Elmar Etzersdorfer

Role of media reports in completed and prevented suicide: Werther v. Papageno effects

BACKGROUND Media reporting of suicide has repeatedly been shown to trigger suicidal behaviour. Few studies have investigated the associations between specific media content and suicide rates. Even less is known about the possible preventive effects of suicide-related media content. AIMS To test the hypotheses that certain media content is associated with an increase in suicide, suggesting a so-called Werther effect, and that other content is associated with a decrease in suicide, conceptualised as a Papageno effect. Further, to identify classes of media articles with similar reporting profiles and to test for associations between these classes and suicide. METHOD Content analysis and latent class analysis (LCA) of 497 suicide-related print media reports published in Austria between 1 January and 30 June 2005. Ecological study to identify associations between media item content and short-term changes in suicide rates. RESULTS Repetitive reporting of the same suicide and the reporting of suicide myths were positively associated with suicide rates. Coverage of individual suicidal ideation not accompanied by suicidal behaviour was negatively associated with suicide rates. The LCA yielded four classes of media reports, of which the mastery of crisis class (articles on individuals who adopted coping strategies other than suicidal behaviour in adverse circumstances) was negatively associated with suicide, whereas the expert opinion class and the epidemiological facts class were positively associated with suicide. CONCLUSIONS The impact of suicide reporting may not be restricted to harmful effects; rather, coverage of positive coping in adverse circumstances, as covered in media items about suicidal ideation, may have protective effects.

Imitative suicide on the Viennese subway.

The number of subway suicides in Vienna increased dramatically between 1984 and mid-1987. In the second-half of 1987 there was a decrease of 75% which has been sustained for 5 yr. This reduction in subway suicides began when a working group of the Austrian Association for Suicide Prevention developed media guidelines and initiated discussions with the media which culminated with an agreement to abstain from reporting on cases of suicide. The characteristics of suicide and attempted suicide on the Viennese subway are discussed and appropriate guidelines for media coverage of suicidal acts are presented.

Preventing suicide by influencing mass-media reporting. The viennese experience 1980–1996

This paper reports a field experiment concerning mass-media and suicide. After the implementation of the subway system in Vienna in 1978, it became increasingly acceptable as means to commit suicide, with the suicide rates showing a sharp increase. This and the fact that the mass-media reported about these events in a very dramatic way, lead to the formation of a study-group of the Austrian Association for Suicide Prevention (ÖVSKK), which developed media guidelines and launched a media campaign in mid-1987. Subsequently, the media reports changed markedly and the number of subway-suicides and -attempts dropped more than 80% from the first to the second half of 1987, remaining at a rather low level since. Conclusions regarding the possible reduction of imitative suicidal behaviour by influencing mass-media-reports are drawn. Experiences from the media campaign are presented, as well as considerations about further research.

Declining Autopsy Rates and Suicide Misclassification A Cross-national Analysis of 35 Countries

CONTEXT Suicides are prone to misclassification during death ascertainment procedures. This problem has generated frequent criticism of the validity of suicide mortality statistics. OBJECTIVE To employ an external measure of the validity of cause-of-death statistics (ie, national autopsy rates) and to examine potential misclassification of suicide across countries from Europe to Central and Northern Asia. DESIGN Cross-national analysis. SETTING Thirty-five countries. PARTICIPANTS Aggregated mortality data. MAIN OUTCOME MEASURES Data from 35 countries during the period from 1979 to 2007 were used to analyze the association of suicide rates with autopsy rates and death rates of undetermined and ill-defined causes, respectively. Analyses were cross-sectional and longitudinal. RESULTS Cross-sectionally, a 1% difference in autopsy rates among nations was associated with a suicide rate difference of 0.49 per 100,000 population. Longitudinally, a 1% decrease in the autopsy rate aligned with a decrease of 0.42 per 100,000 population in the suicide rate. These cross-sectional and longitudinal associations were robust after adjustment for unemployment, degree of urbanization, and prevalence of undetermined or ill-defined deaths. Associations strengthened when analyses were confined to 19 European Union member countries. CONCLUSION Autopsy rates may spatially and temporally affect the validity of suicide mortality statistics. Caution should be exercised in comparing international suicide rates and evaluating interventions that target suicide rate reduction.

