David P. Phillips

The influence of suggestion on suicide. Substantive and theoretical implications of the Werther effect

This paper shows that suicides increase immediately after a suicide story has been publicized in the newspapers in Britain and in the United States, 1947-1968. The more publicity devoted to a suicide story, the larger the rise in suicides thereafter. The rise in suicides after a story is restricted mainly to the area in which the story was publicized. Alternative explanations of these findings are examined; the evidence indicates that the rise in suicides is due to the influence of suggestion on suicide, an influence not previously demonstrated on the national level of suicides. The substantive, theoretical, and methodological implications of these findings are examined.

Clustering of teenage suicides after television news stories about suicide

We examined the relation between 38 nationally televised news or feature stories about suicide from 1973 to 1979 and the fluctuation of the rate of suicide among American teenagers before and after these stories. The observed number of suicides by teenagers from zero to seven days after these broadcasts (1666) was significantly greater than the number expected (1555; P = 0.008). The more networks that carried a story about suicide, the greater was the increase in suicides thereafter (P = 0.0004). These findings persisted after correction for the effects of the day of the week, the month, holidays, and yearly trends. Teenage suicides increased more than adult suicides after stories about suicide (6.87 vs. 0.45 percent). Suicides increased as much after general-information or feature stories about suicide as after news stories about a particular suicide. Six alternative explanations of these findings were assessed, including the possibility that the results were due to misclassification or were statistical artifacts. We conclude that the best available explanation is that television stories about suicide trigger additional suicides, perhaps because of imitation.

Imitative suicides: a national study of the effects of television news stories.

A 1974 ASR paper by Phillips showed that suicides increase in the month of highly publicized suicide stories. Several subsequent papers have built on this finding and have suggested that publicized suicide stories trigger increases in covert suicides disguised as motor vehicle or airplane accidents. If the original ASR findings cannot be replicated, then doubt is cast on all these studies. In this paper we demonstrate that U.S. daily suicides increase significantly after highly publicized suicide stories appear on television evening news programs. We provide the first evidence that the increase in suicides occurs only after and not before the suicide story. In addition, we provide the first systematic study of the length of time a suicide story affects suicides; the effect probably does not extend beyond ten days. These findings support and extend the literature on imitative suicides.

The Impact of Mass Media Violence on U.S. Homicides

The impact of mass media violence on aggression has almost always been studied in the laboratory; this paper examines the effect of mass media violence in the real world. The paper presents the first systematic evidence indicating that a type of mass media violence triggers a brief, sharp increase in U.S. homicides. Immediately after heavyweight championship prize fights, 1973-1978, U.S. homicides increased by 12.46 percent. The increase is greatest after heavily publicized prize fights. The findings persist after one corrects for secular trends, seasonal, and other extraneous variables. Four alternative explanations for the findings are tested. The evidence suggests that heavyweight prize fights stimulate fatal, aggressive behavior in some Americans. (abstract Adapted from Source: American Sociological Review, 1983. Copyright

Suicide, Motor Vehicle Fatalities, and the Mass Media: Evidence toward a Theory of Suggestion

Tarde and other classical sociologists paid a great deal of attention to the concepts of imitation and suggestion, but these concepts have been virtually ignored in modern sociology. This paper presents new findings indication that imitation and suggestion have a powerful have impact on social behavior: Three days after a publicized suicide, automobile fatalities increase by 31%. The more the suicide is publicized, the more the automobile fatalies increase. The age of the drivers is significantly correlated with the age of the person described in the suicide story. Single-car accidents increase more than other types just after the publicized suicide. After persentation of these and related findings, the paper discusses some ways in which the concepts of suggestion and imitation can be incorporated into sociological theory.

A July Spike in Fatal Medication Errors: A Possible Effect of New Medical Residents

BACKGROUNDEach July thousands begin medical residencies and acquire increased responsibility for patient care. Many have suggested that these new medical residents may produce errors and worsen patient outcomes—the so-called “July Effect;” however, we have found no U.S. evidence documenting this effect.OBJECTIVEDetermine whether fatal medication errors spike in July.DESIGNWe examined all U.S. death certificates, 1979–2006 (n = 62,338,584), focusing on medication errors (n = 244,388). We compared the observed number of deaths in July with the number expected, determined by least-squares regression techniques. We compared the July Effect inside versus outside medical institutions. We also compared the July Effect in counties with versus without teaching hospitals.OUTCOME MEASUREJR = Observed number of July deaths / Expected number of July deaths.RESULTSInside medical institutions, in counties containing teaching hospitals, fatal medication errors spiked by 10% in July and in no other month [JR = 1.10 (1.06–1.14)]. In contrast, there was no July spike in counties without teaching hospitals. The greater the concentration of teaching hospitals in a region, the greater the July spike (r = .80; P = .005). These findings held only for medication errors, not for other causes of death.CONCLUSIONSWe found a significant July spike in fatal medication errors inside medical institutions. After assessing competing explanations, we concluded that the July mortality spike results at least partly from changes associated with the arrival of new medical residents.

