Acad Psychiatry 29:495-499, December 2005
doi: 10.1176/appi.ap.29.5.495
© 2005 Academic Psychiatry
The Media and Suicide
Howard S. Sudak, M.D. and
Donna M. Sudak, M.D.
Dr. Howard S. Sudak is a Clinical Professor in the Department of Psychiatry of the University of Pennsylvania School of Medicine and is in the private practice of psychiatry. He is employed part-time by the American Foundation for Suicide Prevention as the Research Coordinator for the Evidence-Based Practices Project for Suicide Prevention. Dr. Donna M. Sudak is an Associate Professor in the Department of Psychiatry at Drexel University School of Medicine and Director of its Psychotherapy Training Program. She is also on the Board of the Greater Philadelphia Chapter of the American Foundation for Suicide Prevention. Address correspondence to Dr. Howard S. Sudak, John Ross House, Suite 402, 401 S. Second St., Philadelphia, PA 19147-1612; hsudak{at}afsp.org (E-mail). Copyright © 2005 Academic Psychiatry.
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ABSTRACT
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OBJECTIVE: The authors aim to inform readers of the theory that when newspapers, film, and television describe suicidal deaths, additional suicides may result by virtue of contagion or copy-cat effects; to review data that support and refute this theory; to present some promising and recommended ways to prevent copy-cat suicide; and to cite news-media examples of both particularly bad and good reporting. METHODS: A review of the literature on media-related suicide was conducted, which included reviewing materials published in scientific journals and data published by the U.S. Public Health Service, Centers for Disease Control, and materials from private, not-for-profit agencies. RESULTS: Data support an increased number of suicides resulting from media accounts of suicide that romanticize or dramatize the description of suicidal deaths. Specific guidelines for the media that may be able to decrease these additional deaths have been devised. CONCLUSION: Psychiatrists should be familiar with the harm that may result from improper reporting of suicide in the media since they may be called upon by reporters or family members following the suicide of one of their patients or following the suicide of a newsworthy person. Following the media guidelines available may prevent such contagion effects from occurring.
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INTRODUCTION
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There are numerous studies and anecdotal descriptions indicating that the manner of reporting and depicting suicides may result in additional suicides. Literary depictions, such as Goethe’s The Sorrows of Young Werther (1) about the suicide of an unrequited lover, were said to have "caused" numerous suicides following their publication. More recently, television, print media, and film have all been implicated as contributing to contagion or "copy-cat" suicides. In this article, we will review the data to see what evidence validates the contagion theory, review what can be done to decrease these effects, and provide examples of helpful and harmful reporting.
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Method
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The authors reviewed scientific literature pertaining to contagion effects and their prevention using Ovid, MEDLINE, and web-M.D. search engines; using literature reviews well-known to the authors (e.g., Phillips, Gould, Stack); and using key words as described in the abstract.
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Results
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Randomized Controlled Trials
Methodological obstacles preclude the existence of double-blind, randomly controlled studies of the effects of the media on future suicides.
Descriptive and Uncontrolled Studies
There are a number of studies that are less powerful statistically than randomized controlled trials, which point to a relationship between the media and suicide. An early and important study was conducted by David Phillips (1), who used a large population base and studied completed suicide rates following a number of international events of a violent nature that received massive publicity (e.g., the Muhammad Ali vs. Joe Frazier, "Thrilla in Manila" world championship fight). He found a subsequent increase in violent deaths, including suicide, presumably due to contagion or copy-cat effects. Hawton et al. (2) focused on suicide methodology in England. Paracetemol (acetaminophen) poisonings rose dramatically following the television showing of "Casualty," a dramatic portrayal of such an ingestion with tragic results. The authors compared the 3 weeks after the showing with the 3 preceding weeks and found a 17% increase in suicide attempts by drug overdosing during the first week after the showing and 9% in the second week after the showing. The increase was greater for paracetemol overdoses than for other ingestions. Approximately 20% of the ingesters revealed that they had actually seen the program, and 20% of those admitted that the program had influenced their choice of agent. It was assumed that others had heard of the program or seen it but either did not wish to admit its influence or were not consciously aware of it. Although other factors could not be entirely ruled out as contributing to the increased rates, the data are quite suggestive. In a later study, Hawton (3) found a markedly reduced rate of suicides and suicide attempts and liver transplants following legislation in the U.K. which banned the sale of acetaminophen in bulk, allowing sales only in packets of up to 16 tablets.
