assess the content of each verifiable suicide event. In total, 336 verified suicide-related events were selected from 4365 media reports. Quantitative data were collected on age, gender, type of suicidal behaviour, method, place and motivation for suicidal behaviour. Data were analysed using the Statistical Package for the Social Sciences software. Fisher's exact test was used to examine the association between gender, age groups and other variables. p-value was set at ≤ 0.05.

RESULTS

Completed suicide was the most common reported suicidal behaviour. Hanging was the dominant reported method, followed by poisoning. Significant gender differences were observed between age groups (p < 0.001) and methods of suicidal behaviour (p < 0.001). Also, significant age differences were observed between the methods of suicidal behaviour (p < 0.001), places (p < 0.001) and motivations for suicidal behaviour (p < 0.001).

CONCLUSION

The study confirms that there are gender and age differences in the trends and patterns of suicidal behaviour in Nigeria.

Acceptability, Safety, and Resonance of the Pilot Digital Suicide Prevention Campaign "Better Off With You": Qualitative Study

Background

The Interpersonal Theory of Suicide posits that there are three key elements of suicidal behavior: perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. The digital campaign Better Off With You was developed to directly challenge the idea of perceived burdensomeness among people who are contemplating suicide in 2 communities within Australia.

Objective

The aim of this study is to explore the needs and preferences of people with lived experience of suicidal thoughts and actions to inform the development of Better Off With You.

Methods

This study involved a series of focus groups that aimed to discuss campaign messaging, scope, and approach. People with lived experience of suicidal thoughts and actions attended the focus groups. After the completion of initial focus groups, the results informed the creation of campaign collateral by creative agencies. Early versions of the campaign collateral were then presented in the user testing sessions. Transcriptions were analyzed via thematic analysis.

Results

In total, 13 participants attended the focus groups and 14 attended the user testing sessions. The following three overarching themes were presented: acceptability, safety, and resonance. Participants believed that suicide is a serious and ongoing issue in their communities and welcomed a localized suicide prevention focus via peer-to-peer storytelling. The idea of perceived burdensomeness required clarification but was perceived as acceptable and relevant. Participants seemed drawn toward peer narratives that they perceived to be authentic, genuine, and believable as given by real people with lived experience. Campaign messaging needs to be clear and empathetic while directly talking about suicide. Participants did not anticipate any significant negative or harmful impact from any campaign videos and highlighted the importance of providing appropriate help-seeking information.

Conclusions

This iterative study provided important insights and knowledge about peer-to-peer storytelling in suicide prevention campaigns. Future campaigns should involve simple messaging, be validating and empathetic, and consider including a lived experience perspective.

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.

Suicide and the agent-host-environment triad: leveraging surveillance sources to inform prevention

Suicide in the US has increased in the last decade, across virtually every age and demographic group. Parallel increases have occurred in non-fatal self-harm as well. Research on suicide across the world has consistently demonstrated that suicide shares many properties with a communicable disease, including person-to-person transmission and point-source outbreaks. This essay illustrates the communicable nature of suicide through analogy to basic infectious disease principles, including evidence for transmission and vulnerability through the agent-host-environment triad. We describe how mathematical modeling, a suite of epidemiological methods, which the COVID-19 pandemic has brought into renewed focus, can and should be applied to suicide in order to understand the dynamics of transmission and to forecast emerging risk areas. We describe how new and innovative sources of data, including social media and search engine data, can be used to augment traditional suicide surveillance, as well as the opportunities and challenges for modeling suicide as a communicable disease process in an effort to guide clinical and public health suicide prevention efforts.

TV News and COVID-19: Media Influence on Healthy Behavior in Public Spaces

The COVID-19 outbreak has dramatically changed our life. Despite the rapid growth of scientific publications about medical aspects of the pandemic, less has been explored about the effects of media communication regarding COVID-19 on healthy behaviors. Yet, the scientific literature has widely debated on how media can influence people's health-related evaluations, emotions, and behaviors. To fill this gap, the aim of this study was to investigate the relationships between media exposure, people's attitudes and emotions toward media contents, and healthy behaviors related to the use of public spaces, such as avoiding crowded places, wearing face masks, and maintaining social distance. A questionnaire referring to these variables was administered to an opportunistic sample of 174 participants in Italy during the off-peak period of the COVID-19 outbreak and before restrictions to mobility were extended to the whole country. Results showed that media exposure, the perception of social initiatives of prevention, and moderate levels of fear increase healthier behaviors in the use of public spaces. Perceiving alarming information did not significantly predict healthy behaviors in the use of public spaces. Results are discussed with reference to the previous literature. Suggestions to media communication to increase preventive behaviors during emergencies are also provided.