Gernot Sonneck

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.

Assessing the impact of media guidelines for reporting on suicides in Austria: interrupted time series analysis

Objective: Media guidelines for reporting on suicides are a widely used means of preventing imitative suicides, but scientific accounts of their impact on suicide numbers are sparse. This report provides an evaluation of the Austrian guidelines that were introduced in 1987 as a natural experiment. Methods: The impact of the guidelines was tested by applying an autoregressive integrated moving average (ARIMA) model and a linear regression model. In addition to a nationwide evaluation, Austria was divided into three areas according to regional differences in coverage rates of the collaborating newspapers and the impact of the intervention was tested for each area separately. Main outcome measures were the overall annual suicide numbers, and the numbers of Viennese subway suicides that were exceptionally newsworthy for the mass media. In order to test intermediate impacts, also quantitative and qualitative changes in media reporting after the introduction of the guidelines were analysed. Results: There was some evidence of a nationwide impact of the guidelines, calculated as a significant reduction of 81 suicides (95% confidence interval: −149 to −13; t = −2.32, df = 54, p <0.024) annually. This effect was particularly due to a significant reduction in the area with the highest coverage rates of the collaborating newspapers. Viennese subway suicides showed a highly significant level shift (t = −4.44, df = 19, p <0.001) and a highly significant trend change (t = −4.20, df = 19, p <0.001) after the introduction of the guidelines. These effects corresponded to significant changes in the quality and quantity of media reporting. Conclusions: The present results clearly support the hypothesis that the media guidelines have had an impact on the quality of reporting as well as on suicidal behaviour in Austria, and stress the importance of collaborating with nationwide, but also with regional media to achieve efficacy. Further research is needed to provide an international insight into this public health issue.

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.

Copycat effects after media reports on suicide: a population-based ecologic study.

This study aimed to investigate whether the risk of increased suicide occurrence after reports on suicide is associated with the social characteristics of the reported suicides and whether this varies with similarity between the reported suicides and suicides in the population. We collected reports on all 179 individual suicides named in the 13 largest Austrian nationwide newspapers from 1996 to 2006. Information on social status and sociodemographic characteristics of the reported suicides, on certainty of labelling the death as a suicide, and on the suicide methods applied were extracted from the articles. We conducted logistic regression analyses, with the increase of post-report suicides within 28 days after the reports as dependent variable. In model 1, the increase of suicides that matched the reported individual suicide with regard to age group, sex and suicide method was used as outcome variable. In model 2, the increase of suicides that were different from the reported suicide with regard to these characteristics was the outcome. In model 3, the post-report increase of total suicides was the dependent variable. Celebrity status of the reported suicide, age of the reported suicide between 30 and 64 years, and definitive labelling as a suicide were associated with an increased risk of a post-report increase of similar suicides; criminality (i.e. the individual was reported as suspected or convicted of crime) of the reported suicide was associated with a lower risk of a post-report increase. In dissimilar suicides, none of the variables was associated with a post-report increase of suicides. Celebrity status of the reported suicide was the only predictor of a post-report increase of total suicides. The findings support the hypothesis that social variables of reported suicides impact the risk of post-report copycat behaviour. Evidence of copycat effects seemed to be strongest in suicides that were similar to the respective model with regard to age group, sex, and suicide method.

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%).

Effects of sunshine on suicide rates

OBJECTIVES Seasonal spring peaks of suicide are well described in epidemiological studies, but their origin is poorly understood. More recent evidence suggests that this peak may be associated with the increase in the duration of sunshine in spring. We investigated the effect of number of sunshine hours per month on suicide rates in Austria between 1996 and 2006. METHODS Suicide data, differentiated by month of suicide, sex, and method of suicide (violent vs nonviolent methods), were provided by Statistics Austria. Data on the average number of sunshine hours per month were calculated from 39 representative meteorological stations (provided by the Austrian Central Institute for Meteorology and Geodynamics). For statistical analysis, analysis of variance tests, Kruskal-Wallis tests, and Pearson correlation tests were used. RESULTS A total of 16,673 suicides with a median of 126 ± 19.8 suicides per month occurred in the examined period. A clear seasonal pattern was observed, with suicide frequencies being highest between March and May and lowest between November and January (df = 11, F = 5.2, P < .0001) for men (df = 11, F = 4.9, P < .0001) and women (df = 11, F = 2.4, P = .008). The average number of sunshine hours per month was significantly correlated with the number of suicides among both sexes (r = .43, P < .0001), violent methods (r = .48, P < .0001) but not with nonviolent methods (r = .03, P = .707). CONCLUSIONS This study shows that seasonal changes in sunshine account for variations in the number of suicides and especially violent suicides. We propose that sunshine, via interactions with serotonin neurotransmission, may trigger increased impulsivity and promote suicidal acts. However, because of the hypothesis-generating design of this study, more research is needed to further clarify the role of sunshine in triggering neurobiologic changes, which might contribute to suicidal behavior.