Examples also exist that indicate that responsible media guidelines appear to decrease suicide. Following the completion of an extensive subway network in Vienna in 1978, there were a large number of suicides caused by jumping in front of the trains. These were reported on widely and in graphic detail in the newspapers. In response, the Austrian Association for Suicide Prevention drafted media guidelines for responsible suicide reporting, and they were implemented in the latter half of 1987. The methods used by suicide victims (e.g., subways) were no longer mentioned in the newspapers. The rates of subway suicide decreased by 80% in the following 6 months and thereafter remained at a low level. Suicidal deaths by all causes in Austria decreased only slightly, however, which points to the guidelines as a likely reason for the decline in rates by subway-jumping and also points to probable method substitution (4).
In addition to concerns about media reporting of suicide, the related issue of the role of the media in engendering copy-cat suicides by fictional accounts is also of concern. For example, a prospective study by Gould and Shaffer (5) with a follow-up study (6) evaluated suicide rates following three made-for-television movies depicting suicide and found increased rates in the weeks following their showing for two of the three. The two which appeared to increase rates focused primarily on the decedents; the one which did not appear to increase rates focused more on the grieving parents than on the decedent. Instead of romanticizing the decedent, a focus on the terrible aftereffects on the grieving family may even deter some suicides. Such media studies, although all correlational and not unequivocally causal in nature, have been replicated by others (7).
Many suicidologists previously believed that the most reasonable explanation for contagion effects was that these were likely inevitable deaths in vulnerable individuals which were simply moved forward in time by virtue of newspaper or other media accounts of suicidal deaths. For example, in a high school of 3000 students, a significant number of them would be expected to have seriously considered suicide due to depression or other causes and, therefore, to be at a higher than normal risk for eventual suicide. The suicidal death of a fellow student, particularly a popular one whose suicide became romanticized by other students or the local media, might be expected to precipitate some suicides among this or another more vulnerable subpopulation. Phillips (1) reviewed a number of such situations, to determine if there was a discernable trough (i.e., a dip in the actual suicide completion rates as compared to the expected rates) following the index suicide report, and could find no such decrease. The absence of such a decrease following an increase suggests that these were not merely "deaths moved forward" in time. To be more definitive, long-term studies of such exposures are needed.
Reviews
Madelyn Gould has performed the most definitive and exhaustive review of media effects on suicide. Her conclusion, from her review as well as her own studies, led her to state that "there is no longer any doubt about the validity of contagion effects on suicide" (7). She reviewed 42 studies of nonfictional media reports of suicides and found that 29 (69%) showed an apparent imitative effect while eight (19%) did not and five (11%) were mixed or equivocal. She also reviewed the apparent sequels to 29 fictional suicide accounts and the results were again positive, although less dramatically so. Fifteen of the 29 appeared to fit the hypothesis (51%); nine of the 29 (31%) did not and five of the 20 were mixed or equivocal (17%). Combining the nonfictional and fictional groups showed 61% fit the hypothesis, 23% did not and 14% were mixed or equivocal. Although not a formal meta-analysis, her results have convincing face validity.
Steven Stack (8) recently reviewed 55 studies of media effects and was able to specify which factors appeared to account for some inconsistencies in nonfictional media contagion results. For example, studies of articles mentioning celebrity or politically prominent or female decedents were five times more likely to show effects than otherwise, and ones which showed negative views of suicide or ones based on television accounts rather than print-media ones (hence, receiving less coverage) were 80% to 99% less likely to show effects than otherwise. His logistic regression analysis of the data resulted in a 77% correct classification of these studies.