Cardiac Mortality Is Higher Around Christmas and New Year’s Than at Any Other Time The Holidays as a Risk Factor for Death

Background—Research published in Circulation has shown that cardiac mortality is highest during December and January. We investigated whether some of this spike could be ascribed to the Christmas/New Year’s holidays rather than to climatic factors. Methods and Results—We fitted a locally weighted polynomial regression line to daily mortality to estimate the number of deaths expected during the holiday period, using the null hypothesis that natural-cause mortality is unaffected by the Christmas/New Year’s holidays. We then compared the number of deaths expected during the holiday period, given the null hypothesis, with the number of deaths observed. For cardiac and noncardiac diseases, a spike in daily mortality occurs during the Christmas/New Year’s holiday period. This spike persists after adjusting for trends and seasons and is particularly large for individuals who are dead on arrival at a hospital, die in the emergency department, or die as outpatients. For this group during the holiday period, 4.65% (±0.30%; 95% CI, 4.06% to 5.24%) more cardiac and 4.99% (±0.42%; 95% CI, 4.17% to 5.81%) more noncardiac deaths occur than would be expected if the holidays did not affect mortality. Cardiac mortality for individuals who are dead on arrival, die in the emergency department, or die as outpatients peaks at Christmas and again at New Year’s. These twin holiday spikes also are conspicuous for noncardiac mortality. The excess in holiday mortality is growing proportionately larger over time, both for cardiac and noncardiac mortality. Conclusions—Our findings suggest that the Christmas/New Year’s holidays are a risk factor for cardiac and noncardiac mortality. There are multiple explanations for this association, including the possibility that holiday-induced delays in seeking treatment play a role in producing the twin holiday spikes.

The Impact of Fictional Television Stories on U.S. Adult Fatalities: New Evidence on the Effect of the Mass Media on Violence.

This paper present the first systematic evidence that violent, finctional television stories trigger imitative deaths and near-fatal accidents in the Unites States. In 1977, suicides, motor vehicle deaths, and nonfatal accidents all rose immediately following soap opera suicide stories. The U.S. female suicide increased proportionally more than male suicides. Single-vehicle crashes increased more than multiplevehicle crashes. All of these increases are statiscally significant and persist after one corrects for the presence of nonfictional suicide stories, linear trends, seasonal fluctuations, and day-of-the-week fluctuations in the data. These increases apparently occur because soap opera suicide stories trigger imitative suicides and suicides attempts, some of which are disguised as single-vehicle accidents.

An Increase in the Number of Deaths in the United States in the First Week of the Month — An Association with Substance Abuse and Other Causes of Death

BACKGROUND AND METHODS There are regular changes in mortality rates, such as increased rates of death from influenza in the winter and from motor vehicle accidents on long holiday weekends. Previous research has shown that among persons with schizophrenia, the rates of cocaine use and hospital admissions increase at the beginning of the month, after the receipt of disability payments. Using computerized data from all death certificates in the United States between 1973 and 1988, we compared the number of deaths in the first week of the month with the number of deaths in the last week of the preceding month. RESULTS The average number of deaths was about 5500 per day, or about 165,000 in a 30-day month. There were 100.9 deaths (95 percent confidence interval, 100.8 to 101.0) in the first week of the month for every 100 deaths in the last week of the preceding month. This was equivalent to about 4320 more deaths in the first week of each month than in the last week of the preceding month in an average year. Between 1983 and 1988, for deaths involving substance abuse and an external cause (such as suicides, accidents, and homicides), there were 114.2 deaths (95 percent confidence interval, 110.5 to 117.9) in the first week of the month for every 100 in the last week of the preceding month. There were significant increases in the number of deaths in the first week of the month for many causes of death, including substance abuse, natural causes, homicides, suicides, and motor vehicle accidents. CONCLUSIONS In the United States, the number of deaths is higher in the first week of the month than in the last week of the preceding month. The increase at the beginning of the month is associated with substance abuse and other causes of death.

The impact of televised movies about suicide. A replicative study

Gould and Shaffer studied suicides by teenagers in the New York City area before and after three fictional films about suicide were televised, and presented evidence suggesting that the films were followed by a significant increase in teenage suicides. Using their methods, we studied teenage suicides in California and Pennsylvania before and after the television broadcast of the same three films. In these states, there was no evidence of an increase in teenage suicides after the films were shown. This remained true when data for New York from the study of Gould and Shaffer were combined with our data from California and Pennsylvania. We conclude that it is premature to be concerned about possibly fatal effects of fictional televised films about suicide.