Lithium in drinking water and suicide mortality

BACKGROUND There is some evidence that natural levels of lithium in drinking water may have a protective effect on suicide mortality. AIMS To evaluate the association between local lithium levels in drinking water and suicide mortality at district level in Austria. METHOD A nationwide sample of 6460 lithium measurements was examined for association with suicide rates per 100,000 population and suicide standardised mortality ratios across all 99 Austrian districts. Multivariate regression models were adjusted for well-known socioeconomic factors known to influence suicide mortality in Austria (population density, per capita income, proportion of Roman Catholics, as well as the availability of mental health service providers). Sensitivity analyses and weighted least squares regression were used to challenge the robustness of the results. RESULTS The overall suicide rate (R(2) = 0.15, β = -0.39, t = -4.14, P = 0.000073) as well as the suicide mortality ratio (R(2) = 0.17, β = -0.41, t = -4.38, P = 0.000030) were inversely associated with lithium levels in drinking water and remained significant after sensitivity analyses and adjustment for socioeconomic factors. CONCLUSIONS In replicating and extending previous results, this study provides strong evidence that geographic regions with higher natural lithium concentrations in drinking water are associated with lower suicide mortality rates.

A Dose-Response Relationship Between Imitational Suicides and Newspaper Distribution

Although the Werther effect is well known, up to now a correlation between the differential distribution of particular media reports and subsequent imitational suicides could not be found. This study investigates a celebrity suicide by gun in Austria, which led to extensive reports in the largest Austrian newspaper, whose distribution shows substantial regional differences. The numbers of suicides by firearm in the 3 weeks after the reporting showed an increase over the 3 weeks prior. Regional analysis revealed a strong correlation of suicides by firearm and distribution of the newspaper (log odds ratios; r(9) = .62; p = .04, one-tailed). This dose-response effect explains 40% of the variability of changes. These results underline the influence of media reports on suicidal behavior.

Attitudes towards suicide among medical students: comparison between Madras (India) and Vienna (Austria).

Abstract Attitudes towards suicide among medical students in Madras (India) and Vienna (Austria) were compared using the SUIATT questionnaire by Diekstra and Kerkhof (1989). Results show a very restrictive attitude in Madras, rejecting the right to commit suicide, nearly always judging suicide as a cowardly act, and rejecting the idea of assisted suicide. On the other hand, in Vienna a more permissive attitude was found. It is interpreted that the Indian pattern comes close to a “medical” or “disease model”, with stronger emphasis on mental illness, impulsiveness and emotional aspects, whereas the Viennese pattern reflects a “theoretical”, “rational model”, concentrating on cognitive factors and minimizing the influence of mental illness, emotional difficulties and restrictions related to suicidal behaviour. This pattern may be influenced by the public discussion on assisted suicide and the right to die in Europe in the last decade. Possible relations to the risk for actual suicidal behaviour are discussed using respective answers concerning previous suicidal ideation and suicide attempts. The answers concerning suicidal ideation seem to be strongly influenced by the different attitude patterns: only 16.8% reported previous suicidal ideation in Madras, compared to 51.5% in Vienna, whereas the percentage of reported suicide attempts is equal in both centres (5.9%:4.9%).

Influence of psychotherapist density and antidepressant sales on suicide rates.

Objective:  Antidepressant sales and suicide rates have been shown to be correlated in industrialized countries. The aim was to study the possible effects of psychotherapy utilization on suicide rates.

Sex differential for suicide among Austrian age cohorts

Etzersdorfer E, Piribauer F, Sonneck G. Sex differential for suicide among Austrian age cohorts.

The gap between suicide characteristics in the print media and in the population

BACKGROUND Programmes to educate media professionals about suicide are increasingly established, but information about which suicide cases are most likely to be reported in the mass media is sparse. METHODS We applied binomial tests to compare frequencies of social characteristics of all domestic suicides in the 13 largest Austrian print media in 2005 with frequencies of suicide characteristics in the population. Additionally, each reported suicide case was linked to its respective entry in the suicide database. We performed a logistic regression analysis, with presence of an article as outcome, and sex of the suicide case, age, religious affiliation, family status, conduction of an autopsy and location of the suicide as explaining variables. Time of the year and federal state where the suicide happened was controlled for. RESULTS Binomial tests showed that suicides involving murder or murder attempt were over-represented in the media. Reporting on mental disorders was under-represented. In the regression analysis, the likelihood of a report was negatively associated with the age of suicide cases. Foreign citizenship was a further predictor of a suicide report. The methods of drowning, jumping, shooting and rare methods were more likely to be reported than hanging, which is the most frequent suicide method in Austria. CONCLUSIONS Suicide characteristics in the media are not representative of the population. The identified discrepancies provide a basis for tailor-made education of mass media professionals.