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Discussion
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Can We Prevent Contagion Effects?
As long as people are able to communicate, it would be impossible to eliminate contagion effects entirely. Experts have written and published guidelines which appear valuable in decreasing the potency of contagion effects. The guidelines have not been rigorously evaluated, because of the methodological obstacles and the low base rate for completed suicide. The American Foundation for Suicide Prevention, the American Association of Suicidology, and the Annenberg Public Policy Center, in collaboration with the Office of the Surgeon General, the Centers for Disease Control, National Institute of Mental Health (NIMH), Substance Abuse Mental Health Services Administration (SAMHSA), the World Health Organization (W.H.O.), the National Swedish Center for Suicide Research and the New Zealand Youth Suicide Prevention Strategy groups have circulated media reporting guidelines for suicide (American Foundation for Suicide Prevention, available on their website: www.afsp.org). Some of the key recommendations for the media are included in Appendix 1.
In addition to guidelines for the media, guidelines for junior and senior high schools and colleges have been published by the Centers for Disease Control (CDC), the State of New Jersey, and others, to help avoid contagion effects within a school community. Since adolescents are generally believed to represent the age group most susceptible to contagion or "copy-cat" effects, special efforts appear warranted to intervene with this population when a suicide has occurred. This is sometimes called "postvention" in contrast to prevention (or called tertiary prevention rather than primary or secondary prevention). Fellow students of a decedent may be viewed as a "selected" (or even "indicated") rather than a "universal" subpopulation. These unique guidelines for schools begin by recommending that schools have a specific plan for how to deal with such a crisis (and understand that suicide indeed represents a crisis). Typical elements of such school plans are described in Appendix 2.
What Data Support These Guidelines?
Although the evidence that media depictions of suicides can engender additional suicides is suggestive, there is little data, other than those cited above, indicating that following these guidelines will decrease suicide rates. This, of course, does not mean that they are without value—only that their value remains to be proven. As stated earlier, the guidelines are mainly common sense and appear to have face validity. However, some "common sense" assumptions regarding traumatic events, including that critical incident stress debriefing (i.e., having the survivors of traumatic events report in great detail what happened to them) should be carried out as quickly as possible following a trauma to prevent long-term effects, have been evaluated as potentially damaging and replaced by recommendations that simple support of basic physical needs (food, clothing, shelter) should be the first-line response (9, 10). Although the effectiveness of school postvention programs has not been rigorously evaluated, no harmful results have been reported from these. Survivors of a suicide that has taken place in any closely contained community of people (e.g., in an office setting, small businesses, hotels and apartment buildings, or other places where coworkers would be expected to be especially upset by a suicidal death) may also benefit from similar postvention measures.
Examples of Good and Poor Media Reporting
It is easy to cite examples of poor reporting of suicidal deaths; it is difficult to find the converse. The Annenberg School of Public Policy, at the University of Pennsylvania, under its Dean, Kathleen Hall Jamieson, is developing a model curriculum to teach future reporters about what constitutes responsible reporting. Although, clearly, the business of newspapers is to sell newspapers, it is reasonable to assume that the media’s goal is not just to sell the news but also to report the news responsibly. Newspaper stories are further complicated—even if the reporter tries to not overdramatize an account—in that the reporter is frequently different from the headline writer. Headline writers are charged with the task of attracting the reader’s attention so that overdramatization becomes a virtue. Errors in media reporting include focusing on single precipitants, as the citations in Appendix 1 about Vince Foster and the French chef losing his Michelin star illustrate. A dramatic example of scapegoating occurred after the suicide of an embattled school superintendent near Philadelphia whose death was deemed due to the "savage grilling" the decedent endured at the hands of a "vicious" prosecuting attorney during his dismissal hearings. Along with vilifying the attorney, the superintendent was almost canonized by the media. Another error in reporting is dramatization of suicides. An example of this was illustrated when three students (or recent students) at Cherry Hill High School in New Jersey took their lives in the same year with no consideration given in the media to whether these three deaths could have been entirely coincidental in such a large school population. Other examples of dramatization were afforded by the lurid reports of suicides at New York University and at Massachusetts Institute of Technology—some replete with pictures of students in mid-air following jumping from a rooftop.
