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Suicide and the Media: What we know and what we don't know

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Associate Professor Jane Pirkis is Principal Research Fellow, Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, University of Melbourne. Together with Warwick Blood, Jane Pirkis is responsible for the internationally-recognised Media Monitoring Project, which examined the extent, nature and quality of media reporting of suicide and mental illness in Australia for a full year. Jane is currently working with Warwick on a follow-up project to examine whether media reporting has changed over time. Her research interests also include the epidemiology of suicidal behaviour and the evaluation of large-scale suicide prevention initiatives.

More about the SPINZ 2008 Seminar Series on the role of media in suicide prevention: http://www.spinz.org.nz/page/19-events-archive+seminar-series-2008

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Suicide and the Media: What we know and what we don't know

  1. 1. Suicide and the media What we know and what we don’t know Jane Pirkis September 2008
  2. 2. What we know and what we don’t know about …The relationship between media reportingof suicide and actual suicidal behaviourThe development, dissemination andimpact of resources on media reporting ofsuicide 1
  3. 3. The relationship between media reporting of suicide and actual suicidal behaviour
  4. 4. The Werther effect 3
  5. 5. Sources of evidenceAt least 100 studies have been conductedinternationally examining the relationshipbetween media reporting of suicide andactual suicidal behaviour 4
  6. 6. Phillips (1974)Examined number of US suicides in months inwhich a front-page suicide article appeared inthe New York Times between 1947 and 1968,and compared this with number incorresponding months in which no such articleappeared (i.e., observed vs expected)Found statistically significant increase in theobserved number after 26 (out of 33) front-pagearticlesThe more days a story appeared on the frontpage, the greater the rise in suicides after thatstory 5
  7. 7. Hassan (1995)Examined Australian national suicide ratesbefore and after ‘high impact’ suicidestories published in the Age and theSydney Morning Herald between 1981 and1990Found that the national daily averagesuicide rate increased after such storiesfor males but not for females 6
  8. 8. Yip et al (2008)Used interrupted time series analysis todetermine whether reporting of entertainmentcelebrity suicides in Hong Kong, Taiwan andSouth Korea led to increases in suicide ratesFound 25% increase in the risk of suicide in thefour weeks following report, 49% increaseamong people in the same age-sex group as thecelebrity, and 63% increase in suicides by thesame method as that chosen by the celebrityEffect greatest in first week; attenuated by thefourth week 7
  9. 9. Etzersdorfer et al (2001, 2004)Examined changes in Austrian suicides inthe 3 weeks prior to and 3 weeksfollowing reporting of a celebrity suicideby gunshot in the country’s major tabloidin 1990Found significant increase in firearmsuicides between the two periods, whichwas not apparent in any other yearIncreases were highest in regions withwidest distribution of the tabloid 8
  10. 10. Schmidtke and Hafner (1988)Used ABABA design to examine effects ofa 6-episode series depicting the railwaysuicide of a 19yo student, shown inGermany 1981 and 1982Found that after each screening there wasa significant increase in suicides by thesame method, with the effect lasting atleast 70 days and being most marked for15-19yo males 9
  11. 11. Hawton et al (1999)Used interrupted time series analysis andquestionnaire data to determine whetherdepiction of a paracetamol overdose in Casualtyled to increases in emergency departmentpresentations for deliberate self poisoningFound that presentations for deliberate self-poisoning increased by 17% in the week afterthe broadcast32 patients who presented during this weekwere interviewed and had seen the episode –20% said that it had influenced their decision totake an overdose and 17% said it had influencedtheir choice of drug 10
  12. 12. Coverage of selected studies Year Country Media type Media focus Outcome of Level of data interest analysisPhillips 1974 United States Newspaper News Completed Aggregate suicideHassan 1995 Australia Newspaper News Completed Aggregate suicideYip et al 2008 Hong Kong, Newspaper News Completed Aggregate Taiwan, South suicide KoreaEtzersdorfer 2001, 2004 Austria Newspaper News Completed Aggregateet al suicideSchmidtke 1988 Germany Television Entertainment Completed Aggregateand Hafner suicideHawton et al 1999 United Television Entertainment Attempted Aggregate, Kingdom suicide individual 11
