Thomas Niederkrotenthaler

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.

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.

Changes in suicide rates following media reports on celebrity suicide: a meta-analysis

Background A growing number of studies indicate that sensationalist reporting of suicide is associated with increases in suicide rates, but in the light of some negative findings, the issue has remained controversial. The aim of this study was to evaluate the best current evidence on the association between celebrity suicide stories and subsequent suicides. Methods Literature searches of six data sources (Medline, Psychlit, Communication Abstracts, Education Resources Information Center, Dissertation Abstracts and Australian Public Affairs Database (APAIS)) were conducted. Studies were included if they (1) adopted an ecological design, (2) focused on celebrity suicide, (3) had completed suicide as outcome variable, (4) analysed suicide rates across all suicide methods, (5) used data from after World War II and (6) satisfied basic quality criteria. Results 10 studies with totally 98 suicides by celebrities met the criteria. The pooled estimate indicated a change in suicide rates (suicides per 100 000 population) of 0.26 (95% CI 0.09 to 0.43) in the month after a celebrity suicide. There was substantial heterogeneity between studies, which was explained by the type of celebrity (entertainment elite vs others) and the region of study, as indicated by mixed-effects meta-regression. The region-of-study–specific effect of reporting a suicide by an entertainment celebrity was 0.64 (95% CI 0.55 to 0.73) in North America, 0.58 (95% CI 0.47 to 0.68) in Asia, 0.36 (95% CI −0.10 to 0.61) in Australia and 0.68 (95% CI 0.51 to 0.85) in Europe. There was no indication of publication bias. Conclusions Reports on celebrity suicide are associated with increases in suicides. Study region and celebrity type appear to have an impact on the effect size.

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.

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.

Exposure to parental mortality and markers of morbidity, and the risks of attempted and completed suicide in offspring: an analysis of sensitive life periods

Background There is evidence of parental risk factors for suicidal behaviour in offspring, but research on variations in their effects with offsprings age at first exposure is sparse. Aims To explore the effects of age at exposure to parental mortality and markers of morbidity on the risks of suicide and attempted suicide in offspring. Methods This was a case–control study effected through record linkage between Swedish registers. Individuals born 1973–83 who committed suicide (n=1407) or were hospitalised due to an attempted suicide (n=17 159) were matched to ≤10 controls by sex, month and county of birth. ORs were measured in time windows representing age at first exposure. Results A general pattern of increasing risks of suicide and attempted suicide in offspring with decreasing age at exposure to parental risk factors emerged. Adjusted suicide risk (OR (95% CI)) was most pronounced in the youngest exposure window for parental psychiatric disability pension (3.1 (1.6 to 5.8)), somatic disability pension (1.9 (1.0 to 3.4)), psychiatric inpatient care (2.5 (2.0 to 3.1)), parental attempted suicide (2.9 (2.0 to 4.1)) and suicide (2.9 (1.7 to 5.2)). For parental non-suicidal deaths, the general pattern was the opposite. Patterns in offspring attempted suicide were similar to completed suicide for parental disability pension, psychiatric inpatient care and non-suicidal death. Attempted suicide risk after parental suicide showed an increasing trend with increasing age at exposure. Conclusion Parental morbidity and parental suicidal behaviour show the most detrimental effects on completed suicide among offspring when they appear early in life. Early interventions in families at risk are necessary to prevent suicide in offspring.

Increasing help-seeking and referrals for individuals at risk for suicide by decreasing stigma: the role of mass media.

Increasing help-seeking and referrals for at-risk individuals by decreasing stigma has been defined as Aspirational Goal 10 in the National Action Alliance for Suicide Preventions Research Prioritization Task Forces 2014 prioritized research agenda. This article reviews the research evidence on the impact of mass media awareness campaigns on reducing stigma and increasing help-seeking. The review will focus on both beneficial and iatrogenic effects of suicide preventive interventions using media campaigns to target the broad public. A further focus is on collaboration between public health professionals and news media in order to reduce the risk of copycat behavior and enhance help-seeking behavior. Examples of multilevel approaches that include both mass media interventions and individual-level approaches to reduce stigma and increase referrals are provided as well. Multilevel suicide prevention programs that combine various approaches seem to provide the most promising results, but much more needs to be learned about the best possible composition of these programs. Major research and practice challenges include the identification of optimal ways to reach vulnerable populations who likely do not benefit from current awareness strategies. Caution is needed in all efforts that aim to reduce the stigma of suicidal ideation, mental illness, and mental health treatment in order to avoid iatrogenic effects. The article concludes with specific suggestions for research questions to help move this line of suicide research and practice forward.

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.

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.

Consistency of immigrant suicide rates in Austria with country-of-birth suicide rates: a role for genetic risk factors for suicide?

Multifaceted evidence (family, twin, adoption, molecular genetic, geographic, and surname studies of suicide) suggests genetic risk factors for suicide. The migrant study design is also informative in this context, but underused. In particular, immigrant studies of suicide with a continental European host country are unavailable. The correspondence of suicide prevalence among 22 immigrant groups in Austria (1970-2006) with those of the homelands during the same period was analyzed. Immigrant and homeland suicide rates were significantly positively associated. Controls for age of suicide victim, immigrant group size, national pride, and quality of life in the homelands left the finding essentially unchanged. This correspondence of immigrant and country-of-birth suicide rates is consistent with the assumption of population differences in the prevalence of genetic risk factors for suicide, for which there is emerging evidence.