An ironic coupling of helpful and nonhelpful articles was provided by the Philadelphia Inquirer, in December 2001, in two separate articles in the same issue of the paper pertaining to the same suicide. The decedent was a woman whose husband had died in the Twin Towers attack on September 11, 2001. The unhelpful article, because of its oversimplification, focused on how much she had loved her husband and stated, "She died when he died," but no mention was made of her drinking problem or depression. The helpful article indicated that suicide is neither the natural nor inevitable result of a devastating loss and focused on depression and mental illness, even indicating that mental illness is treatable.
These and other examples of helpful and harmful media reports, in their original form, and critiques of them are all readily available at the American Foundation for Suicide Prevention’s website: www.afsp.org.
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Conclusions
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There is a large body of literature pointing to ways in which the media depict suicide may have an impact on further suicides. Guidelines exist which may help to diminish such effects. Mental health professionals should be familiar with these interactions to help prevent additional suicides or suicide attempts.
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REFERENCES
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- Phillips D: The influence of suggestion on suicide: substantive and theoretical implications of the Werther effect. Am Sociological Rev 1974; 39:340–354
- Hawton K, Simkin S, Deeks J, et al: Effects of drug overdose in a TV drama on presentations to hospital for self-poisoning. Br Med J 1999; 318:972–977[Abstract/Free Full Text]
- Hawton K: United Kingdom legislation on pack sizes of analgesics: Background, rationale and effect of suicide and deliberate self-harm. Suicide and Life-Threatening Behavior 2002; 32:223–229[CrossRef][Medline]
- Etzersdorfer E, Sonneck G: Preventing suicide by influencing mass-media reporting: the Viennese experience, 1980-1986. Arch Suicide Res 1998; 4:67–74
- Gould M, Shaffer D: The impact of suicide in television movies: evidence of imitation. N Engl J Med 1986; 315:690–694[Abstract]
- Gould M, Shaffer D, Kleinman M: The impact of suicide in TV movies: replication and commentary. Suicide and Life-Threatening Behavior 1988; 18:90–99[Medline]
- Gould M: Suicide and the media, in Suicide Prevention: Clinical and Scientific Aspects. Edited by Hendin H, Mann J. New York, NY Academy of Science, 2001, pp 200-224
- Stack S: Suicide in the media: a quantitative review of studies based on nonfictional stories. Suicide and Life-Threatening Behavior 2005; 35:121–133[CrossRef][Medline]
- Litz B: Early Intervention for Trauma and Traumatic Loss. New York, Guilford, 2004
- Ruzek J: Dissemination of Information and Early Intervention Practices in the Context of Mass Violence or Large-Scale Disaster. National Center for PTSD, VA Palo Alto Health Care System; available at www.AABT.org
This article has been cited by other articles:
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C. Vives-Cases, J. Torrubiano-Dominguez, and C. Alvarez-Dardet
The effect of television news items on intimate partner violence murders
Eur J Public Health,
June 23, 2009;
(2009)
ckp086v1.
[Abstract]
[Full Text]
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N. N. Campbell, J. Heath, J. Bouknight, K. Rudd, and J. Pender
Speaking Out For Mental Health: Collaboration of Future Journalists and Psychiatrists
Acad Psychiatry,
March 1, 2009;
33(2):
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ABSTRACT
INTRODUCTION