  13. 13. A causal relationship?Consistency: The association between media coverage ofsuicide and an increase in actual suicides is consistentlyobserved, regardless of study design and populationsampledStrength: The association is statistically significant, andthere may be evidence of a dose-response effect such thatthe greater the exposure to the media coverage of suicide,the greater the increase in suicide ratesTemporality: The association makes sense in chronologicalterms, in that the exposure variable (media coverage ofsuicide) occurs before the outcome variable (actualsuicides)Specificity: The association is clear, such that mediaexposure is a consistent risk factor for suicideCoherence: The association is in line with known theoriesconcerning suicide 12
  14. 14. Conclusions about the Werther effectThe body of evidence points to a causalrelationship (at least in the case of newsmedia)Factors associated with this relationshipinclude: Timing Amount and prominence of coverage Model/observer relationship Method 13
  15. 15. The development, dissemination and impact of resources on media reporting of suicide
  16. 16. Australia’s resources 15
  17. 17. International resources have similar content … 16
  18. 18. Mediawise DoHA MoH CDC WHO Samaritans TrustAvoid sensationalising orglamorising suicide, orgiving it undueprominenceAvoid providing specificdetail about the suicideRecognise the importanceof role modelsTake particular care inspecial situationsTake the opportunity toeducate the publicProvide help/support tovulnerablereaders/viewersConsider the aftermath ofsuicideAcknowledge thatjournalists are vulnerabletoo 17
  19. 19. … but differ in terms of the waythey have been developed and disseminatede.g., in the extent to which mediaprofessionals, suicide and mental healthexperts, and consumer organisations havebeen involved in these processes 18
  20. 20. Mindframe Media and Mental Health ProjectConducted by the Hunter Institute of Mental HealthAims: To support media organisations in theirunderstanding and use of the resourcesStrategies: face-to-face briefings (full briefings and drop-in sessions) offering ad hoc advice distributing hard and soft copies of the resources and supporting materials working with peak media organisations to incorporate aspects of the resources into codes of practice and editorial policies providing ongoing follow-up and promotion 19
  21. 21. Evaluation of media resources‘There has been little evaluation ofthe extent to which [resources] havebeen embraced by and/or changedthe practices of journalists, and stillless evaluation of their influence onrates of completed and attemptedsuicide’ (Institute of Medicine, 2002) 20
  22. 22. Evaluation of media resourcesPre- and post- study in Switzerland (Michel et al,2000) Demonstrated that the introduction of resources led to less sensational and higher quality reportingPre- and post- study in Austria (Etzersdorfer etal, 1992; Sonneck et al, 1994; Etzersdorfer andSonneck, 1998; Niederkrontenthaler andSonneck, 2007) Showed that the introduction of media resources regarding reporting of suicides on the Vienna subway led to a reduction in the reporting of these suicides and, in turn, a decrease in the rate of subway suicides and in the overall suicide rate The positive impact was more pronounced in regions with strong media collaboration and largely maintained over time 21
  23. 23. The Media Monitoring ProjectAustralian newspaper, television and radioitems on suicide retrieved over two 12-monthperiods - 2000/01 and 2006/07Analysis of items examining: Extent Nature Quality 22
  24. 24. Extent and nature of reportingAlmost a two-fold increase inreporting: 4,813 items retrieved in2000/01 and 8,363 in 2006/07The nature of media reporting showedsome variability, with an increasedemphasis on items about individuals’experiences and a reduced emphasison policy and program initiatives 23
  25. 25. Does the item have any examples of inappropriate language? (2000/01 n=415; 2006/07 n=347) 100 93.9 90 80 70 60 58.3 Percentage Yes 50 No 41.7 40 30 20 10 6.1 0 2000/01 2006/07 24
  26. 26. Is there a detailed discussion of the method used? (2000/01 n=232; 2006/07 n=264) 100 90 86 80 70 60 Percentage 49.6 50.4 Yes 50 No 40 30 20 14 10 0 2000/01 2006/07 25
  27. 27. Does the item provide information on help services? (2000/01 n=415; 2006/07 n=334) 100 93.5 90 82.3 80 70 60 Percentage Yes 50 No 40 30 20 17.7 10 6.5 0 2000/01 2006/07 26
  28. 28. Distribution of total quality scores (2000/01 n=415; 2006/07 n=388) 30 25 20 Percentage 2000/01 15 2006/07 10 5 0 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-100 27
  29. 29. Summary and conclusions
  30. 30. What we knowThere is a clear relationship between mediareporting of suicide and actual suicidal behaviourMany countries have developed resources onmedia reporting of suicide – these are similar incontent but vary in the way they have beendeveloped and disseminatedReporting of suicide in the Australian media hasimproved in quality since the introduction ofReporting Suicide and Mental Illness 29
  31. 31. What we don’t knowSufficient about journalists’ experiences withreporting suicide and using media resourcesSufficient about how members of the publicinterpret media information about suicideSufficient about the nature of the impactmedia resources might have on journalists’reporting practices and rates of completedand attempted suicide 30

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